🐎 Vet’s 2025 Guide to Kissing Spine in Horses

By Dr Duncan Houston BVSc

1. What is Kissing Spine?

Kissing spine—formally called overriding or impinging dorsal spinous processes—occurs when the bony projections on the horse’s vertebrae touch or overlap. This often affects the thoracic region under the saddle, typically between T6 and T18 :contentReference[oaicite:3]{index=3}. Though imaging shows the condition in around 20–40% of horses, not all are painful :contentReference[oaicite:4]{index=4}.

2. Who Is at Risk?

The condition is often linked to:

• Performance and sport horses (e.g. racehorses, eventers)—especially tall, long-backed individuals :contentReference[oaicite:5]{index=5}.
• Poor saddle fit and weak core muscles :contentReference[oaicite:6]{index=6}.
• Genetic predisposition in breeds like Warmbloods and Thoroughbreds :contentReference[oaicite:7]{index=7}.

3. Clinical Signs

Signs vary widely. Some horses are asymptomatic despite severe x-ray changes; others develop:

• Back stiffness, sensitivity when groomed or saddled :contentReference[oaicite:8]{index=8}
• Behavioral changes—e.g., bucking, refusing leads, head tossing, training resistance :contentReference[oaicite:9]{index=9}
• Poor performance, reluctance to collect, trouble with transitions or canter :contentReference[oaicite:10]{index=10}
• Muscle atrophy over topline :contentReference[oaicite:11]{index=11}

4. Diagnosis

Diagnosis combines history, physical exam, and imaging:

• Palpation: Detect tenderness, muscle spasm :contentReference[oaicite:12]{index=12}.
• Lameness & movement evaluation: In-hand, lunged, under saddle :contentReference[oaicite:13]{index=13}.
• X‑rays: Gold standard to visualise overlapping spinous processes :contentReference[oaicite:14]{index=14}.
• Advanced imaging: Nuclear scintigraphy, thermography, ultrasound help confirm active lesions :contentReference[oaicite:15]{index=15}.

5. Treatment Options

5.1 Conservative Medical Management

• NSAIDs, muscle relaxants (e.g. methocarbamol), corticosteroid injections :contentReference[oaicite:16]{index=16}.
• Shockwave therapy + mesotherapy—86% success when combined with rehab :contentReference[oaicite:17]{index=17}.
• Correct saddle fit and chiropractic/acupuncture/therapeutic ultrasound :contentReference[oaicite:18]{index=18}.

5.2 Physical Rehabilitation

Essential in all cases:

• Core & topline conditioning—lunging with Pessoa or side reins, poles, cavaletti :contentReference[oaicite:19]{index=19}.
• Hydrotherapy via aqua-treadmill to build back muscle :contentReference[oaicite:20]{index=20}.
• Structured warm-up and long-and-low work under saddle :contentReference[oaicite:21]{index=21}.

5.3 Surgical Interventions

• Interspinous Ligament Desmotomy (ISLD): Cuts ligament, done standing, ~85% successful return to sport :contentReference[oaicite:22]{index=22}.
• Dorsal spinous process resection: Removes bone; more invasive, longer rehab but high success rate :contentReference[oaicite:23]{index=23}.

6. Rehabilitation & Aftercare

• Strict stall rest post-surgery → gradual rehab with hand-walking, then lunging, poles, under-saddle as healing progresses :contentReference[oaicite:24]{index=24}.
• Ongoing core-strength program to support back and prevent recurrence :contentReference[oaicite:25]{index=25}.

7. Prognosis

With proper multi-modal management, most horses return to performance. Prognosis is best when:

• Early diagnosis and treatment
• Less than five spinous processes involved
• Older horses fare better than young (<5-year-old) :contentReference[oaicite:26]{index=26}
• Youthful horses with many affected vertebrae have guarded outcomes :contentReference[oaicite:27]{index=27}.

8. Prevention Strategies

• Proper saddle fit & routine checks
• Balanced training with core engagement before collection
• Maintain topline muscle & back flexibility
• Pre-purchase X-rays—isolate mild cases for monitoring :contentReference[oaicite:28]{index=28}.

9. Case Study: “Zenith” the Eventing Gelding

“Zenith,” a 7-year-old Warmblood discovered with kissing spine during performance decline, responded well to shockwave + mesotherapy, 12 weeks rehab. Returned to eventing with improved topline and no further discomfort. Behind-the-scenes saddle tweaks and core conditioning were key to success.

10. Ask A Vet Support 🩺

At Ask A Vet, we guide horse owners through diagnosis, treatment selection, rehab planning, and monitoring. Whether for conservative treatments or surgical aftercare, we're only a message away. Download our app for expert vet support anytime, anywhere.

11. Quick Summary Table

12. Final Thoughts

Kissing spines may sound alarming, but with structured veterinary, rehabilitative, and equipment strategies, horses can return to comfortable athletic lives. Early recognition, committed rehab, and close veterinary support—like that found at Ask A Vet—ensure your equine partner stays strong, happy, and performance-ready. ❤️

Download the Ask A Vet app today for personalised support, treatment planning, and lifelong performance care.