This OTTB Went From Kissing Spines Diagnosis To Makeover With Physical Therapy Instead Of Surgery – Horse Racing News

This OTTB Went From Kissing Spines Diagnosis To Makeover With Physical Therapy Instead Of Surgery – Horse Racing News

When Kathryn Jenkins and First Commander stepped into the ring as finalists for the 2020 Thoroughbred Makeover Show Hunter division in October 2021, it wasn’t just the culmination of many hours of hard work – it was a comeback story.

Jenkins had found First Commander, fondly known as Mattis, in early 2020 as she was on the hunt for a new OTTB project. She had lost her last Thoroughbred to a rare neurological disease which had resulted in some explosive behavior and was ready for a new challenge in a quieter package. Mattis seemed perfect, and as a bonus, he was eligible for the 2020 Makeover class.

The Makeover requires eligible horses to have made a start or entered a published workout within a certain timeframe in advance of the competition year, as its goal is to showcase off-track horses at the very beginning of their retraining. When Jenkins found him, Mattis hadn’t yet begun his under-saddle retraining but he looked relaxed, sound, and happy jogging and cantering at liberty in the field and passed a pre-sale veterinary soundness examination. He seemed sweet, quiet, and like he’d be a gentle kick ride – the perfect antidote to the intense, highly sensitive horse she had just lost. She fell in love immediately and took him home to her South Carolina base.

“He just seemed like a big dopey gelding who was real cute,” she recalled. “He seemed like maybe not the best mover, but he was what I needed at the time.”

Most horse owners have had a run of bad luck with their horses, where one problem sidelines them, only to be followed by another. Jenkins’ early months with Mattis were defined by such a run. He made the move to the warmer, damper winter in South Carolina and broke out with a painful bout of rain rot. When he recovered from that, he popped a splint. After the nagging splint calmed, he came up with a suspensory injury. As those periods of rest/recovery/return to work wore on, Jenkins would notice odd bursts of attitude changes in her formerly sweet gelding – an unwillingness to go forward, sometimes sprinkled with sudden and aggressive tantrums. A diagnosis of serious ulcers seemed initially to be the explanation, but the progress he’d made after treatment quickly plateaued. When he came back from his lay-up with the ligament injury, he was a different horse – and not in a good way.

“Then the wheels really fell off. All the mean personality changes really came back,” she said. “I figured something was wrong, so I asked my vet to x-ray his back. She was like, ‘Let’s just rescope for ulcers’ and I said ‘No. Something’s wrong with this horse. He’s five years old. This doesn’t just happen.’

“I was at work and she texted me pictures of the x-rays and didn’t say anything. We’d found the problem.”

The radiographs showed a serious case of kissing spines, the common name for impingement of the dorsal spinous processes in a horse’s back. When seen on x-ray, horses’ vertebrae have long fin-shaped projections at the top. These are covered with muscle and tissue to form the rounded shape we’re used to seeing when we throw a saddle on. Normally, there should be a gap in between each fin in a radiographic image, the same way there are gaps on x-ray between human vertebrae because those spaces are filled with soft tissue which doesn’t show up on a radiograph. In kissing spines, the fins of two or more spinous processes appear in the image to touch, creating painful pinching and friction.

With the advent of digital radiography strong enough to take imagery of a horse’s back, kissing spines has become a more common diagnosis among riding horses in recent years. Thoroughbreds are thought to be at a slightly higher risk than other breeds, but the disorder does not seem to discriminate based solely on age or breed. Affected horses experience significant back pain and may demonstrate this in a variety of ways, including resistance to exercise, unnatural or asymmetrical movement as they try to minimize the need to move their back, or personality changes. Secondary limb injuries can also be seen in cases where the horse will move forward but does so awkwardly.

This radiograph shows an example of kissing spines in another horse

One of the go-to treatments for many practitioners facing kissing spines is a surgery called inter-spinous ligament desmotomy, in which the ligament between two problematic vertebrae is cut, allowing the bones to move apart and return to their correct position.

“He’s not really a surgical candidate because he doesn’t handle stall rest well. At all,” said Jenkins, who had struggled to keep Mattis from injuring himself or others during his ligament rehabilitation, even with heavy sedation. “They said, ‘You can try turning him out for six months to a year and maybe he’ll fuse and you can have a retired 5-year-old. Or, nobody’s going to fault you for putting this horse down.’”

In despair, Jenkins posted on her Facebook page about her options. That’s when she heard from the trainer who sold her the horse, suggesting she reach out to Dr. Chris Newton, partner and ambulatory veterinarian at Rood and Riddle Equine Hospital.

Newton approached Mattis’ case similarly to the way he approaches many other complex lameness cases – with the notion that the lameness problem a horse presents with is likely secondary to a longer-festering underlying cause, and with the idea that physical therapy can address that root cause long-term in concert with therapeutic drugs and (sometimes) farriery changes.

Prior to getting his veterinary degree, Newton grew up riding in Pony Club and eventing regularly. He still events alongside his veterinary practice, where he specializes in sport horse medicine, alternative medicine, physical therapy, and equine reproduction. His eventing experience has required him to understand dressage, and he has been able to combine some exercises from that discipline with his physical therapy approach to treating injuries in athletic horses.

Newton believes that veterinary understanding of kissing spines as a growing and recent problem may be influenced by our sudden ability to see it.

“Prior to the advent of digital radiography, we didn’t even talk about it,” said Newton. “Luckily I’m with Rood and Riddle, which has access to pretty high levels of diagnostics. I began to shoot radiographs on all of my pre-purchases’ backs, just as part of a study and would see a tremendous number of horses with impingement but who didn’t have any pain.”

In fact, it’s hard to know yet how many of those radiographic changes really are responsible for symptoms, and how many horses would x-ray the same way while appearing perfectly comfortable. Having a better system for imaging the soft tissues in a horse’s back would help better define how active the problem is, but Newton said the types of machines that would be strong enough to make an examination of those tissues in an area as dense as a horse’s back are probably a long way off for most equine veterinarians.

Newton’s examination of Mattis did confirm significant back pain which coincided with the radiographic findings. In lieu of surgery, Newton injected Mattis’ back muscles with a medication cocktail to reduce inflammation and cause mild numbing, and showed Jenkins how to use a set of long lines to encourage the gelding to stretch his head and neck down gradually, requiring him to lift slowly with his mid-back. A lifelong hunter, long lining was new to Jenkins, but she was willing to learn whatever she had to.

“It was amazing,” she said. “After his first injection, watching him move was incredible. He was a really nice mover, which I never would have known because he wouldn’t go forward.

“Initially I was long lining him in the dark, in the rain. I would not miss a day.”

Mattis on the lunge, showing the stretching motion Newton was asking for. Photo courtesy Kathryn Jenkins

Unlike humans, horses can’t be convinced to soldier on through physical therapy exercises that may initially cause pain or stiffness with a rational explanation about their long-term benefit, which is why Newton provides temporary pain relief while having owners work the muscles. The idea is the medication will wear off, but the horse’s back and core muscles will get stronger in the interim, helping them hold proper posture. While repeated treatments may be needed, they should become less frequent as the horse’s posture and gait improve, and eventually will no longer be necessary.

The physical work requires horses to stretch their head and necks down at the walk and trot, tightening their core and stretching their mid-back.

“In my opinion, [radiographic findings of kissing spines] is not the cause of pain, but it is the symptom of a hyperlordosis of the thoracic spine which primarily presents with neuromuscular pain and a progressive hyperlordosis due to inability to move the back,” said Newton. “So, accompanied with hyper-dorsoflexive physical therapy and pain removal, I have seen a significantly greater result than the surgical interventions that are currently being enacted.

“Just like treating carpal tunnel syndrome in humans, the surgical procedure, when not accompanied with occupational therapy, is fairly unsuccessful. The surgical procedure in horses not accompanied with physical therapy is fairly unsuccessful. I think that removing the pain and allowing the back to function in the anatomy that it has formed around since its fetal construction is a route we should go forward with in general.”

Jenkins is overwhelmed upon learning the pair came second in the 2020 Show Hunters division at the Thoroughbred Makeover

Now, a year after beginning the process, Jenkins said she has a different horse. Although Mattis never became a cuddly, in-your-pocket personality, his temperament is even and honest. She said he tells her the minute he encounters discomfort and trusts her to help them work through it together. He has discovered a love of the competition ring, adopting a focused and flashy effort there which he didn’t have before.

Although dressage was completely new to Jenkins, she found herself entering both the show hunters and the dressage at the 2020 Makeover. The pair were the highest-placing amateur rider team in 2020 dressage, and were second in the show hunters in a five-horse final that was otherwise populated by professional riders.

In hindsight, Jenkins knows they climbed a mountain together – and that for many people, it would have been easier to move on to a different horse.

“I’m really stubborn,” she said. “That’s probably a big part of it, and the other part is when we were having all these smaller problems, I didn’t quite realize the bigger picture. Once I realized the bigger picture I thought, ‘I can’t have another horse die. If I can do anything to save him, I will.’ My last horse, there was nothing I could do. With Mattis, I thought if I could give him a fighting chance, I’d do it. It’s paid off tenfold because minus the terrible kissing spine, he’s everything I wanted in a horse.”

Mattis and Jenkins plan to spend 2022 continuing in their home territory of show hunters, but also delve into jumpers and foxhunting, mixed in with their regular dressage work and occasional quiet trail rides. With the help of their physical therapy program, it seems the sky is the limit.

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