🐎 Rehabilitation Success After Kissing Spine Surgery: A Case Study in Equine Recovery

Kissing Spine, or Overriding Dorsal Spinous Processes (ORDSP), is one of the most common causes of back pain in horses. It occurs when the spaces between the vertebrae's dorsal spinous processes narrow, causing painful impingement or contact. While often managed conservatively, some cases — especially in performance horses — require surgical intervention.

In this blog post, we explore the post-surgical rehabilitation journey of a 7-year-old Thoroughbred ex-racehorse (referred to as "CS") who underwent dorsal spinous process resection of T14, T16, and T18. With a comprehensive and progressive rehab plan, this horse has a good prognosis to return to previous levels of work.

🔍 Case Overview

After undergoing surgical resection to treat ORDSP, the primary goal for CS was to reduce scar tissue, oedema (swelling) and restore normal movement. Four months post-surgery, much of the bony healing was complete, but soft tissue recovery, postural correction, and muscular symmetry remained priorities.

Additionally, the CS showed pain near the sacroiliac joint, likely due to compensatory postures adopted while suffering from ORDSP — an all-too-common sequela in these cases.

🐴 Phase One: Foundation Through Controlled Movement

In-Hand and Long Reining Work

Beginning in week one, in-hand walking (IHW) and long reining (LR) were implemented to:

• Improve muscular symmetry

• Stimulate lymphatic drainage to reduce oedema in the gluteal muscles

• Encourage hindlimb engagement without the weight of a rider

Incorporating hills, transitions, and hacking at later stages builds core strength and encourages engagement of the dorsoventral chain, key to restoring the horse’s topline.

Static and Dynamic Weight Shifting

Exercises such as lateral tail pulls and backing up were used to:

• Rebalance the horse’s posture

• Address sacroiliac instability

• Promote even weight distribution and muscular recruitment

These gradually progressed to dynamic movements like shallow loops and serpentines to support core and postural muscle development.

🌀 Spinal and Core Engagement: Building from the Inside Out

Dynamic Mobilisation Exercises (DMEs) or Carrot Stretches

In week one, lateral and ventral mobilisations were introduced to improve spinal mobility and strengthen the horse’s deep core muscles, including:

• M. multifidus

• Latissimus dorsi (LD)

• Rectus abdominis (RA)

Pelvic tucks and belly lifts a progression of DMEs were added by week three once sacroiliac discomfort eased, helping to activate abdominal and sub-lumbar muscles for better posture and back support.

Polework Progression

Introduced in week three, polework — including ground poles, raised poles, and fan formations — supported:

• Hindlimb protraction and retraction and joint flexion

• Activation of postural and epaxial musculature

• Coordination and rhythm in gaits

Trotting poles further stimulated muscle activation without vertical trunk movement, which is crucial for horses recovering from back surgery.

👐 Manual and Electrotherapies: Relieving Pain and Supporting Healing - Getting a Veterinary Physiotherapist on Board

Massage Therapy

Techniques such as effleurage, petrissage, and trigger point release were used to:

• Reduce muscle spasms and pain

• Improve tissue extensibility

• Aid lymphatic drainage

• Enhance overall locomotion

Massage also provided psychological benefits — helping CS remain relaxed and cooperative during rehab.

Stretching

Targeted stretching helped reduce tightness, especially in the right gluteals, and improved hindlimb protraction and range of motion (ROM). Evidence supports a minimum of five sessions per week to yield meaningful improvements in flexibility.

Complementary Tools for Pain Management

Photobiomodulation (PBM) - Laser Therapy

Used to target spasms in the Latissimus Dorsi and Gluteals, PBM therapy:

• Increased blood flow and tissue temperature

• Reduced back pain and fasciculations

• Alleviated soft tissue tightness near surgical sites

Pulsed Electromagnetic Field Therapy (PEMFT)

PEMFT was introduced early to manage sacroiliac pain. It is linked to:

• Increased nociceptive thresholds (i.e. less pain)

• Reduced reliance on medications

• Improved mobility and comfort

Training Aids

Pessoa Training Aid (PTA)

Once pain subsided, the Pessoa system was introduced in week three to:

• Improve topline and postural alignment

• Enhance hindlimb engagement

• Encourage a rounded outline without compromising the healing surgical site

Caution was taken to avoid excessive pressure near T14–T18 — key locations of the DSP resections.

🧾 Supporting Recovery Through Thoughtful Husbandry

Successful rehabilitation goes beyond exercise and therapy. Additional things to think about post surgery:

• Walker reduction (if applicable): To minimise uneven forces and repetitive lateral bending

• Remedial farriery: Address any poor hoof conformation

• Nutritional support: Adjusted to meet increasing energy demands

• Saddle fit assessment: Dependant on the surgical intervention, where saddles commonly exert pressure

🗣 Interested in Tailored Equine Rehab?

If your horse has undergone surgery for kissing spine or is struggling with back pain, a structured and individualised rehab plan can make all the difference. Get into contact with us to get your horse moving and feeling better.