10 min read Last updated: January 2026 Worried kissing spine will sideline your UK horse for good? Heres a clear, vet- and physio-backed 4month planstarting with 3 weeks of controlled walking and daily carrot stretchesshowing exactly how to build core strength, optimise saddle fit, and use the RHPE so you can reduce pain and return to regular work with confidence. Quick Summary Short on time? Here are the key takeaways. Area: Ridden Pain Check What To Do: Use the RHPE before, during and after sessions each week, and log behaviours. If pain is flagged, pause ridden work and adjust the plan. Why It Matters: Objective checks keep work painfree and guide safe progression. Common Mistake: Guessing comfort or ignoring subtle behaviour changes. Area: Saddle & Pads What To Do: Book a qualified saddle fitter to check balance and panel contact over thoracics. Use a shockabsorbing pad if advised and recheck fit as topline changes. Why It Matters: Correct pressure distribution reduces irritation under the saddle area. Common Mistake: Swapping pads or shims without professional fitting. Area: Core Activation What To Do: Do daily baited stretches (chin to chest/knees/fetlocks and lateral to girth) and add controlled hill walks when footing is safe. Keep reps slow and symmetrical. Why It Matters: Activates abdominals and lifts the back, easing thoracic loading. Common Mistake: Rushing reps or dropping stretches once the horse feels better. Area: Poles & Lunging What To Do: Start inhand poles 23 times weekly and 1015 minute lunges in a calm frame; consider Equiband Pro to cue core. Progress to raised poles and fan layouts gradually. Why It Matters: Encourages back lift, stride control and straightness without rider weight. Common Mistake: Overlong sessions or adding complexity before painfree basics. Area: Stepwise Progression What To Do: Follow four phases: settle pain, activate core, build strength/straightness, return to work. Only advance when the RHPE is clean; step back a week if new behaviours appear. Why It Matters: Gradual loading builds resilience and prevents flareups. Common Mistake: Advancing by the calendar rather than the horses comfort and quality. Area: Hoof Balance What To Do: Involve your farrier early; use shorter trim/shoeing intervals during rehab to maintain balance. Review mediolateral symmetry and toe length as posture changes. Why It Matters: Balanced feet improve posture and reduce compensatory back strain. Common Mistake: Focusing on the back while ignoring foot balance. Area: Physio & Vet Team What To Do: Work with an RCVS vet and qualified physio for manual therapy, targeted exercises and, if indicated, laser/PEMF or shockwave. Agree a written programme and review fortnightly. Why It Matters: A coordinated, evidencebased plan accelerates recovery and protects welfare. Common Mistake: Relying on single modalities or DIY plans without oversight. Area: UK Management & Safety What To Do: Use small pens and firm, nonslip surfaces in wet months; choose breathable, wellfitted rugs. Wear grippy boots and hivis for handwalking and keep daily notes of walks, stretches and RHPE. Why It Matters: Managing local footing and safety prevents slips and setbacks. Common Mistake: Overrugging, inconsistent surfaces, and poor handler safety habits. In This Guide What is kissing spine and where does it hurt? Early signs and how to confirm pain Can I keep riding during rehab? A proven 4month conservative rehab plan Postsurgery weeks 14: what changes? The rehab toolkit: saddle, rider, feet, physio and nutrition UKspecific management and common mistakes to avoid Kissing spine is no longer a career-ending diagnosis for many UK horses. With a structured plan and the right team, you can reduce pain, rebuild strength, and safely return your horse to regular work.Key takeaway: Most horses with kissing spine improve with a targeted, UK-friendly rehab plan built around core strength, correct posture, and careful progression and some are back in full training in around 4 months.What is kissing spine and where does it hurt?Kissing spine (overriding dorsal spinous processes, ORDSP) most often affects the thoracic spine under the saddle area, where rider weight can exacerbate pain. This is typically towards the back of the rib cage, around the mid-to-posterior saddle panels.Those bony fin-like projections along the top of the vertebrae can touch or overlap, leading to inflammation, muscle guarding, and reduced back mobility. As The Horse Physio explains, location matters: problems right under the saddle make poor fit and rider asymmetry particularly influential and fixable. Thats why rehab prioritises core stability, postural control, and saddle assessment from day one.Early signs and how to confirm painEarly signs include back pain, reduced performance, and resistance under saddle often in the saddle region because of the thoracic location. Confirm ridden comfort using a structured tool like the 20behaviour Ridden Horse Pain Ethogram (RHPE) and your vets examination.Common red flags include ear pinning, tail swishing, hollowing the back, napping, reluctance to canter, girthiness, and stiffness through transitions. The RHPE helps you track pain-related behaviours objectively before, during, and after sessions (The Horse Physio). Combine this with veterinary assessment and high-quality imaging when indicated. Also scrutinise the saddle; pressure points over affected thoracic vertebrae quickly amplify pain (Bark and Ride Physio).Quick tip: Watch your horses reaction during grooming over the saddle area flinching, dipping, or resentment can signal discomfort. A soft brush and consistent routine from our grooming essentials can make daily checks more comfortable and informative.Can I keep riding during rehab?Yes if your horse shows no pain using the RHPE, short, sympathetic ridden work focused on posture and back lift can help rehabilitation. If pain is evident, pause ridden work and build core strength in-hand first.Equine physiotherapist Sue Palmer (The Horse Physio) is clear on how to decide:If the horse is not in pain in his ridden work, which you can measure using the Ridden Horse Pain Ethogram, then its likely that ridden work will benefit him, as long as it is done sympathetically and with the aim of building and supporting core strength, postural stability, and spinal flexibility. Sue PalmerKeep early rides short, prioritise long-and-low frames achieved through relaxation (not gadgets that force the head down), and re-check the RHPE weekly. Ensure your saddle is assessed by a qualified fitter and consider a shock-absorbing pad from trusted brands like LeMieux to buffer pressure over the thoracic spine. If youre hand-walking on verges or quiet lanes, stay safe with supportive riding boots and highvisibility layers from our hi-vis selection.A proven 4month conservative rehab planNon-surgical rehab typically begins with around 3 weeks of box rest/hand-walking, before adding lunging and core work; some horses return to full training by month four. This structured, progressive approach is supported by work from the Ontario Veterinary College, summarised in Equus Magazine.Heres a UK-friendly framework you can adapt with your RCVS-registered vet and qualified physiotherapist:Phase 1: Weeks 13 Settle pain, start controlled movementBox rest or small, well-bedded pen turnout (especially vital in wet, muddy UK winters to avoid slips).1015 minutes of in-hand walking on firm, flat surfaces once or twice daily, increasing slowly if comfortable.Daily baited carrot stretches (chin to chest, to knees, to fetlocks; lateral to girth) to encourage thoracic flexion and back lift (The Horse Physio).Physio-guided manual therapy and, if advised, electrotherapies like laser or PEMF to settle muscle tension (IP Vet Physio).Discuss pain relief with your vet and review saddle fit now to avoid retriggering soreness when work increases.Phase 2: Weeks 46 Activate the core, mobilise the spineIntroduce in-hand pole work 23 times weekly, starting with 46 poles at walk, spacing to promote correct step length and back lift.Add short lunging sessions (1015 minutes) in a controlled frame. Many clinicians favour aids that promote abdominal engagement, such as the Equiband Pro (Equicore Concepts).Continue baited stretches and progress to gentle hill walks if footing is safe and the RHPE remains painfree.Protect limbs during polework with supportive horse boots and bandages to keep the focus on back mechanics, not knocks.Phase 3: Weeks 710 Strength and straightnessProgress pole configurations (fan shapes, slightly raised cavaletti) to challenge straightness and thoracic mobility without fatigue.Begin short, painfree ridden walks if the RHPE is clean and your physio agrees; prioritise soft, elastic contact and a swinging back.Use a well-fitted saddle plus, where appropriate, a shockabsorbing pad (see LeMieux pads and numnahs) to reduce focal pressure over affected thoracic areas.Phase 4: Weeks 1116 Return to workBuild duration in walk and trot with frequent transitions, shallow loops, and gentle lateral work to maintain lift and suppleness.Reintroduce canter only when the RHPE remains painfree in walk and trot, and core stability is evident from the ground.Maintain twiceweekly polework and weekly physio checkins initially; taper as consistency returns.Support softtissue recovery with targeted nutrition (omega3s, antioxidants like vitamin E/selenium) from our curated supplements range alongside veterinary advice.Pro tip: Progressions are earned, not scheduled. If you see new RHPE pain behaviours, stiffness, or resentment, step back a week and reestablish comfort before advancing again.Postsurgery weeks 14: what changes?After kissing spine surgery, the first month focuses on box rest or limited turnout, controlled inhand walking, and gentle manual therapy to manage muscle tension and early scar tissue. Youll still build core strength youll just start more cautiously.Gadd Osteopathy outlines Phase 1 (Weeks 14) as box rest or small penned turnout, short inhand walks, and light osteopathic/physio input to restore comfortable range through the thoracic spine. In UK winters, footing is everything: well-drained, nonslip yards and small pens prevent setbacks. Pain management is veterinaryled; your therapist will layer in gentle mobilisation and softtissue work to prevent guarding. Expect groundwork (poles, lunging with core aids) a little later than in conservative plans, and only as your surgeon and physio agree.Quick tip: Keep records. Note daily walking time, stretch reps, and any RHPE behaviours. Objective notes keep your whole team aligned and help your insurer and yard manager understand the plan.The rehab toolkit: saddle, rider, feet, physio and nutritionSuccess depends on saddle fit, rider technique, hoof balance, and targeted physiotherapy not one element alone. Addressing all four, plus smart equipment choices, is what shifts spinal loading away from painful thoracic segments.Saddle fit and pads A qualified saddle fitter should assess balance, panel contact, and wither clearance over affected thoracics. Shockabsorbing, welldesigned pads can buffer pressure while the back remuscles; our customers rate the quality and consistency from LeMieux.Rider influence Sympathetic riding that encourages a lifted, swinging back is nonnegotiable. Short sessions, frequent transitions, and tactful hands help. Consider a lunge lesson for your own position a small change in your symmetry can transform your horses comfort.Hoof balance Farriery is a cornerstone. Balanced feet improve posture and reduce compensatory strain along the kinetic chain (Dr Barbara Parks). Loop your farrier into the plan; shorter trim intervals during early rehab can help maintain balance as musculature changes.Physiotherapy and electrotherapies The consensus is clear:Physiotherapy is vital in the rehabilitation of horses with kissing spines. A tailored program may include techniques like stretching, in-hand pole work and electrotherapy. Exercises that promote flexibility and core strength are crucial. C Reynolds Vet PhysioExpect manual therapy, sports massage, and modalities like laser or PEMF, all used within a progressive exercise plan (IP Vet Physio, Bark and Ride Physio). Many UK practitioners are mobile, making yard-based rehab straightforward.Core activation tools and exercises Equine rehab specialists at Equicore Concepts recommend baited activations, inhand pole work, and lunging with the Equiband Pro to cue abdominal lift and controlled movement. Start simple; complexity comes later when movement is painfree and repeatable.Veterinary therapies Work with your RCVS-registered vet to plan analgesia and, if needed, therapies such as shockwave or mesotherapy, delivered under UK welfare standards (Animal Welfare Act 2006). Injections and more invasive steps are rarely first-line when conservative rehab and saddle/hoof/rider changes are still to be optimised.Safety and handler comfort Controlled hand-walking and roadwork demand sturdy, grippy footwear and visibility. Choose supportive horse riding boots and layer from our hivis collection for dark winter afternoons.UKspecific management and common mistakes to avoidIn the UK, manage mud with small pens and firm walking surfaces, dont rush ridden work before core stability, and avoid overrugging that restricts back mobility. Seasonal planning prevents avoidable setbacks.Winter and mud Limit turnout to small, well-drained areas in Weeks 14 to prevent slips. If your horse lives out, choose breathable, well-fitted turnout rugs that dont bridge the back or impede shoulder movement, and monitor weight/comfort daily.Spring and summer Capitalise on better ground to progress poles and hill work outdoors. Long daylight helps you fit in two short sessions rather than one long one kinder for backs rebuilding strength.Autumn Damp conditions tempt heavy rugs. Keep them as light as your horses condition allows to protect thoracic movement, checking for rubs as musculature changes. Continue RHPE checks as training ramps up.Common mistakesRushing straight back to schooling once pain eases build the core first, then the workload.Skipping the saddle/hoof/rider triad success relies on all three alongside physio.Inconsistent surfaces alternate between deep and slippery ground and youll court flare-ups; consistency helps tissue adapt.Neglecting daily stretches theyre the cheapest, most effective part of your programme.At Just Horse Riders, we recommend planning your week in advance, pencilling in two short core sessions, one physioapproved lunge, and one easy hack or inhand walk adjusting with the RHPE and your therapists input.FAQsWhat are the earliest signs of kissing spine in performance horses?Back pain, reluctance to go forward, hollowing under saddle, tail swishing, ear pinning, and resistance in transitions are common early clues, particularly under the saddle because the thoracic spine is often involved (The Horse Physio; Bark and Ride Physio). Confirm ridden comfort using the RHPEs 20 behaviours.Can my horse keep working during non-surgical rehab?Yes if theyre painfree on the RHPE. Keep sessions short and sympathetic, focused on postural stability and back lift. If pain appears, pause ridden work, review saddle/hoof balance, and return to inhand exercises until comfortable (Sue Palmer).How long does conservative rehab take?A structured plan can see some horses back in full training in about 4 months, following an initial 3week rest/handwalking phase and progressive lunging/pole work (Equus Magazine). Early, consistent intervention improves outcomes.What exercises help avoid surgery?Daily baited stretches, inhand pole work, and controlled lunging with coreactivation aids like the Equiband Pro are mainstays (Equicore Concepts; IP Vet Physio). Progress slowly to maintain flexibility without overloading.What role does the farrier play?Hoof balance is pivotal. Correct angles and symmetry improve posture and reduce compensatory back strain, supporting thoracic comfort throughout rehab (Dr Barbara Parks).When should I call the vet?If pain persists despite rest and a saddle check, or the RHPE flags repeated behaviours. Your RCVS-registered vet can discuss options such as shockwave or mesotherapy and coordinate with your physio under UK welfare standards.What kit is genuinely useful for rehab days?Coreactivation tools for lunging, ground poles, a wellfitted saddle with a quality pad (see LeMieux), supportive riding boots for you, and visibility for handwalking from our hivis range. Many owners also add targeted nutrients from our supplements collection after consulting their vet.Ready to start? Build your weekly plan, book your RCVS vet and qualified physio, and set yourself up with safe yardwear and simple rehab tools. For everyday essentials from protective horse boots and bandages for polework to breathable turnout rugs our team at Just Horse Riders is here to help. Shop the Essentials Everything mentioned in this guide, ready to browse. Shop Boots & BandagesShop SupplementsShop Turnout RugsShop Hi-Vis GearShop Riding Boots