Horse Kissing Spine Syndrome: Welfare and Rehabilitation

Kissing spine syndrome (overriding dorsal spinous processes) is an increasingly recognised cause of back pain and performance problems in horses. Understanding this condition is essential for welfare-focused equine care.

Key Facts

Kissing spine syndrome (KSS) refers to the overriding or impingement of adjacent dorsal spinous processes (the bony projections on top of vertebrae) in the thoracic and lumbar spine
Radiographic evidence of spinous process narrowing or impingement is found in up to 40% of riding horses, though not all have clinical signs — distinguishing incidental findings from clinically significant KSS is important
Clinical signs include reluctance to be girthed, bucking, rearing, resistance to being ridden, cold-back behaviour, muscle tension, and reduced performance — often misinterpreted as behavioural problems
Diagnosis requires correlation between radiographic findings, clinical signs, physical examination, and response to diagnostic nerve blocks
Treatment options range from conservative management (physiotherapy, targeted rehabilitation exercises, appropriate saddle fit, weight management) through mesotherapy and corticosteroid injections to surgical intervention (interspinous ligament desmotomy or bone-resection procedures)
Surgical outcomes are generally positive when appropriate candidates are selected — studies report significant improvement in rideability and resolution of pain signs in 70–80% of surgical cases
Saddle fit is critically important — a poorly fitting saddle can cause or exacerbate KSS by concentrating pressure on the dorsal spinous processes
Back pain in horses is frequently under-recognised and undertreated; horses cannot verbalise pain and often show subtle or confusing signs before overt lameness or resistance appears

Welfare Considerations

Kissing spine syndrome causes chronic back pain that profoundly affects the horse's quality of life and willingness to work. Horses ridden through undiagnosed back pain experience ongoing suffering — and the traditional equestrian response of increased training pressure or punishment for resistance behaviour compounds the welfare harm significantly. Under-diagnosis is a major welfare problem: because horses adapt to chronic pain and show behaviour rather than obvious lameness, their suffering is often misattributed to temperament or training deficiencies for months or years. Pain-associated behaviour changes — spooking, bucking, tension — are warning signals that deserve investigation rather than suppression. Welfare-centred management prioritises pain diagnosis and treatment before attempting training solutions, and recognises rest and rehabilitation as essential components of recovery.

What You Can Do

If your horse shows back sensitivity, girthing resentment, or unexplained rideability problems, request a musculoskeletal assessment from your vet
Ensure your saddle is fitted by a qualified saddle fitter every 6–12 months — fit changes as horses' toplines develop
Do not dismiss behaviour changes in ridden horses as purely training issues — back pain should be ruled out first
If KSS is diagnosed, work with your vet and a qualified physiotherapist or rehabilitation specialist on an appropriate management programme
Consider whole-back assessment including saddle fit, dental care, and hoof balance as interconnected components of equine back welfare