Jenny E. Johnson, V.M.D.

Calabasas, CA

(818) 809-SHWV (7498)
(818) 878-9458 - fax

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  In This Issue  
What's New in 2012

Shockwave Therapy

   for Kissing Spines

Ask Dr. Johnson

Helpful Links

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Previous Issues
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  Previous Issues  

May 2010
Jumping Radio Show, Expanded Services

October 2009
Treating Arthritis with Shockwave Therapy

March 2009
Veterinary Chiropractic Services

September 2008
Shockwave Therapy and the Equine Foot

June 2008
Suspensory Ligament Injuries

April 2008
What is Shockwave Therapy?



What's New in 2012 with Oakhill Shockwave and Veterinary Chiropractic
January 2012

  The start of a new year is always a time of excitement, a time of looking forward to what the new year brings, and a time to institute changes and improvements.

  Here at Oakhill Shockwave and Veterinary Chiropractic, we will be striving to continue to provide excellent service to you and your horses and to appropriately expand the veterinary services provided in an effort to help your horses attain peak comfort. In addition, we will be providing educational newletters on a more frequent basis on a wide variety of topics related to the equine athlete.

  We will keep you informed of new offerings as soon as they are available. In addition, we would welcome any requests you may have either for additional services you would like to see offered by Dr. Johnson or for topics you would like covered in a newsletter. Please forward all suggestions to

  And we'd love to have you find and like Oakhill Shockwave and Veterinary Chiropractic on Facebook!

  Thank you all for your continued support and we look forward to a successful partnership in 2012.

Treating Kissing Spines with Shockwave Therapy
  In this issue of the Oakhill Shockwave and Veterinary Chiropractic Newsletter, I would like to address kissing spines and their treatment with shockwave therapy.

What are Kissing Spines?
  “Kissing Spines” is a term used to describe a painful condition that is the result of inflammation of the attachment of the interspinous ligament between two adjacent dorsal spinous processes (dsp’s) of two adjacent vertebrae. The technical term for this is an enthesiopathy. With kissing spines, the dorsal spinous processes are conformationally abnormal in that they are closer together than would be normal. This is a developmental abnormality. The severity of the conformational abnormality does not change, but there can be bony remodeling as a result of the inflammation present. It is possible for a horse to have severe kissing spines and not be painful if the horse is never asked to dorsiflex or round upwards at the affected area. In most equine athletes kissing spines are painful, and the level of discomfort can range from mild to severe.

Clinical Signs of Kissing Spines
  Kissing spines are not uncommon in sport horses and the clinical presentation can vary widely. Clinical signs of kissing spines can range from mild discomfort to the horse when saddled, reluctance to move forward under saddle, to severe back pain, to erratic and dangerous behavior. Kissing spines occur most commonly in the thoracic spine, which extends from the withers to the middle of the back. They may be found as a primary issue or in conjunction with hind end lameness.

Diagnosing Kissing Spines
  Making the diagnosis of kissing spines can be challenging. Clinical presentation of kissing spines can vary radically. A horse may show signs as subtle as not rounding properly over a jump, to resistance to particular movement when the saddle is in place, to easily identifiable and localized back pain, to erratic and unpredictable behavior when being ridden. This presents a diagnostic challenge in that the gait or behavior abnormalities are frequently difficult to repeat or reproduce in a consistent fashion. The history and clinical presentation along with physical exam and manual palpation by your veterinarian provide critical information that is important in developing the diagnostic picture. Diagnostic imaging including radiographs and frequently nuclear scintigraphy (bone scan) are essential to confirm the diagnosis.

Kissing Spines

Use of Shockwave Therapy in Treatment of Kissing Spines
  Treatment of kissing spines has always presented a challenge: how to overcome pain caused by a physical abnormality that cannot be corrected. In the past, treatment has revolved around local injection of steroids to decrease the inflammation of the surrounding soft tissue structures and thereby reduce the pain the horse feels. A much more aggressive technique that has recently been employed is to surgically remove the affected dorsal spinous processes. This, in many cases, means removing a part of the horse’s withers. While this treatment can be very effective in some cases, it is obviously a very invasive procedure.

  Shockwave therapy has proven to be a very useful and non-invasive tool in the treatment of kissing spines. It provides a potent anti-inflammatory affect and can help relieve the inflammation of the interspinous ligament and stimulate healing of the surrounding tissues. The clinical response to treatment with shockwave therapy is dependant on the severity of the changes and the physical or muscular conformation of the horse.

  The treatment protocol is dependent on the severity of clinical signs. Horses with mild pain or few clinical signs will typically respond well to 1to 2 treatments. Horses with more severe pain or poor conformation or muscling will usually require a more aggressive therapeutic protocol, with up to 5 shockwave therapy treatments administered at 2-4 week intervals. Additionally, exercises to rehabilitate poor muscling may be prescribed and chiropractic adjustments may be useful to help the horse attain more optimal biomechanical balance. Typically, horses with mild pain from the kissing spines will be rested for a minimum of 1 day following treatment and then longed for 1 week prior to returning to being ridden. More severely affected horses may be rested for a longer period of time, determined by the severity of the pain they are experiencing from the kissing spines.

  The treatment protocol in terms of number of treatments as well as number of impulses used will vary with each individual horse. The number of impulses used is dependant on the size of the lesion present. Horses with mild clinical signs respond well to treatment with shockwave therapy and typically 100% show improvement. The duration of pain relief provided by shockwave therapy can extend up to 8 to 18 months. Horses that are severely affected have a lower response rate, and typically around 65% of horses that have severe clinical signs will show improvement. Those horses may need a combination of therapies to achieve comfort levels needed for athletic performance. Shockwave therapy can be used in conjunction with steroid injection.

  Traditional treatment options for kissing spines have included injection, acupuncture, rest, proper saddle fitting, and in some severe cases, surgical removal of the affected dorsal spinous processes. More recently, shockwave therapy has been used with considerable success in treating kissing spines. It provides a non-invasive therapeutic option for treating an often frustrating condition in sport horses and can provide long lasting pain relief in many cases.


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