Kissing Spine Rehabilitation
What is Kissing Spine?
Kissing Spine is also known as Overriding Dorsal Spinous Processes and is one the most common causes of back pain. It ultimately is where the spinal vertebrae 'kiss' each other and causes pain and usually muscle atrophy. Sometimes, however, the vertebrae do not actually need to be touching to be causing pain, but in the case referred to here, there were bone spurs which when ridden were causing the pain.
The treatment for Kissing Spine varies from conservative treatment where no operations are done, through to the affected spinous processes being shaved. The other operation which is featured here, is the Interspinous Processes Ligament Desmotomy ~ ISLD (usually known as the Ligament snip).
You may have read Troy's Case Study here so would be familiar with his story already. After various investigations in the summer of 2020, it was decided between the owner, Vet and myself that some X-Rays were needed to establish exactly what was going on with Troy as his treatments weren't lasting as long as I would like. After a full lameness workup from the Vet, X-Rays were taken of his back and it was clear that he has bone spurs growing on various vertebrae which when he was static didn't seem to cause too many issues. However, with the behavioural changes he was showing, for instance not wanting to go forward, avoiding the contact and rearing (among others), the vertebrae were most probaly impinging on the ligaments causing him pain. Troy was also showing back pain wih muscle stiffness, extreme palpation reactions around the lumbar and sacrum regions and stiffness when working.
Troy's ISLD operation was booked for mid September and it would be carried out at the Vet's rehabilitation centre. The operation was performed while he was standing up but Troy was sedated and then local anaesthetic was put into the regions where the ligaments would be snipped.
Troy had 9 ligaments snipped in total and the rehabilitation back from this size of operation would be difficult and long but with a good Physiotherapy, Rehabilitation Plan and patience, I was sure we would get him back to full health and fitness. He stayed at the rehabilitation centre for the first 14 days to minimise the infection of the incision sites and I am pleased to say that no infections were seen. He went home after the stitches were removed and the full plans were put into place.
Physiotherapy & Rehabilitation
It's important that good communication with the Vet is maintained from start to finish so that any issues and problems encountered can be sorted straight away. It's also a good idea to put a plan down on paper so that the owner is aware and confident that their horse is in good hands, knowing what to expect along the journey. Obviously, we are dealing with animals so anything can happen throughout the plan so to be adaptive to these changes is equally as important. With Troy's plan, I sent a copy to the Vet and also a copy to his owner and the vet was able to give me their feedback and make any changes before we started.
Included in the initial Physiotherapy plan was Red Light Therapy and this proved to be the most beneficial in the healing of the incision sites and has meant that Troy's back has healed excellently and unless you knew, you would not know the incisions were there. Maintaining flexibility through the incision areas is key as this is the last place you would want to have decreased flexibility and movement, restricted by scarring.
Throughout the first few weeks following the operation, we used a combination of Pulsed Electromagnetic Field Therapy, Therapeutic Ultrasound, simple massage techniques and TENS therapy. Having a mixture of these modalities and techniques meant that we could target different areas like pain, swelling, inflammation and encourage his body to enchance the healing process. Troy was due to be on box rest for appproximately 6 weeks and so we needed to combat stiffness and prevent his legs from filling. He was handwalked every day and from week 3 he started his lunging work, firstly in walk and increasing to trot in week 5. If he could be trusted too, he would get small amounts of restricted paddock turnout... that didn't always go to plan but we did the best we could for him. The main priority of getting him safely through box rest and turnout/exercise was to keep it varied so we included long reining and in hand hacking.
Fast forward to 6 weeks post op, and Troy was given a sign off from the Vet and that ridden work could be commenced. We all agreed that ridden work should not be rushed even though the vet was happy for it to start as it was important now that we continued to make him strong through his back and core to support the saddle and rider's weight. It had been some 4 months since his owner had ridden him and we didn't see the point in rushing now.
Core and Back Strengthening
The initial stages of Physiotherapy and Rehabilitation focused around keeping him pain free and supple. Once exercise and restricted turnout could commence, we needed to concentrate on building his strength through his core and back... this would be the key to ensuring that he was able to return to full fitness and live a fulfilled life with his owner. I implemented a stretching and mobilisation programme showing his owner what she needed to do in between my visits and the frequency of them. Work in the school could now include poles and continued trotting. Luckily their yard has access to some great hacking routes and so walking out up and down hills would be really beneficial. We also started to introduce a core strengthening band which is worn round the back of the legs and encourages the horse to use it's core and thoracic sling muscles. I cannot stress enough just how important those core muscles will become now and its not just the tummy muscles which are included in the 'core' group of muscles.
I started to think outside the box and introduced Troy and his owner to the Balance Pads (see picture). These would allow Troy to find his own centre of balance using all his core muscles and start to activate a deep back muscle called the Multifidus. This muscle is the main stabiliser of the body and is needed more than ever now for Troy.
It will be an ongoing programme of support and strengthening for Troy to keep him strong but I am always on hand for him and his owner.
It was very encouraging to know that the Vet was very impressed with how well his incision sites had healed and she even said that she hadn't seen such excellent healing at the 6 week check... that was the best news. She also said that he was looking in great shape, not too fat and with a bit of continued work, his muscle tone would return.
UPDATE... March 2021
Troy is now following a fittening and conditioning programme which continues to build strength in his core and back. He follows a strict programme of exercises and stretching together with regular monthly physiotherapy to ensure that he is heading in the right direction and any niggles can be sorted before they become problems. Troy has even started jumping again which is excellent news and so great to see.
If you get a diagnossis of Kissing Spine from your vet, don't despair. There is help out there and you are not alone. There is also continued research into the effectiveness of rehabilitation of Kissing Spine and my biggest advice is not to rush it... especially the desire to get back in the saddle. Always remember to get the saddle rechecked before getting back on, as your horse would definitely have changed shape and you want your horse to feel comfortable when being ridden. I was fortunate enough to receive a recommendation and testimonial from Troy's acting vet which can be found here on the main page.
If I can help at all, then please drop me a message