Kissing Spines Isn’t a Death Sentence: Managing Overriding DSP with Rehab
For many horse owners, hearing the words “Your horse has kissing spines” feels like a crushing blow. Images of permanent back pain, career-ending diagnoses, or even euthanasia may flood your mind.
But here’s the good news: kissing spines is not automatically a death sentence. With early diagnosis, smart management, and targeted rehabilitation, many horses with overriding dorsal spinous processes (DSP) return to full, happy, and even high-performance lives.
This post breaks down what kissing spines is, how it’s diagnosed, what treatment options exist, and how conservative management - including physical therapy - can make a world of difference.
🐎 What Are Kissing Spines?
“Kissing spines” (technically overriding dorsal spinous processes) describes a condition where the bony projections along the horse’s spine (the dorsal spinous processes) are too close together. Instead of being spaced normally, they touch - or “kiss” - and sometimes overlap and start to fuse together
Most commonly found in the thoracic spine, just under the saddle area or the lumbar spine just behind the saddle area.
Horses may have one or two affected vertebrae - or multiple sites along the back.
The condition can range from mild and incidental (with no symptoms) to severe and painful.
🔍 How Is It Diagnosed?
Diagnosis usually starts with a combination of clinical signs and imaging:
Clinical signs may include:
Hollowing the back or avoiding collection
Bucking, bolting, or resisting under saddle
Sudden changes in attitude or performance
Difficulty with transitions or lateral work
Sensitivity to grooming or saddling
Shortened stride, especially behind
Veterinary diagnostics may involve:
X-rays to confirm spacing/overlap of vertebrae
Scintigraphy (bone scan) or ultrasound
Local anesthesia blocks to confirm pain source
💡 Key point: Some horses have dramatic X-ray findings and no symptoms, while others show pain with only mild changes. That’s why diagnosis must consider the whole picture - not just the images.
🚫 Why Kissing Spines Isn’t the End
For years, kissing spines carried a bleak reputation. But more recent studies and case reports show many horses improve with a thoughtful, multi-modal approach.
Why? Because:
Pain often comes from muscle tension and compensation, not just the bony overlap itself.
Horses can learn to use their back differently through rehab and conditioning.
Conservative therapies have improved dramatically, we have more tools in our toolboxes.
In fact, many horses with diagnosed kissing spines go on to compete successfully at high levels with proper care.
⚖️ Treatment Options: Surgery vs. Conservative Management
There are two main pathways to treatment:
1. Surgical Options
Interspinous ligament desmotomy (ISLD): Cutting the ligaments between the spinous processes to reduce tension
Osteoplasty or Ostectomy (“bone shaving”): Reshaping or removing parts of the spinous process to create more space.
Surgery can be highly successful, but it is invasive, requires significant recovery, and isn’t always necessary - especially for mild cases.
2. Conservative (Non-Surgical) Management
This is often the first line of defense and can include:
Veterinary care: Pain relief (NSAIDs, corticosteroid injections, mesotherapy, shockwave therapy).
Physical therapy & rehabilitation: Targeted exercises to improve back mobility, posture, and core strength.
Saddle fit: Ensuring no added pressure worsens the problem.
Rider balance & technique: Addressing asymmetry and reducing overloading of the horse’s back.
Hoof balance: Affects posture and load distribution up the chain.
For many horses, conservative care is enough to restore comfort and function.
🧠 The Role of Physical Therapy in Managing Kissing Spines
Here’s where equine physical therapy shines: while medication may reduce pain, rehab addresses the root: how the horse moves.
Goals of PT in kissing spines:
Improve spinal mobility
Build core and topline strength
Encourage correct posture (lifting through the thoracic sling, engaging the abdominals)
Reduce compensatory strain in surrounding muscles
Retrain movement patterns for long-term comfort
🏋️♀️ Key Rehab Strategies & Exercises
1. Core Activation Work
Dynamic mobilizations: Encourage controlled motion into flexion and lateral bend.
Thoracic sling lifts, belly lifts & pelvic tilts: Activate deep stabilizing muscles.
2. Groundwork & In-Hand Training
Correct, slow in-hand walking encourages postural alignment.
Lunging may be done on LARGE circles with a focus on maintaining spinal alignment
Raised poles at the walk/trot can improve spinal flexion and proprioception.
3. Under-Saddle Conditioning (Once Cleared by Vet/PT)
Focus on maintaining spinal alignment and core engagement under the weight of a rider
Transitions (walk-trot, trot-canter) to build strength gradually
Lateral work (shoulder-in, leg yields) may be added for even muscle development and dynamic spinal mobility
4. Cavaletti & Pole Work
Increases range of motion
Encourages engagement of hindquarters and topline
5. Adjunct Modalities
Massage, myofascial release, and other manual therapy techniques for muscle relaxation
Therapies like laser, PEMF, or shockwave may reduce pain and aid healing
⚠️ Important: Exercises must be performed correctly and consistently and progressed only when the horse is ready. Poor form risks worsening pain and exacerbating dysfunction. That’s why professional guidance is so valuable.
🔍 Investigating Root Causes
Why did your horse develop kissing spines - or why did it start showing symptoms now? Rehab isn’t just about treating pain, it’s about addressing what led to the issue.
Potential root causes include:
Saddle fit: Chronic pressure points create tension and hollowing.
Rider asymmetry: Uneven weight encourages crookedness.
Hoof imbalance: Poor trimming or shoeing affects posture.
Lack of conditioning: Weak core muscles fail to support the spine.
Conformation or genetic predisposition: Some backs are more prone to DSP impingement.
By identifying and correcting these factors, you reduce the chance of recurrence and help your horse stay comfortable long-term.
🧭 Setting Realistic Expectations
Rehabbing a horse with kissing spines takes patience, teamwork, and a willingness to adjust goals. Some horses return to full athletic careers. Others thrive in lighter work. Success depends on:
Severity of bony changes
Horse’s age and overall fitness
Owner’s consistency with rehab
Ongoing support from the vet + therapist + farrier + saddle fitter
💡 Hopeful reality: Even if your horse can’t return to top-level sport, they can often enjoy a comfortable, useful, and happy life with proper care.
🧾 Case Example
A 10-year-old Warmblood eventer is diagnosed with kissing spines after sudden resistance under saddle. X-rays show 4 impinging processes.
Step 1: Saddle fitter recognizes ill-fitting tack and muscle atrophy behind the withers, suggests veterinary referral.
Step 2: Veterinarian assesses and diagnoses KS with radiographs, recommends injections followed by a course of shockwave therapy treatments to reduce initial pain.
Step 3: Physical therapy begins with manual therapy, core activation exercises at halt, and short hand walks focusing on maintaining neutral spinal posture.
Step 4: Gradual return to ground work and under-saddle work begins in a long, low frame and progresses to a more natural frame, head around withers height, with transitions and light lateral work.
Step 5: Rider receives coaching to improve balance and lighten the seat.
Within 12 months, the horse returns to light competition and is comfortable, strong, and happier in his work.
✨ Takeaway: Kissing Spines Isn’t the End
Hearing your horse has kissing spines can be frightening, but it doesn’t have to be the end of your journey together. With veterinary care, a strong rehabilitation program, and attention to root causes, many horses live and work comfortably with this condition.
Remember:
Imaging doesn’t always equal pain - focus on the horse, not just the X-rays.
Rehab and PT are critical in building long-term resilience.
Communication between vet, therapist, farrier, rider, and saddle fitter is key.
Your horse’s comfort and quality of life, not just performance, should guide the plan.
With the right approach, kissing spines can be managed, not feared. Your horse’s story isn’t over - it’s just entering a new chapter of care, strength, and partnership. 💙
Want to dig deeper into the condition of Kissing Spines including anatomy, treatment methods, and rehabilitation strategies? Join my Kissing Spines Masterclass - a deep dive into all things Kissing Spines.
You can also read more about interpreting spinal x-rays for signs of kissing spines in this blog post.