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Rebecca Sedgwick; MCSP, BSc (hons) Physiotherapist; PgDip Veterinary Physiotherapy
ACPAT registered Chartered Physiotherapist

Kissing spine is estimated to affect approximately 40% of the equine population. It refers to overcrowding or impingement of 2 or more dorsal spinous processes (DSP), found in both the thoracic and lumbar regions but most commonly found in the region where the saddle sits, between T6-18.
Conformation, training and poor saddle fit are often cited as contributory factors, although research has indicated that there are significant genetic links to kissing spine and breeding from affected horses should therefore be avoided.

Symptoms commonly observed are back soreness and muscle spasm, reluctance on being saddled/ mounted, behavioural issues and reduced performance. In some cases hind limb lameness has been noted. However, back pain can be secondary to hind limb problems and as a number of horses with a presentation off kissing spine do not show clinical signs it is important that thorough investigation enables identification of the primary cause of symptoms.

Treatment may involve corticosteroid injections or surgery. The most common surgeries are ISLD (Interspinous Ligament Desmotomy) or osteotomy via resection of the affected DSP’s. Results can be variable and may be affected by factors such as chronicity of symptoms. Effective rehabilitation and management is key to optimise recovery and return to activity.

Communication between your team of professionals- Vet, Physiotherapist, Saddler, Farrier & Trainer will help to ensure the best recovery and long term management for your horse.

Early assessment from a suitably qualified Physiotherapist is important to identify problem areas and advise on an appropriate rehabilitation plan. The aim of Physiotherapy treatment will be initially to assist with pain management and help to restore correct movement patterns, strength and proprioception.

A generalised protocol may provide some guidance on progression in the Rehabilitation
Programme but it is important to remember that each horse is individual and treatment
should be based on their specific problems and compensation.

Various interventions may be commonly recommended/ incorporated into the treatment programme:

Manual therapy- spinal mobilization/ manipulation and soft tissue techniques have been shown to help reduce pain & improve movement dysfunction in humans by inducing neurophysiological change in tissue & joint structures. There has been some research in horses to support increases in spinal range of movement following treatment

Electrotherapy- eg NMES, H wave. Robust evidence for support of electrotherapy in horses is relatively limited, although studies have showed some evidence for the use of NMES and H wave in reduction of muscle spasm & increase in trunk movement.

Dynamic mobilizations (baited stretches)- research has shown improvements in epaxial
muscle activation with baited stretches & this is a useful intervention to introduce in the
early stages whilst your horse is on box rest. A study incorporating their use in conjunction with gymnastic exercises ( small circles, pelvic tilts, backing up, walking over a raised pole) has shown significant increase in postural muscle size.

Kinesiotape- some therapists incorporate the use of kinesiotape although research has
shown limited evidence of its effects with no statistical change of thoracolumbar flexion/ extension. Individual movement strategies have been noted but which indicates that it may induce a change in movement patterns but care should be taken to deduce that this is a positive effect & not encouraging unwanted adaptive movement.

Lunging aids- The use of lunging aids, eg Pessoa training aid, are often advocated during kissing spine rehabilitation. Research has shown that the use of Pessoa or similar lunging aids can influence stride length & may influence activation of the longissimus dorsi muscle in trot. However, effects on different horses can be variable & their use/ effects should be carefully evaluated.

Elastic Resistance bands- There has been some research supporting the use of elastic
resistance bands in improving core muscle activation particularly in conjunction with
walking & trotting over raised poles.

Pole work- Research has shown an increase pelvic movement in core muscle activation both on its own & in conjunction with resistance bands as above.

Water treadmill- An increase in water depth has shown to increase thoracic and sacral range of movement.

It is important that the effects of any interventions used are carefully monitored. Your
Physiotherapist will use clinical reasoning to choose interventions that address the
individual horse’s problems & dysfunction. They should constantly monitor, evaluate and adapt treatment if required to ensure the horse is progressing as anticipated. This should include assessing effects of training aids, pole work & the use of treadmills , evaluating the horse’s movement & response & regressing or progressing as indicated.

Optimising foot balance throughout the rehabilitation is vital to help avoid compensatory movement so it is important that the farrier is on board with the rehabilitation process. When commencing ridden work, saddle fit is paramount & the ability/ knowledge of the rider to work the horse correctly will have an influence of how the horse progresses in this phase. It may be beneficial for the rider to incorporate the assistance of a suitably experienced rider during the rehabilitation process if required.

In summary, treatment should be specific, measured and progressive. Liaison with the vet and other professionals, as previously mentioned, is important & response to treatment discussed between the owner & team members to incorporate a multi- disciplinary approach to optimise recovery and management.

If you would like help with your horse’s treatment/ rehabilitation following diagnosis from kissing spine or have any other queries how Physiotherapy may help your horse please contact me

Tel 07914 822013/ Email [email protected]
Rebecca Sedgwick, ACPAT registered Chartered Physiotherapist; member of RAMP

Providing Physiotherapy services for Horse & Rider in Hampshire, South Wilts, East Dorset



There is a growing wealth of information available on the internet, books and courses on the importance of strengthening the ‘core’, relating to both horse and rider.  Pilates classes aimed specifically at horse riders are increasingly popular and owners/ trainers are assured of the benefits of certain lungeing/ riding aids for improving their horse’s core.

However, do you really understand exactly what the ‘core’ is, or its importance in the function of horse and rider?  Apart from obvious differences in the human as an upright bipedal and the horse as a quadruped, there are a surprising number of similarities in anatomy and physiological function.  The ‘core’ muscles comprise of a group of muscles whose primary role is to raise intra-abdominal pressure and increase pressure in the fascia, or tissue surrounding the muscles in the thoracolumbar area.  This provides a degree of support and ‘stability’ to the spine.

In the human these muscles are located between the diaphragm and pelvic floor and hip girdle, forming a corset around the trunk and spine.  The ‘core’ muscles of the horse comprise of muscles around the spine and abdominal muscles.  The ‘string and bow’ theory describes the effect of strengthening these muscles to aid greater stability to the back when the horse is asked to carry a saddle and rider (I will talk more about this in my next blog).

Back pain is a common loss of performance for both horses and people.  Studies have revealed that back pain can result in reduced activation of the muscles such as multifidus and transversus abdominus, both in people and horses.  Back pain may be a primary problem, or secondary to another problem, such as hindlimb lameness in the horse, or hip/knee pain in the human.  In either case, compensatory movement patterns and postures are likely to occur, such as reduced spinal movement and or stride length/ limb movements.

We all have a level of asymmetry acquired through injuries and activities that we carry out on a daily basis in the same movement patterns.  In an ideal world, to achieve better symmetry we would carry out all the tasks we do on a daily basis, such as mucking out,  sweeping the yard, using our right and left sides evenly.  We tend to favour our dominant side to carry out these tasks as it is quick, easy and requires minimal effort from the brain in transferring the messages required to perform the required movements.  This leads to the muscles on this side becoming shortened and often overused.

Poor lumbo-pelvic posture in the rider is often associated with related biomechanical factors.  The rider with an anteriorly tilted pelvic posture will generally present with an increased lumbar lordosis and tight, shortened hip flexors and tensor fascia latae.  Gluteus maximus and hamstrings and the key core muscles (trans abs; multifidus; internal obliques) will often be lengthened and weak.

Conversely, the posteriorly tilted pelvic posture may be found in people who spend a lot of time sitting in front of desks in a poor posture and tends to be associated with tight hamstrings and gluteals with weak psoas and lower paraspinal muscles

Studies have shown that rider weight causes overall extension of the horse’s back, particularly in sitting trot or during the sitting phase of rising trot.  Posterior tilting of the pelvis tends to cause an increase in pressure around the wither and shoulders which may contribute to injuries in this area. 

Lateral imbalance will also cause increased pressure on the horse’s back, which over time can cause muscle soreness and loss of performance and muscle imbalance in the horse.

Any postural imbalance in the rider will affect movement patterns of the lower back, which can effectively ‘block’ the horse by creating tension and preventing the horse from moving freely.

It is obviously important, therefore that as riders we ensure that we strive to achieve a balanced posture and train the horse in a way that allows him to develop the correct muscles to support the rider’s weight  (relating back to the string and bow theory mentioned above).  This applies to any horse, whether they are a hack or an elite equine athlete.

So, how can we achieve this perfect postural balance?

This brings us back to ‘core stability’, defined as ‘the ability to control position and motion of the trunk over the pelvis to allow optimum production, transfer and control of force and motion’.

Pilates exercises can help to strengthen those all important core muscles which we know will help us to achieve that perfect position to be able to influence our horse.  It is also often claimed that Core strengthening exercises will cure that back pain that many of us suffer from.

However, although these exercises can certainly help us to achieve greater postural control and may often help with back pain, it is important to address the underlying postural imbalances that may be contributing to poor posture and associated pain.  If there is stiffness through the lumbar spine, core strengthening alone will not necessarily help.  Normal movement patterns and flexibility should first be resolved, along with addressing muscle imbalances.  Current research indicates that core stability exercises have no greater long term significance in improving chronic low back pain than general exercise.  It is best, therefore, to include a range of exercise to include core strengthening, flexibility and general strengthening and cardiovascular exercise.

If you are struggling with back or hip pain, or straightness issues, a Chartered Physiotherapist who specialises in rider assessments will be able to help highlight imbalances and suggest suitable exercises to help address these.

Next time I will talk more about core stability in the horse, associated issues and how to address these.

KEEPING YOUR DOG INJURY FREE Rebecca Sedgwick ACPAT Chartered Physiotherapist & Veterinary Physiotherapist

We all love to see our dogs running and playing.  But do you ever consider what effects running, twisting and jumping have on your dog’s body?  There are multiple processes occurring whenever any of us move, including structures such as soft tissues (muscles, tendons, ligaments); skeletal joints and neurological processes.  Dogs, as with all mammals are designed to perform functional movements as above but there are a number of factors which may lead to increased risk of injury.  Overloading structures due to lack of maturity, repetitive, uncontrolled movement, obesity and poor conformational factors (often due to certain breed traits selectively bred by humans) can predispose your dog to injury and long-term conditions such as osteoarthritis. 

Musculoskeletal conditions/ injuries form a significant portion of complaints seen by veterinary surgeons.  These types of injuries are not only painful for your dog but expensive on your pocket.  Orthopaedic surgery for Cranial Cruciate ligament ruptures (commonly seen cost £3-4000 in veterinary fees plus rehabilitation costs and increased time spent to aid recovery.  However, there are a number of steps/ considerations you can take to reduce risk of injury to your dog.


Dogs reach skeletal maturity at approximately 12-24 months (breed dependant- small breeds will mature earlier while giant breeds will take longer).  Growth plates remain open until the dog has reached its mature height and overloading of the joint with inappropriate exercise and jumping can contribute to joint disorders such as hip dysplasia.

Some breeds are predisposed to certain conditions (e.g. Intervertebral disc disease in dachshunds) so consideration should be taken with activities undertaken by your dog.


Avoid slippery floors- we often see ‘cute’ pictures of puppies slipping around floors on social media but constant slipping on floors is highly likely to contribute to joint problems in any dog.  Puppies and immature dogs are extremely susceptible but care should be taken with any dog.  One of the common things I advise owners when I visit dogs in their homes is to use rugs and runners where possible.  If this is not possible there are products you can apply to your dog’s paws to help improve grip.

Stairs- if your dog does have to go upstairs never allow it to run up/ down in an uncontrolled manner.  Again, try to avoid repetitive use of stairs with juvenile dogs.

Jumping on/off furniture- Many of us allow our dogs to sleep on the furniture but uncontrolled play, hurtling on/ off furniture is likely to put your dog at greater risk of injury.

Jumping in/ out of cars- Take into consideration the age/ type of dog and what sort of car you have.  Research has shown repeated jumping in and out of four x four vehicles may predispose dogs to joint problems.  Young/ old dogs will be more susceptible to injury.  If necessary, lift your dog or use a ramp/ steps.


Obesity significantly increases development of degenerative joint disease.  Using Body Condition Scoring can help you to assess/ manage your dog’s weight.  Seek advice from a professional such as your vet or physio if you are unsure whether your dog is the correct weight.


Ensure your dog is fit enough to carry out the activities you want to do with it.  Dogs, like humans, are susceptible to injury if you overload anatomical structures by suddenly increasing activity levels, e.g. If you are a weekend warrior and go for several hour hikes/ sport after doing minimal exercise during the week. 

Consider the use of collar/ harness used for your dog.  If your dog pulls it may be more susceptible to neck injuries if you use a lead attached to a collar.  If you use a harness make sure it is properly fitted and does not impact on the movement of the dog’s forelimbs.  Current research indicates that certain types of harness can impede shoulder movement and affect the dog’s gait.  Obviously breed/ type will influence what type of harness is most appropriate for your dog.

Warm up- Warming up by using low intensity exercise will prepare the dog’s musculoskeletal system for higher intensity activity by warming up soft tissues and preparing muscle activity/ responses.  If your dog is of an energetic disposition avoid letting it jump straight out of your car and charge around or start throwing balls.  Always do some controlled exercise before allowing more dynamic bursts of activity.  Abrupt cooling of tissue can also increase risk of injury so a warming down period of 10- 15 minutes controlled walking is also advisable.

Avoid over use of repetitive/ uncontrolled activities such as ball throwing/ use of ball lobbers.  This is estimated to cause some of the highest incidence rates of Cranial Cruciate injuries.   For those with ball obsessed dogs try throwing the ball into the undergrowth and encourage your dog to hunt for it.

If your dog takes part in athletic activities such as agility or flyball it is also advisable to do some preparatory training to aid strengthening/ balance/ control, e.g. use of pole work/ grids; balance cushions/ paw pods.  Seek professional advice if you have never used this type of equipment or need some specific advice for your dog.

It is good practice to work your dog evenly from both sides when training- like us dogs have a more dominant side which they will find easier to work from.  Training/ doing exercises on both sides will help to ensure they have a more symmetrical development of the musculoskeletal system.


There are several things you can do to check for any early signs of injury/ development of musculoskeletal disease:

Change in behaviour may indicate onset of pain- e.g. increased reluctance to exercise; reluctance to lie on one side; snapping/ growling.  Always check with your vet if your dog starts to show any change in behaviour.

Change in performance- for agility dogs this may present as knocking poles; reluctance to turn in one direction; missing stride at jumps; reduction in speed.

The following simple checks can be carried out to monitor any changes in your dog before the above becomes apparent:

Observe your dog in standing- do they look comfortable, do they appear to be favouring one side, do they look level through the shoulders/ spine/ pelvis if you observe them from in front/ behind with even musculature.  Try lifting one foot at a time- do they appear to put weight evenly through their limbs (usual weight distribution ration is 40:60 forelimbs: hindlimbs)

Observe your dog moving- do they appear to take even steps; do they appear to swing one leg to the side or move it further across the midline towards their opposite leg.  Check your dog backing up- are they happy to back up (dependant if they are familiar with exercise), again watch for limb placement.  Do they sit happily with even weight on their limbs (dogs will sometimes habitually sit with hindlimbs to one side but it can be a sign of chronic discomfort- can it be easily corrected?).  Do they push evenly during transitions from sit to stand or lie to sit?  Do they move off happily or do they appear stiff for a few steps?

Assess flexibility – use treats to assess spinal movement/ flexibility (ask your physio if you are not sure how to do this).  Ask your dog to move in tight circles clockwise and anticlockwise- are they happy to move in both directions (some dogs will find it harder to move to their non- dominant side but if carried out regularly they should be able to do this happily).  Again, check for limb movement- do they swing out a hindlimb on one side or shorten their steps more one way than another?

For the canine athlete, recording your dog regularly on video and playing back in slow motion can help to identify subtle changes in gait and movement as an early indicator of injury.

When grooming your dog regularly palpate to check for any tender spots or signs of discomfort.

By regularly carrying out these checks you will learn what is normal for your dog and pick up on any irregularities.

Whether you have just acquired your first puppy or regularly take part in sporting/ working activities with your dog, taking some time and consideration can save in terms of cost both for your pocket and short/long term comfort of your four-legged canine partners.