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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.

The Benefits of Massage

Massages feels amazing, especially after a grueling workout—and their benefits aren’t just skin deep. Soft tissue massage is exceptionally good for bone-weary athletes and people with inflammation-related chronic conditions like arthritis and muscular dystrophy, according to research from McMaster University. Vigorous exercise causes small tears in your muscle fibers, and your body’s natural repair process naturally leads to inflammation and soreness.

To see if massage truly aids recovery, the researchers biopsied volunteers’ legs over the course of three sessions—once while at rest, a second time after they’d vigorously exercised on a stationary bike and received a 10-minute massage on one thigh, and a third biopsy two and a half hours after the second to track the repair processes between the massaged and un-massaged legs.

Unsurprisingly, massage reduced the production of cytokines, which play a critical role in inflammation, and stimulated mitochondria—the tiny powerhouses inside your cells that convert glucose into energy for cell function and repair. So make sure to schedule regular massages; your muscles will adapt better to the demands of increased exercise.

Cold Laser for All Animals and People

Cold laser therapy offers a wide range of options for tissue therapy, wound healing, pain management, and improved circulation. Cold laser therapy is a game changer for many pets suffering from painful injuries. This technology allows us to successfully treat many injuries including tissue damage, inflammation, wounds, and even scars with minimal invasion.

The technology has been used in Europe since 1970 to promote healing, but has only been approved by the FDA for use in the U.S. since 2002. It is only recently, though, that U.S. veterinarians have begun using it to treat many different conditions that affect pets today, such as fractures, ligament and tendon injuries, post-surgical incisions, arthritis, nerve injuries, sprains, muscle strains, abrasions, lesions, and more.

Cold laser therapy is non-invasive and makes use of light in order to stimulate activity or regeneration in cells in addition to increasing blood circulation. Unlike hot laser treatments that target tissue deep beneath the skin’s surface, cold laser therapy treats injuries or damage on or near the surface – without the risk of cutting or burning from the lasers. Most conditions require between three and eight treatments, though I have seen great improvement after the first laser session. Most animals enjoy their seession: many fall asleep or thoroughly relax. th


Immediate Pain Relief

Cold laser treatments provide pets with relief from painful symptoms of a variety of medical conditions and diseases. These treatments are non-invasive and painless. Recovery time is greatly reduced.

Both laser therapy and acupuncture are based on traditional Chinese medicine’s concept of chi, or energy. Ancient theories about how chi moves through the body mirror modern medicine’s understanding of how the nervous system functions in the body. Both acupuncture and laser therapy pinpoint specific spots along the body’s chi (or nervous system) where there are blockages, which obstruct the flow of energy or information throughout the body. Blockages hinder the body’s ability to function at an optimal level and heal at an accelerated rate.

Both acupuncture and laser therapy have been shown to increase circulation throughout the body, reducing inflammation, relieving pain, and accelerating healing. These therapies offer pain management and treatment for conditions like immune-related disorders, skin conditions, arthritis, and reproductive disorders.

Low level laser therapy is being successfully used treat pain or stiffness associated with arthritis and other degenerative joint conditions, acute injuries, and post-operative recovery for surgical patients. It has been found to be an excellent, well-tolerated alternative to drugs. This type of laser treatment is different from surgical lasers that cut. This wavelength of light penetrates the skin without cutting or burning it. It stimulates the cells and blood vessels that lie just beneath the skin. It does this without causing any harm to the tissues.

The laser’s contact with injured or diseased tissue promotes the production of ATP, a substance essential to cellular reproduction and repair. This enhances the body’s natural healing abilities. Laser therapy strengthens injured tissues, which makes them less vulnerable to re-injury during the recovery process. It also reduces internal scarring, another potential source of pain and stiffness. Painkilling drugs can only mask the symptoms — they don’t treat the underlying issues.



Restoring Normal Function with LLLT

Reduce inflammation. Decrease pain. Heal wounds. Improve movement. Low Level Laser Therapy does all these things and more. The light energy (called photons) from the laser penetrates about an inch under the skin into cells and stimulates cellular activity. This extra activity helps the cells to repair themselves. 

I recently worked on a beautiful show horse that suffers from painful windpuffs. When I used the cold laser on the swollen areas he did some unusual twitching in his body, so I knew something was going on! The next morning, the swelling and pain were gone and he was being ridden through some intricate movements beautifully.

Excellent results from the cold laser are the norm with arthritis. Wound healing is much faster with a few treatments. I have been treating myself for a torn tendon (I jumped out of the way of a mare that had been frightened by a dog ). I was in quite a lot of pain and thought it might take months to heal. After five days of using the laser for 30 minutes I am now walking quite comfortably (I’m still avoiding hills) and it looks like this will be a fairly quick recovery. 



Transfer Factor and Rheumatoid Arthritis

Rheumatoid arthritis is a disease where the immune system attacks healthy tissue. One for hopeful treatment is with Transfer Factor. I have written often on this blog about my profound gratitude to the 4life company that is the source for Transfer Factor, which restored my body to equilibrium and allowed me to breathe without toxic drugs and inhalers.

TF was used in an experiment with 50 female patients with RA.  The patients were followed for 24 months, with check ups every three months. Of the 50 patients, 30% did not respond to the therapy. Excellent and very good results were obtained in the other 70%. The study confirmed the fact that specific immunotherapy with Transfer Factor represents an important adjuvant in the treatment of Rheumatoid Arthritis.

Here is a testimonial from a physician :

I have had quite severe Rheumatoid Arthritis for nearly ten months now. My Rheumatic Factor was exceptionally high and I was very sick with it.

The bones around the joints; particularly the metacarpophalangeal joints; have become enlarged and deformed. They are also very fragile and I have had a spontaneous fracture-dislocation of one of my finger joints already. It seemed that a wheelchair was in my near future.

However; since taking an increasing dose of advanced generation transfer factors; I am now walking with a normal gait instead of painfully and slowly waddling about.

Getting in and out of cars is no longer a major task; I can turn taps on and off and today I even; admittedly rather gingerly; kicked a soccer ball along the length of a park with my grandson.

If you had asked me a week ago whether I could ever do any of these things again I would have thought that you were either very ignorant or a bit cruel to tease me with these unattainable delights.

Apart from this I feel a lot more “switched on” and people have been telling me how well I look.

Thank you once again and God bless you for having done me so much good.

Dr Alexandra Rodda


Improve Range of Motion and Reduce Pain

No body has to live in pain from injury, arthritis, back pain, sciatica. That sounds like a radical statement but there are many therapies to address chronic pain.  Myofascial Release is a soft tissue therapy designed to change and improve the health of the fascia. Fascia is the soft tissue component of the connective tissue that provides support and protection for most structures within the body.

Fascia literally holds us together.  When we encounter fascial and muscle dysfunction, the result is usually pain and discomfort, loss of range of motion in our bodies ,and a subsequent loss of well-being and quality of life.

When the fascia gets bunched, similar to plastic Saran wrap for example, it can bind down on nerves, blood vessels and organs and thus cause restriction and pain.

Because the fascia cannot be detected on X-ray, CT ,or MRI ,scans it is often the reason for unidentified discomfort.

Myofascial Release breaks down scar tissue, relaxes muscles, and restores good posture. It is used with great success to target chronic pain, sometimes in only a few sessions. I have been working on many horses lately that have been recovering from injuries. In just a few sessions, we are seeing  better joint flexibility and range of motion. Instead of an angular, disjointed profile, the body has a harmonious, flowing appearance.


Acupuncture for Animals

A key component of traditional Chinese medicine, acupuncture can be traced back more than 5,000 years. Acupuncture aims to treat a range of conditions by targeting specific points in the body. It does so through the application of heat, pressure, or laser, with the most widely recognized method being penetration of the skin by thin needles.

Traditional Eastern and contemporary Western medicines differ on their theories of why acupuncture works. Eastern thought holds that stimulating these acupoints corrects the imbalances of qi, or circulating life force, through channels known as meridians. Western physicians largely dismiss such concepts,  but they do believe that acupuncture stimulates the nervous system, and can effectively treat musculoskeletal pain, postoperative pain, and nausea.

In veterinary history, acupuncture charts for horses date around 136 AD. Today, the science has been accepted for more than 30 years as a viable treatment for animals of many different species and sizes. It is even covered by some pet insurance companies in Canada, the U.S., and elsewhere.

Most animals actually enjoy acupuncture or cold laser treatment.  When older patients are suffering from arthritis, cold laser or acupuncture can be the best choice, since medications are often not tolerated well. In that case, acupuncture is a perfect fit to help manage their chronic pain. I use cold laser, or low level light therapy, in much the same way that acupuncture is used. The advantage is that there is no need to penetrate the skin with the needle.



Help for the Arthritic Horse

When a horse is lame from an arthritic joint, massage to the surrounding muscles can help reverse atrophy. When a horse is in pain in a limb, he will stop using that leg, causing the muscles to waste away. In compensation, other legs will take up the load. One of the first things I do when assessing a horse is to make sure the body is symmetrical: all muscles on one side should be the same size as on the other side.

Massage can help little used muscles regain their tone.  Along with correct shoeing, nutrition and supplements, the right turnout and exercise, a horses’ athletic career can be greatly extended.


Negative Side Effects of Steroids

Corticosteroids can be life saving. That was the case with me and severe asthma. Steroids are anti-inflammatory; they decrease pain, swelling, and relieve itching. The problem is that what should have been a very short term treatment turned into 14 years, until I was introduced to Transfer Factor which I have often written about on this blog.  When treating our dogs, horses, cats, and ourselves, it is imperative to be informed.

The negative side effects of corticosteroids are the reason they should be used as briefly, and in as low doses as possible. They decrease the ability of wounds to heal. They increase the chance of infection.They can contribute to destruction of joints by decreasing collagen. They suppress the immune system.  They increase appetite and thirst. In cats, an increase in diabetes has been seen.  Steroid use can also upset laboratory tests, causing misdiagnosis of other problems.

A holistic approach to replacing toxic steroids will include nutrition, omega fatty acids, antioxidants, Vitamins such as C, A, E, glucosamine, MSM, yucca, bromelain,and so many more. These approaches are safe and non-toxic.  You will save money on drugs and vet bills.


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