Sacroiliac Injection

[Sweetpea_4]

My vet and physio have spoken and decided my horse would benefit from having her sacroiliac injected. She is unable to have steroid injections due to the laminitis risk.
Please could anyone share any other treatment options other than steroids for the sacroiliac and how successful they have been.
Many thanks

 

[Goldenstar]

Is the horse over weight ?

 

[Tiddlypom]

What other injectable options are there?

I've had successful results from steroid injections into the SI, but I now always use gel injections for other joints eg hocks, coffin joints. Gel injections IME give better and much longer lasting results. I have been meaning to ask my vet if gel injections are appropriate for SI joint jabs - if they are then consider those. They contain no steroid so there is no lami risk.

 

[Sweetpea_4]

Is the horse over weight ?

She is on the rounder side! She is on soaked hay and low sugar/starch diet, the weight is slowly coming off but due to not being able to consistently exercise her as we have intermittent lameness it is difficult.

 

[Sweetpea_4]

What other injectable options are there?

I've had successful results from steroid injections into the SI, but I now always use gel injections for other joints eg hocks, coffin joints. Gel injections IME give better and much longer lasting results. I have been meaning to ask my vet if gel injections are appropriate for SI joint jabs - if they are then consider those. They contain no steroid so there is no lami risk.

That is what I am trying to find out, are there any other options?
I know about Arthramid and know of great results with it but I don’t think you can use it in the SI joint.
My vet has suggested PRP which she has previously had in her suspensory but not sure how it works in joints??

 

[ihatework]

I haven’t seen anything other than steroid put into the sacro joint.

Id really blitz the weight loss (cruel to be kind), that will reduce the lami risk and also the load on the joints. Then when you are in a better position to inject you should be ready to do the rehab work (which is essential for sacro issues).

 

[Goldenstar]

The thing that will make highest difference is to get her weight right down .
I don’t know if they can put gel into an SI joint it’s a difficult joint to inject .
All orthopaedic issues are improved by weight loss and by improving the horses core strength .
Sue Dyson has a presentation on youtube on weight orthopaedic issues and steroids and Lami well worth seeking out .

You could really drive the diet hard very hard and get a Acpat trained physio with an interest in rehab to visit you and show you in hand stuff using poles to improve the horses core and get the horse out and walk-in hand up and down slopes .
You could discuss with the vet the possibility of using oral anti inflammatory drugs while you try this .

Get on google and research the horses core and how to develop it the more I train horses the more I think that this and developing the thoracic sling in the horse is the route to long term soundness particularly in the more athletic horses with flexi joints who do things easily .

 

[Goldenstar]

Can you lead the horse from another horse to aid weight loss ?
Ask the vet if you have access to another horse .

 

[SEL]

Does your vet think an SI injection is high risk from a lami perspective? My mare has these (although I also prefer gel injections, this wasn't on offer for SI as far as I know), but vet doesn't think its particularly high risk if they use ultrasound to guide the injection into the right place in the joint. I do make sure I manage her tightly in the run up to the injection and for the few days after it - practically glue her into a muzzle - just to mitigate the risk.

 

[sbloom]

Get on google and research the horses core and how to develop it the more I train horses the more I think that this and developing the thoracic sling in the horse is the route to long term soundness particularly in the more athletic horses with flexi joints who do things easily .

This. I see maybe 15 horses a week average and I get more and more convinced of this. I'd never advise against injections but I would caution, and encourage wider reading (I follow a ton of interesting people on FB if you want to look through my likes list) about rehab, posture, proprioception and other inputs, thoracic sling, the link with feet...and of course having everyone work together and making sure once you DO get back on that the horse hasn't had light "fittening/straightening" but has been fully prepared with thorough in hand work to build its posture/back muscles to carry a rider. Otherwise you're straining the SI from the minute you get on.

My overall belief is that we got horses sound from SI injuries before injections, and that injections are there because drug companies invented them, and that ultimately they feed into our demand to have less down time. I think vets have SO many areas they have to be knowledgeable about it's a tough one, and you have to go on their advice, or the advice of A vet, in the end, but it's why I like and recommend The Osteopathic Vet, he looks through the other end of the telescope as his toolkit doesn't have injections. He does work with other vet teams who are injecting, so he's open to them, but he has a ton more tools to hand.

I have a list of groundwork resources I'm happy to email to anyone.

 

[Tiddlypom]

My chiro vet is very highly experienced and qualified (ex Leahurst), and she DOES recommend SI injections in appropriate cases. This was not a short cut. The aim is to make the area painfree, and to then (very importantly) to then up the horse's core strength through the correct rehab work., so that the improvement is maintained.

She recommended that I have two of my horses SI jabbed, and they were last August. Two very different horses, with very different causes for the SI disfunction. Chiro vet was here on Mon, and both horses are still painfree in the SI area 7 months later. The younger mare, who came back from loan very broken, was actually fully sound for the first time in nearly 3 years. The older mare has a wonky pelvis after a field fall, though precisely what she has done is still guesswork as scans were inconclusive. She too is pain free in her back, though she is mechanically wonky, but has been cleared for light hacking.

I've done lots of in hand work inc walking over poles with them both.

 

[ester]

Can you reduce the lami risk by doing one side at a time?

 

[sbloom]

I would like to say, emphatically, that I am not accusing horse owners of being motivated by wanting to speed things up, more about why they were seen so favourably to begin with and perhaps why we plough ahead with new treatments (bearing in mind most SI injuries could be, and were, rehabbedbefore injections) without a full picture of how they work and longer term side effects.

I do hear more evidence of join injections in humans causing long term degeneration, here's one article https://drmagaziner.com/regenerativ...he-side-effects-of-corticosteroid-injections/. The issue seems to be most pronounced with steroids, are the gel injections HA?

I speak as someone who did rehab a horse successfully from an SI injury in 2001 with very little knowledge or level of skill but it took a long time (18 months in all, he kept upsetting it being a t*t in the field). I can see how better groundwork/understanding/skills (I did a bit of longlining, and not well) would have changed things markedly.

 

[blackislegirl]

I speak as someone who did rehab a horse successfully from an SI injury in 2001 with very little knowledge or level of skill but it took a long time (18 months in all, he kept upsetting it being a t*t in the field). I can see how better groundwork/understanding/skills (I did a bit of longlining, and not well) would have changed things markedly.

Hello. I would love to know what rehab programme you followed. My horse has shown a sudden pain reaction (violent bucking when ridden in the school) 3 times in the last 10 months. The first time our physio/masseur saw her and found a lot of tension on her right hip. She soon came right at walk and trot, though remained resistant to canter aids. So I dropped the idea of cantering for a while. Then after 3 months I was building up the schooling (prelim dr level) and she bucked again. I suspect hat reoccurrence was provoked by pratting about in the field. The November lockdown kept me away from the vet till it was over. The mare was then diagnosed with probable sacroilliac issues - she was sound, but 'bunny hopping' when asked for canter strike off on the lunge. So she had SI injections, I followed the vet's advice on rehab, and in late Jan she was seen again and signed off. I built up the work slowly, and after many weeks tried cantering on straight lines - and she was so good, so responsive to the aids on both reins. Then last a week ago she was spooked by a passing lorry tooting its horn as it drove past the school, and then bucked me off. I had the vet out the next day. He says everything points to an SI issue, she is not lame, and he is not sure that a scan will show anything conclusive. He put my girl on a course of bute, and will see her again in a week. Meanwhile I am gutted and worried. The history sounds on the surface like that of sbloom's horse, which piqued my interest. As I am also in Suffolk, sbloom, do you have views on physios working in the county?

 

[sbloom]

I know WAY more now, so wouldn't remotely do the same, hence my mentions above of groundwork. I did a bit of long lining, badly, with him overbent and against the hand, and then did a basic fittening programme, with Bowen treatments.

Now I'd consult with someone like Dan Wain Equestrian (who is one of the links on the sheet I mention) to construct a rehab programme, probably with an assessment from Tom Beech first. Only after that would I work with a local physical therapist. I know several good ones locally, of different modalities, but that's where I'd start.

 

[blackislegirl]

I would like to see the sheet of resources you mention, but I can't see how to pm you on this board.

 

[sbloom]

Just hover over the saddle picture and you'll see "start conversation", I also use my real name so you could find me on Google etc.