Possible Sacroiliac Issues

[Matafleur]

Hello everyone, I'm looking for experiences of return to full work after sacroiliac problems. This is probably a bit previous as we haven't seen the vet yet (booked for work up next week) but obviously I am over thinking while we wait.

Background: horse is training upper level dressage, was seen by an excellent sports horse vet 4 months ago and had both hocks medicated. SI was slightly reactive but thought to be caused by the hocks. Work has improved since until last weekend when the judge spoke to me after our test to say she thought he may be off on the RH. 7s for all trot work but penalised in the paces mark. I videoed him on the Monday eve and he did look lame behind. Physio is coming on Friday ( mainly to make me feel better!) and we are seeing the same vet the next week.

Is it unlikely now that he will be able to maintain the same level of work and collection? Even if the hocks are the underlying cause, I don't think medicating so frequently is sustainable, given it's only been 4 months since they were first done.

Or, is there a good prognosis for medicating again and dropping the work back to low level? I am gutted as his work has been better than ever the last couple of months but he doesn't have the best conformation and isn't the ideal dressage horse. But he has an exceptional brain and tries so hard that we've progressed to a point I didn't think would be possible. He is such a lovely boy, I would rather drop his work right back to a much easier level if that would be sustainable.

Obviously I'll discuss all of this with the vet but posting here to enable my obsessive overthinking in the meantime

 

[Traks]

Did they not talk about Arthramid for the hocks? It’s proven to be very effective in hock OA, and typically each injection lasts a good year or more so less frequently done. I would ask your vet about it, we did my mare in February it’s marvellous stuff!

 

[Peglo]

Did they not talk about Arthramid for the hocks? It’s proven to be very effective in hock OA, and typically each injection lasts a good year or more so less frequently done. I would ask your vet about it, we did my mare in February it’s marvellous stuff!

It doesn’t suit all hock diagnosis. It depends what’s happening in the joint. It wasn’t suitable for mine unfortunately.

 

[daffy44]

I think it varies hugely depending on so many factors, whether its a primary injury, a secondary issue relating to hocks/suspensorys, just general wear and tear etc. Also how upper is upper level, a GP horse will be asked to sit more than a psg horse etc. You need a good chat with you sports horse vet, also can be worth nerve blocking the SI to see how much it is affecting the horse, I hope what ever is found is fixable.

 

[Matafleur]

Did they not talk about Arthramid for the hocks? It’s proven to be very effective in hock OA, and typically each injection lasts a good year or more so less frequently done. I would ask your vet about it, we did my mare in February it’s marvellous stuff!

I asked about arthramid at the time but vet felt that HA and minimal steroid was the way to go. He has a superb reputation so I went with what he suggested. We also did tildren but obviously that wasn't specific to the hocks.

 

[Matafleur]

I think it varies hugely depending on so many factors, whether its a primary injury, a secondary issue relating to hocks/suspensorys, just general wear and tear etc. Also how upper is upper level, a GP horse will be asked to sit more than a psg horse etc. You need a good chat with you sports horse vet, also can be worth nerve blocking the SI to see how much it is affecting the horse, I hope what ever is found is fixable.

Yes, I'm reluctant to get into huge amounts of diagnostics as I'm not insured and I know im lucky for him to have stayed sound this far. He has an extensive amount of scarring on his left hind (and over his body) that makes me think the RH had a compensatory issue.

More PSG than GP, training piris and piaffe, little hope of passage! Excellent collection to the left but always more difficult when the RH is required to carry or push. But he definitely isn't designed for dressage and it's his brain and endless enthusiasm that's allowed me to train him this far.

I know I'm jumping the gun but I'm leaning toward seeing if we can get him sound and then letting him do low level stuff with someone else. If nothing else it's heartbreaking to get so close and then have them break.

We'll see what next week brings I suppose

 

[daffy44]

Yes, I'm reluctant to get into huge amounts of diagnostics as I'm not insured and I know im lucky for him to have stayed sound this far. He has an extensive amount of scarring on his left hind (and over his body) that makes me think the RH had a compensatory issue.

More PSG than GP, training piris and piaffe, little hope of passage! Excellent collection to the left but always more difficult when the RH is required to carry or push. But he definitely isn't designed for dressage and it's his brain and endless enthusiasm that's allowed me to train him this far.

I know I'm jumping the gun but I'm leaning toward seeing if we can get him sound and then letting him do low level stuff with someone else. If nothing else it's heartbreaking to get so close and then have them break.

We'll see what next week brings I suppose

That sounds sensible, but a nerve block to the SI is not that expensive, and it would at least tell you how much the SI is affecting the soundness, then you know better which area to focus on, as a compensating hind leg can also be a potential problem, I hope you get to the bottom of it.

 

[Traks]

In

I asked about arthramid at the time but vet felt that HA and minimal steroid was the way to go. He has a superb reputation so I went with what he suggested. We also did tildren but obviously that wasn't specific to the hocks.

thats fair enough, it does depend on severity and what you want to do etc. sometimes they try the steroid first and if no joy then try Arthramid so I guess see how it goes x

 

[ShouldHaveBoughtAGoldfish]

My beloved old boy came to me with having been thrashed and passed around, with severe DJD in both hocks. We medicated with cortico-steroids for a while until we could no longer get the needle between the joint to medicate. I made the decision to have both hocks surgically fused, which was a raging success and we returned to full work. The vet and I thought (perhaps optimistically) that being the secondary issue to the hock arthritis, the SI discomfort would subside and be manageable with lots of regular physio, remedial shoeing, specialised exercise plans and so on.

Not long (maybe 6 months) after being back in work, he felt "off" under saddle. Not lame - just not right and definitely not striding out properly behind. So I had the vet out again who confirmed the SI was now the primary issue. He proposed medicating the SI joint with more cortico-steroids to make him "ridable". I was advised that he could be a happy hacker "un-medicated" but that I may need to pop him a bute beforehand.

Obviously, it is a case-by-case basis and personal preference, but I decided not to medicate or bute-and-ride and to retire him young and field sound as I knew that medicating his SI would never undo the years of damage, it would be prolonging the inevitable and potentially making it worse for him in the long-term.

He ended up with navicular disease and coffin joint arthritis in both fores due to spending most of his little life compensating the back end issues.

If the hocks were the only issue, I would highly recommend surgically fusing but it can't and wont fix anything else.

 

[sbloom]

As I so often do, just keep in the back of your mind the perspective that all these issues are secondary, and the primary can often be unknown back in the distant past, even a birth trauma. Many horses can improve a lot if you work on the movement patterns once you have a pain free window, that the movement has caused these issues, ultimately, and fixing one symptom so often leaves something else to show the strain. I send my customers to the Slow Walk Work group on FB as a free starting point but there are a few good postural programmes now, as well as a few pros in this country who could work with you hands on with this sort of approach if you're local, but IMO they're not common.

 

[Matafleur]

My beloved old boy came to me with having been thrashed and passed around, with severe DJD in both hocks. We medicated with cortico-steroids for a while until we could no longer get the needle between the joint to medicate. I made the decision to have both hocks surgically fused, which was a raging success and we returned to full work. The vet and I thought (perhaps optimistically) that being the secondary issue to the hock arthritis, the SI discomfort would subside and be manageable with lots of regular physio, remedial shoeing, specialised exercise plans and so on.

Not long (maybe 6 months) after being back in work, he felt "off" under saddle. Not lame - just not right and definitely not striding out properly behind. So I had the vet out again who confirmed the SI was now the primary issue. He proposed medicating the SI joint with more cortico-steroids to make him "ridable". I was advised that he could be a happy hacker "un-medicated" but that I may need to pop him a bute beforehand.

Obviously, it is a case-by-case basis and personal preference, but I decided not to medicate or bute-and-ride and to retire him young and field sound as I knew that medicating his SI would never undo the years of damage, it would be prolonging the inevitable and potentially making it worse for him in the long-term.

He ended up with navicular disease and coffin joint arthritis in both fores due to spending most of his little life compensating the back end issues.

If the hocks were the only issue, I would highly recommend surgically fusing but it can't and wont fix anything else.

Thank you for sharing your experience, it's helpful.

I am back on the rollercoaster of hope again as the physio came on Friday and thought the hocks looked good. She said the SI wasn't that bad and while there was definite tightness that we haven't had before, it did loosen off. He was also moving better after a few days rest. His musculature is good, well developed and even so I'm hoping we've caught it quick and that will help.

It isn't really a problem if he needs to scale back to low level work tbh, I just hate the uncertainty.

Only 2 days until the vet now...

 

[Matafleur]

Thought I'd just update on this. Saw the vet yesterday who said he was only off very slightly on the RH and he was surprised that had been picked up by a judge. I showed him last week's video and then he agreed it was quite a lot worse at that point, but good that it had almost completely resolved with a weeks rest.

However, we are in the medication cycle now, he had his hock redone, and both sides of the SI which the vet thought would see him back to full work quite happily. But obviously he will need doing regularly (the hock at least) if I wanted to continue at the level we are. So overall positive, horse is fixed and should be sound, but I will think now about what I do with him going forward.