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The short version: kissing spine (overriding or impinging dorsal spinous processes) is when the bony tops of the vertebrae under the saddle sit too close together, touch or overlap. It turns up most often between the 13th and 18th thoracic vertebrae, with the 15th the single most common spot. It is extremely common on X-ray, with anatomical prevalence as high as 92% in radiographic and post-mortem studies, but many of those horses are not in pain, so an X-ray alone cannot tell you it is the problem. When it is, horses usually do well: in a 68-horse controlled study, 95% of horses treated with standing interspinous ligament surgery came back sound with no recurrence, while back pain returned in more than half the horses treated with steroid injections alone. Below: the signs, the causes, how vets confirm it, every treatment option with its numbers, a horse called Rocky, and where hemp honestly fits.
What Kissing Spine Actually Is
Two bones that are supposed to have a gap between them, and don't.
Each vertebra in a horse's back has a tall fin of bone pointing upward, called the dorsal spinous process. In a healthy back there is a space between neighbouring processes, filled by the interspinous ligament. In kissing spine that space narrows until the processes touch, rub or overlap. Vets call it overriding dorsal spinous processes (ORDSP) or impinging spinous processes. "Kissing spines" is the barn name for the same thing.
Location is what makes it a riding problem. A 2025 review of the whole literature, by veterinary researchers at the Universities of Camerino and Perugia, describes it as primarily affecting the mid-to-rear thoracic vertebrae, from the 13th (T13) to the 18th (T18), with T15 the most frequently involved (Pilati et al., Animals 2025). That is the area directly under the saddle and the rider. A separate review of radiographs and bone scans from 604 horses found the caudal thoracic spine, T14 to T17, most often affected (Zimmerman, Dyson & Murray, 2011). It can also occur in the lumbar spine further back.
The most important fact about kissing spine is the one owners hear least: the X-ray finding is common and the pain is not. The 2025 review puts the anatomical prevalence in radiographic and post-mortem studies as high as 92%, and states plainly that not every horse with those changes shows clinical signs. The same review notes that the true rate of pain caused by kissing spine "remains speculative." So the question is never only "does my horse have kissing spine?" It is "is the kissing spine what is hurting my horse?"
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Kissing Spine by the Numbers
| Figure | What it measures | Source |
|---|---|---|
| Up to 92% | Anatomical prevalence of overriding processes in radiographic and post-mortem studies. Many of these horses had no back pain. | Pilati et al. 2025 review |
| T13 to T18, peak at T15 | Where it usually occurs: the vertebrae under the saddle. | Pilati et al. 2025 |
| T14 to T17 | Most frequently affected region across 604 horses imaged for back pain. | Zimmerman et al. 2011 |
| Thoroughbreds and older horses | Had higher radiographic grades in the 604-horse study. Warmbloods and Quarter Horses are also described as susceptible. | Zimmerman 2011; Pilati 2025 |
| 89% vs 95% | Horses whose back pain initially resolved after steroid injection vs after standing ligament surgery (68 horses). | Coomer et al. 2012 |
| 19 recurrences vs 0 | Horses whose pain came back after injection vs after surgery, in that same study. | Coomer et al. 2012 |
| 9 of 10 vs 4 of 8 | Long-term improvement after surgery in horses that responded to a pre-surgery nerve block vs horses never tested. | Brown et al. 2020 |
| 70% | Share of surveyed US vets who would consider surgery only after medical treatment failed. | Cited in Pilati 2025 |
Sources: Pilati et al. 2025 · Zimmerman et al. 2011 · Coomer et al. 2012 · Brown et al. 2020
"Radiographic and postmortem studies indicate that the anatomical prevalence of ORSPs can be as high as 92%."
Pilati et al., Animals, 2025 — which is exactly why an X-ray on its own cannot tell you kissing spine is the cause of your horse's pain.The Signs of Kissing Spine
Vague, behavioural and easy to blame on attitude. That is the problem.
The review describes the signs of back pain linked to kissing spine as "vague and nonspecific." What owners usually notice is not a sore back but a horse that has started saying no. These are the signs the literature lists, and what each tends to look like in the barn:
| Sign | What it can look like | Why it points at the back |
|---|---|---|
| Resents grooming over the back | Flinching, pinned ears, swishing or swinging away when you brush the topline. | Direct pressure over the processes and the muscles beside them. |
| Resents saddling or girthing | Moving off, biting, cold-backed dipping when the saddle goes on or the girth is done up. | The saddle sits exactly over T13 to T18. |
| Stiff, flat back under saddle | Hollowing, refusing to round or stretch, a choppy or "braced" feel. | The review lists hypomobility of the spine during ridden work. |
| Poor hind-end engagement | Trouble tracking up, disunited or lost canter, difficulty holding a canter. | The back transfers the push from the hind legs. |
| Jumping changes | Rushing, flattening, refusing, twisting over fences. | Named as poor jumping technique in the review. |
| Reluctance to bend | Stiff on one rein, resisting lateral work or tight turns. | The review notes reluctance to bend or move in certain directions. |
| Bucking, rearing, napping | New behaviour under saddle in a horse that used to be willing. | Classic "reluctance to work" that is pain until proven otherwise. |
| General poor performance | A horse that has simply got worse at its job. | The most common reason a back gets X-rayed at all. |
None of these signs is specific to kissing spine. Hind-limb lameness, sacroiliac pain, gastric ulcers, facet-joint arthritis and a badly fitting saddle can all produce the same picture, and adult horses often have more than one problem at once. The review says the logical starting point is ruling out other causes of lameness or poor performance before blaming the back. Treat the list as a reason to call your vet, not as a diagnosis.
What Causes Kissing Spine
Partly how the horse is built, partly how it is ridden, and partly still unknown.
- Conformation. A short back and particular process shapes, especially in Thoroughbreds, have been proposed as risk factors.
- Breed and genetics. Warmbloods, Thoroughbreds and Quarter Horses appear more susceptible, and a recent study found a correlation between lesion severity and a specific genetic marker, pointing to a heritable component.
- Age. Older horses had higher radiographic grades in the 604-horse study.
- Workload and discipline. Repetitive mechanical stress is a suspected contributor. The review suggests flat racing loads the back differently from dressage or show jumping, which may be why many racehorses with clear X-ray changes show no signs.
- Saddle fit and rider pressure. The review lists improper saddle fit and rider-induced pressure as possible causes of repetitive trauma. In a 205-horse study, saddle slip was significantly associated with hind-limb lameness, and riders' own back pain was linked to ill-fitting saddles (Greve & Dyson, 2015).
One finding challenges the idea that kissing spine is always caused by work. The review's lead author reported a comparable prevalence and severity of kissing spine in Thoroughbred yearlings that had never been in formal training as in adult horses. At least some cases seem to start early in life, before a saddle has ever gone on.
A Back That Took Five Years: Rocky
Rocky is a dark bay gelding at Horse Feathers Equine Center, a non-profit horse rescue in Guthrie, Oklahoma, and one of our rescue partners. He arrived after years of being ridden in a saddle that did not fit. It came down hard on his withers and left real damage along his back. Rocky's vets have not given us a diagnosis to publish, so we will not put a label on him here. His story belongs on this page because poor saddle fit is one of the acquired causes the research lists, and because what happened next is what good back rehab looks like.
There was no quick fix. Under the care of their veterinarians, the Horse Feathers team built Rocky a program and stuck with it for five years: veterinary care, chiropractic, stim therapy, herbal support, and HempMy Pet's equine oil in his feed every day. Today he is being ridden lightly again. The team recently redid his back work, and he is still on the oil.
"…after 5 years of being here [he was] able to be ridden lightly… We HIGHLY recommend it."
Cheri White Owl, President/CEO, Horse Feathers Equine CenterRocky's comeback came from a whole program of care led by his veterinarians, and the oil was one small part of it. Every horse is different, and his timeline is not a promise for yours.
How Vets Diagnose Kissing Spine
The X-ray finds it. The work-up decides whether it matters.
- History and clinical exam. Your vet palpates the back, watches the horse move in hand and on the lunge, and rules out lameness elsewhere first. The review notes there is still no universally accepted protocol, so exams vary between vets.
- Ridden assessment. Watching the horse under saddle often shows the problem most clearly, as long as it is safe for the rider.
- Radiographs. X-rays of the thoracolumbar spine show narrowed spaces, touching or overlapping processes, and bony remodelling. This is the cornerstone of diagnosis.
- Ultrasound. Shows the ligaments and muscles around the processes and guides any injections.
- Bone scan (scintigraphy). Shows active bone change. The review warns that abnormal scans also turn up in sound horses, so scans have to be read alongside the clinical exam.
- Diagnostic analgesia (a "back block"). Local anaesthetic is injected into the affected spaces. If the horse goes better, the kissing spine is very likely the source of the pain. In the Penn Vet study, 9 of 10 horses that responded to a block improved long-term after surgery, against 4 of 8 that were never blocked (Brown et al., 2020).
That last step is the one to ask for. If your horse has kissing spine on X-ray and you are being offered surgery, ask whether a back block was done and whether the horse improved with it.
Treatment Options, Side by Side
The aim of every option is the same: break the pain cycle so the horse can rebuild its back muscles.
| Option | What it involves | What the evidence shows |
|---|---|---|
| Corticosteroid injections | Steroid injected directly into the affected spaces under X-ray or ultrasound guidance. | Often the first step. In Coomer 2012, 89% of injected horses initially came sound, but pain came back in 19 of them. |
| Other medical treatment | Mesotherapy, Sarracenia purpurea preparations, or systemic bisphosphonates. | Used to cut local inflammation and pain. The review groups these as first-line medical management. |
| Interspinous ligament desmotomy (ISLD) | The ligament between the processes is cut through small incisions, usually standing under sedation. | 95% came sound with no recurrences, and the spaces widened on follow-up X-rays (Coomer 2012, 68 horses, not randomised). 13 of 18 improved long-term at Penn Vet (Brown 2020). |
| Ostectomy | Part of the affected processes is removed, open, endoscopic or standing. | Described in several case series with good owner-reported outcomes, but without objective measures or controls. |
| Shockwave, laser, acupuncture | Adjunct therapies alongside the main treatment. | Small studies show better pain thresholds, for example shockwave in 12 sport horses (Trager 2020). |
| Core-strength rehab | Ground poles, carrot stretches, resistance bands, incline or underwater treadmill work. | Builds the multifidus muscle that stabilises the back; elastic bands improved back stability in 4 weeks (Pfau 2017). |
Surgery and medical figures: Coomer et al. 2012 · Brown et al. 2020. Adjunct and rehab studies are summarised in Tables 2 and 3 of Pilati et al. 2025.
A note on how strong the surgery numbers are. The Coomer study was not randomised, and the surgery group had the more severe lesions, so the comparison is encouraging rather than conclusive. The review also reports that most horses in one US survey did not improve in the short term after surgery and still needed treatment later. Rehab is not optional after any of these options. All horses in the Coomer study followed the same controlled exercise plan and returned to work 3 to 6 weeks after treatment.
The oil in Rocky's feed
Full-Spectrum Hemp Oil for Horses · 5,000 mg
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Can a Horse With Kissing Spine Be Ridden?
Very often, yes. Riding is usually part of the treatment, not the enemy of it.
Many horses with kissing spine on X-ray are ridden and competed for years without problems, which is the point of that 92% figure. For horses that are in pain, the goal of treatment is to get them comfortable enough to work correctly, because correct work is what builds the muscle that supports the back. Your vet will set the timeline. In the controlled surgery study, horses were back in work within three to six weeks on a structured plan.
What changes is how they are ridden. Long, low warm-ups, plenty of transitions, poles and hill work, a rider who sits lightly, and a saddle that is checked regularly. In the saddle-fit study, well-fitted saddles were significantly associated with frequent saddle-fit checks (Greve & Dyson 2015). That is the one variable every owner controls completely.
Where Hemp Fits — and Where It Doesn't
We sell hemp oil for horses, so here is the honest version.
No study has tested CBD or hemp in horses with kissing spine. Not ours, not anyone's. If a brand tells you its oil treats kissing spine, it is ahead of the evidence. Hemp will not widen the space between two vertebrae, and it is no substitute for the vet work-up above.
Here is what the equine research does show. In a randomised study of 20 mature horses with mild joint osteoarthritis, horses given CBD oil alongside phenylbutazone had a median Horse Chronic Pain Scale score of 3, against 7 in horses given phenylbutazone alone, along with lower heart and respiratory rates (Interlandi et al., Frontiers in Veterinary Science 2024). That was joints, not backs, and a small trial. Our own equine formula was studied at Tarleton State University: a single serving lowered stall behaviours such as pawing compared with a control, and a dose study found no adverse effects at either dose tested. That research was about behaviour and tolerability, not back pain.
So hemp's honest role for a horse like Rocky is as one part of a daily routine, alongside the treatment and rehab your vet prescribes, to support comfort and normal movement. That is how Horse Feathers used it, and it is how we would suggest anyone uses it.
Before you start:
- Tell your vet. In one equine study, liver enzymes rose in 8 of 12 horses on CBD and returned to normal within 10 days of stopping. A study in ponies flagged an increased insulin response, so take extra care with horses prone to metabolic syndrome.
- Competition horses: cannabinoids are prohibited under FEI, USEF and HISA rules, and there is no published withdrawal time. Use hemp for pleasure, rehab, retired and rescue horses only. More in our horse safety guide.
- Dose by weight. One pump of our 5,000 mg oil is about 20 mg. The Tarleton studies used 0.3 to 0.6 mg/kg, which works out to roughly 7 to 13 pumps per serving for a 1,000 lb horse. Start at the low end. Full chart in our horse dosing guide.
| Your horse weighs | Pumps per serving (about 20 mg each) |
|---|---|
| About 500 lb (pony) | 4–7 pumps |
| About 1,000 lb | 7–13 pumps |
| About 1,500 lb (draft) | 10–20 pumps |
Ranges follow the 0.3–0.6 mg/kg range used in the Tarleton studies of our formula. A bottle holds about 250 pumps, or 3–4 weeks for an average horse at about 10 pumps a day.
What to Do If You Suspect Kissing Spine
- Write down what you see. When it happens, under saddle or in the stall, on which rein, and how long it has been going on. Short videos help your vet more than any description.
- Get the saddle checked. Have a qualified fitter check it on the horse, especially if the horse has changed shape or the saddle has changed.
- Book a vet exam, not just X-rays. Ask for a full lameness and back work-up so other causes are ruled out first.
- Ask about a back block before surgery. A positive response to diagnostic analgesia is the best evidence that the kissing spine is the source of pain.
- Commit to the rehab. Whatever the treatment, plan for weeks of structured core and topline work afterward. Rocky's took years.
- Add supportive care with your vet's OK. Bodywork, shockwave, laser and a daily supplement routine can all sit alongside the main plan.
Frequently Asked Questions
Can a horse recover from kissing spine?
Yes, many do. The bones do not return to their original shape, but most horses can become comfortable and return to work once the pain is managed and the back muscles are rebuilt. In a 68-horse controlled study, 95% of horses treated with interspinous ligament surgery came sound with no recurrence of back pain, and 89% of horses given steroid injections initially came sound, although pain returned in 19 of those. Rehab afterward is what keeps them sound.
What are the first signs of kissing spine in horses?
The early signs are usually behavioural: resenting grooming over the back, dipping or moving off when saddled or girthed, a stiff or hollow back under saddle, trouble holding a canter, and new bucking, napping or refusals. None of these is specific to kissing spine. Hind-limb lameness, ulcers and poor saddle fit can look the same, so they are a reason to call your vet rather than a diagnosis.
Can a horse with kissing spine still be ridden?
Often, yes. Many horses with kissing spine on X-ray are ridden and competed for years without pain. For a horse that is in pain, riding is usually part of the treatment once the pain is under control, because correct work builds the muscles that support the back. In one controlled study, treated horses returned to work 3 to 6 weeks after treatment on a structured exercise plan. Your vet sets the timeline.
At what age does a horse develop kissing spine?
There is no single age. Older horses had more severe X-ray changes in a study of 604 horses, but a 2025 review reports a comparable prevalence and severity in Thoroughbred yearlings that had never been in formal training. So some cases appear to begin early in life, and the changes can progress with age and work.
What causes kissing spine in horses?
It is multifactorial and not fully understood. Suspected contributors include conformation such as a short back, breed (Thoroughbreds, Warmbloods and Quarter Horses appear more susceptible), a likely genetic component, age, repetitive work, and poor saddle fit or rider pressure. A 2025 review also reports cases in untrained yearlings, which suggests that not every case is caused by work.
How common is kissing spine in horses?
Very common on X-ray. A 2025 review puts the anatomical prevalence in radiographic and post-mortem studies as high as 92%. Far fewer of those horses are in pain from it, and the true rate of painful kissing spine is unknown. That gap is why vets use a full work-up, and often a diagnostic back block, before deciding the kissing spine is the problem.
What is the prognosis for horses with kissing spine?
Generally good when the diagnosis is confirmed and the horse gets treatment plus rehab. Long-term improvement after ligament surgery was 13 of 18 horses in one university study, and 9 of 10 among horses that had first responded to a back block. Prognosis is less certain when other back problems such as facet-joint arthritis are present, which is common in older horses.
How much does kissing spine treatment cost?
There is no reliable published average, and costs vary a great deal by region and by what your horse needs. The main cost drivers are the diagnostic work-up (X-rays, ultrasound, sometimes a bone scan and a back block), whether treatment is injections or surgery, whether surgery is done standing under sedation or under general anaesthesia, and the weeks of rehab afterward. Ask your vet for an estimate for each stage before you start.
How long is recovery from kissing spine treatment?
After injections or standing ligament surgery, horses in one controlled study returned to work 3 to 6 weeks later on a structured exercise plan. Building enough core and topline muscle to protect the back takes longer, typically months of consistent work. Rocky, the rescue horse on this page, took five years of combined care to be ridden lightly again, so plan for the long game.
Can kissing spine be cured?
The anatomy does not fully return to normal, so most vets talk about managing it rather than curing it. Surgery can permanently widen the spaces between the processes, and follow-up X-rays in one study showed the spaces had widened significantly. With the pain controlled and the back muscles rebuilt, many horses live and work comfortably, sometimes with periodic maintenance treatment.
Can CBD or hemp oil help a horse with kissing spine?
No study has tested CBD or hemp in horses with kissing spine, so no one can honestly claim it treats it. In a small randomised study of horses with mild joint osteoarthritis, horses given CBD alongside phenylbutazone had lower pain scores than horses on phenylbutazone alone. Hemp can be one part of a daily routine alongside the treatment and rehab your vet prescribes. Check with your vet first, especially for horses with metabolic syndrome, and do not use it in competition horses, because cannabinoids are prohibited under FEI, USEF and HISA rules.
For the daily routine, alongside your vet's plan
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Rocky's Full Story
Five years of rehab at Horse Feathers Equine Center, our rescue partner in Oklahoma.
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Serving by weight, what Tarleton State found, competition rules and what to ask your vet.
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The Short Version
Kissing spine is common on X-ray and much less common as a cause of pain, so the work-up matters more than the picture. If your horse is showing back signs, check the saddle, get a full vet exam, ask about a back block before surgery, and commit to the rehab. Most horses with confirmed, treated kissing spine go back to work. Hemp can be part of the daily routine alongside that plan, but nothing on the market has been shown to treat kissing spine itself.
Horse Feathers & Rocky · Bute for Horses · Equioxx for Horses · Adequan for Horses · Is CBD Safe for Horses? · CBD Dosage for Horses · Equine Case Studies · Ringbone in Horses · Navicular Disease · Banamine for Horses · Calming Supplements for Horses
Marc co-founded HempMy Pet in 2016 with his business partner Natalie Mondine, the company's COO. HempMy Pet breeds its own hemp genetics, grows them on its own Colorado farm, and formulates every batch in-house under human-grade standards — seed to sale, nothing sourced overseas. Every batch is third-party tested and the certificates of analysis are published. More about us.
Our own 5,000mg equine formula was the oil studied in a research program at Tarleton State University by Dr. Kimberly Guay, Ph.D., with Trinette Jones, Ph.D. and William B. Smith, Ph.D. In a single-dose study published in the Journal of Animal Science (2021), stereotypic stall behaviors were lower on CBD than on the control oil (P = 0.03), and a dose study recorded no adverse effects at 0.3 or 0.6 mg/kg. The transport-stress arm found no significant change in cortisol, and we report that too. Read what was measured.
Our canine research: HempMy Pet also ran a 90-day study of 37 dogs with chronic joint discomfort, overseen by Dr. Robin Downing, DVM, MS, with Lori Kogan, Ph.D. and Peter W. Hellyer, DVM of Colorado State University. Of the 32 dogs that completed it, 30 (93%) showed a benefit and 94% of owners reported improved quality of life. In 2005 Dr. Downing became only the third veterinarian in the world credentialed as a Diplomate of the American Academy of Pain Management; she founded the International Veterinary Academy of Pain Management and was the AVMA's 2020 Bustad Companion Animal Veterinarian of the Year. See our clinical trials.
This article is general information for horse owners, not veterinary advice. It is reviewed and updated as new peer-reviewed evidence is published, and where the evidence is thin or negative we say so.
How We Sourced This Article
Every figure above comes from one of these. Where we could read the full paper we did; where only the abstract is public we used the abstract.
- Pilati N, Pressanto MC, Palumbo Piccionello A, De Angelis Corvi F, Beccati F. Impinging and Overriding Spinous Processes in Horses: A Narrative Review. Animals, 2025. PMC12466526. Supports: location T13–T18 and T15, prevalence up to 92%, breeds, causes, the yearling finding, signs, diagnosis, the 70% survey figure and the adjunct and rehab tables.
- Zimmerman M, Dyson S, Murray R. Comparison of radiographic and scintigraphic findings of the spinous processes in the equine thoracolumbar region. Veterinary Radiology & Ultrasound, 2011. doi 10.1111/j.1740-8261.2011.01845.x. Supports: 604 horses, T14–T17, the breed and age effect.
- Coomer RP, McKane SA, Smith N, Vandeweerd JME. A controlled study evaluating a novel surgical treatment for kissing spines in standing sedated horses. Veterinary Surgery, 2012. doi 10.1111/j.1532-950X.2012.01013.x. Supports: 68 horses, 89% vs 95%, 19 recurrences vs none, odds ratio 24, wider spaces on follow-up, return to work at 3–6 weeks.
- Brown KA, Davidson EJ, Ortved K et al. Long-term outcome and effect of diagnostic analgesia in horses undergoing interspinous ligament desmotomy. Veterinary Surgery, 2020. doi 10.1111/vsu.13377. Supports: 13 of 18 improved, 9 of 10 vs 4 of 8.
- Greve L, Dyson S. Saddle fit and management: an investigation of the association with equine thoracolumbar asymmetries, horse and rider health. Equine Veterinary Journal, 2015. doi 10.1111/evj.12304. Supports: saddle slip and hind-limb lameness, rider back pain, and frequent saddle checks.
- Interlandi C, Tabbì M, Di Pietro S et al. Improved quality of life and pain relief in mature horses with osteoarthritis after oral transmucosal cannabidiol oil administration. Frontiers in Veterinary Science, 2024. PMC10876772. Supports: the pain-scale medians of 3 vs 7.
- Turner PL, Guay KA, Jones T et al. The Effects of Feeding Cannabidiol Oil on Behavior of Stalled Horses. Journal of Animal Science, 2021. doi 10.1093/jas/skab235.008. Supports: the Tarleton single-dose behaviour finding on our formula.
- Yocom AF, O'Fallon ES, Gustafson DL, Contino EK. Pharmacokinetics, safety and synovial fluid concentrations of oral CBD in horses. Journal of Equine Veterinary Science, 2022. PubMed 35307550. Supports: liver enzymes in 8 of 12, normal within 10 days.
Disclosure: HempMy Pet funded the Tarleton State research on our equine formula, donates product to Horse Feathers Equine Center, and sells the product linked on this page. We had no involvement in any other study cited above. Spotted an error? Email support@hempmypet.com and we will correct it.
These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. This article is general information, not veterinary advice. Rocky's story reflects one horse's experience as part of a veterinarian-led program of care; individual results vary. Consult your veterinarian before use, especially if your horse is pregnant, nursing, competing, or taking medication.
