The Problem Of Kissing Spine Syndrome

The Problem Of Kissing Spine Syndrome

The Problem Of Kissing Spine Syndrome (KSS, also called dorsal spinous process impingement (DSPI) is the discomfort caused mostly by an inflammatory response of the periosteum, the thin soft tissue layer covering the bone. When periosteum gets irritated, proportionate swelling will occur which makes it easier for the processi (see header picture) to touch one another. The formation of osteophytes (see header picture) narrows the gaps even more. That is why steroid injections are administered, however, there are many more things you and your vet can consider. If contact between spinous processes becomes bone-to-bone then of course there is no alternative to surgery e.g. gap widening or height reduction of alternative processes.

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The stability of any joint is determined by a) joint shape, b) ligaments/joint capsule and c) muscles. So it comes as no surprise that improving the top line (the erector spinae muscle group) is a very sensible thing to do. That starts with building top line muscle by way of feeding broad spectrum amino acids and other related nutrients. Beyond exercise including stretches, you keep this muscle group flexible by reducing cross-fibre linkage by way of transverse frictions (a particular form of massage), this is far more specific than Cyclomassage, not least because the latter doesn’t provide any feedback. Try to reduce reactive spasm by sustained well-tolerated pressure on myofascial points or with professional laser equipment. The benefits of electro-therapy is long established within physiotherapy and devices such as Arcequine or Vet H-Wave may help in addition to manual therapy but not instead of it. Also ours is a specialist feed supplement that can modulate the natural inflammatory response.

Beyond a raft of other nutrients, Aloeride aloe vera’s plant steroids, plant sterols and plant beta-linked polysaccharides can contribute hugely to keeping soft tissue cool. Reactive spasm comes secondary to an inflammatory response, so it would be no use to manually address the former without doing something about the latter. You shall want to improve the local perfusion, in the blood are the molecules that deal with inflammation, so the more blood flows to the affected area, the greater the chance of reducing inflammation. Local circulation can be helped by normal infrared (warm water bottle), deep infrared, high output ultrasound, laser or electro-magnetic fields (shortwave diathermy). Needless to state that circulation is improved by (slowly warming up) exercise assuming this doesn’t trigger the KSS. A professional review of the biomechanics with a view to loading and mobility around the Kissing Spine Syndrome level should be part of your approach.

Remedial Therapy for KSS

Be this done by a Chartered Veterinary Physiotherapist or a Registered Equine Osteopath or a Veterinary Surgeon, in the earlier stages of KSS the following will help to keep symptoms at bay: 1) Transverse frictions along the entire erector spinae (go much further up and down that where the KSS is located), 2) Follow this up by mobilising the neck in sideflexion/rotation i.e. get your horse to grab a piece of carrot that you are holding near its flank or behind its front hooves. Also mobilise the hip flexors as much as this is possible in a horse., 3) Spend much much more time on unloaded cardio-vascular exercise (lunge lines or Claydon Horse Exercisers), 4) Apply local warmth (FIR or Diathermy), 5) Apply slightly pulsed high output local ultrasound, 6) Apply local therapeutic laser, 7) Unfortunately you cannot use electro-acupuncture in horses but you can use manually-very-regularly-stimulated needles, 8) Feed 1 Aloeride sachet 1x/day – or 1 Aloeride sachet 2x/day in flare ups, 9) Complex homeopathic remedies Zeel and Traumeel (Heel GmbH) i.m. before considering corticosteroid injections, 10) address the cause why spinous processes deform due to otherwise natural pull exerted on them.

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The problem of Kissing Spine Syndrome (KSS) may well be preventable. Two horses, both in work, one develops osteophytes and the other one doesn’t. Soft tissue pull on osseous tissue is similar, yet in one horse the bone’s Calcium-Phosphate morphs into spikes (see header picture). This is where feeding for bone strength and bone density offers prevention as well as perhaps a remedial opportunity. Healthy bone isn’t just Calcium-Phosphate, for Calcium to lock into bone matrix trabeculae properly, your horse (and you) needs Boron, Magnesium, Manganese, vitamin D, vitamin K2. This is why at Aloeride we talk about nutrient intake, nutrient uptake and nutrient expenditure… it is over the first two that you have a handle. This is where Aloeride augments good grazing and good feeding. Finally, the rider’s body mass index is something that must be approached with sensitive persuasion. Saddle fit is another thing to check thoroughly. For both horse and rider this particular article may be of practical interest (click to read).

Boron and KKS

The relationship between Boron and KKS simply is that Boron makes bone tissue much harder. Boron helps bone maintain its genetically defined shape in spite of tensions put on it. In Kissing Spine Syndrome it is the strength of the spinous processes that falters. Boron is also used in treating laminitis and, in humans, Boron is used for the prevention and treatment of osteopenia and osteoporosis (see my article “When a racehorse jockey breaks his back“). Now you either make sure that the Boron content of your grazing is up to snuff or you (preventatively or curatively) supplement Boron. In respect of grazing please note that chemical fertilizers inhibit the uptake of Boron from the soil. An organic apple grown in rich soil may have 20 mg Boron, but if grown with fertilizer it may have only 1 mg of Boron, similar goes for the grass that your horse feeds on. If your soil is alkaline (pH >7.0) then a Boron deficiency is likely, same happens when you have low carbon, free draining soil. The best way to establish the soil’s Boron status is through soil / plant analysis (aim for on average 22ppm in pasture tissue e.g. 11ppm grass forage, upto 30ppm in alfalfa). Some vets recommend feeding a horse approximately 4g to 5g of borax once a week. Alternatively you dissolve 20g borax powder (one rounded tablespoon) in one litre of hot water and this then will contain 2,260mg of Boron – give each horse 30ml per day, preferably split over two feeds. This will provide each horse with about 67mg Boron per day or 474mg per week. As you read earlier, at Aloeride we always point out nutrient-intake, nutrient-uptake, nutrient-expenditure… well, Boron can increase the uptake of Calcium and Magnesium – just to name two inorganic minerals relevant to bone strength – by as much as one third. Beyond boosting nutrient intake (good organic aloe vera contains some Boron also), Aloeride helps the nutrient uptake over the gut wall. Bottom line is, between Boron and Aloeride you have a sensible and effective handle on how KSS progresses once it has been diagnosed.

Dietary Boron influences the activity of many metabolic enzymes, as well as the metabolism of steroid hormones and several micronutrients, including Calcium, Magnesium, and vitamin D. Boron supplementation in rats and chicks has been shown to increase bone strength. Boron may also play a role in improving arthritis, plasma lipid profiles, and brain function. [Journal Critical Reviews in Food Science and Nutrition, Volume 43, 2003 – Issue 2] Interestingly enough, in respect of Boron’s metabolic influence, research suggests that physiologic amounts of Boron may help reduce the amount of insulin required to maintain plasma glucose: dietary Boron deprivation induces hyperinsulinemia. Hyperinsulinemia is most often caused by insulin resistance (IR). Insulin resistance may eventually lead to the development of type 2 diabetes in humans but in horses IR is part of Equine Metabolic Syndrome.

The femur weight, bone mineral content and density, trabecular bone volume and trabecular thickness, were significantly higher in the exercise plus boron group (p < 0.005 to 0.0001). It was concluded that boron preserves bone mass in rats that have been exposed to intense exercise. [Influence of Boron Supplementation on Vertebral and Femoral Bone Mass…, Journal of Clinical Densitometry, 2002, Volume 5, Issue 2, Pages 187-192]

One empirical KKS improvement of many

Victoria Bax is both a three day event rider and re-trainer of racehorses, she started one of her horses on 1 sachet a day. Up to that point her vet had to come in at regular intervals to administer a steroid injection for KSS to keep her horse in competition. A significant time later another steroid injection was deemed necessary and the vet commented “wow that last injection must have hit the spot because that was a long time ago!”. It is reasonable to say that vets inject into the right spot almost always, so, it is reasonable to say that feeding 2,000mg of very helpful nutrients had something to do with the lengthening of the discomfort-free period…