Groundwork: One of the Most Valuable Tools in Kissing Spine Rehabilitation
A diagnosis of Kissing Spine can understandably be one of the most worrying diagnosis for any horse owner.
When the radiographs show overriding or impinging dorsal spinous processes, it is very easy to focus on the images and the spine itself. However, successful rehabilitation is rarely about treating one structure in isolation.
Instead, we need to look at the whole horse - how they move, how they carry themselves, how they use their abdominal and spinal musculature, how they balance, and how they respond to exercise.
One of the most valuable tools that can form part of a carefully structured rehabilitation programme is groundwork.
Done correctly, groundwork can provide an opportunity to develop strength, coordination, posture, proprioception and neuromuscular control without immediately placing the additional demands of a rider on the horse's back.
What exactly are kissing spines?
"Kissing spine" is the commonly used term for overriding or impinging dorsal spinous processes (ORDSP), where the spaces between some of the vertebral processes become narrowed and the processes may come into contact.
Importantly, radiographic changes do not automatically mean that a horse is experiencing pain. Some horses have radiograpahic changes without obvious clinical signs, while other horses with similar-looking radiographs may have significant pain and performance problems.
This is why diagnosis needs to involve the horse's clinical history, physical examination, movement and where appropriate, diagnostic analgesia and imaging.
Research also highlights just how complex equine back pain can be. Back pain may involve bone, joints, ligaments and muscles, and the visible abnormality on an X-ray may not necessarily be the only source of the horse's discomfort. That is why rehabilitation needs to look beyond the radiograph.
Why groundwork?
One of the biggest advantages of groundwork during rehabilitation is that is allows us to work on how the horse moves before asking them to carry a rider. A horse experiencing back pain may develop compensatory movement patterns. They may brace through their back, avoid engaging their hindquarters and are likely to hollow rather than lift and stabilise their trunk. Over time, these adaptation can become habitual.
Groundwork gives us an opportunity to gradually re-educate movement and build strength in a controlled environment.
The science behind the exercises
There is growing research supporting the use of targeted exercise to influence the musculature responsible for spinal stability.
A particularly interesting study by Stubbs et al. investigated dynamic mobilisation exercises in horses. Eight horses performed a series of controlled neck flexion, extension and lateral bending exercises over three months, without ridden exercise. Ultrasound measurements showed a significant increase in the cross sectional area of the multifidus muscles at all six spinal levels examined, as well as improved symmetry between the left and right sides.
The multifidus is particularly important because these small muscles contribute to stabilising the spine. This doesn't mean that dynamic mobilisation exercises are a "cure" for kissing spine.
What it does demonstrate is that appropriately selected exercises can produce measurable changes in the muscles responsible for spinal support. That is highly relevant when we are thinking about rehabilitation.
The importance of the core
The horse's core isn't just the abdominal muscles. The central body axis provides stability for the spine and creates a platform from which the limbs can move effectively.
A review of equine core training and rehabilitation concluded that dysfunction of the deep stabilising musculature appears to be common in horses and that core training can have a therapeutic role when back pain is identified. The authors specifically discuss balancing exercises and dynamic mobilisation exercises as part of equine back rehabilitation.
More recent research continues to investigate exactly how different rehabilitation exercises influence the trunk musuclature.
A 2026 study measuring muscle activity during dynamic mobilisation and therapeutic trunk exercises found that particular exercises produced increased activity in muscles including the external abdominal oblique, rectus abdominis, and longissimus dorsi. The researchers found particularly strong activation during exercises involving lateral bending and pelvic rounding.
Again, this isn't about finding one magical exercise.
It is about understanding what we are trying to achieve with each exercise.
Groundwork isn't about making the horse work harder
One of the biggest misconceptions about rehabilitation is that progress means doing more. More repetitions, poles, transitions, time and difficult exercises. But rehabilitation isn't about constantly increasing the workload. It is about increasing the horse's capacity to move well.
A simple in-hand transition can be valuable if it encourages the horse to organise their body shift their weight appropriately and step underneath themselves.
A carefully introduced pole can challenge proprioception and limb placement. A change of direction can encourage the horse to rebalance. A correctly performed lateral exercise can encourage controlled mobility through the body. The quality of the movement is far more important than simply completing the exercise.
Why neuromotor control matters
One of the most interesting developments in equine rehabilitation is the growing focus on neuromotor control.
A 2025 review of the functional anatomy of the equine thoracolumbar spine and its relevance to rehabilitation highlighted that back pain can alter muscle activation patterns and that rehabilitation programmes should begin addressing neuromotor control.
This is particularly relevant to groundwork. Before asking a horse to become stronger, we need to help them understand how to use their body effectively. Strength without coordination isn't necessarily useful. A horse can become stronger while continuing to move poorly. Our aim should therefore be to develop strength alongside balance, coordination and appropriate movement patterns.
What does the research say about rehabilitation for kissing spine?
This is where it is important to be honest about the evidence. There is promising evidence surrounding rehabilitation and exercise, but we don't currently have enough high-quality research to say that a particular groundwork programme will resolve kissing spine in every horse.
A 2023 survey of equine veterinarians found that 82% of respondents reported seeing some level of improvement in clinical signs of primary back pain with rehabilitation alone. Rehabilitation exercises were the most commonly recommended rehabilitation modality with 95% of respondents recommending them.
However, this was a survey of veterinary opinion and clinical experience, rather than a randomised clinical trial proving that rehabilitation cures kissing spine.
Rehabilitation is not necessarily "instead of" veterinary treatment.
There can sometimes be an unfortunate divide between medical treatment and rehabilitation, as though an owner has to choose one or the other. In reality, the best outcomes are often achieved when the different parts of the rehabilitation team work together.
Veterinary assessment is essential for establishing whether the horse's back is actually painful and identifying potential pain sources. Depending on the individual case, treatment may include medication, injections, surgery or other veterinary interventions.
Rehabilitation can then form an important part of restoring appropriate movement, strength and function.
An international survey of equine orthopaedic specialist published in 2024 found that 71% of respondents preferred conservative management for overriding spinous processes and recommended surgery for horses that did not respond to conservative treatment. Controlled exercise was also one of the most commonly selected components of treatment alongside local injection.
Rehabilitation is not an after thought. It can be a significant part of the overall management plan.
The horse needs to be treated as an individual.
There is no universal kising spine exercise programme.
Every horse is different. Two horses can have very similar radiographs but completely different clinical presentations. One may have significant pain. Another may have no clinical signs at all. One may have developed extensive muscular compensation. Another may simply need changes to their training, saddle fit and conditioning. This is why exercises should be selected based on the individual horse's current ability, movement quality, pain status and rehabilitation goals. Exercises should progress gradually.
Ultimately, the goal of rehabilitation is often to return the horse to a comfortable and functional life, which may include ridden work.
Groundwork therefore shouldn't be viewed as something that replaces ridden exercise forever. Instead, it can provide the foundations for returning to ridden work. Before putting the additional load of a rider onto a horse, we want them to have developed as much strength, coordination, balance and confidence as possible.
Think of groundwork as building the foundations before putting the roof on the house.
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