Kissing spine syndrome — overriding dorsal spinous processes — is a significant cause of back pain in horses. Modern rehabilitation approaches offer good welfare outcomes for many affected horses.
Kissing spine welfare impact is highly variable: some horses with radiographic kissing spine are entirely comfortable, while others experience significant chronic back pain. The challenge is that back pain in horses is often expressed through behavioral changes that are misread as disobedience — bucking, napping, or reluctance to work. Riders and trainers who respond with escalating pressure when the horse is actually in pain create both a welfare problem and a safety issue. Accurate diagnosis and targeted rehabilitation, including physiotherapy exercises, saddle fit assessment, and appropriate veterinary management, can restore comfort and function in many affected horses.