📋 At a Glance
⚠️ Signs Requiring Veterinary Contact
- A horse that was previously willing and cooperative and has become resistant, irritable, or difficult to ride
- Bucking — particularly at transitions, when asked for collection, or when mounted
- Sensitivity when the back is touched, brushed, or saddle applied — flinching, swishing tail, pinning ears
- Cold back — the horse humps up or is stiff and resistant when first mounted, improving after extensive warmup
- Asymmetric performance — consistent difficulty bending, tracking up, or collecting in one direction
- Reluctance to engage hindquarters, shortened hind stride, or dragging of hind toes
- A horse diagnosed with 'behavioral problems' that fails to improve with multiple training interventions
What Is Kissing Spine?
The dorsal spinous processes are the bony projections that extend upward from each vertebra — what we see and feel as the ridge of the horse's back. In a normal spine, there are spaces between adjacent processes. In kissing spine, these processes come into contact or overlap, producing pain through direct bone contact, periosteal (bone surface) inflammation, interspinous ligament pathology, and in some cases, soft tissue compression.
The condition is most commonly identified in the thoracic spine under the saddle area (T13–T18) because this is where collection and rider weight create the greatest compressive forces on the spinous processes. However, the lumbar vertebrae and the junction between the two regions can also be involved.
One of the most clinically important points about kissing spine is that the degree of contact visible on radiographs does not directly predict the degree of pain. Some horses with dramatic radiographic overlapping show no clinical signs; others with relatively mild contact are significantly affected. This is why the clinical examination, nerve blocks to confirm that the back pain originates from the spinous process region, and the horse's response to treatment are all essential components of diagnosis.
The Training-Medicine Interface
Kissing spine creates a particularly challenging diagnostic and management situation because its signs — resistance, bucking, behavioral changes, and performance decline — overlap completely with what trainers might attribute to evasion, lack of training, or attitude. This means horses with genuine back pain often undergo months or years of attempted training solutions before a structural cause is identified.
The key distinguishing factor is the response to training intervention. A horse with a training issue will gradually improve with consistent, appropriate work. A horse in back pain from kissing spine will not — and may worsen as the demands of collection increase. If a horse shows persistent back-related behavioral signs that don't respond clearly to training intervention, a veterinary evaluation should precede further training attempts.
Treatment Options
Treatment of kissing spine is multi-modal and should be tailored to the individual horse's severity, which segments are involved, and the intended use. Your veterinarian determines the appropriate approach.
| Treatment | What It Does | Typical Use |
|---|---|---|
| Interspinous corticosteroid injection | Reduces active periosteal and interspinous ligament inflammation directly | Most common initial treatment; may be repeated; combined with rehabilitation |
| Mesotherapy | Intradermal injection of medications targeting spinal nerve pathways | Adjunct to injection therapy; particularly for widespread back pain |
| Extracorporeal Shockwave (ESWT) | Mechanical wave stimulation reduces inflammation and may promote tissue remodeling | Often used alongside injections; multiple treatments typical |
| Interspinous Ligament Desmotomy | Surgical incision of ligaments between painful spinous processes | Horses that fail to respond adequately to conservative management |
| Bone removal (ostectomy) | Partial removal of the most severely impinging spinous process tips | Severe cases with close impingement not responsive to other treatment |
| Rehabilitation exercise | Core strengthening, baited stretches, hill work, cavaletti, physiotherapy | Essential component regardless of other treatment chosen |
Saddle Fit, Rider Biomechanics, and Kissing Spine
Two external factors consistently contribute to back pain in ridden horses — poor saddle fit and asymmetric rider biomechanics. A saddle that bridges (doesn't contact the back evenly), is too narrow, or concentrates pressure on specific spinous processes can directly cause or exacerbate kissing spine pain. A rider who sits crooked, overweights one seatbone, or applies asymmetric aids can similarly perpetuate back pain even when the horse's condition is being medically managed.
For this reason, best-practice management of kissing spine includes a professional saddle fit evaluation alongside the veterinary treatment, and often a rider biomechanics assessment by a qualified trainer or equestrian physiotherapist. Addressing all three components — the horse's pathology, the equipment, and the rider — produces significantly better long-term outcomes than treating the horse alone.
✅ Action Steps — While Contacting Your Vet
- Contact your veterinarian for a back examination — do not increase training pressure on a horse showing resistance that may have a physical cause
- Arrange a saddle fit evaluation by a qualified fitter — often the most immediately impactful intervention
- Document the specific behaviors: when they occur (saddling, mounting, transitions, collected work), how long present, and any correlation with workload changes
- Ask about imaging options — radiographs provide a starting point; bone scan (scintigraphy) identifies active inflammation; MRI evaluates soft tissue involvement
- Discuss rehabilitation exercise protocols — baited stretches, core work, pole and cavaletti work are typically part of comprehensive management
📋 Prevention & Long-Term Management Discussion Points
- Saddle fit reassessment — essential component of any kissing spine management plan
- Rider position evaluation — asymmetric rider weight is a significant contributing factor
- Rehabilitation progression — specific exercises that build thoracolumbar strength and promote proper back movement
- Return to collected work timeline — typically gradual and vet-guided based on treatment response
- Recurrence prevention — ongoing saddle management, appropriate conditioning, and monitoring for recurrence of back pain signs
Questions to Ask Your Veterinarian
- How significant is the radiographic contact relative to what you typically see, and do nerve blocks confirm that this is the pain source?
- Which treatment approach do you recommend for this horse's severity and use?
- What is the typical recovery and return-to-work timeline after the treatment you recommend?
- Should we involve a saddle fitter, and should we also evaluate the rider's position?
- What specific rehabilitation exercises should we start and when?
- What signs should prompt me to call you — for instance, if treatment isn't producing improvement within a certain timeframe?
