Osteopathy vs Kissing Spine Surgery

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A few decades ago, 'kissing spines' was barely a term in the equine world. Horses with back pain were labelled difficult, disobedient, or simply unsound. Today, overriding dorsal spinous processes (ORDSP) is recognised as the most common cause of primary back pain in horses, with surgical interventions costing upwards of £1,700 per procedure — and the diagnosis appearing with increasing frequency across all disciplines and breeds. The question this thesis poses is not how best to treat the condition, but whether it can be prevented. The author, writing from within the equine community and drawing on both clinical literature and osteopathic philosophy, maps the biomechanics of the condition with precision. Kissing spine occurs when the dorsal spinous processes of the thoracic vertebrae — most commonly between T13 and T18, the site where the rider sits — come too close together, touching or overlapping where there should be a clear interspinous gap. The causes are genuinely multiple: early training before musculoskeletal maturity, poor rider technique that fails to develop core stabilisation in the horse, ill-fitting tack, compensatory guarding from hind limb lameness, and breeding practices that prioritise aesthetics over conformation. Archaeological evidence shows the condition predates modern equitation, which complicates any single-cause narrative and demands a systemic response. That systemic response, the author argues, is osteopathic manual therapy delivered consistently throughout the horse's working life. By maintaining full articulation of the musculoskeletal system, supporting optimal fluid circulation, and identifying somatic dysfunction at its earliest and most reversible stage, the osteopath acts as the body's early warning system. The TART framework — tissue texture, asymmetry, restriction, tenderness — provides a clinical language for catching minor dysfunctions before they cascade into the structural changes that drive spinous process contact. There are limitations honestly acknowledged: genetics, birth defects, and certain rider disciplines present challenges that no amount of manual therapy can fully offset. But the core argument holds — a horse maintained in functional health is a horse far less likely to need a surgeon.