Please note I am not a veterinary professional, I am writing this post to help others based on my own experiences only, if you suspect your horse has kissing spine please speak to your vet for a full veterinary assessment.
Here is a little insight into what has helped Jack recover from Kissing Spine.
A is for Alternative Therapies - physiotherapy, Mctimoney, osteopathy, Chiropractic, Acupuncture, Acupressure, hydrotherapy etc. The list of alternative therapies available goes on! Personally I use Physiotherapy, McTimoney and hydrotherapy for Jack but there are lots of variations and I wouldn't rule out anything if it might help. During rehab Jack needed regular physio to help him be able to work as he quickly became sore, without this he wouldn't have been using himself correctly and all the work would have been in vain. He now has a check by either physio or McTimoney Therapists every 3-6 months just to keep him tip top and address any tightness that creeps in. It is important to use properly qualified therapists and I wouldn't use anyone that isn't a vet recommended therapists. I'm considering acupuncture having heard lots of good reviews from other KS horse owners that have had surgery.
B is for Bank Balance - Or lack of! Having any horse that needs veterinary treatment is not cheap and even with insurance my already straining bank balance took a big hit. If you have a horse with KS be prepared for yours to take a serious dip what with the vets fees, insurance excesses, rehabilitation, supplements, training aids, new saddles and various other pieces of equipment that might help! My vet fees exceeded my insurance claim limit so I had to put a fair amount to cover the bills. It is important to remember most insurances wont cover stabling or travel expenses either so budget for those if you need to visit and stay in a vet hospital.
C is for Calmers - I could not have got through 6 weeks of box rest following Jack's surgery or the early reahb without a Calmer for him. During box rest he found the other horses turn out times especially stressful and I used Instamag instant spray on calmer from Freestep superfix and find it extremely effective in taking the edge off when he gets stressed out. It's a staple of my grooming box now and I've been so impressed with it's effectiveness. Following application, which is just a quick spray on the neck, Jack is visibly less stressed and goes from box walking and rearing in his stable to standing eating hay almost instantly. I have also used it before getting on board during the walking phase of rehab which Jack found vey boring and when I used it he was much less of a handful and more rideable. Ingested calmers take much longer to take effect and have to be fed daily to keep up the effect where as this is just used as and when you need it so it's more cost effective too! Win Win!
D is for Don't Give up - There were times I felt like it, when I felt like we were getting no where and I couldn't ever imagine my horse being normal again. The rehab is an incredibly hard process both physically and mentally for horse and owner and it can be a real roller coaster with lots of good and bad days along the journey. I had to keep the end goal in mind and if things weren't going so well then back off and try again another day. Rehab is a marathon not a sprint and the longer it takes the more likely of a successful outcome. You can do no harm taking things slow but you can do a lot of damage rushing the process so take your time, listen to your horse, get as much support as you can from vets, therapists, instructors, facebook groups or friends who have been through it and understand how you are feeling and most of all Don't Give Up!
E is for Exercise - I find a variety of exercise works best with Jack, I do lots of hacking, try not to school more than once a week, lunge approx. once a week in a pessoa type lunging aid and occasionally loose jump/school. I also do lots of stretches with him before and/or after exercise. While most vets recommend lunging in a pessoa to begin rehabilitation with Jack this wasn't the preferred approach due to him also having arthritis in his hocks. Repetitive exercise like lunging puts a lot of stress on the joints so this was to be avoided knowing there was already problems. It is also important to fully warm up at the start of any session and properly cool down at the end to avoid further problems. I start with doing 15/20mins walk beginning on a completely loose rein and then asking for a long, low stretch as we do some large circles and serpentines. I also get up out of the saddle in the first canter on both reins as this helps Jack to loosen in his back and get moving. When hacking I often trot in a light seat to allow his back to move more. I'm also careful to canter on both leads while hacking and if doing a rising trot I will change diagonal often so he develops evenly.
F is for Fitness - I am really careful not to ask too much too soon and make sure Jack is fit and strong enough to do the work I am asking of him. Once back under saddle I slowly got him fit by doing lots of hacking over a variety of terrain. I use a fitness tracker to take the guess work out of planning my rides. This way I know how far each of my local routes is and can plan an effective fitness routine rather than just wandering the bridle paths without a plan and not really knowing how far we've ridden or for how long. Although I use this quite scientific approach I also make sure I am listening to Jack too and if he is feeling fresh may use a more hilly route while if he is feeling a little tired may do a shorter, flatter route. I have found it extremely important to listen to Jack if he is in need of a few days off or easier days.
G is for Ground Poles - Since his surgery I hardly ever school or lunge Jack without putting out a few poles to keep him on his toes and get him thinking. They help to loosen him up, get him moving forwards, engage his core, stretch over his spine and increase his range of movement to build a stronger top line. I use various different sets ups to keep things interesting and keep Jack thinking and I enjoy thinking up new challenges for us both. As his fitness increased I started to add more raised poles. It also helped me get my eye back in for jumping which neither of us had done for a while during his recovery! He seems to enjoy schooling much more with some poles out rather than just flat schooling and it gives us both something to concentrate on.
H is for Hacking - this has been key to Jack's successful recovery and is so important for general fitness. He is naturally more forward and relaxed out of the menage so I use this to my advantage and try to hack over varied terrain and routes to keep things fresh and interesting. Many underestimate the benefits of long hacks just in walk. Using hill work in a long low frame really works the whole horse, they have to engage their core, push with their glutes and hamstrings etc. It builds all the muscle we need to target with a KS horse. I use an app to map my rides so I know exactly how far I've ridden and for how long each day which really helps especially when rehabbing.
I am careful about doing to much trotting on the roads and cantering on too hard or too soft ground due to his other issues.
I is for In Hand - Certainly in the early days of rehab I became a bit of a pro at in hand exercise! I still enjoy doing some in hand exercises with Jack now and find them really beneficial. From starting with simple carrot stretches to pole work and hacking in hand, lunging and loose schooling/jumping once he was fit enough, we've done it all. It helped rebuild my bond with Jack and started to rebuild our trust in each other. It is really helpful to look at him working from the ground regularly to see how he is improving in his stride length, range of movement and his muscle development. I often take little videos too so I can watch them back and compare to previous sessions to see the improvements and know we are going in the right direction. This is especially helpful when things don't seem to be going so well, to be able to look back and see how much improvement has been made gives you a boost when you need it.
J is for Jumping - A bit of jumping has been really good for Jack as he now enjoys it and it works different muscles. Grid work has been especially helpful in building additional core and hind end strength with Jack, once he had completed his basic rehab and was fit enough as this is hard work for them. I have found that adding some regular grid work helped get him to sit back on his hocks and take more weight behind while also helping him to make a better shape over a fence which opens the spine. He really muscled up once we started doing weekly grids developing a strong topline and core muscles to protect his spine. I started with just a couple of ground poles and built up the amount of poles we used over a period of weeks, then started raising some of the poles and once that was easy adding small jumps. We only have a 20x40 ménage but I can fit in 7 poles/jumps on bounce distances. It really gets him working and improves balance and rhythm too. I'm careful to ensure I work on both reins evenly.
K is for Kissing Spine support groups - I know for a lot of people getting a diagnosis of Kissing Spine for their horse is devastating but for me it was a huge relief to finally know what was wrong with Jack and be able to make a plan to fix him. He had been difficult for a long time and I had spent an awful lot of time and money on various phyios, saddlers, farriers, dentists, instructors and vets trying to get to the bottom of what was wrong only to be repeatedly told my horse was just naughty and I was letting him get away with it and needed to be firmer. Although I knew we had a long battle ahead to get him better at least I now knew why he was being so difficult and that he wasn't just a bad horse. I did lots of research and had so many questions for the vets at the hospital but they were brilliant and fully supported me along the way. I also found the facebook group Horses with Kissing Spine which was a huge benefit being able to talk to people who had been through or were going through the same as me. It can feel very lonely on a yard where everyone else's horses are healthy so being able to chat to people in the same position really helped me cope.
L is for lunging - I usually lunge Jack no more than once a week. My preferred lunging aid is a pessoa. There is a real divide in peoples opinions of Pessoa's and I have received negative comments on social media about using one but personally I find Jack works very well in his. I have it set fairly loose and he has been seen working in it by our vet, physio and rehab centre and all confirm he is working correctly in it so for me I am happy to continue to use it as part of our fitness regime. I do sometimes lunge in just a bridle/headcollar and I have used various other aids such as kavalcade and equicore systems but so far I have not been persuaded that any are better for Jack than the Pessoa. Some horses don't work well in the pessoa as they don't like the strap around their back legs so it is important to find the right aid for your horse, if they are sensitive around their legs the Kavalcade maybe a better option. There are also a lot of good things said about the equiami and I am tempted to try one.
M is for Magnetic therapy - I have been very impressed with the results of using a magnetic back pad and hock boots on Jack. I find them to be particularly beneficial to Jack in the colder weather. Having worn the back pad while he is stabled his back is lovely and warm to the touch and the muscles underneath are soft and relaxed. I also notice he is stiffer and takes longer to loosen and warm up if he has not had them on especially in colder weather. I am tempted to invest in a full rug.
N is for Non surgical options - Surgery is not always possible and in some cases it is not the best course of action. There are lots of non surgical options for treating the symptoms of kissing spine. It seems most vets are keen to try medicating the back in the first instance and we did try this using steroid injections with Jack prior to operating. Many people have successfully rehabilitated on steroid injections alone, others have used a combination of pain relief drugs, injections, SWT, physio etc to rehabilitate and avoided surgery. The steroid injection did provide some relief for Jack and gave us a window in which to try to rehabilitate him to open up the affected processes. Unfortunately the effect didn't last long enough for us to make enough of a difference and once the pain returned Jack was worse than ever becoming dangerous to ride and miserably unhappy. At this point he was re x-rayed and his back was even worse than before so both I and our vets felt further attempts to inject would be a waste of time and money and that an operation was the best course of action for a full and permanent fix.
O is for Operation - There a now several options for operating on a Kissing Spine the main 3 are:
1 ) Traditional operation which is done under general anasetic and involves completely removing the top section of every other affected vertebrae.
2 ) The ligament snip which can be done under local or sedation small incisions are made and the ligaments around the affected vertebrae cut to allow the vertebrae to move apart.
3 ) The Re-shaping operation which can be done under general or local anasetic and involves removing only part of the bone of the affected vertebrae.
Some vets offer their own variations of the different types.
6months after his diagnosis Jack was operated on by the super team at Oakham Equine Veterinary Hospital. They pioneered a variation of the reshaping and ligament snip operation where they shaved the bones of the worst affected vertebrae and then snipped the ligaments of the next few vertebrae. He stayed with them for 5 days after his operation and I was allowed to visit him on the 2nd day. I was pleasantly surprised how alert and happy he was. He came home with 10 days of bute and 5 days of anti biotics and a pad on his back to cover the wound. after 10days my own vet came and removed the staples. He had to have a total of 6 weeks complete box rest (no hand walking or grazing). After 6 weeks he returned to Oakham and was assessed by his surgeon and re X-rayed. At this point he was discharged and allowed to be turned out on his return home. He had a fairly large dose of sedalin to survive the journey, trot up etc and this was still in his system when we got home so he went straight into a small paddock so he didn't go tearing off and injure himself. He had a week in a paddock on his own next to his mates and then returned to the herd to relax and be a horse for a few weeks before rehab commenced.
P is for Patience - endless patience is required to rehabilitate a horse from Kissing Spine either with or without surgery. I think it is important not to put a rigid time scale on your rehab plan but rather listen to your horse and let them guide you when they are ready. There are so many times I have felt like we took a step back during rehab but I didn't let this bother me and didn't compare our recovery with others I just did my best to listen to Jack and back off when I felt he was telling me he needed a rest. We were given a basic rehab plan from our vet and although I did use it as a basic guide I took much longer at some stages as I felt Jack needed more time to adjust both mentally and physically. Fortunately this approach worked well for us and 10 months post surgery we were back out competing successfully.
Q is for Qualified help - I found out the expensive way that not all people advertising themselves as professional equine therapist are the same! I wasted a lot of money prior to Jack's diagnosis on so called professionals who all gave me different reasons for his behaviour. I now will only use vet recommended, qualified (and listed on the governing bodies website) people. I also like to have people who have personal experience with KS so both our physio and McTimoney Therapists have horses that have KS. I find this helps them understand the difficulties we have and they are more sympathetic to both Jack and me.
R is for Rehabilitation - Rehabilitation seems very scary to me in the beginning, despite so many years of owning and riding horses I'd little experience in rehabilitation from injury. I was so worried I'd do something wrong and screw up Jack for life! I discussed my concerns with my vet and they recommended I send Jack to a professional rehab yard with a water treadmill to begin Jack's rehab. After his box rest and then being turned away for a few weeks Jack was taken to Bennett Equine rehabilitation centre in Tutbury to begin his rehab. He arrived and settled well being introduced to the treadmill slowly, dry at first and with water height rising to mid cannon bone over a period of a couple of weeks. He stayed a total of 4 weeks and I visited him weekly to see how he was progressing. He also saw our fab physio Tamsyn regularly while he was there. I picked him up after 4 weeks and he was fit and ready to begin ridden rehab. This way I was able to avoid having to do weeks of lunging rehab which is such hard work on their joints and with Jack already having hock issues this was much better for him. Before I began any ridden work I had his saddle checked, while I was waiting for this to happen I kept him ticking over with alternate lunging in a pessoa and long reining sessions. Once his saddle was sorted I began by giving him a quick lunge then getting on to walk for 5 minutes to cool him down every other day, long reining in between. I was very careful not to rush him and regularly had to go back a step if he felt like he was struggling. Once I was confident he was ok under saddle I did lots of hacking building up the time and distance slowly over a period of months to build his fitness and muscles. I schooled only once a week at most during this time as I felt Jack needed a bit more time to mentally recover enough for schooling.
S is for Stretches - Daily carrot stretches have helped Jack become more supple and encourage him to engage his core muscles. I on alternate days do carrot stretches and fore limb stretches to help keep him soft in his neck and shoulders which seem to become quite tight. Jack like any other horse is a little one sided and tends to fall in on the left rein and fall out on the right rein through his left shoulder. I have had to work quite hard to get him to work his inside hind. Before I get on I will always turn Jack on a tight circle each way to get him to step under himself with his hind legs and back him up a few strides which helps. I will also always give him a good long warm up of at least 20mins before asking him to work.
T is for Turnout - Jack loves his field time, he is so much happier living out than in. Being able to graze naturally stretches the entire spine and moving about the field helps to keep him supple and calm to ride. Personally I think every horse should be turned out daily to give their mind and bodies chance to relax and stretch but I think it is especially important for a horse with back issues. I have to be careful with Jack's weight as being half native he is prone to piling on the pounds if he is on grass 24/7 but I find having him out at night and in during the day works pretty well.
U is for Unknown cause - A lot of us really want to know what caused our horse to develop a Kissing Spine but most of the time we will never really know. There are so many possible causes and it is often impossible to narrow it down to a single cause or event. There is a lot more research being done now a days into the causes of Kissing Spine. Jack is quite short coupled so it is possible he was born with the condition. He had never had a fitted saddle until I brought him, he was using in a riding school at a young age and ridden by lots of different riders, some heavier than others, which his back may not have been strong enough for. It could have been caused by him avoiding using his hind end correctly due to the arthritis in his hocks. It's possible it was caused by a field accident or a combination of all of these. I have been over so many scenarios in my head over the years trying to understand how we got to the point he was so bad that he was dangerous. I will never know and all I can do is try to avoid him getting like that again by following the advice from my vets, physio, rehab centre etc on the exercises to keep his back strong and healthy and use common sense. Jack has 3 monthly checks to ensure we are keeping on the right track and nip any issues in the bud before they develop.
V is for Vet - Our own vet is a small practice so for problems needing more in depth investigation and surgery they refer to Oakham Equine Veterinary hospital. I have had experience at Oakham with my previous horse (not kissing spine related) and knew what to expect. There facilities are excellent and the staff were very friendly and helpful. I think it is important to feel comfortable with your vet so that you can ask all the questions you need to, sometimes I had really silly questions but the vets, nurses and other staff made me very at ease and able to ask as much as I needed to put my mind at rest. I have found through talking to others who have been through KS surgery with their horses that nearly every vets approach to the surgery and recovery is different. I found this quite confusing to begin with but followed the advice of the vets at Oakham as they were the ones who knew and were treating Jack. Whenever I asked them about any aspect of the surgery or recovery they were able to provide me with a full explanation, in terms I could understand, to ease my worries. The whole time Jack was with them I was given twice daily updates and their care was exceptional. If I was not happy with any aspect of my vets advice or diagnosis I would definitely get a second opinion.
W is for Water therapy - Jack's surgeon recommend Water therapy or Hydrotherapy on an Aqua treadmill for his rehabilitation following surgery. As it was vet recommended it was covered under the alternative therapy part of my insurance policy otherwise I would have struggled to pay for it. The treadmill was at a specialist rehab yard with vast experience of rehabilitating horses with Kissing Spine or having had Kissing Spine surgery. After calling and discussing Jack's case with the rehab centre owner I was left in no doubt this would give him the best start on his rehab and give us the best chance of a complete recovery. After visiting the yard and seeing several horses at different stages of rehab working on the treadmill my decision was easy and it was definitely the best thing I could have done for Jack. In Jack's case we wanted to avoid the usual rehab of weeks of lunging in a pessoa as this would have put his arthritic hocks under a lot of strain and a month of working on the aqua treadmill is roughly equivalent to 6 weeks lunging. This meant that on his return he was at the stage of being able to begin ridden rehab. I still do water therapy with Jack about once a week but I now do it in the river by our yard (I'm very lucky to be close to a shallow part of a river!) I take him down and ride him in the shallows, the resistance of the water and the increased range of movement are good for both his joints and developing and strengthening top line muscle. Best if all its free!
X is for X-rays - As an X-ray is the only sure way to diagnose Kissing Spine. Our own vets mobile x-ray machine was not strong enough to penetrate the thick muscles of the back and get a clear image although they did indicate KS so we were referred to Oakham where their stronger x-ray machine was able to get a clear image which confirmed our suspicions. Although X-rays can confirm kissing spine they can't tell you what other issues are going on and sometime a horse with severe KS will show little signs while others who's x-rays show only mild KS may display severe ridden behaviours. How it effects each horse is different. A bone scan can provide further insight but is costly. Thermography can also give some indication of problem areas that might be worth investigating.
Y is for You Know Your Horse Best - I can't stress this point enough. It is so true with a horse with KS, you know them, you know what's best and if your horse is telling you something listen to them! I'm not suggesting you ignore professional help but listen to you gut too if you feel something is not right. My Physio has always said you can't hurt your horse by taking your time with him but you can do untold damage by rushing him. I always remember this and if I'm having problems with Jack I usually find the best way to deal with them is to back off, give him more time and try again another day.
Z is for ZZZ's - Rest for both your horse and you is really important, rehab is hard work for both of you!! Regular rest days help you both to recover both mentally and physically from the demands of rehab. I find 2/3 days of work then a rest day works best for Jack.
