05/06/2021
🔷 Kissing Spines - also known as Spinal Crowding Syndrome
Both horses in the photo below have kissing spines. The top one looks like the classic picture of a back that may have kissing spines, the bottom one has a back that looks better than many horses I see that are out competing at local shows and he also has kissing spines.
Kissing spines refers to a condition in horses where two or more of the spinous processes (the flanges of bone sticking up from each vertebra in the spine) are positioned so that they touch or rub against each other. A horse with kissing spines may develop back pain, bone cysts, arthritic changes, and other problems (Kentucky Equine Research).
Kissing spine is often secondary to another issue and is often the end of a problem, not the start of one. For a horse who has not been ridden or strengthened correctly or has another chronic (long term) complaint that they have been compensating for, kissing spines are the end result of a larger, more complicated picture. The good news with this, is that it can be reversible when managed correctly.
A horse with kissing spines will be reluctant to flex its back, therefore it will not use its body to the fullest extent. The horse will tend to alter its posture and way of going to compensate, which creates imbalances that put undue strain on certain muscles, joints, ligaments, and tendons.
🔷Causes of Kissing Spines
- Congenital/conformational
- Incorrect rider/horse weight ratio
- Weakness and instability in the multifidus muscle group - explained in detail below and how to rehab this
- Incorrect riding/training
- Lack of core strength
- Lack of postural stability
- starting horses too young or too much/too soon
🔷Signs and symptoms of Back Pain in horses
- Cold backed
- Fidgeting when being groomed or tacked up
- Nipping or kicking out when having the girth tightened
- Misbehaviour under saddle (bucking, rearing, kicking out, head tossing)
- Dragging one or both rear toes
- Inability to get the correct canter lead on way
- Awkward in gait transitions
- They have shifting lameness
- Stiff to one side
- Inability to flex or collect
I am aware that lots of these are symptoms of other biomechanical dysfunction but the most important thing to note here is that if your horse has been having regular bodywork (with the appropriate qualified professional), saddle fits well and it is still not improving, then there may be something more going on - this requires a vet and x-ray to diagnose.
❌ A note on cold backed horses - 99.9% of the time there is always a reason. You cannot simply say - 'my horse just does this'. No, they don't. They will have a degree of discomfort somewhere which may be related to muscle tightness, restricted vertebrae, pain in the ribcage, ulcers, incorrect saddle fit, kissing spine, shoulder pain, incorrect rider-horse weight ratio or that they are simply not strong enough through their backs to perform what is being asked of them.
🔷Diagnosis
Diagnosis of kissing spines needs to be done by your veterinarian and can be made based on history, physical examination, thermography, and radiography. The affected vertebrae can be in the thoracic or lumbar region but are often those that are positioned directly under the seat of the saddle. Sometimes four or more vertebrae are involved.
🔷Treatment
🔹Physical Therapy
As osteopaths our approach is a holistic one. To manage kissing spine, we'll need a treatment and management programme that involves manual techniques as well as a rehab programme. To manage kissing spines long term, this rehab programme will be what you will have to do with your horse for the rest of its career.
It is important to make sure that the horse is functioning its best in all areas of its body so that there is no extra loading or unhelpful compensatory patterns happening over the top of the spinal problem. This will require a combination of spinal mobilisation, myofascial release, specific soft tissue techniques, stretches, cranial and rebalancing techniques.
🔹🔹The Multifidus System and Carrot Stretches 🥕🥕
There is a complex system of muscles that run under the spine called the Multifidus System. These are the body’s ‘core’ muscles and need to be strong and short to counteract spinal dipping and keep the gaps between the processes open when carrying the rider. Simply asking the horse for more forward effort in an effort to engage the quarters will not build the Multifidus system, particularly if the spine has learned already to dip as the horse is working against himself.
When our horses become more mature and we ask for work in a more advanced outline, the muscles over the spine can become very tense as they further attempt to defend the spine from the potentially uncomfortable twisting of an active gait, while the increased impulsion and muscular tension creates a critical counter force leading to further compressions of the processes. At that stage, there is a possibility for kissing spine to develop, where the vertebrae have become kinked by the strong Longissimus Dorsi muscles in spasm, and the spinal processes start to touch/rub one another.
A secondary effect of the spine losing elasticity is that kinetic force is thrown forwards towards the shoulders as it can no longer be absorbed through the horse’s centre. This pushes the lowest part of the cervical section of his spine, the base of the neck, downwards between his shoulder blades and robbing him of forehand ‘suspension’, plunging him downhill, onto the forehand and heavily into the rider’s hand making straightness and balance physically impossible It is likely that advanced cases may have spinal interference in the C6, C7, T1 which contribute to the bracing resistance found in the rein contact of affected horses (Visconte Simon Cocozza - https://www.horsetalk.co.nz/2015/02/04/help-horse-kissing-spine-goodbye/)
🥕🥕 Carrot stretches are the best exercise to engage the multifidus system. Carrot stretches are dynamic mobilisation exercises that create spinal mobility and core stabilsation in which the horse is trained to move its chin to a specific position by following a piece of carrot/treat.
🔶 The positions you need to do 5 times a week for a horse with kissing spine and weekly for prevention are -
1) Chin-to-chest in which the chin was moved as close as possible to the chest bone
2) Chin-between-knees in which the chin was moved as far back as possible with the bottom of the nose at the level of the knee
3) Chin-between-fore fetlocks in which the chin was taken as far down and back as possible between the fore fetlocks
4) Thoracic/Sternal lifts - pressing your fingers into the sternum of your horse and asking it to lift and hold its back in flexion
5-7 preformed on both the left and right sides of the horse
5) Chin-to-girth in which the horse stretched laterally (to the side) until the chin reaches the level of the girth
6) Chin-to-hip in which the horse stretched laterally with the chin moving toward the point of the hip
7) Chin-to-hock in which the horse stretched laterally toward the hock reaching as far back and down as possible
The horse should encouraged to hold each position for 5 seconds and then be rewarded with the piece of carrot. For a rehab programme each of these exercises should be repeated 5 times, 5 days a week for 3 months. This programme is the human equivalent of around 45 abdominal crunches per day.
🔹Gymnastic exercises
In less severe cases where you are still able to ride (as well as do your ground work), gymnastic exercises will help to maintain top line and abdominal strength.
- Long and low leg yield with the horse bending its neck down and away from the direction its yielding - encourages the hips to rotate in the opposite direction from the shoulders
- Bend and stretch at walk on a small circle - encourage lots of inside bend and a lowered head position
- Turn on the forehand - builds the lateral and rotative pelvic control muscles, as well as simultaneously lifting the spine and separating the spinus processes. Start with quarter turns and graduate to full turns
- Walk pirouettes - develops the thoracic sling range of motion, encouraging the horse to carry his thoracic spine higher between his shoulder blades. Start with half pirouettes and graduate to full.
🔹Changing or refitting saddles is helpful for many horses with kissing spine. Make sure you check your saddle fit regularly as the fit will change as your horse develops and changes its way of going.
🔹Medical treatment
Unless the Kissing Spines are very advanced, most veterinarians will likely recommend starting with a conservative, medical approach to the treatment of this condition. These are methods to control the pain and inflammation and therefore break the muscle spasm cycle. One of the most common methods of pain and inflammation management is corticosteroid injections, as well as, non-steroidal anti-inflammatory drugs, veterinary acupuncture, therapeutic ultrasound and shockwave therapy.
Veterinarians may recommend surgery for Kissing Spines as the first treatment option or after an unsuccessful course of medical and physical therapy.
🔷 Prognosis
While every case is different, the majority of horses with Kissing Spine that are diagnosed, treated, and rehabbed appropriately are able to return to work. Some will be able to perform at their previous level while others may need a step down in order to remain comfortable. While the formal physical therapy program may have ended, trainers and riders should continue schooling horses in a frame that encourages a rounding of the back, self-carriage, and balance as well as maintaining multifidus strength with carrot stretches - just less regularly than in the rehab program.
Links to sources
https://ker.com/equinews/kissing-spines-horses/
https://www.horsetalk.co.nz/2015/02/04/help-horse-kissing-spine-goodbye/
https://www.paulickreport.com/horse-care-category/kissing-spines-a-manageable-disease-with-the-right-treatment-program/
https://thehorse.com/117917/exercises-to-strengthen-equine-back-muscles-reduce-pain/
The science behind Kissing Spine and avoiding it with simple exercises to improve your horse's gaits.
