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A few decades ago, ‘kissing spines’ was barely a term in the equine world. Horses with back pain were labelled difficult, disobedient, or simply unsound. Today, overriding dorsal spinous processes (ORDSP) is recognised as the most common cause of primary back pain in horses, with surgical interventions costing upwards of £1,700 per procedure — and the diagnosis appearing with increasing frequency across all disciplines and breeds. The question this thesis poses is not how best to treat the condition, but whether it can be prevented.


The author, writing from within the equine community and drawing on both clinical literature and osteopathic philosophy, maps the biomechanics of the condition with precision. Kissing spine occurs when the dorsal spinous processes of the thoracic vertebrae — most commonly between T13 and T18, the site where the rider sits — come too close together, touching or overlapping where there should be a clear interspinous gap. The causes are genuinely multiple: early training before musculoskeletal maturity, poor rider technique that fails to develop core stabilisation in the horse, ill-fitting tack, compensatory guarding from hind limb lameness, and breeding practices that prioritise aesthetics over conformation. Archaeological evidence shows the condition predates modern equitation, which complicates any single-cause narrative and demands a systemic response.

That systemic response, the author argues, is osteopathic manual therapy delivered consistently throughout the horse’s working life. By maintaining full articulation of the musculoskeletal system, supporting optimal fluid circulation, and identifying somatic dysfunction at its earliest and most reversible stage, the osteopath acts as the body’s early warning system. The TART framework — tissue texture, asymmetry, restriction, tenderness — provides a clinical language for catching minor dysfunctions before they cascade into the structural changes that drive spinous process contact.

There are limitations honestly acknowledged: genetics, birth defects, and certain rider disciplines present challenges that no amount of manual therapy can fully offset. But the core argument holds — a horse maintained in functional health is a horse far less likely to need a surgeon.

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The hands of the osteopath remain the primary diagnostic instrument — palpation, motion testing, and clinical observation form the bedrock of assessment. But in a high-performance equine context, where the margin between subclinical dysfunction and career-ending injury can be measured in days, the question of whether objective imaging tools can add value is worth asking seriously. Isabelle De Smet’s thesis does exactly that, examining medical infrared thermography — MIT — with both enthusiasm and rigour.


Thermography works by recording infrared radiation emitted from the skin surface, which reflects local circulation and tissue metabolism. Because the autonomic nervous system directly controls microcirculation, thermal patterns become a window into vasomotor activity — revealing areas of inflammation, altered blood flow, or sympathetic-mediated vasoconstriction that would be invisible to even the most experienced hand. In clinical terms, MIT is at least ten times more sensitive than manual palpation at detecting skin temperature differences, and a differential of just 1°C is considered clinically significant.

The early detection potential is one of the thesis’s most compelling threads. In racehorses, thermographic changes associated with dorsal metacarpal soreness have been shown to precede radiographic findings by two weeks — a window in which training load adjustments can prevent the injury from becoming structural. Similarly, MIT can identify altered blood flow in the contralateral foot before laminitis becomes irreversible, and it has been used to detect subclinical inflammation associated with lameness well before it manifests as a gait abnormality.

De Smet also addresses treatment monitoring — an area with obvious relevance for osteopaths seeking to objectify their outcomes. A long-term study of 51 horses treated osteopathically for somatic dysfunction found that thermographic abnormalities improved or resolved in all horses that returned to work, with over 90% resuming normal activity. A separate case study documented a 79% reduction in overall thermal asymmetry following joint manipulation, with statistically significant temperature increases in previously hypothermic areas — direct evidence of autonomic nervous system response to manual intervention.

The limitations are handled honestly: artefacts from ambient temperature, hair coat variation, and scar tissue can compromise readings; there is no gold-standard protocol for equine back thermal imaging; and the technique demands experience to interpret correctly. De Smet concludes that MIT is not a replacement for palpatory examination, but a valuable complement to it — one whose potential, particularly for objectifying osteopathic treatment outcomes, has not yet been fully realised.

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A horse grazes for up to sixteen hours a day under natural conditions. That means the temporomandibular joint — the TMJ — is one of the most continuously loaded structures in the equine body, yet it remains one of the least studied. While human TMJ dysfunction has attracted decades of clinical research, the equine equivalent sits in a diagnostic grey zone, where vague and overlapping symptoms make it difficult to distinguish a functional problem from outright pathology.

This thesis by Hanna Musakka sets out to map what is known about the equine TMJ, examine the range of dysfunctions that may arise, and assess whether osteopathic manipulative treatment — so well-established in human TMJ care — can be rationally applied to horses. The investigation draws on equine anatomy, veterinary literature, and a substantial body of human osteopathic research, building a case for cross-species application where direct equine studies remain scarce.

The anatomy alone is revealing. Equine TMJ fibrocartilage shows a unique zoning pattern suggesting higher regenerative capacity than its human counterpart — which may explain why clinical TMJ pathologies appear relatively rare in horses, or simply why they go undetected. The joint’s proximity to the hyoid apparatus, the guttural pouch, and multiple cranial nerves means that dysfunction here can cascade into problems that look nothing like a jaw complaint: headshaking, bit resistance, altered head carriage, even recurrent colic.

Musakka surveys the osteopathic literature on human TMJ treatment — myofascial release, muscle inhibition, balanced ligamentous tension, joint mobilisation — and makes a carefully reasoned argument for adapting these approaches to the horse. The cervicomandibular relationship proves particularly important: manipulation of the upper cervical spine in humans consistently improves mouth-opening range, pointing to a biomechanical link that almost certainly holds across species.

The thesis is candid about the limits of current knowledge. Without equine-specific clinical trials, the transfer of human treatment protocols requires both theoretical grounding and hands-on caution. Musakka, a licensed equine massage therapist turned osteopath, brings both — and shares her own clinical observations from treating horses presenting with hypertonic masticatory muscles and hyoid tension. The results, she notes, have been encouraging.

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Sacroiliac joint dysfunction sits at the intersection of frustration and complexity in equine practice. Horses are stoic creatures — pain is masked, subtle gait changes are dismissed as training problems, and by the time a diagnosis is confirmed, the damage is often well established. This thesis by Emma Ramanathan asks a question that reframes the conversation entirely: what if we stopped waiting for dysfunction to appear and started preventing it from developing in the first place?

Ramanathan focuses on three distinct causes of sacroiliac joint dysfunction — trauma, repetitive use and conformation — and examines how osteopathic care might reduce both the likelihood and severity of each. The sacroiliac joint, connecting the spine to the pelvis via dense, inelastic ligaments, has remarkably limited movement yet bears enormous force during locomotion. When that system is compromised, the consequences ripple throughout the entire musculoskeletal chain.

The thesis draws on a combination of published research and personal clinical experience, including two horses from Ramanathan’s own yard. These case studies ground the academic argument in lived reality, illustrating what it looks like when osteopathy is integrated as a long-term maintenance strategy rather than a crisis response. One horse, written off at seven years old, went on to compete at elementary dressage following osteopathic intervention.

What emerges is a nuanced picture. Osteopathy cannot prevent a horse from slipping in a field, nor alter the structural facts of straight hocks or a long back. But it can, the thesis argues, build a body better equipped to cope — one where compensatory patterns are caught early, muscle balance is maintained, and recovery from injury is faster and more complete. Ramanathan also draws on a 2025 peer-reviewed study showing measurable improvements in hindlimb movement patterns following a single osteopathic treatment. This is a thesis about prevention as a clinical strategy, and it makes a compelling case for treating the horse before it breaks down rather than after.

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A horse that weaves in its stable, cribs obsessively, or shies at the slightest movement is often labelled simply as ‘difficult’ or ‘nervous’. What is less commonly asked is whether that horse is in pain, and whether the behaviour is a sophisticated survival response rather than a character flaw. In her thesis submitted to the London College of Animal Osteopathy, Emily Ethier examines the physiological underpinnings of equine anxiety and makes a carefully reasoned argument for osteopathic manual therapy as a meaningful part of its management.

Ethier opens by drawing a clear parallel between human and equine anxiety disorders, noting that both share roots in the activation of the sympathetic nervous system and the limbic system’s pain-response pathways. In horses — prey animals hardwired for flight — anxiety is not merely a psychological inconvenience; it is a physiological state with real consequences for musculoskeletal health. A horse in a near-constant state of hypervigilance will develop chronic tension through the topline and cervical spine, disrupted sleep, reduced blood flow to the viscera, and, over time, a nervous system that interprets innocuous stimuli as genuine threats.

The mechanisms behind these changes are explored in depth. Repetitive stress or pain causes specific nerve pathways to become the path of least resistance — a process of central sensitisation that makes the horse increasingly reactive even after the original stimulus is removed. Stereotypic behaviours such as weaving and stall pacing are not simply bad habits; each generates its own pattern of compensatory musculoskeletal tension that, if left unaddressed, will affect the rest of the horse’s body through fascial and myofascial connections.

Ethier draws on a systematic review by Rechberger, Biberschick, and Porthun published in the European Journal of Medical Research to provide evidence that osteopathic manual therapy — including HVLA techniques, cranial osteopathy, and joint mobilisation — produces measurable changes in autonomic nervous system function in humans. High-velocity low-amplitude cervical techniques showed increased parasympathetic activity, while the CV4 cranial technique demonstrated direct influence on parasympathetic tone. Since the mechanisms are shared across mammalian species, Ethier argues that these findings are relevant to the horse. By alleviating joint restrictions, resetting aberrant nerve pathway signalling, and helping the body move toward homeostasis, osteopathic treatment can reduce the physical amplifiers of anxiety and create the neurological conditions in which a calmer, more settled horse becomes possible.

Ethier is careful to position the osteopath not just as a hands-on therapist but as an advocate for the whole animal — one who assesses the horse’s environment, training practices, social needs, and management conditions alongside its musculoskeletal status. Anxiety rarely has a single cause, and treatment rarely has a single answer. What this thoughtful thesis makes clear is that osteopathy has a meaningful role to play in the conversation.

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What if the reason a horse’s hoof won’t balance is not a farriery problem — but a whole-body problem rooted in the thoracic sling? That is the provocative and clinically compelling question at the heart of this thesis by David Harrison Schaefer, a practising farrier who undertook equine osteopathy training at LCAO and discovered that the two disciplines are far more intertwined than most practitioners realise.

The thoracic sling — the muscular system that suspends the horse’s forelimb from the thorax — plays a direct role in dictating the forces applied to the hoof. When asymmetry or restriction exists within this complex, one limb effectively becomes “higher” than the other, altering load distribution across the entire distal limb. The hoof, which like bone responds to the forces placed upon it by growing more material in areas of lower stress, compensates accordingly — often producing excessive heel growth, toe stunting, or medial-lateral imbalance that resists conventional farriery.

Schaefer builds his argument through anatomy, biomechanics, and a detailed case study of Shine, a 12-year-old Missouri Fox Trotter whose right forelimb deterioration was traced back to a diagonal compensatory pattern following an old left hind injury. Over three osteopathic sessions across eighteen weeks — combining indirect techniques, Osteopathic Articular Balancing, and visceral work addressing the lung pleura — Shine’s thoracic sling restrictions were progressively cleared, allowing his hoof growth to normalise in a way that farriery alone had been unable to achieve.

Perhaps most striking is Schaefer’s attention to the often-overlooked organ component of sling dysfunction: fascial restrictions in the visceral pleura, the hypothalamic-pituitary-adrenal axis, and the autonomic nervous system all feature in his analysis. His conclusion is clear — treating the hoof without treating the whole horse is an incomplete solution, and the collaboration of osteopath and farrier is essential to achieving lasting change.

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Statistics about equine dental disease are striking. A 1994 survey of 500 equine skulls found evidence of dental disease in 80% of subjects. By 2012, a UK study identified dental irregularities in 95.4% of horses aged fifteen and over — yet only a quarter of owners were aware their horse had a problem requiring attention. Despite decades of routine dentistry, these numbers have barely shifted. Christina Hall, writing for the London College of Animal Osteopathy, asks a provocative question: could the way we approach equine dentistry be part of the problem?

Hall, who practises as both an equine osteopath and a qualified equine dentist in the United States, brings a rare dual perspective to this thesis. Her central argument is that modern equine dentistry operates almost exclusively within an allopathic framework — addressing the visible signs of dental abnormality, from hooks and ramps to ulcerations and malocclusions, without asking why those abnormalities exist in the first place. She contends that the answer almost always lies in immobility somewhere in the body, and that osteopathic assessment is the tool best placed to find it.

The thesis draws on A.T. Still’s four principles of osteopathy to reframe every aspect of dental care. If a horse presents with recurring tongue ulceration, for instance, the standard response is to file the offending tooth surface. But Hall argues the cause is likely restriction at the temporomandibular joint — and that restriction, in turn, may originate in a hoof imbalance, a visceral restriction, or a fascial tension pattern running from the hind limb to the skull. The concept of the ‘six legs’ — the three paired extremities of mandible, forelimbs, and hindlimbs that govern mobility patterns across the horse’s entire body — is introduced as a clinical lens for understanding how restriction in one region cascades throughout the whole.

Hall reserves particular concern for routine dental practices such as prolonged speculum use and head positioning on extended dental stands, arguing that these techniques place the upper cervical spine into hyperextension and impose excessive strain on the apical ligament and the temporomandibular joint disc. With nine of twelve equine myofascial kinetic lines originating or terminating at the skull, the downstream consequences of dental procedures performed in biomechanically unsound positions may be far greater than is currently appreciated. This is a thesis that will challenge the assumptions of every equine professional who reads it.