Managing Kissing Spines: How Medical Therapy and Targeted Exercise Save Performance Careers

What Happened

Performance horse practitioners are seeing an influx of back pain cases, with some clinics reporting that nearly one-third of their caseload involves spinal issues or second opinions regarding performance declines. A prominent case study involving a five-year-old eventing prospect at Virginia Equine Imaging highlights the diagnostic and treatment path for "kissing spines", the common term for dorsal spinous process impingement.

The young gelding presented with significant back soreness, bucking tendencies, and a lack of topline muscling. Radiographs confirmed impingements ranging from Grade 1 to Grade 4. Dr. Kent Allen, DVM, Cert. ISELP, utilized a combination of extracorporeal shock wave therapy and mesotherapy to manage the condition.

The treatment focused on "downregulating" pain receptors in the bone and interrupting sensory pain signals in the skin and muscle layers. By neutralizing the pain, the horse was able to stop the cycle of muscle spasms and begin rebuilding the topline strength necessary to stabilize the spine. After eighteen months of maintenance, including twice-yearly treatments and specific exercise protocols, the horse successfully returned to competition with minimal soreness.

Why It Matters

For riders and trainers, this case underscores that a "kissing spines" diagnosis is often a management challenge rather than a career-ending injury. However, it requires a shift in how owners view daily care and training.

• The Pain-Muscle Loop: When a horse is in pain, its muscles spasm. This prevents the horse from developing the topline muscle needed to support the skeleton, leading to further pain. Breaking this cycle with medical intervention is often the only way to make rehabilitation possible.
• The Early Onset: While often thought of as a wear-and-tear injury, research shows these issues are developmental, often appearing by age 6.5. This means owners of young horses should be vigilant if they see "avoidance behaviors" or difficulty holding a frame.
• Management Over Surgery: While surgery exists, many top practitioners now prioritize medical management (shock wave, mesotherapy, and injections) combined with physical therapy. Surgery is increasingly viewed as a last resort due to rehabilitation risks.

Discipline Context

While back pain affects all horses, the impact is most visible in disciplines requiring significant back flexion and engagement:

• Eventing/Jumping: The "pounding" of the trot and the exertion of jumping can exacerbate impingements.
• Dressage: Horses are required to sit and lift through the back; if the spine is impinged, this becomes physically impossible, often leading to "naughty" behavior that is actually pain-based.
• Youth & Amateur Horses: Because back pain can lead to unpredictable behaviors like bucking or bolting, proper management is a critical safety issue for less experienced riders.

Training & Maintenance Tips

Dr. Allen recommends several "best practices" for horses managing spinal issues:

• Modified Warm-up: Start with the walk and canter rather than the trot. The trot creates a "pounding" motion on the spine, whereas the canter allows for more fluid stretching.
• Long and Low: Encourage the horse to stretch the neck down and out to pull the dorsal spinous processes further apart.
• Carrot Stretches: Specifically drawing the nose down toward the knees (rather than side-to-side) helps flex the back upward.
• Saddle Fit: While not the root cause, a poorly fitting saddle will compound the pain of a horse already dealing with skeletal impingement.

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