How equine patients with back pain attributed to “kissing spines” can benefit from osteopathy.

As you most likely know, the modalities and treatment options available for treating back pain in equine patients are varied. This article looks at how osteopathy can be used to treat immobilities in the spine and other areas, and achieve long-lasting solutions to back pain.

KISSING SPINES

I have many clients who come to me because they have a horse with back pain diagnosed from radiographs, bone scans or ultrasound. The diagnosis of “kissing spines” is often given along with a poor prognosis and a lifelong sentence of “back problems”. I don’t think this is the case. Often, the back pain results from immobilities in the spine, back or pelvic viscera, fascia and muscles, and is often exacerbated by poor saddle fit, poor riding posture, and negative palmar angles in the feet, among other things.

Let’s start by taking a look at the sacrum osteopathically, and imagine how it could relate to kissing spines.

• When a rider has a nice easy seat and light hand, and the horse has his neck in front of the vertical, with the feet balanced and the saddle shaped to allow the back to flex and lift, the spine should come into flexion and the sacrum should move so that the cranial portion of the sacrum is slightly higher than the caudal portion. In these cases, the horse’s back lifts and the tail lowers. As you can see in Figure 1, the vertebrae get spaced further apart and the risk of kissing spines begins to decrease.

• Conversely, in the case of a rider with a driving seat or heavy hand; a horse with his neck behind the vertical; a banana-shaped saddle that puts pressure on the back preventing a rounded flexion; or a horse with negative palmar angles(especially in hind end), theopposite sacral position may occur. Some of the common osteopathic immobilities associated with the second picture (see below) include a depression or lack of motion in the cranial aspect of the sacrum, and in L4, L5 or L6. Often, the pelvic portion of the SI joint will lack full motion and be unable to move dorsally and medially.

This often creates a posture in which the hind legs are out behind the horse. The horse will appear to be unable to track easily into the front footprint when asked to move up. The psoas muscles on these horses are often contracted and tight, pulling the lumbar spine down and caudal towards the proximal femur and ilial wing. Viscerally, these horses often have restrictions in the groin area, near the inguinal ring or in the length of the suspensory ligament of the ovary. They can also have tension and restrictions around the branching of the caudal aorta and sacroiliac region.

As you can see from Figure 2, this posture positions the spinous processes closer together and makes kissing spines much more likely to occur.

The good news is that spinal remodeling can change, and either improve or worsen with our influence! Mobilizing the sacrum and visceral structures associated with this area can have profound effects on the ability of the horse’s spine to flex. This will then allow the horse to lift his spine and come under himself easily and efficiently by just mobilizing the spine using the gluteal muscles to lift the cranial sacrum.

OSTEOPATHY — 3 PILLARS OF THERAPY

One of the things that makes osteopathy so different from chiropractic is its three pillars of therapy: structural manipulation, visceral manipulation, and cranial sacral manipulation. All these are performed during each exam and therapy session to create maximum improvement and help make long-lasting changes.

Another interesting osteopathic connection

The diaphragm and psoas are intimately interwoven and connected right at Th17, Th18, L1 and maybe all the way to L3. This area is often where the back of the saddle rests. In many cases, saddles balance incorrectly and put excessive pressure on this area.

One side of the diaphragm is attached at the underside of the spine and transverse processes(where it interweaves with the psoas minor), and the other side attaches to the edges of the ribs(on the ventral side and cartilaginous portions of the ribs) and also to the caudal portion of the sternum. Restrictions in the sternum can then also add to tightness and restrictions in the ribs in the girth area and behind the withers.

I believe there are also connections between the hyoid and TMJ that are related to the restrictions in the sternum. For this reason, we can start to correlate hind-end lameness and restrictions with poll and TMJ restrictions.

When working on mobilizing the spine in the horse, I think it is critical to balance these“ventral line” restrictions that are pulling the spine and thorax ventrally and into extension. This includes manipulating and releasing the psoas major, psoas minor and iliacus; mobilizing the diaphragm and ribs; mobilizing the sternum and thoracic inlet; and mobilizing the TMJ and hyoid and its related structures.

It is common for horses to only need osteopathic treatment once every few months after their initial exam. Osteopaths believe in the idea that if mobility is created in the body, then the body’s natural immune response, nervous system response and vascular response to a given area will also improve and help the area maintain the correction and improve further on its own.

STRUCTURAL MANIPULATION

First, let’s discuss structural manipulation of the spine and sacrum. I frequently find that horses with back pain have very little motion in the sacrum. They especially have a hard time lifting up the cranial aspect of the dorsal.

I manipulate these areas by releasing the psoas muscles and supraspinous ligaments first, then use a long lever technique to have the horse lift the upper part of the sacrum and increase mobility in the SI joint. I also use a rotational/lifting long lever technique to mobilize the lumbosacral joint and create motion in the lateral joints of the L-S joint. Then I mobilize the pelvic portion and any rotational restrictions down the hind leg.

Most of the lumbar spine will become free just from these maneuvers, but any restrictions the area still present are then manipulated individually. Next, I look at the ribs and ribcage and any diaphragm connections holding it in restriction. Once these are released, I deal with any further thoracic restrictions and finish off with a sternal release.

VISCERAL MANIPULATION

What about visceral osteopathic connections of the lumbar spine and sacrum? From an osteopathic standpoint, we always need to take into account the neurological inputs to a given area — motor, sensory, and especially the autonomic nervous system. Hypertonicity and upregulation in the autonomic nervous system sympathetic chain ganglions can have an influence on the mobility of structures and overall health of the tissues and organs they innervate. This can happen due to a spinal immobility at the level of the sympathetic ganglion.

For example, lumbar immobility along L3 can affect the innervations of the bladder, flank area, stifle area and hip. Another example might be immobility in the suspensory ligament of the ovary, feeding back and impacting the sympathetic chain at the level of L1, L2or L3 and preventing lasting resolution of immobility when structural manipulations are perfomed in this area.

Sacral immobility can affect parasympathetic nervous system innervation to the majority of the body’s organs, as well as innervation to the perineal area and any area that is innervated by the sciatic nerve.

For this reason, any time I find restrictions in the sacrum, poll, TMJ and at least two or three continuous lumbar segments, I will include a rectal exam with manipulation of the organs and muscles restricted in these areas. I also find that indirect manipulation to the stomach and esophageal region can have a profound effect on releasing the chest and likely mobilizing and affecting the vagus nerve.

CRANIAL SACRAL MANIPULATION

Lastly, in order to really connect a horse from front to back, and allow fluid motion of the spine, osteopathic manipulation should include a cranial sacral exam and treatment. This may often include an assessment as part of the initial diagnostic exam, and involves treatment after all structural and visceral components have been addressed. This gives the osteopath the best way of having an effect using cranial sacral techniques.

Patterns that show a significant restriction in the skull and occiput on the midline will often show significant findings in the sacrum and coccygeal vertebrae, and vice versa. Patterns that show significant temporal bone asynchrony will also often have significant pelvic/ilial restrictions on the same side, and can be addressed structurally and with cranial sacral techniques.

Osteopathy can have a profoundly positive effect on back pain caused by immobilities in a horse’s spine and related areas. It’s a modality to consider next time you are presented with a equine patient that has been diagnosed with kissing spines.