Category Archives: Equine

Owners and riders of horses may, at some point, experience the frustration of not knowing what to do in the event of their horse becoming a “headshaker”. There can be many different reasons for horses to head-shake, and so the most important thing is to work with the Vet and other paraprofessionals to ensure a cause (or likely cause) is found.

Head-shaking can become dangerous in extreme cases by unbalancing the horse, leading to potential falls, secondary trauma through head impact, or potentially injuring a handler or rider. The causes of headshaking can also create learned behaviors that become very hard to decondition.

Headshaking 

The presentation of a head-shaker will vary, but many clinical signs are common. Most head shaking will be up and down on the sagittal plane, while some may twist and rotate at the same time.

Sometimes the actual action of the headshake can help to identify a cause and isolate maintaining factors involved. The action of headshaking is sometimes quite violent and sometimes just a bobbing action; however, even the most light of headshaking will, over time, produce secondary concerns.

Veterinary attention will seek to rule out other causes before concluding a headache. It is important to remember that a headache could arise as a result of another initial cause. Some potential triggers for headshaking could include:

• Mites (in the ear)
• Otitis media/interna/externa (ear infections)
• Ocular conditions
• Guttural pouch infections
• Dental issues
• Rhinitis

The list could go on… (Lane and Mair, 1987)

Obvious signs of infection, both clinically observed and through lab testing, would not discount a headache, as pain could be a secondary factor and maintain or exacerbate the head shaking.

The action of headshaking in horses can often become more noticeable or prevalent during exercise, often showing no signs at rest. There may also be a seasonal difference in symptoms, which may indicate an allergic rhinitis present. Around 60% of headshakers have shown spring/summer seasonal worsening of symptoms (Roberts, 2019).

Headaches

There can be a multitude of factors that lead to headaches in horses. The type of headache will depend on the pathophysiology of the causes, but various types can lead to headshaking behaviours.

Potential causes can include:

• Dental issues
• Sinusitis
• Cervical spine dysfunctions
• Poll issues
• Meningitis
• Space-occupying lesions – Tumours, Abscesses
• Cranial trauma
• Neuralgia

Clearly, with some causes, lab testing and veterinary clinical examination can make the definitive diagnosis to allow for treatment. However, sometimes the cause or even causes of the headache can be more elusive, and it may require a process of elimination type approach.

Headache pain can be worse on exertion, and so horses may react more when ridden or driven. Even a mild headache can affect the horse when under saddle or in work, and this impact can often be misconstrued as a behavioural issue. Of course, no amount of training will fix a headache.

Central sensitisation

When we consider the reactions of the horse who is suffering from a headache, they may not seem entirely congruent with the present trigger or obvious trauma/condition. This may be due to the pain sensitivity being “dialed up” internally. Central sensitisation is a state of heightened responsiveness in the central nervous system, which can amplify pain signals.

There may not be present inflammation or tissue damage, but hyper-excitability of the nervous system can signal the same level of pain as if there were severe trauma.

The causes are many and complex, and the study of this Nociplastic pain (as it is now often called) is continuous. Hormonal imbalances are sometimes highlighted as a trigger, as are chronic inflammatory states; however, there can be a genetic predisposition or even psychological influences.

One way to imagine the process taking place is to think of the nervous system like pathways through a dense forest. If someone walks a particular pathway every day, treading down the plants and clearing the route, then the pathway becomes easier to navigate. If a nociceptive (pain) pathway is continuously stimulated, then this same phenomenon could be responsible for the increased sensitivity. In this sense, it is easy to see how even a rider’s or handler’s activities around the horse could lead to sensitivities.

Osteopathy for Headache and Headshakers

As discussed in previous articles, and is always the case, a proper veterinary diagnosis is essential before we, as Osteopaths, aim to assess and treat. Vets often refer to Osteopaths and other paraprofessionals for this kind of condition, as a multi-disciplined approach is often the best course of action.

Osteopathic assessment of the horse may be able to isolate a causative factor and maintain factors within the head and neck, and so treatment may be only regional. However, there may be wider factors that the Osteopath can address. There may be postural concerns that are impacting the horse’s head and neck positioning; these could be a result of spinal restriction, foot and limb balance, or an injury.

If the horse’s head and neck position is affected to the point of making compensatory patterns, then this could, in turn, trigger headache pain. There is also the possibility of jaw alignment or the hyoid apparatus being affected by more distal structures due to large muscle connections with the shoulder and neck. Jaw pain or temporomandibular joint dysfunction could trigger headshaking.

The key factor in a treatment being Osteopathic is that it is guided by the principles and philosophy of Osteopathic medicine. The body functions as an interconnected unit, therefore, the practitioner who is aware of this may find triggers and causes that seem as though they would be far removed from the symptomology. It is a case of tracking what is found in a logical way to the presenting complaint.

With the trigeminal nerve being a major factor in a large number of equine headache cases (Newton, Knottenbelt and Eldridge, 2010), the Osteopath may seek to find areas where the path of that nerve is compromised. This perversion of function could be through compression or stretch of the nerve, for example.

Remember that structure and function are reciprocally interrelated. The compression or malposition of the nerve structure will alter the function, resulting in pain or numbness. Various structures can compromise nerve pathways, including muscle, bone, fluid swelling, and space-occupying lesions like tumors.

If we find that neural pathways are being perverted by muscle tension, then we can apply soft tissue release techniques to alleviate pressure on them. To be complete, however, we may want to ask the question “why is this muscle/muscles doing this?”.

There will be a configuration that requires the muscle to be in this state; our work can then seek to discover why. This configuration could be a postural or traumatic positioning that necessitates it, or it could be environmental, such as horses’ feeding position or tack influences.

While a headache that is caused by temporomandibular joint (TMJ) dysfunction may be treated by articulation of the joints, release of the masseter, temporalis, and pterygoid muscles, the actual reason for the joint dysfunction may be further away.

It might be that the TMJ dysfunction is caused by stress and subsequent jaw clenching and tooth grinding. This could be found within the case history and questioning when the owner mentions the horse is grazed alone and spends time walking the fence line, and calling. The practitioner may suggest a gradual introduction of a field companion to allow for natural behaviour to flourish and reduce stress.

What can we do to avoid headshaking?

There will, of course, be some cases of headache and or headshaking that will be beyond our control to avoid, such as traumatic injury or neoplastic (cancer).

Our role as owners and keepers of horses is to ensure that all possible precautions are taken and that any signs of illness are picked up on as soon as possible.

Much of the time, it is education and awareness that help to improve horse care and welfare. Many owners are not aware of the intricacies of tack fitting, and of course, professionals train for years to become proficient in this. Some simple checks can help, however.

• Check the pressure of the bridle at key points of contact, such as the poll, nose band (if using one), and around the ears.
• Ask a professional (saddler or trainer) to help you fit the bridle and ensure that the position of all parts are correct.
• Check for any sharp or irritating parts of the tack, such as loose stitches, sharp edges, and bulky straps.
• Try different types of bridle sets up and materials to see what suits your horse best.

If your horse is sensitive to dust and pollen, then you may find that keeping your riding or exercise to times of the day when pollen count or dust is lower is best. You could also investigate the use of nose nets or applying pollen capture gels around their nostrils. Nasal irritation can be a cause for headshaking and so try keeping their nose clean with a soft sponge and clean water to gently clean around the other part of their nostrils.

Many horse owners and equine professionals will have come across a horse with the diagnosis of “Kissing Spines,” but despite the widespread occurrence, there appears to be considerable confusion and conflicting information around causative factors and the management of the condition.

Here I aim to demystify the condition and provide a clearer understanding of what is actually occurring, why it may have developed, and how to manage it. As with any of our articles on animal pathologies, all advice and information given is a guide only and all animals presenting with illness, lameness, or veterinary emergencies must be seen by a qualified Vet.

What is Kissing Spines?

Kissing Spines can have a number of presentations depending on the spinal level affected, the bone development present, and the impact on surrounding tissues. The term “Kissing Spines” comes from the radiological finding of the dorsal spinous processes touching or even overriding one another with osteophyte development known as Baastrup’s sign (Filippiadis et al., 2015). Depending on the type of finding, it may sometimes be referred to as Impinging Spinous Process (ISP) or Over Riding Spinous Process (ORSP).

The condition could occur at any age, but the most common range is between 5 and 10 years old (Hill, 2018). Commonly, the location of the spinous processes approximating is in the low thoracic region, which is clearly often affected by the weight of the saddle and rider.

However, there may be cases where the location of dysfunction is more cranial or caudal, which will depend on a range of factors. The lower region of the thoracic spine is also where the angle of the dorsal processes changes, making it more likely for impingement to occur (Young, 2019).

The horse has long, pronounced thoracic spinous processes that act as attachment sites for strong muscle groups and connective tissues supporting the forelimb and its long neck. On radiography and dissection, these spinous processes can appear fragile, and fractures can occur with falls, particularly at the withers where they are at their longest.

While the equine spine does have movement in all ranges, the degrees of motion are limited compared to some other quadrupeds, such as dogs and cats (Jean-Marie Denoix, 2019). This natural development of a sturdy spine is the feature that has made them so good for riding.

By considering Osteopathic philosophy here, we can see that adding the weight of a rider and tack created an allostatic load on the body. While breeding specific traits into our horses can attempt to improve their vital reserve to support this extra weight bearing, the fact still remains that without correct conditioning, posture, and capable riding, the load may not be supported without detrimental changes occurring.

Causes and Maintaining Factors

Each animal is an individual, and so the situations that led to them presenting with kissing spines will be equally unique. Many factors, however, will be common among affected horses. Some of the factors include:

• Posture
• Conformation
• Fitness and condition
• Age
• Riding – Training level and rider ability
• Tack fit

Horses with conformation that predisposes them to kissing spines may be long-backed and have developed sway back posture, creating excessive extension of the spine. If a horse is not regularly in work and lacks muscular condition, they may not have the abdominal strength to support a neutral spine with the added weight of a rider.

A younger horse who has not been trained to a higher level of schooling may not have the coordination or self-carriage to avoid hyperextension (hollowing). Rider ability can heavily affect a horse’s way of going, as well as riders who are too heavy for the horse. Should a saddle be positioned incorrectly or too long for the horse, this can place the rider’s weight in a position more difficult to support

While, as with any condition, there may be some genetic predisposition, Kissing Spines research is ongoing. Research in recent years has made progress on identifying genetic links.

A study published in the December 2022 is of, Research in Veterinary Science journal found that a region on Chromosome 25 “increased the average grade of kissing spines by one for each copy of the chromosome, called an allele, with the mutation. For each of the horse’s two copies of the allele (one from each parent), the data indicates an average increase in one severity grade of kissing spines, thus confirming the link between genetics and the severity of the disease.”

However, we can consider that certain breed commonalities may impact the ongoing sporting/riding development of the horse.

Some horse breeds that display more upright confirmation in the head and neck may more naturally “hollow” their back during movement. It is important that all training of horses considers their unique physiology and essential that steps are taken to provide support to body structures that are already predisposed to spinal extension.

Popular driven breeds such as Hackney, Gelderlander, and Welsh Section D can show higher natural head carriage, as can the American Saddlebred. These breeds shouldn’t be made to move in a way that is not conducive to their conformation, but there should be sufficient conditioning in their training to engage spinal flexion and isometric strength.

The current thinking is that there are both heritable and non-heritable factors that influence the development of Kissing Spines.

Bone Changes Kissing Spines

The development of bone changes, including bone spurs, callus, and malformation, is described in Wolff’s Law. The bone tissue will alter in shape depending on the forces placed upon it (Rowe, Koller, and Sharma, 2023).

The spongy cancellous bone will become more dense and strong, and the cortical bone layer will strengthen and thicken too. Unfortunately, this bone change can create ongoing problems and worsen symptoms in the case of kissing spines.

As the spinal processes make contact, the pressure applied stimulates bone callus and overgrowth to occur. This change is actually the body attempting to protect itself and reduce the excess movement that is creating dysfunction. However, once this change has occurred, the bone spurs (osteophytes) and enlargements can irritate the surrounding tissues, and of course, by altering structure, function is altered too.

Once radiological findings show excessive bone growth at the site of kissing spines, Vets may opt for surgery to reduce the growths. This is clearly a much more invasive process than some other earlier interventions, and so early diagnosis and intervention are most sought.

This process is known as an Osteotomy, in which space is created between portions of the spinous processes that overlap by ‘bone shaving’, which can reduce pain. This procedure will vary in its impact and recovery time depending on the severity of the condition and the location of the surgery. Vets may suggest this surgery even in retired horses and horses not in work, as the bone changes can impact the horse’s natural healthy behaviours such as rolling, lying down, and social interaction.

Another more modern surgical procedure that may be performed is inter-spinous ligament desmotomy (ISLD). In this surgery, vets will locate the point of the infringement and cut the inter-spinous ligament between the affected dorsal spinous processes. This is with the aim of reducing pressure and creating space. It is also less invasive than Osteotomy and is done while the horse has standing sedation as opposed to full anesthesia. It is less expensive and has a faster recovery time than Osteotomy.

Management and Osteopathy

Clearly, prevention of a condition is far better than a cure. In the early stages of kissing spines, the signs can be very mild or not even shown at all. Many horse owners and trainers may mistake the signs for something else less severe, or even dismiss them as bad behaviour.

Types of behaviours include:

• Reluctance to move forward under saddle
• Cold backed when mounting
• Bucking
• Napping
• Rearing
• Aggressive or painful behaviour when getting up
• Head shaking
• Tail swishing

This is by no means an exhaustive list of signs. Some signs might just be noticed when grooming, such as muscle spasms when brushing their back. The key is to remember that any sign your horse shows that is not normal for them, when they are fully happy and healthy, should be checked out.

Regular Osteopathic treatment can help to highlight these signs, and your Osteopath can then refer back to the Vet to get a diagnosis. An Osteopath can use their palpatory skills and clinical assessment to investigate the early signs of kissing spines that might not be noticed by the owner, such as: Spinal restriction, tenderness on palpation, muscular fasciculation, gait disturbances, unevenness, postural asymmetries.

Prevention and conservative treatment often look exactly the same. While the Vet might consider giving steroid injections at the affected area to reduce inflammation and pain, the rest of the work is very much a daily management process. Importantly, the management routine must be conducted within the horse’s abilities at the time; graduation of exercises and gentle progression will be more successful than rushing the process.

Owner care Kissing Spines

Owners can be directed by their Osteopath and Vet to use exercise and care tips to treat kissing spines. This can include:

• A formal routine of progressive exercise
• Groundwork to encourage conditioning without the rider’s weight
• Poles (ground and raised poles) – this encourages abdominal engagement and spinal flexion to improve spinal control
• Stretching exercises – usually focused on spinal flexion and perhaps lateral flexion to gap the approximated tissues
• Sometimes heat pads and rugging advice might be given in colder months
• Nutritional advice to manage weight and its impact on the spine – also useful during conditioning to ensure adequate protein and energy intake
• Tack fitting and use education

Osteopaths Kissing Spines Care

The Osteopath will use their understanding of the horse’s entire lifestyle and routine to come up with a care plan that aims to remove blockages to health while also dealing with potential initial causes.

The Osteopath will often work with the owner’s trainer, saddler, and other professionals to combine ideas and ensure continuity in the care plan.

Direct interventions the Osteopath may employ include:

• Manual mobilisation of the spine and peripheral joints
• Soft tissue therapy/massage to relieve pain and improve function
• Core engagement techniques
• Spinal manipulation
• Some Osteopaths may also be trained in the use of electrotherapies such as shockwave and pulsed electromagnetic field therapy

Indirect interventions the Osteopath may employ could be:

• Exercise planning
• Rehabilitation plans
• Turnout and stabling routine advice
• Feed and hay positioning – lower to encourage flexion
• Owner care advice, such as simple massage techniques and stretching

Conclusion

The pathophysiology of kissing spines is predominantly one of mechanical strain and eventual loss of painless function. There may be compounding factors to the development of the condition, such as systemic health problems that could lead to muscle weakness and loss of condition; conformational faults and postural abnormalities causing predisposed spinal extension.

However, due to the mainly mechanical nature of this issue, the best form of intervention is education around the biomechanics of the spine and how to monitor factors that place excessive strain on the horse.

Riders should always be aware of their position, training level, and, of course, their weight. Talking to riders about their weight can be a difficult subject, but it is imperative to maintain their horse’s health. There is much to be gained from having all tack fitted properly by a qualified individual who will be able to recognise any signs of pain and could even recommend tack additions and adjustments that could help during the rehabilitation phase.

It is evident from the current research into kissing spines that conservative and preventative care are most recommended by the veterinary profession due to the surgical approaches being highly invasive and requiring a lengthy recovery time.

Prevention can involve an Osteopath to visit regularly and continually assess the horse for pain and mobility disturbances. A good Osteopathic practitioner will offer plenty of education and advice to allow owners to care for their horse’s backs and recognise signs early.

Bibliography:

Filippiadis, D.K., Mazioti, A., Argentos, S., Anselmetti, G., Papakonstantinou, O., Kelekis, N. and Kelekis, A. (2015). Baastrup’s disease (kissing spines syndrome): a pictorial review. Insights into Imaging, 6(1), pp.123–128. doi:https://doi.org/10.1007/s13244-014-0376-7.

Fiske-Jackson, A. (2018). Diagnosis and management of impinging spinous processes. UK-Vet Equine, 2(1), pp.15–21. doi: https://doi.org/10.12968/ukve.2018.2.1.15.

Hackney Horse Society. (2021). Breed Standard – Hackney Horse Society. [online] Available at: https://hackney-horse.org.uk/breed-standard/.

Hill, J. (2018). Kissing Spines in Horses: More Than Back Pain. [online] The Horse. AvailaJean-Marie Denoix (2019). Essentials of Clinical Anatomy of the Equine Locomotor System. CRC Press.

Jean-Marie Denoix (2019). Essentials of Clinical Anatomy of the Equine Locomotor System. CRC Press.

Rowe, P., Koller, A., and Sharma, S. (2023). Physiology, Bone Remodeling. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK499863/.

Young, A. (2019). Kissing Spines. [online] School of Veterinary Medicine. Available at: https://ceh.vetmed.ucdavis.edu/health-topics/kissing-spines.

Etalon (2023) Understanding Equine Kissing Spines: Symptoms, Causes, Diagnosis, Treatment & Prevention, https://etalondx.com/news-media/understanding-equine-kissing-spines-symptoms-causes-diagnosis-treatment-prevention/

Another standout work by an LCAO student! Read about Osteopathy and its effects on foals and growing horses in a thesis by International Diploma in Equine Osteopathy student, Claire Delisle Legrand.

 

As part of LCAO´s ongoing endeavour to publish outstanding work, we share “Osteopathic Manual Therapy to Facilitate Healing in Traumatized Horses” by PhD and International Diploma in Animal Osteopathy graduate, Catherine Slaney. Click on the thumbnail to read the full work below.

 

International Diploma in Animal Osteopathy (Int’l DipAO) graduate, Frouke-tea Friedhoff explores the use of neurological segmentation in equine osteopathy as her thesis subject.

 

 

Frouke-tea Friedhoff

Honoring Our Noble Companions: Celebrating the National Day of the Horse

Every December 13th, we honor one of humanity’s most loyal and noble companions with the National Day of the Horse. This day serves as a tribute to the profound influence horses have had on our lives, shaping history, culture, and even the economy. Whether they are galloping freely in the wild, standing proudly in a parade, or offering quiet companionship, horses remain symbols of strength, beauty, and resilience.

The Legacy of the Horse

For thousands of years, horses have played an integral role in human civilization. In the United States, their contributions are deeply intertwined with the country’s story. From aiding humans in mobility and hunting to powering the expansion westward, horses have been steadfast partners in exploration and survival. They’ve tilled fields, carried soldiers into battle, and transported goods across vast terrains. Their legacy is one of tireless service and unwavering loyalty.

More Than Just Work

Horses aren’t only remembered for their labor. They are companions, athletes, and healers. Equestrian sports like show jumping and dressage highlight their incredible athleticism and intelligence, while therapeutic riding programs provide solace and recovery for individuals with physical and emotional challenges. Wild horses, such as the mustangs of the American West, or the Alberta Wildies of Canada, embody a spirit of freedom and untamed beauty that continues to inspire us.

Why This Day Matters

The National Day of the Horse is a moment to reflect on how deeply connected we are to these magnificent creatures. It also raises awareness about the challenges they face today, from habitat loss to issues of neglect and overbreeding. Advocacy and education are key to ensuring that horses continue to thrive in both domestic and wild settings.

Ways to Celebrate

If you’re looking to honor horses today, here are a few meaningful ways to celebrate:

• Visit a Stable or Sanctuary: Spend time with horses to appreciate their gentle nature and strength. Many local stables or rescues offer tours and volunteer opportunities.
• Learn About Their History: Explore the rich history of horses in your region or dive into books and documentaries that showcase their impact on society.
• Advocate and Donate: Support organizations dedicated to protecting wild horses, promoting equine welfare, and offering therapy programs.
• Share Your Story: Use social media to share your experiences with horses. Whether it’s a childhood memory or a recent trail ride, personal stories highlight the special bond we share with them.

A Lasting Bond

Horses are more than animals; they are a testament to the enduring partnership between humans and nature. As we celebrate the National Day of the Horse, let us honor their legacy and ensure that future generations have the opportunity to marvel at their grace and power. Take a moment today to appreciate these incredible creatures and the immeasurable joy they bring to our lives.

For more information on how you can become an Equine Osteopath, click here 

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Click on the thumbnail below to read about myofascial kinetic lines as a diagnostic tool.

 

 

Erika Walton

Click on the thumbnail below to read about the effect of the rider on horses asymmetries in consideration of equine osteopathic diagnosis.

 

 

Click on the PDF below to read a stand out exploration of the role of osteopathic manual treatment in performance horses.