The Honest Equine

12/09/2026

⚠️ KISSING SPINE: The man, the myth, the legend. ⚠️

This is a long one kids so buckle up - you all know how obsessed with KS I am as a pathology.

Kissing spine is often spoken about as though it is one single problem with one single treatment.

But from an MSK point of view, it is much more useful to ask:

What are we actually treating?

Because pain, structure, soft tissue and function are not the same thing and different interventions target different parts of that picture.

A horse may have close or overriding dorsal spinous processes on imaging - that is the structural finding.

But - structure alone does not tell us the whole story.

There may also be local inflammation, nociceptive input and tissue sensitivity. There may be irritation or pathology involving the interspinous ligament. There may be secondary epaxial muscle tension, protective guarding and altered recruitment around the thoracolumbar region.

And then there is function…

• How well is the horse controlling the spine?
• How freely is the thoracolumbar region moving?
• How are the epaxial and supporting muscles recruiting?
• Has the horse developed compensatory strategies elsewhere?
• How is the pelvis moving?
• How is load being transferred through the body?
• Has pain changed the way the horse has learned to move?

This is where I think treatment discussions can become oversimplified.

▫️The steroid injection ▫️

A steroid injection, for example, is primarily targeting pain and inflammation.

It can reduce the painful or inflammatory environment around the affected interspinous region and, in some horses, that may significantly improve comfort.

But:

• It does not physically widen the gap between the dorsal spinous processes.
• It does not remove bone.
• It does not automatically restore spinal control or rebuild muscle.

-

▫️The ostectomy / bone shave ▫️

A bone shave or ostectomy is doing something completely different.

That procedure physically alters the bony anatomy and creates more space between the affected processes.

-

▫️ Interspinous ligament desmotomy ▫️

A ligament snip, or interspinous ligament desmotomy, is different again. It alters the interspinous ligament and local tissue environment.

-

▫️ Rehabilitation ▫️

That is where the focus shifts toward function:

• Strength
• Control
• Coordination
• Movement quality
• Progressive loading
• Rebuilding the horse’s capacity to use the thoracolumbar spine effectively again.

-

So:

Steroid ≠ bone shave ≠ ligament snip ≠ rehabilitation.

They are not interchangeable because they are not trying to achieve the same biological outcome.

That is why “the treatment worked” can mean very different things.

• Did pain reduce?
• Did the anatomy change?
• Did the horse return to work?
• Did the horse return to the same level of performance?
• Did the horse simply become easier to ride?
• Did spinal function actually improve?

Those are all different outcomes.

From an MSK perspective, perhaps the most important part comes afterwards.

Because - even if pain has been successfully reduced, the horse may still have spent weeks, months or even years protecting that region.

→ Guarding does not necessarily disappear overnight.
→ Muscular weakness does not immediately reverse.
→ Altered recruitment patterns do not automatically normalise.
→ Compensatory movement strategies can remain even when the original pain generator is much quieter.

So, the horse still has to relearn how to use the body well.

This means restoring appropriate spinal movement, improving muscular recruitment, rebuilding strength and endurance, addressing compensation and gradually increasing load until the horse can tolerate the demands of normal work again.

This is also why two horses with very similar radiographs can behave, move and respond completely differently.

The X-ray is important, but it is one part of a much bigger clinical picture.

Treating the radiograph and rehabilitating the horse are not the same thing:

• Pain matters
• Structure matters
• Soft tissue matters
• Function matters
• And good rehabilitation is about understanding how all of those pieces fit together in the individual horse standing in front of you.

⚠️ There is one part of the conversation that doesn’t get talked about enough: quality of life.

• Not every horse with kissing spine needs to return to ridden work.
• Not every horse will.
• And not every horse should.

Sometimes the kindest, most appropriate outcome is retirement, a lower-level workload, hacking, groundwork, or simply living comfortably without the pressure to return to the job they had before.

From an MSK perspective, success should not only be measured by whether a horse gets back in the arena.

It should also be measured by:

→ Is the horse comfortable?
→ Can they move freely enough to enjoy daily life?
→ Can they lie down, roll, graze and interact normally?
→ Are they able to cope with the physical demands we are asking of them?
→ And are those demands still fair?

❗️There is no failure in changing the goal.

Sometimes rehabilitation is about rebuilding performance.

Sometimes it is about rebuilding comfort.

And sometimes the most successful outcome is recognising that the horse’s quality of life matters more than getting them back to work.

This post is from an MSK and rehabilitation perspective and is not intended to diagnose kissing spine or recommend veterinary treatment. Veterinary diagnosis and treatment decisions should always sit with the treating vet.

10/09/2026

👀 WHAT IF THE PAIN CAN’T BE SEEN ON A SCAN? 🧠

We talk a lot about investigating behaviour.

Bucking.
Rearing.
Refusing to go forward.
Suddenly becoming dangerous under saddle.

And quite rightly, we’re becoming better at asking:

“Could this horse be in pain?”

But what happens when we investigate…and still can’t find the answer?

A fascinating case series looked at 14 performance horses with severe, persistent performance problems and dangerous ridden behaviour.

These weren’t simply horses that had bucked once.

They had undergone extensive assessment including lameness, neurological, myofascial and chiropractic examinations alongside diagnostic imaging. Multiple treatment attempts had failed to produce any meaningful or lasting improvement.

Eventually, the severity of their problems led to euthanasia.

And postmortem examination revealed something remarkable -

Every horse had moderate-to-severe inflammation involving dorsal root ganglia around the spine.

These structures form part of the sensory nervous system, carrying information towards the spinal cord and brain. Inflammation here may therefore provide a possible mechanism for neuropathic pain; pain arising from abnormal or damaged nervous-system function.

And here’s the bit I think deserves attention:

It couldn’t simply be seen on conventional imaging while those horses were alive.

* That doesn’t mean imaging failed *

It means not every source of pain is currently something we’re capable of visualising easily in the living horse.

But there is a HUGE caveat -

This was 14 very specifically selected horses with exceptionally severe presentations.

It does not mean:

Bucking = ganglionitis.
Rearing = neuropathic pain.
Normal X-rays = hidden nerve disease.

And - it certainly isn’t something an owner or MSK practitioner can diagnose from a single behaviour, or should take from a single behaviour.

In fact, the researchers emphasise that many horses displaying pain-related behaviour have identifiable, treatable causes and improve when those causes are addressed. These particular horses were unusual because extensive investigation and treatment produced little or only short-lived improvement.

But - I think the study raises an incredibly important question about the way we interpret horses:

* Absence of a diagnosis isn’t necessarily evidence of absence of pain *

Sometimes our diagnostic tools may simply not yet be able to tell us the whole story.

From an MSK perspective, that’s another reason I take patterns, changes in behaviour, palpation responses, movement and owner observations very seriously, without pretending any one of those things provides a diagnosis.

Sometimes my role isn’t to tell you what is wrong.

It’s to recognise:

“Something here doesn’t add up, and this horse needs further investigation.”

Behaviour isn’t proof of pain.
A normal scan isn’t proof of comfort.
And unanswered questions shouldn’t automatically become:

“He’s just being difficult.”

Sometimes science catches up with what the horse has been trying to tell us all along.

🔗: https://equusmagazine.com/behavior/behavioral-problems/neuropathic-pain-dangerous-equine-behavior

09/09/2026

😂 THE ICKS I GIVE MYSELF AS AN EQUINE MSK PRACTITIONER.

Apparently I have a very specific appointment vocabulary and absolutely no intention of changing it.

“Interesting…”

“Ooooh… HELLO.”

“Good girl!” because the horse literally breathed.

“I’m just going to watch them walk one more time.”

And the absolute lie of:

“I’ll be finished in a minute…”

20 minutes later 😭, sorry guys.

There’s also a very real risk that you’ll ask me one innocent question and accidentally receive a completely unsolicited biomechanics lecture because I’ve found a compensation pattern I’m far too excited about.

Occupational hazard, apparently. 😂

Fellow equine professionals - what’s an ick YOU give yourself at work? And owners… what does your therapist say EVERY single appointment? 👀

08/09/2026

👀 WHAT ARE WE ACTUALLY SEEING HERE?

This tape was applied across the thoracolumbar junction with tension through the centre of the application.

From the side, you can clearly see a small amount of skin tenting and superficial tissue deformation beneath the tape.

But this is the important bit:

The tape is not lifting the spine.
It is not separating the spinous processes.
And it is not mechanically fixing the back.

Kinesiology tape works much more superficially than that, no matter what someone on social media reports it as.

The elastic recoil of the tape creates movement and shear through the skin and superficial tissues, while also providing continuous sensory input to the nervous system.

In practice, that can influence things such as:

• proprioceptive awareness
• local muscle recruitment
• protective guarding
• movement confidence
• how the horse responds to motion through that region

For a horse showing thoracolumbar sensitivity, or tension, I’m far more interested in what changes functionally than whether the tape visibly “lifts”.

Does palpation response change?
Does the horse move more freely?
Is there less guarding?
Does thoracolumbar flexion appear easier?
Do transitions or backing improve?

That is where the useful information is.

And this is also why kinesiology tape should be considered an adjunct, not a treatment for underlying pathology.

If a horse is suspected of having conditions such as overriding dorsal spinous processes / kissing spines, veterinary investigation and an appropriate rehabilitation plan remain essential.

The tape may influence the horse’s sensory and muscular response around the area, and help from a therapeutic standpoint and assist with rehabilitation process and progress.

It does not, however, change the underlying bony anatomy.

Observe. Compare. Reassess.

08/09/2026

🤍 THE HONEST EQUINE COLLECTIVE

Want to understand your horse a little better?

For just 99p a month, The Honest Equine Collective gives you access to a growing library of subscriber-only equine education, real clinical cases and behind-the-scenes content.

And there’s already plenty waiting for you inside. 👀

🖐️ Palpating the Horse mini-series
Our latest 10-part series takes you through palpating the hindquarters - from anatomy and muscle tone to asymmetry, fascia, reactions to palpation and how I put findings together.

🩻 Fran’s Friday Report Breakdown
Real, anonymised reports where I explain what I found, what mattered and the reasoning behind my treatment and rehabilitation choices.

☕ Inside My Week
Come behind the scenes of my appointments and explore interesting findings, compensation patterns and real-life cases.

🩺 Clinical Corner
Deeper dives into equine musculoskeletal health, biomechanics, rehabilitation and the questions owners regularly ask me.

🔬 Research Made Simple
Equine research without needing a science degree to understand it. 😂 I break down the papers and explain what they actually mean for owners.

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Downloadable guides and resources created specifically for Collective members.

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And there’s much more planned.

Why did I make it only 99p? Because I want The Collective to remain an easy-access learning community.

You don’t need to be a professional.

You don’t need an anatomy degree.

And you definitely don’t need to know all the terminology and jargon.

You just need to be curious about your horse. 🐴

My aim is to help owners observe more, understand more and ask better questions, without encouraging you to diagnose your horse from a Facebook post!

For 99p a month, you can join, explore everything already inside and follow along as the library continues to grow.

🤍 Tap Subscribe on The Honest Equine page to join The Honest Equine Collective: https://www.facebook.com/61578154696163/subscribenow

Come and learn with us!

Observe • Understand • Question • Learn

07/09/2026

👀 Now THIS is interesting!

Definitely one to watch in the world of osteoarthritis research.

Most of what we currently do with equine OA revolves around managing the consequences of the disease; pain, inflammation, function, workload and maintaining the horse’s capacity to move comfortably.

This research is looking at something potentially quite different: whether targeting proteins called CDK8/19 could actually influence the disease process itself.

In an arthritic mouse model, researchers found improvements in movement, OA biomarkers and cartilage health following treatment with a CDK8/19 inhibitor.

BUT important research-head-on moment 🧠

This does not mean we’ve suddenly found a treatment that reverses arthritis in horses.

The work is still preclinical and was carried out in mice. The next step is further proof-of-concept research before we can know whether this translates into a safe and effective treatment for equine patients.

Still, the possibility of moving from simply managing OA symptoms towards therapies capable of modifying the underlying disease?

That’s incredibly exciting.

Especially considering how frequently we work with older horses and horses whose workload has to be adapted around arthritic change.

Promising? Absolutely.
Proven in horses? Not yet.
One I’ll be keeping an eye on? Definitely. 👀

Research spreads hope for new osteoarthritis treatment in humans and animals. Read more below

02/09/2026

Where does PREHAB end… and REHAB begin? 👀

We use both words a lot in the equine world.

But I think there’s a pretty important grey area between them that doesn’t get talked about enough.

Prehab is proactive. It’s about developing physical capacity, strength, coordination and resilience before there’s an injury to rehabilitate.

Rehab is different. It exists because something has happened: injury, pain, pathology, loss of function - and ideally has a clinical reason, an assessment and an appropriate plan behind it.

But then we get to the bit in the middle…

A horse develops an asymmetry.
They start moving differently.
Their topline changes.
One hindleg doesn’t seem to be contributing quite like the other.
Something that used to be easy suddenly isn’t.

Do we strengthen it?
Do we treat it?
Do we change the training?
Or do we investigate WHY it changed first?

And this is where I think the distinction really matters.

Because not every weakness needs rehabilitating.
Not every asymmetry needs correcting.
And equally, not every problem can be strengthened away.

Sometimes exercise is exactly what that horse needs.

Sometimes exercise is simply loading a body that is already compensating for something we haven’t identified yet.

Knowing the difference is a huge part of genuinely evidence-informed, horse-centred care.

And it’s one of the topics we’re getting into during a very exciting conversation coming this September. 🎙️

One hour. One conversation. No fluff.

I’m still not telling you who it’s with just yet… 👀

But I will say this: if you’re interested in prehab, rehabilitation, evidence-informed care and developing horses without constantly looking for something to “fix”, I think you’re going to enjoy this one.

The Honest Equine × ???
Coming 15th September 2026.

01/09/2026

Things owners apologise for at their horse’s treatment that genuinely DON’T bother me… 😂🐴

“Sorry, they’re absolutely filthy.”
I work with horses. I promise, grease is not going to offend me. 😂
Although if I lose my hand somewhere underneath it, we may have a problem.

“Sorry, they won’t stand still.”
They don’t have to stand like a statue. Moving, repositioning, looking around and responding to what I’m doing can actually give me useful information.

“Sorry, they’re being grumpy with you.”
Please don’t apologise for your horse communicating.
Ears, tail, posture, movement and reactions are all information to me. I’d much rather see their genuine response than have it corrected away.

“Sorry, I haven’t done the exercises.”
Just tell me! 😂
Life happens. Knowing what has actually been done helps me assess what we’re seeing now and decide what we do next.

“Sorry, I don’t know what you mean - can you explain it again?”
YES. Ask me.
You are absolutely not expected to know anatomy or biomechanics. Half of my job is helping you understand what I’m finding.

“Sorry, I feel like I’m telling you loads of irrelevant stuff.”
Keep talking. 👀
That random comment about struggling with one canter lead, suddenly refusing to stand for the farrier or feeling different downhill might actually be very relevant.

“Sorry, I don’t know if I’m imagining it…”
Tell me anyway.
You know your horse’s normal better than I do. A subtle change you’ve noticed can be incredibly useful when I’m building the wider picture.

“Sorry, they’re old/unfit/have no topline at the moment.”
I’m not there to judge what your horse looks like.
Age, workload, fitness, time off, previous injury and management are context, and context helps me understand the body in front of me.

And my personal favourite…

“Sorry, my horse is a bit weird.”

Excellent.

They’re a horse, and I love weird.

You don’t need to present me with the perfectly behaved, immaculately groomed, beautifully muscled version of them.

Give me your horse as they actually are.
Tell me what you’ve actually noticed.
And ask me absolutely anything you don’t understand.

That’s far more useful to me. 🤎

31/08/2026

And that’s a wrap for the week! 🤎

Finishing off with the beautiful Lexi, who at 19 years young is looking absolutely fantastic.

Lexi does have arthritic changes through her hocks, but she’s a great example of how much thoughtful, sympathetic management can matter as horses get older.

Her owner is really considerate about her workload, what they ask of her and keeping her comfortable - adapting things to the horse in front of them rather than simply focusing on age.

She certainly doesn’t look ready for her bus pass just yet 😂

That’s my last treatment done before I take a little week off! 🔔

I’ll still be around and answering messages as normal until Thursday, then I’ll officially be ‘out of office’ between Thursday - Sunday.

Anything sent during that time will be picked up when I’m back on Monday.

Time to give these hands a few days off too! 😂🐴

30/08/2026

🧠 🐎 YOUR HORSE HAS A TENDON OR LIGAMENT INJURY… WHAT ACTUALLY AFFECTS THE PROGNOSIS?

A tendon or ligament injury can be one of the diagnoses horse owners dread hearing…

But “soft tissue injury” isn’t a prognosis.

Two horses can injure the same structure and have very different outcomes.

Why?

Prognosis depends on considerably more than simply which tendon or ligament is injured.

Things that matter include:

→ The structure involved:
An injury to the superficial digital flexor tendon isn’t biologically or mechanically identical to an injury involving the suspensory ligament, deep digital flexor tendon or an accessory ligament.

→ Where the lesion is:
Location matters. Different regions of the same structure experience different forces and can have different implications for rehabilitation and return to work.

→ The extent of the damage:
Cross-sectional area affected, fibre disruption, lesion length and severity all contribute to the clinical picture.

→ What the horse needs to return to:
Returning comfortably to hacking isn’t the same rehabilitation target as returning to racing, eventing or high-level jumping.

And then we get to something owners sometimes underestimate:

Healing ≠ returning to normal tissue.

Tendons are designed to tolerate ENORMOUS loads while storing and releasing elastic energy (sometimes as much as 1000 - 2000kg, around 2x its own body weight!)

Following injury, the repair stages involve inflammation, proliferation and then a long remodelling phase.

The resulting tissue doesn’t simply regenerate overnight into an identical copy of the original tendon.

Collagen fibres have to reorganise and adapt to mechanical loading.

That process really takes months, not weeks.

Which is why another common misconception needs addressing:

REST ISN’T THE SAME AS REHABILITATION.

Reducing load is often necessary during the appropriate stage of an injury.

But eventually - healing tissue needs appropriately dosed mechanical stimulus.

Too much load too soon can exceed the tissue’s capacity, but too little load for too long doesn’t adequately prepare that tissue for the forces it’ll experience when the horse returns to work, and in the long term can be just as detrimental, or put the horse back to stage 1.

That’s where progressive rehabilitation becomes so important.

Protect → introduce appropriate load → reassess → progressively increase capacity.

Not:

Rest → wait → suddenly return to work.

This is also why I’d be cautious with claims that massage, supplements or any single therapy alone can somehow “repair” an injured tendon.

Nutrition matters. Veterinary treatment may matter. Rehabilitation absolutely matters. Adjunctive therapies have roles in particular cases.

BUT - and it’s a big but - there isn’t one magic ingredient.

The goal isn’t simply to make the horse look sound.

It’s to gradually rebuild the capacity of the injured structure, and the rest of the horse, to tolerate the demands we’re eventually going to place upon it.

• Muscle strength
• Coordination
• Joint range of motion
• Trunk stability
• Movement quality
• Cardiovascular fitness
• Progressive exposure to the specific demands of their job

They all become part of the return-to-performance picture.

Even then, a previous tendon injury can carry an increased risk of reinjury - that’s why prognosis should always be individual.

• The scan matters
• The horse matters
• The discipline matters
• The rehabilitation matters

And most importantly:

TIME OFF and REHABILITATION are not interchangeable.

A tendon can be given time.

Rehabilitation is what progressively prepares it - and the horse attached to it - for what comes next.

Any suspected tendon or ligament injury requires veterinary assessment. Rehabilitation should be guided by diagnosis, imaging where appropriate and veterinary recommendations.