Dorsal spinous processes (DSPs) are the bony projections at the top of the horse’s vertebrae. When those projections touch (impinge) or overlap (override), this is referred to as “kissing spines.”  The area of the back where the condition is most often diagnosed is between thoracic vertebrae T13 and 18—directly under where a rider sits in the saddle.

A horse with four sites of impingement with bone remodeling, suspected to be causing the horse’s pain under saddle. Photo by Alan Nixon

Signs a Horse May Have Kissing Spines Include:

◆ Obvious discomfort with pressure on back

◆ Loss of muscling across topline

◆ Change in behavior (tail swishing is common)

◆ “Hollowed out” back when ridden

◆ Resistance to transitions between gaits

◆ Asymmetric, uneven gaits

◆ Difficulty picking up correct lead or maintaining canter

Obvious discomfort from pressure on the back is one possible indicator of kissing spines. Photo by Talitha/Adobe Stock

A Diagnosis is Not Always Career-Ending

Although radiographs may look alarming, the presence of kissing spines isn’t necessarily the kiss of death for a horse’s athletic career. In fact, many horses whose X-rays reveal the condition have no clinical signs and compete at top levels.

Researchers at the University of California-Davis recently studied groups of horses that compete successfully in high-level show jumping and racing over fences. X-rays of these horses’ backs showed that kissing spines was very common, yet there was no correlation with poor performance. In fact, horses with the worse radiographic evidence of kissing spines often had better jumping scores and racing accomplishments.

“It’s incredibly common to have horses show abnormalities of their backs on X-rays, but our clinical experience and research studies show that kissing spines doesn’t necessarily mean a horse has back pain or poor performance,” says Sarah le Jeune, DVM, DACVS, DACVSMR, CVA, of UC Davis, who regularly works with horses with the condition. Le Jeune specializes in equine integrative sports medicine and rehabilitation, and she is also a surgeon.

“Kissing spines is getting blamed clinically for a lot of things, so you have to rule out other problems,” says le Jeune. “I rarely see horses with primary back pain; it’s usually secondary to lameness, poor saddle fit, or unbalanced riding.” Her goal is getting to the root of the problem and fixing it.

“Back pain and lameness are highly correlated and hard to separate,” she notes. “If there’s an underlying lameness, once the horse is better, he starts using his back better.”

Not Just X-Rays

Radiographs alone should never be the sole evidence for a diagnosis of kissing spines. It’s believed that almost 35 percent of horses show evidence of the condition on X-rays, but they may have no clinical signs.

“Typically, when you X-ray horses’ backs, they’re sedated, and their posture is passive,” says le Jeune. “They’re not engaging their abdominal muscles and are kind of slouching.”

This doesn’t reflect the horse in movement with an engaged hind end and lifted back.

“It’s not uncommon to see kissing spines on X-rays, but the sedated, standing horse is not the same as the dynamic horse in motion,” she adds.

The condition has even been seen on X-rays of foals’ backs, which proves it’s not related to being ridden.

When conducting a pre-purchase exam, le Jeune won’t necessarily “red flag” a horse with kissing spines on the X-rays if he moves well and has no back pain, but she lets the buyer know it could become a problem if the rider is not able to ride the horse with an engaged and lifted back.

Because the condition is so frequently seen on X-rays, an accurate diagnosis of kissing spines must include clinical correlation.

“Horses with clinical kissing spines have obvious pain upon palpation and riding,” says le Jeune. “The diagnosis has to be confirmed with physical examination and palpation of the back, including a thorough lameness evaluation, neurological evaluation, and saddle fit evaluation.”

She also recommends evaluation of the horse being ridden by a veterinarian well-versed in sports medicine.

Why Horses Develop Kissing Spines

There is no single answer as to why some horses develop kissing spines. Likely, the condition is the result of multiple factors, including breed predisposition and genetics, poor saddle fit, unbalanced riding, and lack of training that allows the horse to not engage his core.

At times, conformation is to blame. A horse that genuinely has bad posture related to conformation may be physically incapable of using his body properly for high-level performance.

“Saddle fit is a huge problem,” adds le Jeune. “The saddle has to fit the rider, not just the horse. Most owners want to do what’s right by their horses. It might mean getting a different saddle or becoming a more balanced rider. It takes self-awareness and willingness to address the root problem.”

Different Approaches to Kissing Spines

When all other issues have been ruled out and a horse has a definitive diagnosis of kissing spines, there are different approaches to addressing the condition:

◆ Medical treatment

◆ Postural rehabilitation

◆ Surgery

Medical treatment may involve muscle relaxants, anti-inflammatory medication, and steroid injections between the offending DSPs. Some horses with the condition may benefit from steroid injections a couple times per year to reduce inflammation in the affected area(s) of the back.

Le Jeune has also seen improvement using shockwave therapy, chiropractic adjustment and acupuncture. Although these therapies can be very helpful, the horse must still have a strong back and move correctly, which is why postural rehabilitation is key.

Secondary to postural rehab, Le Jeune has also seen improvement using shockwave therapy, chiropractic adjustment and acupuncture. Photo by RD-Fotografie/Adobe Stock

Postural rehabilitation involves exercises that engage core muscles and strengthen the muscles that support the spinal column. The goal of postural rehabilitation is getting the horse to use his back properly, by tucking his pelvis and lifting the back.

“Postural rehab can include resistance bands like the Equiband Pro System, the ProSix, or the Pessoa Lungeing System,” says le Jeune. “All of this is done without a rider and rehab can take two to three months.”

Postural rehabilitation, which might include the Pessoa longeing system, involves exercise that engages core muscles and strengthens the muscles that support the spinal column. Photo by matilda553/Adobe Stock

When owners choose surgery for severe cases, there are two options. The most common surgery, known as interspinous ligament desmotomy (ISLD), involves snipping the ligament(s) holding those segments of the spine together.

“A branch of the spinal nerves in that region are cut during the surgery, so it’s like a neurectomy, meaning the horse won’t be able to feel that area of the back,” explains le Jeune, adding that this may possibly make the back less stable.

A more radical and invasive surgery, known as ostectomy, actually cuts away the top of the dorsal spinous processes that are touching.

Post-operative image of the same horse following cranial wedge ostectomy of the four sites. Photo by Alan Nixon

Some surgeons are combining ISLD surgery with a process known as “bone shaving,” which removes smaller bone sections and is less radical than an ostectomy.

While surgery for kissing spines is common, le Jeune believes it’s only warranted when the diagnosis is absolute and there are no better treatment options. In practice, she has found that postural rehabilitation is often a more successful approach.

When an owner chooses this option, it’s important to work with an expert who is experienced in rehabilitation, which is usually a veterinarian who is board certified in sports medicine, so don’t hesitate to seek out a specialist.

Return to Work

Most horses with clinical signs are able to return to work after treatment, but owners should be aware that rehab takes time and commitment on their part.

“As long as you’ve ruled out everything else, it’s very rare that postural rehab doesn’t work,” says le Jeune. “But correct riding is crucial. You need to have a skilled rider once the back is strengthened in order to keep the horse engaged and using his back properly.”

Correct riding is crucial when returning to work. A strong equine back and skilled rider is needed to keep the horse engaged and using his back properly. Photo by RD-Fotografie/Adobe Stock

As an avid rider herself, le Jeune understands the condition from this perspective.

“Once the horse develops more back muscling, he’ll get wider, so you may need to adjust or change saddles,” she adds, noting that regular saddle re-evaluation is essential, with adjustment as needed.

Key Takeaway

Although kissing spines has become a common diagnosis in performance horses, le Jeune emphasizes that the condition shouldn’t be the go-to explanation for poor performance or back pain.

She encourages owners and veterinarians to definitively rule out any other problems, particularly lameness, before confirming a diagnosis of kissing spines and pursuing treatment.

She adds that choice of treatment should always focus on what’s right for the horse long term—not necessarily the option that brings about the fastest results.

This article about kissing spines in horses appeared in the January/February 2025 issue of Horse Illustrated magazine. Click here to subscribe!

The post An Overview of Kissing Spines in Horses appeared first on Horse Illustrated Magazine.

As a rider, your back is part of every move you make in the saddle. Photo by Amanda/Adobe Stock

The Importance of the Back

The back comprises three major regions: the cervical, thoracic, and lumbar. Each of these regions has a specific function that contributes to improved rider stability, flexibility, and strength. However, maintaining a healthy back can often be a challenge, especially with the repetitive movements and demands on horseback.

Without strength in the core, back, and pelvic areas, our ability to communicate effectively with our partners diminishes, leading to discomfort and, even worse, potential chronic pain.

A strong and supple back allows you to maintain proper posture for longer without fatigue, absorb your horse’s movements, and provide clear and consistent aids. Photo by Terri Cage/Adobe Stock

Back Pain in Riders

In the fast-paced, go-go-go world of equestrian sport and culture, we consistently push our bodies to the limit. Riders frequently suffer from back pain due to the rigorous physical demands of riding, which includes the need for dynamic balance and control.

This pain routinely hinders the ability to perform at your best, both in training and competition. It also directly affects your horse, as he can sense your discomfort and tension and compensates in his body as a result.

Exercises for Riders with Back Pain

Adding regular mobility exercises into your exercise routine ensures that your back muscles remain supple, strong, and pain-free.

Try this quick and effective mobility sequence targeting the back, helping you move more freely in all directions. Regularly practicing these few exercises, you can expect to improve your flexibility and strength, ultimately leading to a stronger and more supple back in the saddle.

Let’s explore these exercises in detail.

1. Child’s Pose

The author demonstrates child’s pose, which helps lengthen the spine, relieve tension in the lower back, and open the hips—common and critical areas that often become tight and restricted during riding. Photo by Jamie Isaacs Photography

Start by kneeling on the ground with your knees and feet hip-width apart. As you push your hips back, allow the backs of your thighs to rest on your calves, and reach your hands forward as far as you comfortably can. This is known as the child’s pose, a staple in yoga that’s fantastic for stretching the spine, hips, and shoulders.

For riders, the child’s pose helps lengthen the spine, relieve tension in the lower back, and open the hips—common and critical areas that often become tight and restricted during riding.

Hold this position for two to five deep breaths, allowing your body to relax deeper into the stretch with each exhale.

The child’s pose is not only beneficial for the back, but also for mental relaxation. The deep breathing associated with this pose can help calm your mind, reducing stress and anxiety. This is particularly useful for riders, as a calm and focused mind is essential for clear communication with your horse.

By incorporating the child’s pose into your routine, you can improve both your physical and mental well-being, leading to better performance in the saddle.

2. Mid-Back Rotation

The mid-back rotation enhances mobility of the thoracic spine, the area of the back that often becomes stiff due to long hours at the barn and time spent in the saddle. Photo by Jamie Isaacs Photography

Once you’ve completed the child’s pose, move into the mid-back rotation. Get on all fours, ensuring that your wrists are directly below your shoulders and your knees under your hips. Inhale deeply as you reach one arm up towards the ceiling, allowing your eyes to follow your hand.

This movement stretches your chest, shoulders, and upper back, promoting independence between your hips and upper body. Hold the stretch for one deep breath, then switch sides.

The mid-back rotation is particularly important for riders because it enhances the mobility of the thoracic spine, the area of the back that often becomes stiff due to long
hours at the barn and time spent in the saddle. Improving the flexibility of this region, you can achieve better posture and more independence between upper and lower regions of your body.

Additionally, this exercise helps to balance and stretch the muscles on both sides of your spine, reducing asymmetries that can lead to discomfort, pain and even horse imbalances.

3. Thread the Needle

Threading the needle is a powerful stretch for riders because it targets the upper back and shoulders, areas that are prone to tension and tightness due to the various postures and positions used while riding. Photo by Jamie Isaacs Photography

Return to your starting position on all fours for the thread the needle stretch. Push your hips back slightly, and then thread one arm under the opposite armpit, reaching as far through as you can. Allow your eyes to follow your hand as you lower your shoulder and rest your upper body on the floor. Hold this position for one or two deep breaths before repeating on the other side.

This exercise is excellent for stretching your upper back, shoulders, and neck. Once you’ve completed the stretch on both sides, return to the child’s pose for a final relaxation.

Threading the needle is a powerful stretch for riders because it targets your upper back and shoulders, areas that are prone to tension and tightness due to the various postures and positions developed while riding.

By regularly practicing this stretch, you will improve your range of motion, leading to a more balanced and effective seat. This also enhances better alignment of your spine, reducing the likelihood of chronic pain.

You can repeat this entire cycle from movements 1 through 3 a few times a week for optimal results.

The Importance of a Healthy Back

Riding requires a harmonious relationship between you and your horse, and a healthy back is crucial to this connection. A strong and supple back allows you to maintain proper posture for longer without fatigue, absorb your horse’s movements, and provide clear and consistent aids.

When your back is tight or weak, it adds stiffness in your seat, causing discomfort for both you and your horse. Discomfort leads to compensatory movements that place undue stress on other parts of your body, such as your hips, knees, and ankles, further increasing the likelihood of bad habits and issues.

By incorporating regular stretching and mobility exercises into your routine, you can ensure that you remain flexible and pain-free for years to come.

Learn more about rider fitness at ifafit.com.

This article about rider back pain appeared in the January/February 2025 issue of Horse Illustrated magazine. Click here to subscribe!

The post Exercises for Riders with Back Pain appeared first on Horse Illustrated Magazine.

This article about back pain in horseback riders is adapted with permission from

Low back pain is one of the most common and most costly medical problems in industrialized countries. Over 90 percent of the U.S. population seeks help for back pain at one point or another in their lives, including horseback riders. Approximately 50 percent of working-age people in the U.S. suffer from acute low back pain every year, and it is estimated that the annual productivity loss from this condition totals between $20 and $50 billion.

Back pain affects four out of five people at some time during their lives. It is the leading cause of disability for people between the ages of 19 to 45. Back pain is second only to the common cold for causing adults under 45 to miss work. Furthermore, as we age, low back pain becomes more and more common, affecting half of the population older than 60 at any given time.

Photo Courtesy Trafalgar Square Books

Back Pain and Horseback Riders

Though no back injury is desirable, it can be even more problematic for those who live with horses and love them. Back pain can literally rob you of the enjoyment you get from riding and working with your horses.

The rider with a healthy back will exhibit both flexibility and strength. The informed rider will also do a little bit each day to ensure continued back health.

Back strength and flexibility are not absolutes. It’s not a matter of “you either have it or you don’t.” Both flexibility and strength are measurable on a continuum. Time and circumstances can influence one or both for the better or the worse.

If you are a horseback rider experiencing back pain, you certainly should have a competent physician who is experienced at diagnosing and treating back disorders take a look at you before you begin any exercise program. Ideally, the physician you choose will be relatively experienced with horses, but this tends to unreasonably narrow the talent pool. Unfortunately, very few physicians combine a solid knowledge of the spine with an understanding of the medical aspects of riding. Don’t be surprised if you hear, “If your back hurts, don’t ride,” from well-meaning members of the medical profession. This is an attitude that I hope to change by emphasizing your responsibility and initiative for dealing with and avoiding back pain.

The Importance of Flexibility

Building flexibility and strength in your back and in related body parts is the key. In this article, I’m going to focus on flexibility.

Why do we want flexibility in our backs? The answer is simple: strength without flexibility is force produced in a limited manner, in only one direction. Flexibility enables a rider to exert a reasonable amount of force in all directions.

This is terribly important in riding, because maintaining your balance and changing your mechanics during the different gaits requires not only strength, but also coordination of that strength through a relatively broad range of motion. In order for your muscles to work efficiently and produce the strength and motion necessary for good riding, you must have some flexibility.

Age is not necessarily a contraindication of flexibility. Some elderly patients exhibit excellent range of motion.

Muscles that are flexible, and have been properly stretched, are the ones that can be trained to be the strongest. Muscles that are continuously tight, through the ligament tightening and muscle tightening, are inefficient and simply don’t provide the optimal strength and endurance possible.

Photo Courtesy Trafalgar Square Books

Stretching Correctly

Stretching the muscles in a methodical, controlled, targeted manner is the best way to increase your range of motion. For optimum flexibility, it’s just as important to stretch your muscles after doing some sort of physical activity as it is to stretch beforehand.

The back is a somewhat difficult area to stretch at first. Learning to stretch your back effectively, safely, and for best results takes practice. Nevertheless, once you are aware of the muscles and movements involved, you can stretch your back muscles just as well as any other group of muscles in the body.

Back stretching involves stretching the hip and buttock (glute) muscles as well as the back. You can’t stretch the back very effectively without involving the hips and glutes, as well.

Back stretching exercises also stretch the muscles and ligaments in the legs at the same time. In terms of the benefit obtained, and from a muscular point of view, it’s best to stretch the back, hips and legs in concert, because you ride with them in concert.

The total time taken to do the kind of stretches I recommend is only four or five minutes, but it will pay off. It could be the best couple of minutes you’re going to spend on yourself all day, next to the actual riding time itself.

Photo Courtesy Trafalgar Square Books A-Frame Back Stretch 1. Stand up straight, with your feet placed shoulder-width apart and your weight balanced evenly through both legs. Raise your arms overhead. Place both hands together, one on top the other. Inhale, breathing deeply. Keep your arms straight throughout the stretch.     Photo Courtesy Trafalgar Square Books 2. Bend at the waist and slowly stretch down and sideways, trying to touch the outside of your right foot with both hands. 3. Slowly return to a vertical position. Keep your hands together. Photo Courtesy Trafalgar Square Books 4. Bend at the waist and slowly stretch down and sideways, trying to touch the outside of your left foot with both hands. Keep both legs straight and stretch as far as possible. 5. Slowly return to a vertical position. Four or five repetitions of this exercise are generally sufficient.

JAMES WARSON, M.D. (ret.), founded Front Range Brain and Spine Surgery practice in Fort Collins, Colo., in 1978. He devoted the majority of his practice to spine surgery; diseases of equestrians caused or aggravated by riding were Dr. Warson’s field of expertise. In 1984, Dr. Warson established J & J Farms, where he bred, trained, exhibited, and sold multiple Grand National and World Champion Morgan horses. Today Dr. Warson is based in Fairfax, Va., where he is the Mid-Atlantic Medical Director for the Medeval Corporation and serves as Medical Director for Rider Health and Safety with the Western Dressage Association of America.

This article about back pain in horseback riders originally appeared in the November 2019 issue of Horse Illustrated magazine. Click here to subscribe!

The post Fit Rider: Stretches for Horseback Riders to Help Back Pain appeared first on Horse Illustrated Magazine.

Photo: nd3000/Shutterstock

I never should have stretched those extra few inches, reaching to hang my new floor-length curtain panel. Three days later, a sharp pain in my lower back and abdomen—unlike anything I had experienced before—ushered me straight to urgent care. According to the doctor, it was just a muscle spasm. She administered a cortisone shot and stated that I would experience relief in about 30 minutes.

The shot didn’t help, and my pain intensified to the point where I wondered if I was dying. Lightheadedness seized me, and I started to sweat while my arms and fingers tingled. I was sure one or all of my internal organs had burst as I lay sprawled out on my kitchen floor with my dogs staring down at me.

I was whisked away to the emergency room via ambulance, and my alarm lessened as the cute EMT started telling me about his sister’s upcoming wedding. He didn’t seem on a mission to save my life—just to distract me from my pain.

During my eight hours in the emergency room, various painkillers were given until one ended my torment. I was discharged with a written excuse to stay home from work for a week and a prescription for steroids. That day, riding my horse was the last thing on my mind.

Types of Back Pain

Back pain among equestrians is not uncommon. The causes are diverse, ranging from arthritis and poor posture to aging and weight gain. And some are silly, preventable accidents like my muscle sprain from trying to hang a curtain alone.

Taylor Bodson slipped and fell when running in socks down hardwood stairs. Bodson, blogger at The East Coast Equestrian, sustained two closed lumbar vertebrae fractures and herniated discs during her tumble.

“Spine injuries in riders tend to be bulging intervertebral discs caused by aging and compression fractures usually due to osteoporosis or osteopenia,” says horseman and retired neurosurgeon James Warson, M.D., author of The Rider’s Pain-Free Back.

Every individual’s back pain story is unique, but the good news is that the condition causing the pain can often be addressed, or at least the pain can be managed, making a comfortable return to the saddle achievable. The most important thing is to seek medical attention at the onset of back pain to determine the cause, which will shape the plan for healing.

“The first doctor or diagnosis may not always be correct,” says Bodson. “Don’t take their word over how you actually feel.” Her first doctor missed the fractures on the X-rays, diagnosed her with muscle spasms and send her home with steroids.

Treating the Back

Warson observes that a threefold approach of stretching, especially after a ride, weight loss where appropriate, and anti-inflammatory medicines can have a positive effect on bulging discs.

According to Warson, osteopenia can be treated with bisphosphonates (a class of medicines that stop calcium loss). By combining bisphosphonates with the use of calcium citrate and vitamin D, as well as implementing a flexibility and isometric exercise program, he has witnessed that most riders can be back in the saddle for trail-type riding in about six weeks.

He has also seen success in restoring bone strength in advanced osteopenia and osteoporosis patients through the use of the Equicizer, a mechanical horse that simulates all the gaits based on a rider’s strength and ability.

Hip flexor stretch: Keep your shoulders back as you bend your knee up on a step; press forward and hold. Photo: Elizabeth Moyer

Stretch Yourself

Eventer and physical therapist Carlene Kelly, DPT (Doctor of Physical Therapy), finds that most equestrians have tight iliopsoas muscles from the hip flexion of riding and all the sitting most of us do in life. She recommends stretching before and after each ride and as part of a daily routine. One of her favorite stretches is the hip flexor stretch (see pg. 20).

“Make sure to keep your foot on the ground, pointed forward or slightly rotated in, and keep your shoulders upright and slightly back as you bend your knee up on a step,” she advises. “I hold for three to four seconds, back off slightly, then repeat 10 times on each leg.

“The second muscle that is a big culprit to low back and sacroiliac joint pain is the piriformis muscle,” Kelly continues. “The seated piriformis stretch is simple: Sit with one ankle crossed over the other knee, sit up tall and bend forward at the hip (chest leading) until you feel a stretch across the back of your hip on side of the crossed leg.”

Kelly is no stranger to back pain, as she has a history of sacroiliac joint injury.

“The best I have ever felt is when doing aquatic exercise and Pilates. Both of these are excellent cross-training activities for riders due to the core strengthening in lengthened positions it provides. We all need to not be restricted on our horses.”

Seated piriformis stretch: Sit up tall and bend forward at the hip with one ankle crossed over the other knee. Photo: Elizabeth Moyer

Overlooked Back Pain Prevention Tips

In some cases, evaluating your mount and possibly making a change could be the key to greater comfort for riders who struggle with back pain.

“A good start to prevention is to start with the horse,” says Warson. “The harmonics of the horse and the rider are critical. [The sitting trot is] a quick way to separate horses out. A tall rider may find that an Arabian or Tennessee Walker is better for them due to the longer horizontal gait component.”

Journey to Healing

My back healed through many of hours of Netflix on the couch accompanied by steroids, ibuprofen, ice, frequent chiropractic adjustments for several weeks, and the use of a TENS machine. I incorporated stretches, a new chair with better lumbar support at work, and a new standing desk.

My doctor recommended breaking up my hour-long commute by stopping halfway to get a coffee, which allowed me to walk around and stretch. I also kept my car’s seat heater turned on. When I started riding my horse again a few weeks later, I walked him for a longer-than-usual warmup and did stretches, such as leaning over to try to touch my toe and leaning forward to reach for his poll and back toward his tail. I only cantered a few strides during my initial rides, and I rode them in a half-seat.

It has now been a year and a half since my injury and I’ve made a full return to riding and jumping, although some days my back feels a little tight. When that happens, I opt for a shorter ride. If I’m in a lesson, I will tell my trainer I need to cut it short, and do stretches afterward.

We horse owners generally baby our horses when they get hurt, and give them as much time off and TLC as they require. We need to be willing to extend that same luxury to ourselves.

“Take your time,” Bodson advises. After a three-month riding hiatus she’s back in the saddle, but learned a valuable lesson along the way.

“Despite doctor’s orders, I snuck in a few early rides and immediately regretted it. Let your body heal. Your horses will be waiting for you.”

What could be better motivation to rest and recuperate than that?

This article about horseback rider back pain originally appeared in the September 2018 issue of Horse Illustrated magazine. Click here to subscribe!

The post Fit Rider: Battling Back Pain appeared first on Horse Illustrated Magazine.