09.30.11
Hope for Kissing Spine
This is just my story and my experience with kissing spine. I’m sure others have equally notable stories since as many as 80% of all horses have some touching of the dorsal spinous processes at some point in their life. First a little introduction. Kissing spine, otherwise known as the Overriding of the Dorsal Spinous Processes is defined in the Merck Veterinary Manual as “Impingement of the summits of the dorsal spines predisposing the horse to back pain. Pressure points between adjacent overriding spines are shown by local periosteal reaction, small bone cysts, and false joint formation. Radiographic lesions of this type are sometimes seen in horses that do not suffer from back trouble, although incidence is lower and lesions are less severe. Diagnosis can be aided by injection of local anesthetic into the affected interspinous spaces. Many cases respond to rest and physiotherapy, but treatment in persistent cases is by resection of one or more of the summits to relieve the crowding of the spines.”
Anecdotal evidence suggests various levels of success in horses returning to full work. Some horses were retired, some could return to a lower level of work and some were able to return to full work and be top competitive horses. I believe age, fitness, confirmation, severity, symptoms and amount of rehabilitation all play a role in prognosis. Each case is individual.
Symptoms include back pain, tightness in the back, being “cold backed”, girthy or agitated when saddling, bucking, bolting, exploding when mounted, refusing to jump or do certain movements, grouchy, unwillingness to perform, hollowing of the back or not accepting the bit. Obviously, these symptoms could describe numerous lamenesses or problems and a veterinary diagnosis is needed to be sure.
Treatment involves relieving pain, correcting the imbalance and problem (if possible) and rehabilitating the horse to develop strong core muscles to support the horses back and allow him/her to hold rider weight. Recently, correcting the problem via surgery is an option to discuss with your veterinarian. Please be advised, no matter what, rehabilitation is the KEY ingredient, especially after surgery. Additional treatments include:
NSAIDS: can help alleviate pain, some horses respond better than others
Injections: Corticosteroids injected in the back and between the vertebra can alleviate inflammation, reduce pain. B12 can be injected into acupuncture points and be part of a Chinese medical treatment.
Shockwave: (positive pressure acoustic waves) is shown to be good for healing bone, tendon and ligament problems. Success has been documented with kissing spine patients.
Mesotherapy: pharmaceuticals are injected in the mesoderm layer of the skin to help healing and to reduce pain.
Acupuncture: based on Chinese medicine, acupuncture relieves pain, rebalances the energetic body to speed healing in both bone and soft tissues and also works along the meridians to release the muscle, tendons, ligaments and fascia.
Myofascial Release: a manual therapy that works on correcting fascial imbalances and snares that pull on the musculoskeletal system creating lameness and pain.
Craniosacral Therapy: energetic manual therapy that concentrates on the bones of the pelvis, sacrum, lumbar/thoracic and cervical spine and cranium (head). Obviously any imbalance here could lay the foundation for developing kissing spine and be a causative factor.
Infrared Therapy/ Magnetic Therapy/ Ceramic blankets and others: all work on reducing pain and inflammation.
Surgery: surgically repairs the dorsal spinous processes and eliminates the touching between the processes.
Horses must be kept in work even if its light work. Time off, stall rest etc does not help correct the problem and may only be palliative. Core strength, muscle development over the top line, and stretching and strengthening the back are all very important factors for having success in bring a “kissing spine” horse back to solid work. However, the rider/trainer must always remember that from day to day the horse may change how he/she feels, sometimes for no apparent reason. Patience is a virtue when training these horses and listening to the horse is imperative. Never should work be demanded or forced on them. Just like other rehabilitation situations, pushing for just a little more without over facing is a very precarious balance and it is easy to cross that very fine line into over expectation.
Building the Core: one of the best ways to build the core muscles of the equine body without the added weight of the rider is through long lining, Pessoa types systems and ground exercises.
Long Lines: horse can be put through dressage exercises and stretch out the back
Core strengthening exercises on the ground
Pelvic tilts
Belly lifts
Carrot stretches
Engaging the core through weight shifts
Combining the above
Adding a leg lift
Pessoa: good to replace basic lunging especially for horses that are tight in their backs.
Riding and Beyond
Start with a long easy warmup including lots of walking. Exercises for suppleness including shoulder in, haunches in, turn on the forehand, turn on the haunches, flexion and counter flexion and frequent changes of direction. All the while encouraging a loose swinging back and no tension in the top line.
Another important aspect is very correct work in short duration. Taking ideas from physical therapy for humans, it is best to do very correct training for 5-10 minutes with walk breaks in between than to haphazardly ride around for 30 minutes. For instance, riding the horse correctly over the top line for 5 minutes (while they can actually hold their body correctly) then free walk for 3 minutes and repeat. When this becomes easy time can always be increased. The same goes for ground exercises. Duration and frequency can always be increased as the horse gains strength and flexibility. For anyone who has trained for a marathon or picked up a new sport, you understand how starting slowly and building is a key component to success. Let me also stress frequency. Rehab doesn’t work if you only do it once a week. Instead, think of riding 5-6 times per week for 15 minutes with sets of quality work for 3-5 minutes. Building this until you reach 45 min rides with 10 minute sets.
Cross training and Building Strength
Not only does cross training keep the horse mentally fresh but it also encourages building of good stability muscles and general conditioning. Navigating trails, logs, jumps, hills etc will greatly increase your horses athleticism all on its own. No amount of ring work can replace this type of conditioning. Starting at the walk, as the horse gains strength trot and canter can be introduced. Hill work even at the walk is hard work and great conditioning exercise. Eventually trot poles, jumping and return to regular work can be introduced as the horse builds strength.
Long term prognosis
How easily your horse progresses through rehab, the better you learn to ride, the more diligent you are in the rehab schedule, the better the horses confirmation and the response to treatment all dictate the prognosis. I find the worst case scenario develops because the rider/trainer was inconsistent in their riding schedule, not because the horse couldn’t succeed.
My own personal experience:
When my horse was first diagnosed (and it took a long time for the vets to find it) surgery was not an option. We opted instead for treating with corticosteroid injections between the spinous processes, mesotherapy, acupuncture, core strengthening exercises, long lining, lunging with the Pessoa system, careful consistent dressage work, cross training and mindful conditioning. It took 3 years of consistent, patient training to get him back. Keep in mind, he had 2 years of rest because the kissing spine was not found originally. In that 2 years he lost all conditioning and all his core strength. I basically had to build him back from nothing. After many years of not thinking he would ever be sound again, he now is back doing 2nd level dressage and enjoying his work. Would he have made it further if he hadn’t had kissing spine… probably. But for a 15h Morgan not bred for dressage, I am really pleased.
