Sacroiliac experiences please?

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Chunkie

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I would be grateful to hear from anyone who has or is managing a sacroiliac condition through excercise alone.

My mare has a sacroiliac injury sustained 12 months ago. I didn't know what it was at the time and on vets advice rested her over the winter and brought her back into work very very slowly at the end of February.

All was well whilst I was riding through the summer, then she had a foreleg lameness (probably a slight sprain although I never found out exactly what) which I gave her two weeks rest for. She then went sound on the front, but this then caused last year's injury to flare up due to the loss of muscle while she was resting.

We have been to the vets where she has been x-rayed & nerve-blocked. I am riding in walk almost every day on vets advice with the intention of trying her in trot again towards the end of next week.

The vet doesn't want to give her the steroid injection as she has mild laminitis. He doesn't know how effective Tildren will be, but would like to try shockwave therapy on her. I am unsure about that, as it requires box rest for 4 weeks, and to cut a long story short, that would be very difficult for me to manage.

Vet thinks I can probably keep her ok as long as she is fit, but that does mean I will need to ride all the time, because if she has even a week off, she can lose enough muscle to cause the injury to show itself again.

Any advice/experiences gladly received.
 
Hi - i'm around a year or so from where you are now

mine rolled and trapped a leg in post and rail - after months of rehab and no improvement a bone scan revealed some mild boney changes in his spine and a suspected sacrolilliac joint injury - the sc joint suspected to be the cause of his issues.

there was a 'shadow' over his sc joint area - this along with his action made the vet suspect this injury.

Rehab (as you've been recommended) improved to a slight shortening of stride in one hind in trot extension and a strange movement in canter. I was very much into dressage but he can't cope with the collection/engagement involved and is retired

however - the vet recommended that i keep him in work as long as he is happy - he's been built up slowley to assess what he can cope with - and seems happy hacking and handles long rides with no issues.

The vet had seen numerous sc injuries and in his experiance the only treatment worth trying was tildren - although this had only had effect in around 50% of cases and he was very non-commital.

He had steriod injection for his spine but he felt that it was a waste of time for the sc joint due to the the amount of muscle and the joint being enclosed (I *think* this was the term he used but it was a long time ago!) He did say there were loads of treatments he could try but he hadn't seen much/any success with them and thought that it would be a waste of money -

although he was showing potential for higher level dressage he's my pet rather than a competion horse, he may have become sound but continuing at the level he was was likley to cut his ridden life short. I made the decision i'd rather have him as a happy hacker for as long as possibe which likely lead to this advice.

I'm not sure of what shock wave treatment involves but having told the vet that i would try any treatment he thought might be worth a shot his only recomendation was the tildren (i don't know if this had any effect or if the combination of rest/rehab would have had this result anyway)

My lad's coping fine now - my physio advised to crack on and do what i wanted now and he'd tell me what his limits were (she's due for a 6 month check for any more subtle issues that i can't feel) the only limits i found is the higher level schooling as mentioned (ele/medium collected trot and extension) - i only pop the odd small jump when out due to a previous tendon injury so haven't tested jumping ability.

He lives out 24/7 now which seems to have helped no end (although this will be his 1st winter out so he may have a different opinion soon!) I excerise him roughly every other day - 15-20 minutes on the lunge or long low work ridden between hacks (this is to keep him ticking over enough for longer rides - mooching around the field seems to to prevent any issues surfacing in relation to the injury)

At the old yard he was stabled (overnight)and had turn out only in a small field - i had to feed hay most of the year- he took a long time to warm up - magnets helped. I noticed that issues would re-surface if he had more than 3 days off. He's now in 5 acres.

So to get to the point (can you tell i find that differcult!) he's more than likely got a lesser degree of injury. Any work that involves 'sitting'/taking weight through his sc joint is a no-no (although this is 18.2 shire x) or a large degree of extension results in shortness.

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My mare has a suspected SI injury (vet couldn't definitively diagnose as nothing showed on scans etc) with Spavin and now it's become clear that she has/had soft tissue damage in her front feet.... To be honest I suspect it is the foot pain which caused her to alter her posture (she leans back in an almost laminitic stance when grazing) which then cause the strain to her SI and the spavin.

Anyhow she became unrideable with the pain about 1.5 years ago and for a while I was very dispondent. However you'll be pleased to know it was the exercise regime which brought her back to the fun happy horse she was before.

I took her to a friend's yard for 2 months so that I could work her on a surface daily and gradually built her up. Nearly a year on she still has a slight gait abnormality (unless she's really working well she is slightly short on one hind and not quite straight) but other than that she's loving her work and very well.

I've also taken her barefoot as my otherwise brilliant farrier just couldn't keep on top of her odd hoof growth (they twist horribly). Now I can nibble away at them on a weekly basis you'd hardly know anything was wrong with them and her SI recovery has matched this change. (hence thinking it was the feet that started it all)

She isn't in a hard work load - ridden anything from 1-3 times a week and seems to maintain a good level of fitness from that. I do plenty of suppling exercises with her and have learned lots of stretches from the physio over the years so if she slips in the field and becomes stiff again I can ease her off. Magnets don't work for her but they do help my arthritic horse alot so they might help yours.

Oh and she's on arnica and MSM/glucosomine and occasionally Buteless and this combo seems to do the trick.

I'd suggest you stick with it, keep nibbling away at her fitness and I'm sure she'll stablise. Good luck.
 
I have one with an acute sacroiliac ligament strain and have been managing him for 3 yrs. He is an ex-sj who was overjumped as a baby and is now retired from sj (I used to do little jumps with him, but he would panic and rush anything over 2 ft so dont bother now, although theoretically he should be ok up to 3ft as he wont have to properly bascule over the jump).

I got some really good advice from Scarlett and Hussar on here.

Primarily, the secret is consistent work. Which is hard when you had an accident prone horse like mine who is also fond of abscesses.

You need to lunge, at least once a week, preferrably over trotting poles. This keeps the topline as much as possible. Then schooling x2 and hacking once or twice. The best is working every other day, or giving 2 days off after a long hack. My boy will become very unlevel behind after 2 hrs out.

Get a good chiro - the unlevelness in the pelvis causes a lot of poll tension and the chiro can help release this tension. Mine used to come every 2 months, and now we are up to 4 monthly visits. I also do lots of stretching with him (not as much as I should recently - will readdress!) and I also use the equilibrium massage pad to relieve any tension before and after I ride. They tend to be sensitive on their backs as they are unable to bring their legs underneath them to work properly.

If you can, go barefoot behind. I used to have mine shod all round, but he is so much more comfortable not having to abduct his leg behind for a long time shoeing, so now I just restrict roadwork to once or twice a week.

When you ride, make sure you are always trying to work him from behind to build as much topline as possible. And be very aware of saddle fit. Mine has a Saddle Company saddle (I am a fitter) and I adjust his saddle very regularly, as if he has more than 1 week off work he loses what little topline he has).

Supplement wise, he has a joint supplement (Superflex) and Boswellia everyday. On good days he is 1/10ths lame (most people cant tell he is lame but I can as he doesnt give me a true bend on the right rein - he tilts his head to the left to try and balance himself as he doesnt want to take the weight fully on that inside hind) and on bad days he is 4/10ths lame. For 2 days in every 3 weeks he also has 7 tablets each day of arnica and rhuta grav.

A magnetic rug in winter is also beneficial - mine wears one over night in the stable.

this is my normal routine:

day 1: rest
day 2: school 40 mins
day 3: rest
day 4: school 40mins / lunge 20 mins
day5: stretching/in hand work 10 mins
day 6: school 30 mins
day 7: hack 1-2 hrs

Sometimes I ride on day 5 as well if he is full of beans and I am not going to ride the next day, but he is generally in work 4 - 5 times a week.

I used to ride him everyday, but after 3 months he broke down and had to have 4 months complete rest. When bringing him back into work, I just lunged every other day for 6 weeks, then started riding at the end of a lunge session for 5 mins in walk, building up after each lunge session for 2 wks, then just went to ridden work. Largely this is due to the fact that my horse is quite sharp, so I cant just get on and ride him after 4 months off, but also because he has zero topline off after that much time so I would be literally sitting in his spine. Even if he has had more than a week off, I have to lunge a couple of times and hold off on canter, just doing lots of slow trotting to build up his muscles again.

I didnt have steroid injections for him, as he has a chronic injury, but for an acute I would treat with steroids and tildren if I caught it very early on and no/low risk of heart attack etc from Tildren.

Hope that helps.
 
Thank you all for your responses - it hasn't been easy for any of you, has it?

CBAnglo, it's interesting that you say it's best to work every other day, and that you used to ride every day until he broke down. I am riding almost every day on the vets advice at the moment (6 days out of 7), and notice that my girl is considerably better and more forward going the day after she has been rested. She is also quite short at the front and unlevel after I've been on her for an hour (I'm currently riding in walk only for 45mins to an hour & 15 mins per day).

I actually want to give her a good three/four months off but the vet seems keen to start the shockwave immediately. I think the rest first will benefit her, as she was very well after her rest last winter, and came back sound straight away.

Kizzyjerry, my girl lives out anyway, and I'm sure that helped when she had her rest period last winter - in fact the vet advised that I should only give her the time off if she was going to live out, as it wouldn't be of any benefit if she was stabled. However, that's where my problem lies with the shockwave - I'm just not set up to cope with a horse living in, let alone being box-rested!

I note that OrangeEmpire and CBAnglo both mention using Arnica going barefoot, so that will be something else to discuss with the vet.

Thanks again
smile.gif
 
To be honest, I havent had good experienced with shockwave for treatment on soft tissue - I doubt it works on ligaments, especially for something that isnt acute.

Is she covered by insurance? if not, then dont bother with shockwave. If she is short in front, then I would take her shoes off and chuck her in the field for winter. When you are bringing her back into work, get a good chiro (I use a McTimony one) to come and release any tension in her poll and to manipulate her sacroiliac area to try and release the toxins etc that may have built up. Then 6 weeks lunging, 20 mins every day. Introduce poles after 2 weeks and use them on alternate days. Then by week 6 you can have a sit on in walk for 5 mins, increasing the ridden work. Then go to riding every other day for 40 mins or so.

A vet told me to work him every day as well - but they have no idea what it is really like to manage a SI horse.

I wouldnt be without my chiro and my little bottles of arnica. Oh, and a natural pain relief - it is basically going to hurt when you ride, but they adapt to a very low level of pain. It is kinder to actually work them properly rather than to just retire as them as they will get stiff very quickly.

I only have one long hack a week - mostly walk, with some trotting and canter. I wouldnt do that more than once a week.

After adopting my new regime (sacked the useless vet) my chiro said this is the best he has seen my boy in the last 18 months.
 
My horse has just returned from Newmarket Equine Hospital having had a bone scan (scintigraph) revealing a 40% uptake in his left SI. The vet there, who we can all assume really knows her stuff has suggested strict box rest and bute for 8 weeks. A programme of inhand walking for 6 weeks, followed by 6 weeks ridden walking exercise.

There is also some foreleg lameness, requiring broad web seated out shoes, which is probably as a result of shifting weight of his hind legs as nothing unusual can be seen on x rays of pedal, coffin, laminae etc.

She advised that steroid injections are usually not possible into the SI joint, especially with my type of horse 15.1hh haflinger x section D as he is very compact and has round quarters. Laminitis is of course a risk even if it were possible.

I'm a little surprised that everyone is saying they are exercising their horses as the SI is an immobile joint which after suffering any dysfunction needs to be stabilised with box rest. Please be careful SI Joint dysfunction is completely different to SI ligament damage.

I've never heard of Tildren and it has not been recommended by the specialist vet.
 
As the OP was asking about shockwave I assumed this was a soft tissue/ligament issue - you are talking about something completely different. Also you are talking about an acute injury - we are talking about managing a SI strain long term.

Also, various vets will have a different opinion as to the preferred treatment for a SI strain - steroid injections are given into the joint - it is quite easy for them to be done (I had one on my other horse and tildren at the same time).
 
I understand that, thanks for clearing that up. My horse has a joint injury which needs to be stabilised as shown up by the bone scan. I'm not sure however, both for the OP and my own interest how you differentiate between the two without a definite diagnosis? The referral vet at Newmarket definitely said it is impossible to inject directly into the joint on a lot of horse conformation types. (natives, cobs etc)
 
It may depend on the type of horse - my TB was injected in to the SI joint twice last year (immediate return to soundness - was 4/10ths lame before that) by Cambridge Uni vet school. At the time it wasn't known whether this was a joint problem or a ligament problem. Subsequent ultrasound has indicated that the ligaments are all good as new, and thus Ron's SI lameness may be caused by early degeneration of the SI joint which is undetectable by scans/x-rays etc. He was box-rested for about 5-6 weeks following the injections (a month apart), then did 6 weeks walking, commenced trot and he was lame with PSD.

There is a lot of differing opinion about SI, because there are very few experts in the field. Sue Dyson has written a paper or two on it, but very few others have.
 
As RonaldoToo says, the normal course of treatment for an acute injury is injection into the joint (this is before distibguishing between joint or ligament issue) and then box rest.

I had one steroid injection into the joint + tildren + 3 weeks boxrest (or turnout in a paddock the same size as the stable) then trot up to see if sound. He wasnt so he was on 6 weeks further restricted turnout and then we started walking exercise. He had the chiro twice in that time (every 6 weeks).

with my chronic case, the injury is at least 7 yrs old so there is little that can be done except management which I outlined above.
 
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