Kissing spines

Veterinary advice should be sought before applying any treatment or vaccine.

Kissing Spines

Dorsal Spinous Process Impingement

Dorsal spinous process impingement, also known as "Kissing spines", is a condition of the horse's back which can cause significant pain. The dorsal spinous processes (the sections of bone which project upwards from the horse's vertebral column) are interconnected by ligaments (called interspinous ligaments). In the back of a normal horse, these processes are evenly spaced apart from one another. However, if the space between the spinous processes is reduced and they get too close together, they this will cause them to impinge on one another.

The condition may be dynamic, where impingement only occurs when the horse is moving, or static, where impingement occurs even while their at rest and may even become fused. It is this impingement which is what causes the horse pain, which can range from mild to severe. Kissing spines most frequently affects the horse's thoracic vertebrae, which consists of the area from the withers to just behind where the saddle would sit.

Clinical signs

Kissing spines usually has a mild to severe impact on the horse's performance and behavior. Behavioral changes are associated with handling on the ground, while ridden, and/or discipline-specific.

How Kissing Spines is Diagnosed

Your veterinarian will likely want to watch your horse while schooled at different gaits. Thermographic imaging may also be a useful aid in diagnosis. Kissing spines is confirmed through radiographs (x-rays) taken of the horse's back from the withers through the lumbar vertebrae. Radiographic changes such as sclerosis, narrowing of interspinous spaces, periosteal reactions, and occasionally cyst-like lesions/radiolucent areas, mainly in the area from T13-18 are observed.

Treatment and Management of Kissing Spines

Your veterinarian's recommended treatment for kissing spines will differ depending on the severity of the condition, amount of pain your horse is in, and the intended use and expectations of the horse. Horses which don't seem to be in much pain and aren't expected to perform athletically may get by with long-term treatment with oral anti-inflammatories (aka bute). Therapies often used to help with the pain include local corticosteroid injections, Tildren, and mesotherapy.

There are several beneficial adjunctive therapies which can help with the pain and muscle spasms, which include acupuncture, chiropractic adjustments, equine message, and shockwave therapy.

For more severe cases where horses show no improvement with medical management, and depending on the expectations for performance level of the horse, your veterinarian may recommend surgery. There are several different surgical procedures available which have shown varying success.

One of the most important aspects of long term management of kissing spines is physical therapy. Physical therapy is aimed at strengthening specific muscles in the back and pelvic areas----M. multifidus (adjacent to the spine), M. psoas (under the spine to the hips), and the abdominal oblique muscles which run along the abdominal wall. Exercises often may involve lots of lunge work, frequently with side reins, using a Pessoa system and belly lifts.


Hollow back
Back sore to touch
Hard to get on the bit
Behind the leg
Slow to warm up
Stiffness in one direction
Trouble with gait transitions
Change in head carriage
Brushing hypersensitivity
Refuses or chips jumping fences
Intermittent hind toe dragging
Trouble in canter
Head tossing
Running past barrels
Kicking out
Excessive shying
Rushing fences


  • History
  • Clinical signs
  • Physical exam
  • Schooling evaluation
  • Nerve block
  • Radiography
  • Thermography



Physical therapyOne of the more important aspects of long term management of horses with kissing spines.
MesotherapyA technique which involves the use of multiple, shallow injections of certain medications along the back by injecting the mesoderm (the middle layer of skin) with very fine needles. This process is intended to help stimulate the sensory nerve fibers which, once stimulated, help block or inhibit signals that come from them which detect pain.
InjectionsTreating affected areas with injections of a combination of sarapin and corticosteroids has been beneficial in some cases.
Shockwave therapy
Laser therapy
Chiropractic adjustments
Equine message
Saddle refitting
SurgeryInterspinous ligament desmotomy (ISLD), a procedure where the ligaments between the spinal processes are cut using a Mayo scissors. It can be done while the horse is under standing sedation.


  • Hire a saddle fitter to ensure your saddle properly fits your horse
  • Don't let inexperienced riders ride your horse

Scientific Research

General Overviews

Risk Factors

  • Horses with short backs
  • Ponies are more at risk then horses
  • Inexperienced or poor quality riders
  • Poorly-fitted saddle
  • Lesson horses

Horse Case Stories

Commonly Affected Breeds

Thoroughbred icon