SI problems & prognosis - injections & shockwave

[IrishMilo]

For a while, on and off, horse has been unable to bend to the right under saddle and on the lunge, bucking and bunny hopping, not wanting to go forward in the arena, but explosive to hack. I haven't ridden him for months as I couldn't get him into the vet sooner because of CV.

Vet was very confident he wasn't lame, did flexion tests and palped back and legs, all fine. He was very sore over the sacrum (he's been treated periodically for this with regular physio and massage therapy, and about six saddle adjustments in the last year and a half). Teeth have always been done every six months.

He's had steroids bilaterally into the joint and shockwave, with plans to have two more shockwave sessions over the next few months.

If he doesn't improve after this rehab he'll be x-rayed all over, but assuming there isn't some secondary issue going on, what's been your experiences with recovery to normal work? (Normal work for us is hacking a few times a week, few flat sessions and some jumping).

My plan is to hack exclusively for the next month or so, with in-hand pole work mixed in. I can't do any more than walk under saddle right now because I know he's not going to keep all four feet on the ground, and I don't want to exacerbate it.

He's out 24/7 on a sparse bit of field. I manage him as PSSM positive due to his symptoms.

 

[be positive]

Mine had several months of rehab after his injections, he was hacked 6 times a week with daily in hand work on top plus his routine stretches and physio treatment, which I think was every week for the first month then dropped to once a month, he came back to the type of work you want but due to another, totally unrelated, issue he was retired and is now happily mooching about with no signs that the area has deteriorated, I think having about 8 months of solid rehab allowed the area to fully recover but it was pretty full on for me at the time.

 

[ForeverBroke_]

Mine is off to a treadmill now he's had the injection to see if that will help him build up the appropriate support muscles. He's been hacked for the last year as he previously damaged his suspensory also. He's sound but he's not really returned to his previous work as there's been a few other niggles / I've not felt comfortable putting him back in the school yet.

 

[Cowpony]

Mine had injections but not shockwave therapy. She needed another set of injections about a year later, but since then has been fine (touching all available wood!). That was several years ago and she's doing affiliated dressage at Novice level, show jumping up to 2'6" (only because I don't want to risk a recurrence, vet hasn't said anything about height) and low level XC. She came 11th in SJ at Hickstead Sunshine Tour with my sharer last year.

I rehabbed her quite slowly - 6 weeks of walk in straight lines, gradually building up the amount of trot work each week etc, and then did a lot of strengthening schooling work, poles etc.

 

[IrishMilo]

Mine had several months of rehab after his injections, he was hacked 6 times a week with daily in hand work on top plus his routine stretches and physio treatment, which I think was every week for the first month then dropped to once a month, he came back to the type of work you want but due to another, totally unrelated, issue he was retired and is now happily mooching about with no signs that the area has deteriorated, I think having about 8 months of solid rehab allowed the area to fully recover but it was pretty full on for me at the time.

Good to hear he came back into work. Did you do shockwave as well or no?

 

[IrishMilo]

Mine had injections but not shockwave therapy. She needed another set of injections about a year later, but since then has been fine (touching all available wood!). That was several years ago and she's doing affiliated dressage at Novice level, show jumping up to 2'6" (only because I don't want to risk a recurrence, vet hasn't said anything about height) and low level XC. She came 11th in SJ at Hickstead Sunshine Tour with my sharer last year.

I rehabbed her quite slowly - 6 weeks of walk in straight lines, gradually building up the amount of trot work each week etc, and then did a lot of strengthening schooling work, poles etc.

Good to hear, thanks! I'll probably write off doing anything much this year. I'd rather take it really slow and give it the best chance, though the vet was quite positive that this could be worked through, especially as he's still young.

 

[be positive]

Good to hear he came back into work. Did you do shockwave as well or no?

No just the injections.

 

[scats]

Mine couldn’t have injections as they deemed her too risky to attempt. I manage her by regular sessions with the vet chiro, lots of long-reining and hacking and only one under saddle school session a week.

 

[IrishMilo]

Mine couldn’t have injections as they deemed her too risky to attempt. I manage her by regular sessions with the vet chiro, lots of long-reining and hacking and only one under saddle school session a week.

Because of the implications of steroids/lami, or something else?

 

[scats]

Because of the implications of steroids/lami, or something else?

Unfortunately because she was trying to kill everyone who went near her. They just about managed to inject her hocks but the vet said they nearly had to abandon that as she was so bad.
She doesn’t help herself, sadly.

 

[Tiddlypom]

My mare responded really well just to the bilateral SI steroid injections. Shockwave wasn’t mentioned at any point.

She was referred for them by my chiro vet (coincidentally the same one as scats uses). My mare has bilateral hock arthritis and PSSM, which led to her moving wonkily which will have caused the SI pain.

Lots of straight line walking, both in hand round the perimeter of the arena over raised poles and out ridden hacking. The Equicore is fab, I recommend it, and so did the chiro vet. You can see the clipped area where the procedure was done.

 

[BBP]

In my experience, injections reduce inflammation but do nothing to ‘fix’ the underlying physiology that caused the injury. So you need to think of using this period of reduced inflammation to work on improving the horses posture and way of going. If you think of the structure of the back, is it yet strong enough to have your weight on it? I had Tom Beech out last year to mine and he recommenced that I didn’t ride at all. (He okayed the odd hack for variety). But otherwise all in hand work. Rein back, rein back, rein back. Working on posture, straightness, core work and mobilisation. Lots of straight line work, gradually incorporating poles and raising them, stretches to mobilise the SI. Teeth done due to link between jaw and sacroiliac. Only bringing in trot when I get a really nice swinging walk with good straight over track.

He has had sacroiliac issues on and off for years now, but mostly because he’s an idiot, has no self preservation and likes to gallop, leap and fall over a lot. Every reinjury has been due to a field fall. He’s feeling great at the moment, hacking out for hours and getting some real power back behind. But I have resigned myself to not doing a lot of jumping or intensive work or to make competitive plans, he leads a very easy life! We still have a huge amount of fun together.

 

[sbloom]

I'm with BBP, in hand work, correct the cause which is so often posture. Limit ridden work or even eliminate for now but I'd work under a good in hand trainer who really understands these issues, perhaps one of Tom Beech's trainers that he works with.

 

[IrishMilo]

In my experience, injections reduce inflammation but do nothing to ‘fix’ the underlying physiology that caused the injury. So you need to think of using this period of reduced inflammation to work on improving the horses posture and way of going. If you think of the structure of the back, is it yet strong enough to have your weight on it?

He has had sacroiliac issues on and off for years now, but mostly because he’s an idiot, has no self preservation and likes to gallop, leap and fall over a lot. Every reinjury has been due to a field fall

I definitely don't think he's too weak for ridden exercise - the vet actually commented yesterday that he's nicely muscled and a very well balanced horse. But I'm going to take things very slowly.

He used to be in herd turnout on a bog pit where he was forever coming in with injuries. He's the sort who instigates play and galloping around so I don't doubt that didn't help. He's on a much smaller paddock on his own now (with others over each fence line) and even though I much prefer for them to be together, he was being way too much of an idiot to safely stay in that situation (and costing me a fortune in vet bills).

 

[sbloom]

I definitely don't think he's too weak for ridden exercise - the vet actually commented yesterday that he's nicely muscled and a very well balanced horse. But I'm going to take things very slowly.

It's not necessarily to do with weakness, it's about posture, you don't of course want to go against vet advice but in hand work, done well, will only improve things, ridden work may not. Something has caused this, as Gillian Higgins says the vast majority of equine "injuries" are the result of repetitive strain injury, they don't come out of nowhere, so something has been amiss. Vets have injections, surgery etc as their tools, they're not always looking at it in the way that someone like Tom Beech does.

 

[IrishMilo]

It's not necessarily to do with weakness, it's about posture, you don't of course want to go against vet advice but in hand work, done well, will only improve things, ridden work may not. Something has caused this, as Gillian Higgins says the vast majority of equine "injuries" are the result of repetitive strain injury, they don't come out of nowhere, so something has been amiss. Vets have injections, surgery etc as their tools, they're not always looking at it in the way that someone like Tom Beech does.

I'm going to do in hand work too (per my first post).

 

[BBP]

I definitely don't think he's too weak for ridden exercise - the vet actually commented yesterday that he's nicely muscled and a very well balanced horse. But I'm going to take things very slowly.

He used to be in herd turnout on a bog pit where he was forever coming in with injuries. He's the sort who instigates play and galloping around so I don't doubt that didn't help. He's on a much smaller paddock on his own now (with others over each fence line) and even though I much prefer for them to be together, he was being way too much of an idiot to safely stay in that situation (and costing me a fortune in vet bills).

What i meant was if you have an injury, even in a strong well muscles back, that is an area of weakness. If you think of it as suspension bridge that has a structural weak spot or point of damage, if you add extra weight on top of that bridge, before you have reinforced that damaged area (with your in hand work) you could increase the strain on that weak spot. Just how I think of it, no idea if I’m making sense!

 

[MrsMozart]

Little Cob has a SI issue. Unfortunately the injections only lasted a couple of months. We tried twice if I remember right (it was some years ago now), but no joy. He's been retired for years. Fine in a field. We think he had other issues after that so retiring was the only option.

I hope you get a much better outcome.

 

[Cortez]

Unfortunately I'm going to tell you that when I was working with high-ish level dressage competition horses, the success ratio was so small that we tended to just retire horses with persistent SI problems. I've rehabbed a few and none has ever returned to useful work.

 

[IrishMilo]

I won't be devastated if I have to retire him - he's only 6 so it would be a bummer but it is what it is and I'll keep him as a field ornament. I'll take things slow and steady and see what's what in a few months.

 

[IrishMilo]

Little Cob has a SI issue. Unfortunately the injections only lasted a couple of months. We tried twice if I remember right (it was some years ago now), but no joy. He's been retired for years. Fine in a field. We think he had other issues after that so retiring was the only option.

I hope you get a much better outcome.

Thank you. What were your Cob's symptoms?

 

[MrsMozart]

He had a very (very!) slightly angled way of moving forwards at times, both under saddle and not, which was picked up on by Sue Dyson when he went to the AHT.

He's pretty consistently slightly lame on the back end. He'll happily run and trot about, but the times we've tried to get him back into work, no matter how slowly we took it, he just wouldn't stay sound.

I think he must have been retired for about ten or so years. I've lost track with the period where we tried to rehabilitate. He was only about six rising seven when he retired. He seizes up if stabled so has been living out the majority of that time.

 

[Flicker]

Sadly I had my mare PTS last year because of recurring SI lameness. She would progress to a point, then break. I tried steroids, structured exercise and cartrophen under supervision of a very knowledgeable vet. After a year, I ended up with no insurance money and a lame horse. I really hope your horse improves with structured exercise.

 

[piglet2001]

Positive story here. Horse had history of physio always picking up very mild tightness over back and just behind saddle at routine checks. Horse sound and competing at national level. This came to a head very suddenly resulting in severe muscle spasm and unable to walk down a hill. Bone scanned, Injected, 2 days off, light work for 3 days then back into hard work. Turned out 24/7, Regular physio. Very very experienced vet who recommended not to do raised poles. Was repeated 12 months later and horse not looked back since. Was still in hard work until last year and currently in light work as I don’t have as much time as I would like. Vet didn’t have any faith in shockwave for si. Hope this gives you hope.

 

[IrishMilo]

Positive story here. Horse had history of physio always picking up very mild tightness over back and just behind saddle at routine checks. Horse sound and competing at national level. This came to a head very suddenly resulting in severe muscle spasm and unable to walk down a hill. Bone scanned, Injected, 2 days off, light work for 3 days then back into hard work. Turned out 24/7, Regular physio. Very very experienced vet who recommended not to do raised poles. Was repeated 12 months later and horse not looked back since. Was still in hard work until last year and currently in light work as I don’t have as much time as I would like. Vet didn’t have any faith in shockwave for si. Hope this gives you hope.

That's interesting, thanks. I know that the steroids aren't a magic fix, but just a short-term solution to him being a bit more comfortable and hopefully allowing us to get over this bump, so he can start working more comfortably long term. I'm not convinced that there's been a trauma to the SI as such, I think it's more just that he's mega tight over that area for whatever reason. All this being said and done, it might be nothing to do with his SI and something totally different, but only time will tell!

 

[minesadouble]

Not sure how helpful my reply will be as I have no experience of SI issues in horses, but I have recently had shockwave myself for hip tendinopathy and it worked brilliantly for me!

 

[Flicker]

He certainly doesn’t look like he has the characteristic ‘hunter’s bump’ that is typical of chronic SI dysfunction. Let us know how you get on with him.

 

[sbloom]

My boy came back fully, 5 months field rest then 18 months of hit and miss and rather ignorant "rehab", long reining for a short period then ridden. If I had my time again I'd do things very differently as although he was sound I never got his posture 100% again. I didn't have him long enough to say if his long term soundness suffered, I would expect it did, though had no idea that would have been the prognosis at the time. The amount I have learned as a saddle fitter that I wish I had known then!

 

[IrishMilo]

We're about a week past SI injections and I've ridden him twice. The first time he was still humping his back, plus had an episode of explosive behaviour (five or six huge bucks and bogged off across the field with me). Second time good as gold, no indication of an issue (but all this was in walk). I have three options - back to the vets for X rays, treat for ulcers, or turn away for six months-a year, and see what's what after that.

 

[piglet2001]

In my experience turning away a horse with back and/or SI issues would be the last thing I’d want to do. They need to activate and build their core and keep well muscled. I have always combined regular work with a good ACPAT registered physio. In some horses pole work can be very beneficial. I never lunge if I can help it although I do acknowledge lunging divides opinions on whether it’s helpful. Personally I hate it! I just find that very few can lunge properly and people often lunge on unsuitable surfaces.

If the horse cannot manage lots of higher intensity work then walk, walk and walk, building up the inclines. The point of medicating the joints is to break the cycle of inflammation and allow the horse to move correctly and in many cases develop muscle. Most horses will not do this mooching round a field.