Overriding dorsal spinous processes (kissing spines) cause back pain in horses, with treatment success and return to work outcomes improving substantially when combined with appropriate physiotherapy rehabilitation.
Kissing spines cause significant pain during ridden work that is often expressed as behavior problems rather than obvious lameness. Horses managed without diagnosis experience sustained pain during every training session. Surgical treatment addresses the mechanical cause but must be accompanied by rehabilitation to build the muscular support that protects the treated area. Welfare outcomes from kissing spines treatment are substantially better when comprehensive rehabilitation follows surgery rather than early return to ridden work. Monitoring welfare throughout treatment and rehabilitation through behavioral indicators provides important feedback on pain management adequacy.