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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.

Long Lasting Relief!

When there is pain, it is safe to assume that there is something wrong in the function of tissues. Those tissues could be in muscle, ligament, tendons, nerves, or cartilage.

Every tissue in your body is made of very small cells. An injured tissue is merely cells not working, and struggling to recover.  Light at specific frequencies can stimulate the cells to function better. That is the beauty of low level or cold laser therapy. The light energy from the laser gives a jump (just like jumper cables to your car battery) to cells.  Treatment time can be measured in minutes.  There are no side effects. And best of all patients, whether two or four legged, get relief because their injured tissues are restored. There is no chemical masking of the pain with a drug.

The laser can speed the healing of sprains and strains, tendinitis, wounds ,and other chronic conditions that are stubborn to respond to any other therapy.

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Cold Laser or Ultrasound?

I have written many articles on this blog about the wonders of cold laser, or low level laser, therapy. Recently, an equine client of mine pulled a muscle on an upper level cross country outing, and therapeutic ultrasound was added to the arsenal of healing technology used on him. His treatment also included cold laser therapy, body balancing, rest, ice, and arnica. He has made a complete recovery (in about 10 days) and is fit and ready to compete again.

Therapeutic ultrasound uses high frequency sound waves that provides heat that vibrates soft tissues deep within the traumatized area. The energy from these sound waves can penetrate as far as five centimeters, though the intensity of the waves (and thus effectiveness) decreases the further it penetrates. One chief benefit is that these waves cause microscopic air bubbles that seem to stimulate the parts of the cell membranes important in healing inflammation, thus helping alleviate both sore muscles and joint pain.

Ultrasound was first used in the 1940’s and is the longest standing form of electrotherapy to still be in regular use. It is still used extensively in physical therapy (physiotherapy, sports therapy, chiropractic and osteopathic) clinics to treat patients with soft tissue injuries.

It is most commonly used to treat superficial localised conditions such as muscle strains, tendon injuries,and bursitis. The treatment is applied via a treatment head using a gel to aid smooth movement and adherence to the skin. Ultrasound tends to be most effective on tissues with a higher collagen density (such as ligaments and tendons), than muscles and cartilage.

Cold laser therapy was first developed in 1967, but has only recently been used extensively in injury and pain management clinics. It is used to treat a range of conditions, for example tendon injuries, neuropathic pain ,and joint pain such as osteoarthritis.

Laser and LED beams stimulate the cells that repair tissues, reduce inflammation and pain. These effects are photochemical, not thermal.

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Natural Approaches to Arthritis

Lameness is a common symptom of arthritis in older animals. Many veterinarians prescribe corticosteroids, or other potentially toxic medications, but there are more natural and safe options. Conventional therapies treat pain and inflammation, but rarely help the stiff and swollen joint to heal .

Each animal is an individual and a dedicated owner may have to try several treatment options before the magic cocktail is found.  The goal is not just to suppress symptoms, but to actually heal the body in a holistic way.

I have discussed acupuncture, cold laser therapy, massage,Transfer Factor (wonderful for the inflammation of arthritis) and other homeopathic and herbal remedies on this blog. Many natural remedies can relieve pain and supply nutrients to help cartilage heal.

Arthritis results from erosion of the cartilage lining of the joints. Since there are no nerves in this cartilage, a great amount of damage can occur before the surrounding joint tissues become inflamed and painful. So once again, prevention is the key. The earlier diagnosis is made, the greater the chance for healing.

Glucosamine, chondroitin, hyaluronic acid, enzymes, fatty acids, can all help heal cartilage.

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Retraining Tight Muscles

There is an extraordinary degree of organization in the muscular system in order for movement to occur. Many different parts need to work together.

When there is muscle tension,  movement patterns become disrupted, and some muscles will have to work too hard or remain too lax. Movement will then become more strenuous and less efficient. This dysfunctional movement can become a bad habit if it is not quickly corrected. It starts to feel familiar, even if it is not right. This can lead to hardened muscles, tendon strain, and degeneration of cartilage.

One of the easiest and fastest ways to prevent muscle dysfunction (and to retrain muscles) is through massage. You and your equine partner can be returned to supple, balanced, free movement. Comfort and effortless movement can be restored with body work.

If your horse is suffering from any of the following, a massage session may be in order:

Sore back
Hollow back
Difficulty picking up a lead
Difficulty bending in one or both directions
Paddling with front legs
Little or no swinging motion in hips and barrel
Difficulty stepping under
Lack of impulsion
Pain and stiffness associated with arthritis or injury
General lack of coordination or balance
General resistance or grouchiness

Releasing tight muscles can eliminate all of these problems.

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After Your Mare Foals

During pregnancy, the cartilage of the pelvis softens and stretches to allow the foal to pass through. It takes several months after foaling for the pelvis and the muscles connected to it (psoas,adductor) to regain stability. During that time, injury to the pelvic area can happen very easily, especially when spring rains make the ground slippery. If your mare is standing wide behind, if she has little action in the hocks when trotting, if she has difficulty picking up the canter, she may need an adjustment of the pelvic area. Myofascial release and massage can reverse the condition, but rest will be needed. Recovery will take some time.

Do You Have a Young Horse?

Did you know that the skull of a newborn foal is made up of 34 bones connected by cartilage? And that it takes 8 years for the skull to solidify and become unyielding? Until then many of the bones are only loosely connected.

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