Category Archives: Structural Integration

Identify and Treat Equine Sacroiliac Problems

By Elaine Pascoe With Kevin K. Haussler, DVM, DC, PhD – See more at: http://practicalhorsemanmag.com/article/identify-and-treat-equine-sacroiliac-problems-11803#sthash.Omnty5wB.dpuf

Your horse gallops, jumps, collects, turns and extends his stride with power from his hindquarters. And his sacroiliac (SI) joint?the ?meeting place of his pelvis and spine?is critical at every stride. It transfers the action of his hind legs to his back, translating the push into forward motion.

Given the forces that this joint handles day in and day out, it’s not unusual for horses to develop SI pain. The trick is recognizing the problem: SI injuries are notoriously hard to pin down, with subtle and confusing signs, easily mistaken for other physical or even behavioral problems. Even a “hunter’s bump,” a raised area at the top of the croup that’s often thought to reveal SI trouble, isn’t a reliable sign.

How can you tell if your horse develops SI pain? And, more to the point, what can you do to help him if he does? For this article, we asked Kevin Haussler, DVM, DC, PhD, of the College of Veterinary Medicine and Biomedical Sciences at Colorado State University, for help in answering those questions. Who’s at Risk? Any horse can injure his SI joint in a fall or some other accident. The injury may leave the joint less stable than it was originally, so it can become a source of chronic pain. Performance horses may develop SI problems through simple wear and tear?and the more mechanical stress the joint comes under, the greater the risk, Dr. Haussler says. SI problems are fairly common. In one recent survey, these problems accounted for more than half of 124 horses presented for back problems at the University of Minnesota equine clinic. Show jumping and dressage seem to be especially hard on the joint, according to a study carried out by Sue Dyson, FRCVS, and others at the Center for Equine Studies, Animal Health Trust, Newmarket, United Kingdom. That study analyzed records of 74 horses seen for SI pain at the center. Dressage horses and show jumpers accounted for almost 60 percent of the group. Slightly more than half were warmbloods, suggesting that breed may play a role. And horses with SI pain tended to be taller and heavier than average, another sign that mechanical stress is an important factor. Under stress, Dr. Haussler says, the joint can be injured in several ways. The SI ligaments can tear, just as ligaments and tendons in a limb can give way under stress. And the joint itself, like the hock or any other joint, can become inflamed. Over time, osteoarthritis develops?cartilage wears away and bone remodels. Thoroughbred racehorses sometimes get pelvic stress fractures directly over the SI joint, and those need to be differentiated from SI joint arthritis.

What You’ll See SI problems are hard to spot. The joint has almost no range of motion and is buried under layers of muscle and fat, so you can’t really see or feel it. And signs of SI pain are often frustratingly vague. Your first hint of trouble may be a change in your horse’s performance or attitude?he’s not working at his usual level or seems unwilling to work. He lacks impulsion behind, and his quality of movement isn’t what it was. Your farrier may tell you that your horse is difficult to shoe behind. You may see other signs as well. Some may show up when your horse works on a longe line or in-hand. But ?often signs are worse when your horse is ridden or is asked to canter, because these demands call for more hind-limb ?impulsion and put more stress on the SI. Sometimes the signs are apparent only when your horse is ridden, and sometimes they are felt only from the saddle. Horses with SI problems may not look lame, even to a skilled observer, but they often feel worse to a rider.

Besides lack of impulsion and reduced quality of movement, you may notice that your horse

is reluctant to move forward.

holds his back rigid.

tends to throw his rider upward and forward.

is reluctant to work on the bit.

has trouble with lateral work, such as shoulder-in and half-pass.

is stiff and crooked at the canter.

changes his leading hind leg (swaps off behind) at the canter.

has trouble with flying lead changes.

bucks and kicks out.

refuses jumps.

Working your horse in-hand (on a firm surface), you may also see that he travels with a wide-based gait behind and has trouble with foot placement on circles. A “hunter’s bump” just indicates a prominent bony crest?the tuber sacrale underneath the muscles at the top of the croup. Prominence on one or both sides may be normal for a particular horse, Dr. Haussler says, but if your horse has pain, muscle spasms and joint stiffness in the SI or pelvic region, then the bump is likely to be significant. It may signal subluxation a partial displacement of the tuber sacrale.

Asymmetrical muscling in the hindquarters is another red flag?or, perhaps, a red herring. Unfortunately, most signs of SI pain can be produced by other conditions. In fact, SI pain often appears along with other musculoskeletal problems. In Dr. Dyson’s study, 25 percent of the horses also had lameness in a front or hind limb, and another 25 percent had arthritis or other problems somewhere in their spines. The problems are often related, but it can be hard to know what came first. Did a lower-leg lameness cause your horse to change his way of going in a way that stressed his SI? Or did SI pain cause him to alter his gaits in a way that overloaded a limb and caused the lameness? Solving the puzzle is a challenge for your veterinarian. Determining the Problem Your horse’s performance history and a clinical examination are the starting points for the diagnosis, Dr. Haussler says. Your veterinarian will watch your horse in motion and perform a hands-on exam, checking for asymmetries and for pain in response to manual pressure. Only the top parts of the dorsal (upper) SI ligaments can be felt directly, and signs of pain and swelling here suggest ligament damage. The joint itself and the ventral ligaments are too deep to check this way, but rectal palpation of the SI region may also produce a pain response. The SI joint can also be blocked with an injection of local anesthesia (in the same way that nerve or joint blocks are done in the limbs). This test can confirm that the SI region is the source of your horse’s discomfort, but it doesn’t tell ?exactly what’s going on. The joint’s deep location makes it difficult to image, but several techniques can help zero in on the nature of the problem:

A bone scan (nuclear scintigraphy) can reveal osteoarthritis. Your horse is ?injected with a radioactive substance that accumulates in areas of active bone remodeling, and a gamma camera tracks the substance as it moves through his body.

Ultrasound scans can detect damage to ligaments. Transrectal ultrasound (the technique used for equine pregnancy checks) may reveal irregular SI joint margins?a sign of arthritis?as well as damage to the ventral (lower) SI ligament.

Ultrasound or radiographs can help identify a displaced tuber sacrale.

Even with these tools, it’s sometimes hard to figure out the exact nature of an SI problem. But knowing the cause of your horse’s pain will increase the odds of ?successful treatment and make a relapse less likely.

Customize His Treatment
Treatment should be customized to the individual case, Dr. Haussler says. Medication, reduced exercise, physical therapy and alternative therapies may all play a role in the program. Here are three key components:

Reduce inflammation. This is the first step in treating SI pain. Your veterinarian may prescribe a course of oral phenylbutazone (bute) or another nonsteroidal anti-?inflammatory drug. If arthritis or ligament damage is diagnosed, local injections of corticosteroids can help reduce pain and inflammation. The injections are similar to those used in other inflamed joints, such as the hock.

Reduce exercise. Limited exercise helps by strengthening the muscles that surround the joint?but too much work will aggravate the injury. Your veterinarian can help determine how much and what type of exercise is best for your horse. The program might call for light work in-hand, on the longe line or in a round pen for several weeks. If your horse is comfortable with that, you might start light riding at the walk and then at the trot. Increase work slowly, ?watching carefully for signs that your horse is uncomfortable or ?unwilling.

Allow turnout. Stall rest isn’t recommended for most SI injuries. In most cases, turnout in a small paddock with good footing is helpful. Avoid deep mud, large rocks, poor footing and steep hills, which may aggravate SI problems.

Arthritis in the SI joint can lead to chronic, low-grade pain. In this case, careful management will help keep your horse comfortable.

Use a progressive (gradually increasing) exercise program to strengthen and supple his hindquarters. Tailor the length, frequency and intensity of the work to suit your horse, Dr. Haussler says, backing off if your horse seems unwilling or if other trouble signs return.

Use cross-training techniques?for example, alternate flatwork, hacks in the field and cavalletti work to avoid constant or repetitive stress on the joint.

Avoid activities that are especially hard on the SI region: jumping, galloping, abrupt transitions, tight turns and circles.

Turn out your horse as much as possible. Moving around at liberty will help him maintain flexibility, reducing joint stiffness.

Several alternative therapies may help keep your horse on the road to recovery:

Acupuncture may be useful for pain control in the SI region.

Therapeutic exercises can help restore impulsion and coordination in the hind limbs. Hind-limb stretching exercises that draw the leg forward (protraction) and backward (retraction) may help relax spastic muscles or contracted connective tissue and restore joint mobility.

Chiropractic or osteopathic techniques may be helpful in chronic cases to restore normal, pain-free joint mobility.

Massage may help relax muscle tightness in the croup or upper hind limbs.

The outlook for horses with SI injuries depends on the severity and duration of the problem, Dr. Haussler says. A horse with a mild injury should recover and has a good chance of returning to full work. Horses with more severe cases of osteoarthritis or ligament damage may return to a low level of exercise, but their outlook for returning to high performance isn’t so good. As a rule, a horse who responds well to treatment has a better chance of full recovery than one who does not.

Could Your Horse Do Better at Shows?

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If your horse has squeaky clean X-rays and MRI’s, does that mean the horse is pain free? You can ask the same question about your own body. The answer is, of course, no. If you play tennis or ski or ride or dance or even garden, you know you can hurt without being injured. The same goes for your horse. What surrounds the skeleton is of more importance than the skeleton itself. Until fairly recently, the fascia has been largely ignored by most health care professionals, and cannot be seen in standard tests such as X-rays and MRIs.

The body work that I do on horses is meant to alleviate the pain and stress of horse sport. If the body is balanced and symmetrical, then the body can move gracefully, without distortion. This restoration of the body can be done gently and thoroughly with a combination of myofascial release, stress point, and trigger point therapy,

Strains, due to injuries and accidents, get lodged in the body when a horse compensates movement during the healing process. Unless these compensations are fully released and realigned, they eventually become chronic strains that limit coordinated movement and cause pain. Horses need massage just as much, if not more, than any human athlete, since they have to carry someone on their back! The benefits of massage are the same for horse or human, with increased suppleness, better range of motion, and quicker recovery from injury. This therapy is so much more than a relaxation massage. It improves performance and longevity in whatever sport or casual use they are involved in.

My biggest thrill is to help an animal become pain free. They behave and perform differently. Their whole personality and energy can change. And the results of the massage can be long lasting.

How the Body Regulates Muscle Tension

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Tendons connect muscles to bone. There are groups of cells within a tendon, where the fibers of the muscle meet the tendon, called Golgi tendon bodies. Made up of strands of collagen, the Golgi organ also contains nerve tissue. The major function of this organ is to sense muscle tension when a muscle is contracted, sending signals to the brain about how much force is being exerted.

Golgi tendon organs and muscle spindle cells work together to prevent injury to muscles. The more the muscle tries to stretch and the faster it tries to stretch, the more the Golgi tendon organs cause it to contract.

These nerve cells and fibers can be influenced by massage. Golgi tendon organs react to sustained pressure such as trigger point therapy and stress point therapy, by telling the muscle to relax.

The Importance of a Gentle Warm Up

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Probably the biggest problem I observe is riders demanding a “frame” from their horse within moments of mounting. Using hands to force the head and neck into a fixed shape causes damage that is difficult to reverse. Without a good period of time that allows the horse to stretch, warm up muscles, and find their balance under the rider, muscles and fascia tend to get stuck into adhesions.

Superficial fascia is the connective tissue that is found beneath the skin. This tissue links and covers blood vessels, nerves, muscles, and bones. The fascia and muscle combine to form the mysofascial system. Adhesions limit muscle movement which interferes with performance. Adhesions can also cause severe pain, reduced flexibility, and tender trigger points.

To release adhesions, I use a technique called ‘myofascial release.’ This technique involves applying gentle but sustained pressure on the soft tissue. During this technique, it is also important to target the fascia. This helps to lengthen and soften the fascia and break up the adhesions and any scar tissue that is present between the bones, muscles, and skin. Scientific evidence shows that myofascial release offers relief from different types of joint and muscle pains. Flexibility and movement is then restored.

More Benefits of Equine Massage

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My job description: using my hands to free soft tissue to encourage length, motion, and geometrical balance in the muscles, tendons, and ligaments. I have to be extremely observant, since communication with animals is non-verbal, to figure out how they can be better aligned and balanced.

After a session, most animals are both relaxed and energized. Since I see a bodywork session as a collaboration between me and the animal (not me imposing something upon them) they are always happy to see me again.

One of the reasons it is so important that muscles and fascia be relaxed and elastic is that if muscles are tense, when the hoofs hit the ground, more concussion will be taken by the joints. This is a set-up for injury and early degeneration of the joints. Healthy muscles make sure that the impact when the hoof hits the ground is distributed throughout the body. Supple muscles are able to absorb the force of the feet hitting the ground much better than tight muscles.

Become Involved in Your Own Health Care!

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Pain is the primary reason people seek medical treatment in the United States. The majority of this pain occurs in the musculoskeletal system. It would seem essential that medical professionals have in depth knowledge of this subject. If not, your doctor might fall back on old standards of care for chronic muscle and joint pain, such as anti inflammatory meds, possible antidepressants, and sleep medications. None of those “cures” get to the underlying cause of pain, and all have toxic side effects. Did you know that anti-inflammatory drugs inhibit the healing and tissue regeneration process? Nonsteroidal ani-inflammatory drugs, the number one prescribed drug for chronic pain, can cause tremendous damage to tissues. Why not try myofascial release, or trigger point therapy?

In 1998, a study was completed to assess the competency of recent medical school graduates in musculoskeletal medicine. 82% of the recent graduates failed the exam. The study went on to report that the average time spent in medical education in orthopedics was 2 weeks. One third of all medical school graduates had no orthopedic education. Because the results of the study were so shocking, it was repeated in 2002. A passing score was set at 70%. 78% of recent medical graduates failed to demonstrate basic competency in musculoskeletal medicine.

Needless to say, it may be very difficult to find help for your lower back pain, muscle pain, or joint pain. I am not a doctor, but I have found many ways in my studies and experiments (on myself, friends, and animals) to relieve pain using nutrition, supplements, low level laser therapy, myofascial release, and sports massage. Not only can pain be eliminated, but wellness and disease prevention can all be achieved with safe lifestyle changes.

Care of Your Equine Athlete

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People often make comments to me like “You must have really strong hands” or “Your arms must have big muscles”, but Trigger Point Therapy, Myofascial Release, Stress Point Therapy are all fairly gentle practices. Accuracy, through knowledge of anatomy, reduces the need for brute strength. The massage is deep, with firm pressure, stimulating endorphins, and the horse often helps me by leaning into my hands.

Trigger Point therapy targets areas of stress where muscle attaches to bone. The treatment specifically targets areas of constriction that refer pain signals to other parts of the body. Myofascial release is related to trigger point therapy, but focuses on tightness , or other disorders afflicting the fascia, a membrane that surrounds the muscles and may restrict their motion. What makes my work so exciting is that I can switch methods as I move around the horse, using what is needed for each area of the body.

All animals need to have their bodies in balance to live long and active lives. For show horses it makes the difference between winning and being withdrawn from the competition Tight muscles can affect posture, and poor posture can cause spinal misalignments. The reverse is also true — spinal alignments can lead to muscle strain.

Massage therapy should also be part of the process of rehabilitating from injuries, regaining lost range of motion, or coping with chronic pain conditions. Body work for your horse can produce dramatic results in a short period of time: one of the many reasons it is so exciting for me to go to work!

My Detective Work

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I often say that doing body work on animals is detective work. I get a medical history from the owner, but not from the client himself. The horse or dog can’t point out where they might be feeling pain, so I have to tune in to all their subtle signals (and you would be amazed how stoic some animals can be!).

About 75% of trigger points are not where the pain is, so a thorough knowledge of anatomy, stress, and trigger points is essential. I worked on a young mare that was expressing discomfort in her neck. She tossed her head a lot, especially during transitions. When her rider picked up the reins, she curled her nose to her chest. She was showing discomfort, but after examining her, I found her pelvis was very uneven. Her right pelvic crest (what some people might call the hip) was a good two inches higher than the left. It took three adjustments during the session to finally get her body level, but she was very focused on helping during the work. She walked off showing a fluid movement that we had not seen before, and she kept stretching her neck out. Reports from the rider have been very positive: the mare continues to improve, stretch, move forward, and seek contact.

Trigger point referral patterns from multiple trigger points can overlap, causing a composite referral pattern. This has been the case with the young and green mare. As one problem gets resolved, it leads me to the next. Instead of resorting to gadgets to fix her head tossing, the wise owner had an inkling that the mare was feeling pain. If I only work on the area where the pain is presenting, there will not be relief.

This mare is competing very well at her first show as I write this. I will continue to help her keep her body balanced and pain free. I’m expecting great things from this wonderful athlete who just needed a little help to take off!

Extend The Career of Your Equine Athlete

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Many riders tell me their horse feels off when they first get on, but works out of it. In some cases, this could be the sign of something serious needing further investigation. Soreness can disappear as the horse warms up, and then reappear a few hours after the work out. The reason is that soft tissue injuries almost always cause more pain when they are cold, because that is when the muscles are tightest. As the muscles warm up, they stretch out and send fewer pain signals. After the work out, all the soft tissue cools down and tightens again, often adding a few more muscle fibers to the tight area. You can see how, over time, this scenario can turn into more pain and escalate into an injury requiring a long lay-up.

Just because an injured area feels better after it warms up doesn’t mean that everything is okay. Stiffness and pain mean something, especially if they create a pattern over time. That is not to say that all muscle soreness is bad. Some aches are inevitable in becoming fit.

Sports massage for your horse can help ease soreness and pinpoint areas that are prone to tightness. Massage is helpful both before and after (after the horse has cooled down; I never massage right after a workout) exercise.

Massage therapy benefits the body in ways that most warm-up routines fail to do. Over time, select muscles may tighten and shorten. This greatly endangers the body, and unfortunately, an athlete is rarely aware of it until after an injury has occurred. A further benefit of regular sessions is that oxygen flow is naturally improved, which creates healthier conditions for muscles, optimizing body tissue. Increasing the flexibility in soft tissue can greatly reduce the incidence of injury.

What is the Secret to Horse Show Success?

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The number one cause of injury is overuse: working too much, too fast, too soon, or too often. As riders, it is a huge responsibility to protect your horse from these training errors. It is tempting to overdo it when there are shows you want to go to, or if you have a young and talented horse. There is a limit to how much training the body can absorb. Rest and recovery are as important as hard work. Realigning the body with massage therapy is another key to preventing injuries. Flexibility is an important indicator in the prevention of injuries. The horses I know that avoid injuries and are at the top of the leader board are the ones who are on a carefully planned fitness program, have superior nutrition, regular body work, are ridden on good footing, and have knowledgeable farriers.

Pain is a warning signal that needs to be listened to. Pain is an important signal that something is about to go very wrong. If you saddle up your horse and he has a strong reaction, pay attention to that. If your horse starts refusing jumps, listen to him. If your horse comes out of the stall very stiff, or is taking longer to warm up, there is discomfort present. If dealt with early, many sources of pain can be alleviated through deep massage. If pain signals are ignored, they will inevitably get worse. Something minor can lead to something very serious, or permanent, in a muscle, tendon, ligament, or joint. When in doubt, use the cold laser, or have body work done. Needless suffering can very often be avoided.

Once an injury occurs, scar tissue forms as it heals. This tissue is not as elastic as the original and thus is more prone to re-injury. As I keep saying, prevention is the key to a long and successful athletic career.