Welcome to my second blog post! I hope the new year is treating everyone and their horses kindly…
Quick update first off – I am delighted to say I now have the most brilliant mentor, Ceola Reece! Ceola is a vet physio as well as an anatomist, and she lectured me in my second year of uni. Having Ceola on board for guidance on clinical cases, business advice and general support will help me provide the best possible service I can for you and your horses, so needless to say I am very excited!
I wanted to use this blog post to discuss the very common (and often undiagnosed) pathology – over-riding dorsal spinous processes (ORDSPs) or kissing spines. I have a few ongoing cases with ORDSPs, and I want to share with you a few key goals for the rehabilitation of this pathology.
Firstly, what actually is/are kissing spines?
Kissing spines refers to a skeletal abnormality where the dorsal spinous processes (the parts that stick up on your horse’s spine) are touching or rubbing together, causing pain, reduced range of motion, muscle atrophy and behavioural changes. This often occurs in the last few thoracic vertebrae (where the rider sits). In more severe cases, there can also be damage to the interspinous ligament or facet joints of the vertebrae.
Why does this happen?
Whilst we cannot give a definitive cause of ORDSPs, it is thought that there could be a genetic component. Very commonly found in thoroughbreds, it is also accepted that kissing spines could be the result of intense training at an early age before skeletal development is complete.
Clinical signs – what are we looking for?
The presentation of kissing spines is not always connected to the clinical significance of the changes on x-rays. For example – a horse with mildly impinging spinous processes can present behaviourally worse than a horse with severely overriding processes and concurrent damage to other structures. Of course this is not always the case, but it is something to be aware of. Common clinical signs include poor performance, muscle atrophy, sensitivity to grooming/tacking up, bucking and rearing, and hindlimb lameness.
How are ORDSPs diagnosed?
Once all other causes of hindlimb lameness have been eliminated, X-Rays should be taken, and nuclear scintigraphy (bone scan) if necessary. Relying on palpation alone can lead to error.
What next?
Depending on the severity of the case, there are various different treatment options. These can be broadly broken down into surgical or conservative.
Surgery can involve resecting the portions of the spinous processes that are touching or transecting the interspinous ligament to create more space between the vertebrae. In some more extreme cases, both can be performed. Both surgical procedures require lengthy rehabilitation protocols and have varied results.
More conservative treatment involves tailored physiotherapy and rehabilitation to build the horse’s topline to support the spinal column. If needed, long-acting steroids can also be used locally to reduce inflammation in the area.
What are our key rehabilitation goals?
Whether your horse has undergone surgery, or you have opted for the more conservative route, the rehabilitation aims are very similar.
· Build the topline
· Strengthen the core
· Increase mobility
· Improve the posture
Spinal stability and core strength are integral to helping your horse in his kissing spines rehabilitation. Exercises such as pole work, baited stretches or dynamic mobilisation exercises are brilliant for this – see studies linked at the bottom of this blog.
Increasing your horse’s lateral flexion is also important, along with encouraging your horse to ‘round’ over his back and avoid a ‘hollow’ extended posture. We are trying to create flexion through the spine, and as the spine rounds there is more space created between the dorsal spinous processes. If the spine is extended and your horse adopts a hollow posture, the projecting bony processes are closer together and risk touching.
If your horse has had kissing spines surgery, it is vital that you consult with your vet regarding your horse’s readiness for certain exercises and progressions.
If you have any questions regarding kissing spines and your horse, please don’t hesitate to get in touch. The links below are research into dynamic mobilisation exercises and increased cross-sectional area of the multifidus muscle. Happy reading!
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