Kissing Spines and Core Strength

Equine Conditions – Kissing Spines

Dorsal spinous process (DSP) impingement also known as Kissing Spines is the most common cause of back pain in horses (Coomer, 2013; Jeffcott, 1980).

Looking at the anatomy of the horse’s spine helps understanding of this condition (see Fig 1).  The horse’s spine is divided into 5 regions:

  • Cervical
  • Thoracic
  • Lumbar
  • Sacral
  • Caudal

Each of these sections has a number of vertebrae that are different shapes depending on their location and role.  There are:

  • 7 cervical vertebrae
  • 18 thoracic vertebrae
  • 6 lumbar vertebrae
  • 5 sacral vertebrae
  • 15-25 caudal (coccygeal) vertebrae

Picture1

                                               Figure 1

The thoracic, lumbar and sacral vertebrae have dorsal spinous processes for muscle attachment, the thoracic vertebrae have the tallest spines (DSPs) which should have equal spacing between them.  In horses with kissing spines there is a narrowing of this space in mild cases progressing to the spines touching or even overlapping or fusing causing pain in severe cases (Fig 2)

Picture2

Figure 2

The area most commonly affected in the thoracic region, under the saddle (T11-18) but it does occur in other areas of the spine.

It has been found that 39% of horses have kissing spines (Turner, 2011) but many of these do not display signs and are clinically normal (Erichsen et al., 2003).  Symptoms of kissing spines range in severity from loss of performance to extreme behavioural issues (Zimmerman et al., 2012).

Diagnosis is normally a combination of symptoms displayed, reduced spinal movement, X-Ray and/or scintigraphy.

There are several treatment options available, the least invasive and usually attempted first is rest and physiotherapy depending on the extent of the symptoms.  The next (more common) step is steroid injections into the interspinous spaces affected to control pain and inflammation usually alongside physiotherapy to assist pain management and reduce muscle spasm (Walmsley et al., 2002).  If these methods are not successful or do not last long term the next step is surgery.

There are 2 main surgical procedures commonly available, DSP resection and interspinous ligament desmotomy (ISLD).  DSP resection involves the removal of the summits of the affected (touching or close) DSPs.  This surgery is invasive with a prolonged rehabilitation time of around 6 months (Coomer, 2013).  ISLD is less invasive with similar success rates and reduced rehabilitation time (6 weeks) (Coomer et al., 2012, Coomer, 2013).

DSP resection aims to recreate space in the spine to remove pain and ISLD aims to relieve tension on the nerve endings found at the ligament insertion to remove the sensation of pain.  This combined with controlled exercise and physiotherapy to release muscle spasm resolves KS permanently (Coomer et al., 2012).

Lameness is also often associated with KS (Zimmerman et al, 2011) due to the lack of muscle surrounding the spine caused by back pain.  This muscle loss reduces core stability which effects spinal movement and causes gait adaptations in an attempt to relieve the pain (Bromiley, 2009).  These compensations can lead to both forelimb and hindlimb lameness issues including foot related lameness, tendon/ligament and sacroiliac issues (Coomer, 2012). Zimmerman et al., (2012) found that some horses have developed a coping strategy in association with either forelimb or hindlimb lameness (often mild and bilateral) becoming progressively stiffer and more restricted in their movement.

Research suggests that allowing horses with overriding or impinging DSPs time out of work is detrimental due to links between the lack of spinal musculature and KS.

There is research to support the use of core strengthening exercises in horses to help maintain strength and mobility which is not only beneficial for horses with KS but also as a preventative measure and for general wellbeing, strength and suppleness.  Stubbs et al., (2011) found that regular use of baited stretches increases the size of the multifidus muscle which is a spinal stabilizer.  If you have any concerns about your horse, you should consult your Veterinary Surgeon.

Core Strength

The equine athlete needs to learn to use his muscles for mobility but also for stability.  The muscles that support the spine and abdomen need to be recruited to enable the core to support itself which allows the limbs to function correctly without the extra burden of an ill supported core.

There are numerous simple exercises that can be done daily (5 times a week) to assist in building core strength.

Baited stretches are good for horses that are not too food obsessed and likely bite!  Make sure that your horse is stood on a non-slip surface. Stretches should be held for around 5 seconds and repeated 3-5 times (* – both ways)

  1. chin to chest
  2. chin to knees
  3. chin to fetlocks
  4. chin to shoulder (*)
  5. chin to outside of knee (*)
  6. chin to outside of fetlock (*)

Tail pulls are another simple exercise to improve core strength targeting abdominals and pelvis stabilisers.  Ensure that the horse is stood on a non-slip surface, grasp the tail gently but firmly towards the base of the dock and gently pull in the desired direction, be careful not to pull the horse off balance you are aiming to see the abdominal muscles contract without moving the horse.  When releasing the strain do not let go of the tail, gently release the pressure to allow the horse to return to it’s natural balance. Hold for 5 seconds, repeat 3-5 times.

  1. Tail pull to the left
  2. Tail pull to right

Another simple exercise than can be added into your existing routine is transitions, as many as you can do – on your way to/from the field, out hacking and of course when schooling.  Adding these simple exercises to your routine can help make your horse stronger, more supple and agile and reduce wear and tear on the limbs!

References

Bromiley, M. Rehabilitation. In: Equine Back Pathology: Diagnosis and Treatment. 1st Edition. Oxford, UK. Blackwell Publishing Ltd 249-261

Coomer, R.P.C. McKane, S.A. Smith, Vanderweerd, J.E. 2012. A Controlled Study Evaluating a Novel Surgical Treatment for Kissing Spines in Standing Sedated Horses. Veterinary Surgery. 41 890-897

Coomer, R. 2013. New Surgery for Kissing Spines. Veterinary Times. 43 (21) 20-21

Erichson, C. Eskell, P. Wistrom, C. Roethlisberger Holm, K. Johnson, C. 2003. Scintigraphic Evaluation of the Thoracic Spine in the Asymptomatic Riding Horse. Veterinary Radiology and Ultrasound. 44 330-338

Jeffcott, L.B. 1980. Disorders of Thoracolumbar Spine of the Horse: A Survey of 433 Cases. Equine Veterinary Journal. 12 197-210

Turner, T.A. 2011. Overriding Spinous Processes (Kissing Spines) in Horses: Diagnosis, Treatment and Outcome in 212 Cases. AAEP Proceedings 57 424-430

Stubbs, N.C. Hauptman, J. Clayton, H.M. 2011. Dynamic Mobilisation Exercises Increase Cross Sectional Area of Musculus Multifidus. Equine Veterinary Journal. 40 (1) 14-20

Walmsley, J.P. Petterson, H. Winberg, F. McEvoy, F. 2002. Impingement of the Dorsal Spinous Processes in 215 Horses: Case Selection, Surgical Technique and Results. Equine Veterinary Journal. 34 23-28

Zimmerman, M. Dyson, S. Murray, R. 2012. Close, Impinging and Overriding Spinous Processes in the Thoracolumbar Spine: The Relationship between Radiological and Scintigraphic Findings and Clinical Signs. Equine Veterinary Journal. 44 178-184

 

 

 

 

 

 

 

 

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Veterinary Physiotherapy – What’s it about and who should you use?

What is Veterinary Physiotherapy?

Veterinary Physiotherapy identifies movement dysfunction, musculoskeletal and/or neurological conditions in animals.  Physiotherapy involves static, dynamic and thorough “hands on” assessment combined with anatomy and physiology knowledge to enable identification and treatment of any problems or potential problems using a variety of techniques.

Why Physiotherapy?

Animals, like people respond to physiotherapy.  The purpose of physiotherapy is to restore and maintain mobility, function, suppleness wellbeing and performance.  Regular check-ups enable the detection of any weaknesses or potential problems before they manifest to achieve the best possible outcome and maintain peak performance long term.

Which Therapist Should I Use?

There are numerous different types of practitioner or “back person” available to treat your animal and choosing who to use can be difficult.  Word of mouth is always helpful when making a decision but you should still check the qualifications of your chosen practitioner whichever background they have come from.

Veterinary Physiotherapists specialise in assessing movement and muscle function.  They assess the animal statically, observing conformation and muscle development and then dynamically to identify any abnormalities.   Following this the animal is then palpated to consolidate the observations and localise any areas of pain or tension.  If there are any concerns the animal may need to be referred back to the vet but if not then a treatment program will be devised and discussed with you to help address these issues using physiotherapy techniques and remedial exercise.  The animal is looked at as a whole and all involved professionals are consulted and kept informed to enable the best possible outcome.

Currently the title Veterinary Physiotherapist is not protected, this means that anyone can call themselves a Vet Physio and treat animals with little or no training.

When choosing a therapist, you should check what qualifications they carry, ideally you are looking for a Postgraduate qualification such as a Postgraduate Diploma (PgD) or Masters (MSc) Veterinary Physiotherapy.  Practitioners who have taken this route will have been through extensive training to gain this qualification including academic and practical skills.

Chartered Veterinary Physiotherapists studied human physiotherapy and gained an undergraduate degree before completing a PgD or MSc Veterinary Physiotherapy.  Only human trained Physiotherapists can use the protected term “Chartered” and will be ACPAT members.  ACPAT Physiotherapists are highly skilled professionals who have undergone human training initially however, there are now other, equally skilled Veterinary Physiotherapists who have undertaken extensive training at Postgraduate level to become a Veterinary Physiotherapist.

Veterinary Physiotherapists who carry a postgraduate qualification have purely studied animal physiotherapy and usually have prior industry experience and an animal science or veterinary/vet nursing degree before commencing the Postgraduate course.  During their training they will have covered anatomy, physiology and disease modules,  as well as physiotherapy and rehabilitation modules.  Alongside the extensive academic side there is also a large practical element which involves hands on teaching and placements with practicing Veterinary Physiotherapists.

Alongside checking the qualifications of your chosen therapist you can also see if they belong to a governing body which indicates that the practitioner is not only qualified but also insured to give extra security.  Recommended sites include:

  • National Association of Veterinary Physiotherapists (NAVP)
  • Association of Chartered Physiotherapists (ACPAT)
  • Institute of Registered Veterinary and Animal Physiotherapists (IRVAP)