Getting to the cause of the injury
Part 2 of Rollie’s story
In part 1 of our series we got to know our Director Jo Schneider and her horse Rollie who have been going through the upsetting rollercoaster of an unsound horse. Here in our second part we learn about how Jo uncovered that Rollie’s soundness issues were related to his Kissing Spines condition and what she’s doing to try and get her lovely home bred horse back to the competition arena.
One morning at 3am I suddenly ‘knew’, this injury we were managing, was not the main issue, there was something far more substantial and sinister going on. When I met with my equine physio Carly she had come to the same conclusion and so we decided it was time to bring in reinforcements. I went to a different ‘fresh’ horse specialist vet (Ruth at HorseMed here in the Adelaide Hills) and rather than looking at the presenting issue, I explained that I’d had ongoing symptoms for about 2 years and despite all the rehab and treatment he was doing, I couldn’t get this soft tissue injury to heal.
She agreed that the care he was getting should have shown more significant improvement in that soft tissue injury and after a full assessment including flexion tests, ultrasound, full x-rays (legs and back) it was determined that there was another issue at play where 4 of his thoracic dorsal processors in his mid back (right where the saddle sits) were quite close together. Now they were not significantly close to the point that they were rubbing. Apparently many horses with this level of interference do not present with pain however this is coupled with significant soft tissue inflammation in the area. So the question stands at this point, how much of the issue is related to this kissing spines, and how much is the soft tissue injury, and which one came first? Chicken or egg?
I made the decision to proceed with cortisone injections to address this issue. This would give me approximately 12 weeks (from May) to assess his response and gauge if this is considered to be the underlying issue. I also changed his saddle, not that there was anything drastically wrong with my saddle, but the fitter did think that it did have some pressure in the area of concern. I also felt that psychologically that familiar feeling on his back may be connected with pain association and might not help us move forward. Surprisingly finding a suitable saddle was the easiest part of this whole ordeal and my cousin had a quite rare but perfectly suited saddle that I was able to use!
After giving him a short break following the treatment, it was back to our lunging regime (which at this point he is getting very good at!). I kept up all the therapy and supplements I outlined previously and decided to add in dry needling to the mix which he seemed quite responsive to as well as starting him on 4cyte.
Don’t forget we were now effectively dealing with two issues, the kissing spines and the ‘original’ soft tissue injury. The Activo Med Power Pad was my absolute go to in this period. The difference in softness of the tissue even after a 10-15 minute treatment was remarkable, so I used this to manage the soft tissue injury (which remember hadn’t been able to heal yet after almost a year) while the cortisone worked its magic on his back.
I was seeing such good immediate results with the Power Pad (light & PEMF) but it still wasn’t ‘holding’, and so his vet suggested that shockwave therapy might be suitable in helping heal the soft tissue, so that’s what we did. Wow what an amazing difference that made! I found it really interesting as I’ve used a lot of different therapies in my time owning horses, but nothing with quite the response that I saw with the shockwave with Rollie. It was interesting in that it has a gradual effect over 3-4 days, and then that’s kind of it. But the effect it had on this injury was substantial. You could feel immediate reduction in tension, scar tissue and increase in softness and a ‘fullness’ or ‘roundness’ in the affected area that wasn’t there before. I ended up doing two sessions during this time and I believe this was critical in helping this area recover.
So to assess the kissing spines diagnosis and treatment, the main issue I now had to deal with was behavioural. After all of his pain associated with work and riding, combined with all of my (massive) guilt with pushing him when he was sore and getting it ‘wrong’ so many times, we now had a difficult cycle to break through.
One of my main challenges was when to push through a behaviour, and when to stop because it was painful. I brought back Justin the fantastic horseman who broke him in originally. Justin has an amazing ability to not only read the horse but simplify complex situations and explain it in a way that an emotional horse owner like me can learn and apply. This was pivotal in our progress as I learnt some tools I could use on how to assess pain responses, giving him the benefit of the doubt, but also creating discomfort when he was engaging in negative learned behaviors so he found more pleasure in moving forward.
It took about 9 weeks to get through this and get him to a point where he was working as what I would call a standard young, prelim horse. He could do circles, transitions, change reins, basic leg yields – all pretty happily.
So it seems that kissing spines is the issue. And I can’t tell you how relieved I was! I finally allowed myself to feel some hope that we’d worked it out and this could be resolved. I had my ‘old’ horse again – he was sensible and relaxed, he tied up quietly, his funny and cute character was coming out again, his eye was bright and he was inquisitive and interested in his surroundings and his work – my baby was back! It made me realise how much we had lost him in this pain and injury. More guilt for me.. but mostly joy.
For a couple weeks anyway. And then the cortisone wore off. And then more heartbreak – horses hey, who’d have them?!
Working things out
So the good news – the soft tissue injury during this time was actually able to heal for the first time in at least 18-24 months. The response to the cortisone lends itself to the fact that the kissing spines is a significant contributor. His muscle and strength has increased significantly during this time.
The unknowns – we still don’t know what is the primary issue. Did the kissing spines create this soft tissue injury, are they unrelated but both couldn’t heal together, or did the soft tissue injury create inflammation in a vulnerable area causing the kissing spines symptoms? What exact part of this is causing the pain for Rollie?
So to find out we blocked the spinal area with local anaesthetic. I didn’t trust my judgement anymore so I had the vet, a nurse and the physio all watch me ride him before and after. The before ride he was resistant, I was nervous to push him as I could feel the potential for an aggressive acrobatic response (which I had developed some fear around – also not helpful), he was dragging his toes and unable to bend to the right.
After the anaesthetic, we saw improvement in the paces and I was able to push a bit and ask for both a rein change and a canter (both of which he cannot do if he’s in pain). So it seems that the kissing spines is a major contributor to the pain he is in.
I have decided to do another course of cortisone to give him another 12-16 weeks to build strength and assess how he can cope with work when he is not in pain. Given the majority of the last period was spent dealing with behavioural issues, I’d like to see how far we can get him while he can actually work comfortably for this period of time.
For now, I have just started his lunging post cortisone and will be riding him this week. My plan is to get him going again and pick up from where we left off in the next week or two. This will give us a solid 8+ weeks of work that he hasn’t had before. During this time I can assess his potential to undertake future work comfortably.
Side note – the Equiband has been an incredible piece of equipment and since the success with Rollie I have decided to stock them in Animal Therapeutics online store. I’d love to hear your experiences with them as this is my first time using one.
Also, now that the secondary soft tissue injury is largely resolved, we are also going to direct more attention to the local kissing spines area. With physio, dry needling, PEMF & light therapy, and shockwave directly to this area. I’ll let you know how this goes however given it has been aggravated since the beginning, I’m not naive enough to think a few months of treatment will solve it. But it might give us some indication of the likelihood of response for a future resolution.
Going through these notes has been an interesting and cathartic exercise. The benefit of hindsight with a clear outcome allows me to see signs all the way through that were not clearly visible at the time. This is comforting in a way as it clearly not something that was my doing or avoidable. Of course I feel guilt that we didn’t work it out earlier, but that’s hindsight isn’t it? The other thing it suggests is that perhaps the soft tissue injury was not in fact an independent injury, but that was possibly the result of uneven loading and compensation due to the kissing spines. The downside is that it’s likely that the kissing spines is conformational and was probably always going to be an issue. This of course holds the suggestion that long term this may not be a resolvable thing. Time will tell.
Stay tuned for more Rollie updates as we follow his journey together no matter where it may lead us. Kissing spines is only recently (in the past few years) being diagnosed more regularly so it’s a topic that needs more people learning, sharing and knowing more about it. If you have a horse with kissing spines let us know. We’d love to hear more about and share ideas for helping to get our horses back to soundness.