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Kissing spine in horses

Suspicion or diagnosis of kissing spine in horses is a source of fear and misery for horse owners. In this article, I share some basic information on kissing spine and what you can do for your horse.

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What is kissing spine, or kissing spines, in horses?

Kissing spine is the colloquial name given to what is more correctly called ‘over-riding dorsal spinous processes’. The vertebrae of the horse, which means the bones of the spine, are each formed of a kind of central bony ring, with wings of bone coming out from each side of the ring (the lateral processes) and a bony spine sticking upwards (the spinous processes). Kissing spine occurs when the spinous processes are too close together. They might be almost touching, slightly touching, or even completely fused. Often, there will be roughening of the bone where the spinous processes come into contact with each other. It can be just two of the spinous processes that touch, or it can be more than two.

How do you know if a horse has kissing spine?

The short answer is that you don’t know if a horse has kissing spine unless you can see it on an X-ray. Even if you can see it on an X-ray, you don’t know if it’s bothering the horse or causing pain. We know for sure that what we see on an X-ray, in both people and horses, does not always match the symptoms that are reported. A person can have horrendous arthritis in their knee and not feel any pain or instability. Equally, someone can have mild arthritic changes on an X-ray yet be in significant pain. Although they can’t talk, we know from using nerve blocks that something similar applies to horses. Equally, there is strong evidence in horses to show that lameness, either in front or behind, can lead to back pain. So, just because a horse is sore in his back does not mean that he has kissing spine.

Why does kissing spine happen in horses?

We don’t know why kissing spine occurs in horses. It’s more commonly diagnosed in Thoroughbreds and Sports Horses, but that’s possibly because they are more likely to be doing the kind of work that would lead an owner to recognise symptoms of kissing spine. There is thought to be a genetic link, and studies are ongoing to look into this. It seems logical that dressage-type work would be protective against kissing spine since it asks the horse to lift through his back. And that jumping and galloping, where the horse spends more time with his back extended, might be more likely to predispose a horse to kissing spine, but I don’t know of any robust scientific evidence that suggests this. As far as I’m aware, there is currently no link between whether a horse with a long back or a short back is more likely to have kissing spine.

Can you ride a horse that has kissing spine?

As is often the case, whether or not you can ride a horse with kissing spine depends very much on the individual situation. Kissing spine, more correctly known as over-riding dorsal spinous processes, is a disease where two or more spinous processes are too close together. However, this disease is not always painful. If the horse is not in pain in his ridden work, which you can measure using the Ridden Horse Pain Ethogram, then it’s likely that ridden work will benefit him, as long as it is done sympathetically and with the aim of building and supporting core strength, postural stability, and spinal flexibility. If, however, the kissing spine is causing pain, then it’s important to discuss the situation with your vet and your physio.

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How is kissing spine diagnosed?

Only a veterinarian can diagnose kissing spine, more correctly known as over-riding dorsal spinous processes. This is because diagnosis requires an x-ray of the horse’s back. Since we know that many horses have kissing spine without it appearing to cause pain, your veterinarian will use nerve blocks (local anaesthesia) in the relevant area to assess whether this affects the symptoms your horse is showing due to the kissing spine. If the kissing spine causes your horse pain, the symptoms will change when the area is nerve-blocked. If the symptoms remain unchanged, there may be another issue, and your veterinarian may need to conduct further investigations and diagnostic tests.

Where does kissing spine happen in horses?

Kissing spine in horses most commonly occurs in the thoracic spine. This is the part of the spine attached to the rib cage. The most common area for kissing spine is towards the back of the rib cage, under the back of the saddle. This, of course, means that the weight of the rider on the back of a horse who has pain from kissing spine is likely to have a negative impact, potentially causing more pain. This also means that a horse with kissing spine may be particularly sensitive to slight changes in saddle fit.

What can you do about kissing spine in your horse?

If your horse has kissing spine, you can work with your veterinarian and your physiotherapist to ensure that you get him the right help. Assuming he does not need veterinary intervention, you can do in-hand and ridden exercises that promote core strength, postural stability, and spinal flexibility. One effective in-hand exercise is baited stretches, especially encouraging the horse to stretch down and round, prompting him to lift through his back. Pole work can be a useful ridden exercise, asking your horse to stretch down over the poles. You might also take him to a water treadmill. Managing the level of work is important, asking for enough to develop strength and condition, but not too much that he gets tired.

What can your physio do about kissing spine in your horse?

Physio plays an important role in rehabilitating the horse with kissing spine, whether or not he has had veterinary treatment. The physio may offer manual therapy, exercises, advice, and education, electrotherapy, or something else. There will be a focus on building core strength, postural stability, and spinal flexibility. They will look for where your horse is stiff or sore and treat these areas to help him be more comfortable and move more easily. This, in turn, will enable him to do his exercises better, and his body will work more efficiently. Tight muscles and stiff joints will create altered movement, which could lead to more pain. The physio will look at the body as a whole to reduce pain and improve function.

What can a veterinarian do to treat kissing spine?

There is a lot you can do yourself to help your horse with kissing spine, and there is a lot your horse’s physio can do. However, there are also veterinary options. If there are other physical issues, such as hindlimb lameness or stiffness in the neck, it’s important to consider how the treatment and rehabilitation for one issue might impact the other co-existing issues. Veterinary treatment for kissing spine most commonly involves medication of the painful area of the back or surgery. There are two main types of surgery. One involves ‘shaving’ the bone to prevent the contact causing the pain. The other involves cutting the interspinous ligament, which relieves tension on the ligament and alleviates the pain from the kissing spine. Sometimes, a portion of the spinous process is removed.


If you are worried that your horse is sore in his back, my on-demand online course, ‘Horse Health Check: The 10-Point Plan for Physical Wellness,’ will help you gather more information to share with your instructor, vet, and physio. The better informed you are as an owner, the better decisions you can make on behalf of your horse.

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Meet Sue Palmer

Sue Palmer MCSP, aka The Horse Physio, is an award-winning author, educator, and Chartered Physiotherapist. Sue specialises in understanding the links between equine pain and behaviour, focusing on prevention, partnership and performance. She promotes the kind and fair treatment of horses through empathetic education, and is registered with the RAMP, the ACPAT, the IHA, the CSP and the HCPC.

You can find The Horse Physio on the web, on Facebook, on Instagram, and on YouTube.

Online courses

Horse Health Check: The 10-Point Plan for Physical Wellness

Head to Hoof: An Introduction to Horse Massage

Horse Massage for Horse Owners

Stretching Your Horse: A Guide to Keeping Your Equine Friend Happy and Healthy


Harmonious Horsemanship, co-authored with Dr Sue Dyson

Understanding Horse Performance: Brain, Pain or Training?

Horse Massage for Horse Owners

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