The trouble with X-rays
Findings of diagnostic imaging do not always match the symptoms. This can make rehab especially tricky.
Kissing spines
Findings of diagnostic imaging do not always match the symptoms. This can make rehab especially tricky.
Lately I've been reading a lot of research done on human athletes, especially how diagnostic imaging, primarily x-rays and MRI actually poorly corelate with symptoms. In a nutshell, it happens very often that the person is experiencing severe back pain, but there is nothing that can be found on the X-ray or MRI. On the flipside, we might have a person who is perfectly well-functioning, with no major complaints, whose spine might look horrid on X-ray or MRI. What gives?
The truth is, there is still sooooo much we just don't know about to musculo-skeletal pathologies, pain pathways and movement dysfunction. We see a similar thing in horses. Sometimes the diagnostic imaging just does not fit into the clinical picture. With humans it's much easier though, because they can tell us that despite their spines looking like a train wreck on MRI, their back actually feels fine. With horses we do not have this luxury.
To make matters worse, back pain often shows up as a secondary or even tertiary issue. So, it's not uncommon to have a horse with back pain and while looking for a cause we stumble upon a kissing spines diagnosis. At this point it's very tempting to conclude the horse's back pain was caused by kissing spines and focus on that. But what if that's not the case? What of the horse is experiencing back pain due to a subtle hind limb lameness and the kissing spines actually don't bother him at all? If we miss this and just focus on the kissing spines it will be very hard to make any meaningful progress, because we are not addressing the real problem.
So, what can be done? It's a pretty tricky situation and one that does not have a clear-cut solution. Being aware of this discrepancy between diagnostic imaging and symptoms is a good start. This will enable you to be more thorough and think outside the box. It might also make the diagnosis of kissing spines seem a little less hopeless. How so?
Well, yes, your horse has kissing spines. But no, it does not necessarily mean he has to be retired. I'm not saying we should ignore X-ray findings and keep riding the horse without changing anything. Even if the horse has no symptoms today, he might have some tomorrow. So, upon getting the diagnosis, we should start thinking about a game plan. What can we do to make sure the horse's spine will be as safe as possible? It's useful to actually write down the plan (consult a professional at this stage), and start implementing it asap. This will enable to horse to function as best as he can. And if he does have symptoms and they don't get better despite our efforts, keep looking. Maybe there's something you're missing. Musculo-skeletal dysfunction can be a hard puzzle to tackle (both in human and equine athletes), but we owe it to our horses to give it all we can.