Sacroiliac (SI) Joint Injection & Rehab Process

[equidstar11]

I have been on a journey with my warmblood of poor-performance and bilateral lameness, and having treated other areas we are now fairly confident the SI joint is the issue - and as such is having it injected with steroid next week.

My question is around rehabbing SI joint ‘injury’ - his is more likely to be from long term compensatory patterns from hock pain, however his hocks were treated quite some time ago.

I am well aware I have a lot of postural resetting to do, to help show him that he should be able to use his body properly again. For info since I know this often pops up, he is trimmed by a podiatrist every 3-4 weeks (always has been barefoot, brilliant feet, no issues or history with NPA etc). Understandibly he does not like use his hind end currently, so is lacking muscle across his topline.

I have started using the balance pads with him, and we have been doing in-hand polework, groundwork etc (incorporating walking diagonal over poles, poles raised at different heights/angles, randomly spaced poles, weaving over poles, turn & crossing of the hind legs, rein-back steps) and this will be my main plan for him to hopefully begin help the SI joint after it is injected.

He is turned out on sloping fields, with some proprioception interests added (branches/poles) etc - all fields have large sides of hedgerow grazing to add extra eating heights (which i often see them use).

I was just looking for other, more specific exercises in-hand (and later ridden) that may help, and also some experiences that other people have had of rehabbing SI joint injury - eg how long did you stay on the ground before starting some work under saddle eg hacking.

Thanks & happy Friday

 

[nutjob]

Mine definitely had an injury as I saw him fall, not a degenerative condition. The vet said it was OK to ride shortly after the injections but I was worried about being bucked off as he had pain in the area close to the back of the saddle. Pole work in hand was the main thing in the rehab program . Before working him I put a massager or a tens machine on. The physio uses an H wave machine which you can see gets the pelvis mobilised.

I did find having regular physio helpful as the report showed improvement and you could see the areas of pain / stiffness / tension get less at each session. If yours has other issues you need proper advice about what is appropriate given the hock issues also, my vet didn't help much with rehab but physio was excellent.

I initially tried rehabbing without the injections but it didn't work, I assume due to pain and stiffness preventing correct movement. The injections made an immediate improvement but you need to push on with the exercises promptly to get the full benefit.

 

[equidstar11]

Mine definitely had an injury as I saw him fall, not a degenerative condition. The vet said it was OK to ride shortly after the injections but I was worried about being bucked off as he had pain in the area close to the back of the saddle. Pole work in hand was the main thing in the rehab program . Before working him I put a massager or a tens machine on. The physio uses an H wave machine which you can see gets the pelvis mobilised.

I did find having regular physio helpful as the report showed improvement and you could see the areas of pain / stiffness / tension get less at each session. If yours has other issues you need proper advice about what is appropriate given the hock issues also, my vet didn't help much with rehab but physio was excellent.

I initially tried rehabbing without the injections but it didn't work, I assume due to pain and stiffness preventing correct movement. The injections made an immediate improvement but you need to push on with the exercises promptly to get the full benefit.

Thanks! Very helpful.

His hocks are fully treated now (and we have checked stifles too, all fine), he only has the pain in SI.

Can I ask did your physio have the TENS setup for SI from loin to croup, or wither to croup? I’ve seen both used.

 

[nutjob]

From loin to croup.

 

[Pinkvboots]

Tail pulls are good to strengthen the si joint start with slight pressure and slowly release then repeat and just increase the amount you do and the pressure.

Once they get used to it you can do pulls slightly to the side and just increase those slowly.

I find alot of horses like them and will lean into them Arabi does I think its just a nice stretch for them.

 

[Tiddlypom]

I have had good and long lasting results with SI joint medication as long as it is the last issue left standing, which it seems be in your case . It is important to crack on with the rehab in the pain free window post medication.

My chiro vet prefers to treat the horse about 3 weeks after the jabs. She is hands on, she does have some gadgetry and also acupuncture, but has never needed to use those on any of mine.

Good luck.

 

[equidstar11]

I have had good and long lasting results with SI joint medication as long as it is the last issue left standing, which it seems be in your case . It is important to crack on with the rehab in the pain free window post medication.

My chiro vet prefers to treat the horse about 3 weeks after the jabs. She is hands on, she does have some gadgetry and also acupuncture, but has never needed to use those on any of mine.

Good luck.

Very helpful thanks
Can I ask, how long did you wait before riding again?

 

[Tiddlypom]

Very helpful thanks
Can I ask, how long did you wait before riding again?

In hand until cleared to ride by the chiro vet after the 3 week post medication treatment .

I find that the chiro vet is the trickier one to pin down for an appointment, so I get her booked in then book the horse in 3 weeks before that at horsepital for the jabs.

 

[Melody Grey]

My physio has always recommended backing up five strides a couple of times as a good re-hab exercise, first on the flat and then slightly uphill- can’t remember whether it was for the SI or KS specifically as the horse had them done together….but it’s easy and quick to do so might be helpful for general thoracic sling and back strengthening. Also rubbing under the tummy to lift the back a few times and watching it relax and then repeating.

 

[equidstar11]

Thanks all. He’s just had the injection and is having a few days off in the field. Our fields aren’t flat and he unfortunately hasn’t had the memo to rest and has been enjoying some running around

I think I’ve got a decent plan of exercises to do in hand, with stretches too, alongside a postural course by Annie Dillon (recommended by bloom).
I may include some TENS sessions over his SI region early on (maybe some hot water bottles too) and I’ve added some devil’s claw & boswellia (high %) to his feed just to see if it helps him a little (although, bute trial didn’t touch the SI pain).

The vets rehab plan included lunging in a Pessoa and riding straight away …

Hopefully we can make some postural improvements and start to fix the dysfunction so that he can actually use himself properly and build some muscle to support it. Definitely the focus before we get back on board.

 

[TPO]

Disclaimer that I don't have personal experience with SI injections. However I've found these books very helpful, especially the first one, for understanding the whole horse and seeing/correcting compensations. The books also have inhand and ridden exercises, the first one has good detail of "at home" massage and stretches for pre/post exercise that coincide with the posture work.

https://amzn.eu/d/h56IabQ

https://amzn.eu/d/59GtxQB

https://amzn.eu/d/iGRlO7m

This book for when the horse is in ridden work

https://amzn.eu/d/cJ5W8f6

 

[equidstar11]

Disclaimer that I don't have personal experience with SI injections. However I've found these books very helpful, especially the first one, for understanding the whole horse and seeing/correcting compensations. The books also have inhand and ridden exercises, the first one has good detail of "at home" massage and stretches for pre/post exercise that coincide with the posture work.

https://amzn.eu/d/h56IabQ

https://amzn.eu/d/59GtxQB

https://amzn.eu/d/iGRlO7m

This book for when the horse is in ridden work

https://amzn.eu/d/cJ5W8f6

ooo my favourites - I do actually own all of these books apart from #1. Jec Ballou’s books are great aren’t they! I have pulled quite a few exercises out of them to use in hand
Thank you!

 

[TPO]

ooo my favourites - I do actually own all of these books apart from #1. Jec Ballou’s books are great aren’t they! I have pulled quite a few exercises out of them to use in hand
Thank you!

No.1 is new to me, although it's been in my basket for ages.

Finally bit the bullet and I'm really impressed by it.

This one is good too, but I'd pick no.1 over it

https://amzn.eu/d/1ciEtt7

 

[equidstar11]

No.1 is new to me, although it's been in my basket for ages.

Finally bit the bullet and I'm really impressed by it.

This one is good too, but I'd pick no.1 over it

https://amzn.eu/d/1ciEtt7

I’ve just ordered that book (#1 on your list), agreed looks very good!

Fingers crossed for some success this time. I’m in no rush to do anything except make him feel better.

 

[sbloom]

I always encourage focus on the how, on the very small "steps" that lead to correct posture, which means that so often polework and even backing up are used too soon and just strengthen the dysfunction. Even Jec's work can reveal missing bits, the fundamentals.

Look forward to seeing you in Annie's group!

 

[Birker2020]

I have been on a journey with my warmblood of poor-performance and bilateral lameness, and having treated other areas we are now fairly confident the SI joint is the issue - and as such is having it injected with steroid next week.

My question is around rehabbing SI joint ‘injury’ - his is more likely to be from long term compensatory patterns from hock pain, however his hocks were treated quite some time ago.

I am well aware I have a lot of postural resetting to do, to help show him that he should be able to use his body properly again. For info since I know this often pops up, he is trimmed by a podiatrist every 3-4 weeks (always has been barefoot, brilliant feet, no issues or history with NPA etc). Understandibly he does not like use his hind end currently, so is lacking muscle across his topline.

I have started using the balance pads with him, and we have been doing in-hand polework, groundwork etc (incorporating walking diagonal over poles, poles raised at different heights/angles, randomly spaced poles, weaving over poles, turn & crossing of the hind legs, rein-back steps) and this will be my main plan for him to hopefully begin help the SI joint after it is injected.

He is turned out on sloping fields, with some proprioception interests added (branches/poles) etc - all fields have large sides of hedgerow grazing to add extra eating heights (which i often see them use).

I was just looking for other, more specific exercises in-hand (and later ridden) that may help, and also some experiences that other people have had of rehabbing SI joint injury - eg how long did you stay on the ground before starting some work under saddle eg hacking.

Thanks & happy Friday

I did various exercises targeted and improving Lari's s core and helping strengthen his S.I. from the ground.

One that I remember was standing at his side and getting him to reach under his front legs behind his girth area for a treat as well as carrot stretches. This meant he was using his S.I to carry out the exercise which strengthened it.

Another was holding his tail to the side whilst pushing his quarters but standing him still (sorry I don't remember that one too well) I could never do it with him as he kept moving over rather than leaning out and back in like he was supposed to.

Another exercise was getting him to walk backwards between parallel poles with his head down low to the floor (hold treat so it literally sweeps floor).

He went from the top photo to the bottom photo following 4 months of groundwork, and being fed myoplast.

Sadly he was too badly affected to be a riding horse as he had multiple over compensatory issues: neck, hocks, coffin joints and probable PSD. We medicated everything bar his neck and never bothered with his suspensories but he was never comfortable and was always very reactive to the slightest thing and always felt (and did) 'about to explode'. He is retired in a large herd. He was 11 when I bought him, is now 14. And I love the bones of him. But it's very sad that I never got to ride him and compete him, as was my dream as he was a super ex comp horse and meant to he a 'school master' but was just too badly damaged. He was jumping 5yr old class at Hickstead, too much too soon.

 

[bottletop]

I did various exercises targeted and improving Lari's s core and helping strengthen his S.I. from the ground.

One that I remember was standing at his side and getting him to reach under his front legs behind his girth area for a treat as well as carrot stretches. This meant he was using his S.I to carry out the exercise which strengthened it.

Another was holding his tail to the side whilst pushing his quarters but standing him still (sorry I don't remember that one too well) I could never do it with him as he kept moving over rather than leaning out and back in like he was supposed to.

Another exercise was getting him to walk backwards between parallel poles with his head down low to the floor (hold treat so it literally sweeps floor).

He went from the top photo to the bottom photo following 4 months of groundwork, and being fed myoplast.

Sadly he was too badly affected to be a riding horse as he had multiple over compensatory issues: neck, hocks, coffin joints and probable PSD. We medicated everything bar his neck and never bothered with his suspensories but he was never comfortable and was always very reactive to the slightest thing and always felt (and did) 'about to explode'. He is retired in a large herd. He was 11 when I bought him, is now 14. And I love the bones of him. But it's very sad that I never got to ride him and compete him, as was my dream as he was a super ex comp horse and meant to he a 'school master' but was just too badly damaged. He was jumping 5yr old class at Hickstead, too much too soon.

Sorry to read this but good on you for looking after him. So many horses are totally ruined by being ridden too young. My 5 year old will not jump until he is 7 and my now 7 year old has been very slightly lame since I bought him from Ireland at 3 - and I found out they hunted him before I bought him! He should never have passed the vet in Ireland.