Kissing spine, which in technical terms is referred to as the impingement of the dorsal spinous processes, is a diagnosis made through evaluating radiographs of a horse’s back. The condition occurs in the dorsal spinous processes, which is the tips of the spine that you can feel if you press down on the horse’s midline. When they touch or overlap this is considered to be “kissing.”
Although kissing spine is suspected to occur in 39% of the horse population, it is not always a source of pain. Kissing spines are more likely to be clinically significant in Thoroughbreds and dressage horses, in horses under 5-years-old and when more than five vertebra are kissing.
There is not a magical product that can cure Kissing Spine. As might be expected treatments can vary. The most important concept is that regardless of the treatment, physical therapy is even more integral to a successful outcome. The treatments can help manage the soreness short term and even for longer periods.
Skeleton of a horse
Dorsal Spinous Process (DSP) impingement or “Kissing Spines” is a condition recognized as a significant issue for horses. What constitutes the problem is debatable and how to make a conclusive diagnosis can be an elusive process. The following article will discuss the anatomic findings, diagnostic process, therapeutic options and prognosis.
In order to understand the issues behind DSP impingement you have to understand a few anatomical factors. Generally the problem is located in the thoracic section of the vertebral column – the area where the rider sits. Less commonly, involvement of the lumbar vertebrae behind the saddle area can be the source of the problem.
As you can see with the attached picture to the left, the thoracic vertebrae begin with the withers and go through the saddle area.
Diagram of 2 Thoracic Vertebrae with attached rib. The DSP’s are in a normal position, paralell to one another
The part of the vertebrae that we are interested in is the vertical part that projects up and should be evenly spaced from the adjacent process. In the following picture two dorsal spinous processes are seen with the correct relationship.
Horses with this condition can exhibit a range of signs from being asymptomatic, that is exhibiting no abnormal signs, up to having a horse that is unrideable, possibly bucking, refusing to be saddled and/or having behavioral issues even on the ground. The question isn’t understanding the more obviously affected horse; instead, it’s the asymptomatic horses. The radiographic changes didn’t occur overnight and there are certainly horses that have been in regular work during this time and able to do jump, be used for dressage and/or western pleasure while the radiographs would have looked abnormal. Something must change in order for the problem to be evident and something must change again if the problem is going to get under control.
The most common one relates to behavior-training issues. Generally the horses may not be overtly lame, but rather exhibiting avoidance behaviors that affect their work such as: refusing to accept bit contact. preferring to travel with their heads up and their backs dropped (not rounded), unwilling to bend one direction or the other, not consistently picking up the correct lead, feeling disconnected or possibly cross cantering. Obviously these signs could be associated with a number of issues for example: stomach ulcers, Lyme disease, tack, training, rider to name a few.
What are some of the factors contributing to this condition?
At this point we consider that a horse may be genetically predisposed to this diagnosis. For example, the horse may have a very short back or prominent withers with a low back. And the condition can also be exacerbated by riding exercises. Any factors that may make the horse drop his back and invert can contribute to worsening of the problem; including issues such as poor saddle fit, weakness, poor riding, gastric ulcers or front or back leg lameness.
For example, if a horse’s front feet hurt because he is barefoot and has thin soles he will carry his head high and drop his back. Then, if he is young and weak and his rider is heavy and inexperienced sitting in a saddle that does not fit, well then he will invert even further.
Making the diagnosis can be a straightforward process in some cases; in others it’s a process of elimination. The history and clinical signs are particularly beneficial to the Veterinarian. Following this Radiographs are the first line of defense. Digital x-rays allow us to take radiographs of a horse’s back in a matter of minutes and clearly see if there are issues present.
Ultrasound is also sometimes employed. While x-rays penetrate bone and show the margins and inside of bones, ultrasound shows a significant amount of detail about the bone surface and soft tissues attached to them. Thermography can also used to evaluate heat output which can correlate to inflammation. By using a thermal camera you can visualize areas of the back, legs and even saddle fit. The more intensely red or white areas correlate with inflammation. In cases where there are more questions as to the involvement of the back versus other areas a Nuclear Scan can be done. These are procedures done at referral hospitals. The advantage is that, like thermography, they are dynamic exams and show problems in real time as opposed to static exams such as radiographs or ultrasound that show what is currently there, but don’t necessarily correlate to inflammation.
The treatment for Kissing Spine is two-fold: First, stop the pain; and second, strengthen the back and abdominal muscles.
There are a variety of ways to control the pain: cortisone injections, shockwave therapy, mesotherapy, chiropractic, acupuncture, non-steroidal anti-inflammatory medications, and muscle relaxants. Every case is different and some horses will respond better to one therapy than another.
There is a lot of new information out there about physical therapy and strengthening exercises to build up a horse’s back. Most start without a rider on the back and involve a long and low frame and gradual re-introduction of a rider.
In some of the acute conditions, laser can be used to treat focal areas of inflammation. Laser treatments can treat inflammation of the bone, soft tissues and nerves.
Hidez Compression Suits can be beneficial in aiding to pain management by massaging the horse, supporting to the muscle groups (multifidus muscles, psoas muscles,abdominal oblique muscles), as an all-natural anti-inflammatory aid. Hidez Compression Suits can be beneficial in aiding to pain management by massaging the horse, supporting to the muscle groups (multifidus muscles, psoas muscles,abdominal oblique muscles), as an all-natural anti-inflammatory aid. So why compression?
Well, according to Kenneth Knight , “Cryotherapy in Sports Injury Management” (1995), compression helps control edema formation and reduces the swelling by promoting reabsorption of this fluid. Not only does the compression aid reabsorption, it shuts down the area and therefore will not allow for additional edema to formulate. If there is less tissue debris, there is less free protein which will lower the tissue oncotic pressure. Tissue oncotic pressure pulls fluid from the capillaries and will increase edema. This compression enhances the body’s natural circulation and provides the following injury recovery benefits:
- Less swelling – Inflammation and swelling are not only uncomfortable, they can also inhibit the healing process. Compression therapy is proven to help reduce swelling, especially in combination with cold therapy.
- Less edema – Excess fluid buildup can also slow down the healing process and inhibit range of motion if the injury is at or near a joint. Compression can help reduce this excess fluid in the body.
- More nutrients – Active compression helps stimulate the flow of lymph fluid, which carries vital nutrients, to the damaged tissues surrounding the injury. Lymph fluid is also important for removing waste from cells and body tissues, an important function during the tissue regeneration process.
- More oxygen – Injured tissue requires oxygen for it to repair itself. However, swelling can inhibit the flow of blood to an injury, slowing down the healing process. Active compression helps improve blood flow, thereby enhancing the delivery of oxygen to damaged tissue.
- Faster tissue repair – The combination of reduced swelling and delivery of oxygen and nutrients to the injury site enables more rapid tissue repair and an overall faster healing process.
Tildren is another newer medication for treatment. Most of the research with this drug has been done in Europe and it has proven benefits for horses with kissing spines. The essential mechanism is that it decreases the bone destructive process of bone inflammation and “turns on” the bone cells that help to rebuild damaged bone. What is unique with this medication is that its role is not to mask pain, but to improve damaged bone which interrupts the destructive process and improves long term comfort. While it is somewhat costly, the benefits far outweigh any negatives.
Alternative modalities such as acupuncture, chiropractic adjustments, mesotherapy and/or massage can also have a role here. They can be used as a first line treatment as well as in a more supportive role. In the case of significant bone reaction along with kissing spines then the benefits of chiropractic may be minimal and possibly counter productive; however, acupuncture or mesotherapy can reduce the pain and dysfunction. There are a number of individuals in our area that practice equine massage and are frequently recommended.
Again physical therapy should be considered the essential component for management of this condition. Using exercises that help to build core strength and ones that allow the back to lift are the main concepts. When referring to building core strength it’s not the back muscles that are over the spine but rather the ones adjacent to the spine (multifidus muscles), the ones that go from under the spine to the hips (psoas muscles) and the ones that run along the abdominal wall (abdominal oblique muscles) that we try to strengthen. These are the muscles that work to lift or flex the back versus the ones on top that extend the back.
Of course the physical therapy piece of the puzzle is easier than it sounds and may take months to fully appreciate the benefits. Of course the physical therapy piece of the puzzle is easier than it sounds and may take months to fully appreciate the benefits. Combining it, along with some type of therapy that makes the horse more comfortable is the best way to go.
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Sources: Kissing Spine Disease – Dorsal Spinous Impingement
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- Bobby Gene TummoloWhy… is Mikey sore or something? Just wondering. How’s he doing physically? He looks and acts in your vids as young as a colt!
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