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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.

Should My Horse Rest After a Massage?

I am often asked after I do body work how much time the horse should have off afterwards. The answer in most cases is: None! If the horse is sound, or even rehabbing from an injury, one of the best things to do after the body has been balanced by a massage is to move. Even a long walk will help the body of the horse create muscle memory when he is moving more freely. Bad patterns created by tight muscles can best be re-patterned after a massage.

At a horse show I can pinpoint certain areas of the body to work on depending on the event. Before stadium jumping I often use the cold laser on shoulders and joints of the hind legs to enable quick response at a jump. For dressage I might focus on the muscles of the top line and haunches for maximum pushing power. Before cross country I will make sure the pectoral muscles and jaw are free to enable deep breathing. There are over 700 muscles (and that is not counting cardiac muscles, eye muscles, etc!) and releasing tight ones can hugely benefit performance.

For a nervous horse, body work can be very soothing and relaxing. For a lazy horse, he can feel free and energized after a massage session. My job is to observe reactions and adjust accordingly. I love the challenge!


How Nature Designed Horses

Nature designed horses to be giant lawnmowers, but domestication and generations of selective breeding have turned them into high-performance athletes. And just like human athletes, horses experience muscle pains and aches that can diminish performance and lead to long-term damage.

Horses pay the price in injury and pain for the sports that we put them in. For many horse owners, equine massage therapy has become an important feature of the care they provide for their animals. Racehorses, polo ponies, dressage horses, three day eventers, show jumpers, and endurance horses can all prevent injuries and prolong their competitive careers with equine massage.

For instance if your horse has back or hind quarter soreness or is prone to “tying up” in these areas, then, to ease the discomfort the horse will place extra stress on the fore legs which in-turn places further stress on the tendons, which on occasions can lead to a bow.

This can also work in the reverse, say a horse has an existing tendon or foreleg problem; then the extra strain will be placed on the back and hind quarters, leading to strain or muscle problems.

Most people treat the symptoms after the injury has occurred, but what if the body could be balanced through stress point therapy and myofascial release? Many lamenesses and injuries can be avoided by maintaining proper nutrition, fitness, and balanced posture. I see it every day in my clients: horses that struggled to pass vet inspections, struggled to keep weight on, or struggled to perform certain movements rise above all those struggles once tight muscles have been released and nutritional imbalances are corrected.



















For instance if your horse has a back or hind quarter strain or is prone to “tying up” in these areas, then, to ease the discomfort the horse will place extra stress on the fore legs which in-turn places further stress on the tendons, which on occasions can lead to a bow.

This can also work in the reverse, say a horse has an existing tendon or foreleg problem, then the extra stain will be placed on the back and hind quarters, leading to strain or muscle problems.

For instance if your horse has a back or hind quarter strain or is prone to “tying up” in these areas, then, to ease the discomfort the horse will place extra stress on the fore legs which in-turn places further stress on the tendons, which on occasions can lead to a bow.

This can also work in the reverse, say a horse has an existing tendon or foreleg probl


em, then the extra stain will be placed ockand hind quarters, leading to strain or muscle problems.


An article from Sustainable Dressage


Riding Front to Back – Hand Riding

To address the outline of the horse from the front is like painting a loaf of dough brown to make it baked. It is simply going about it the wrong way. It’s trying to mimic the finished results by adding it’s appearance, not by developing it’s prerequisites. The rein aids are a fact in dressage, there is no way around that. Some of the more sterner “purists” hardly acknowledge that the hands have any role at all to play in dressage, but renouncing rein aids is, of course, equally wrong. Relaxing the jaw, positioning to the inside, bending, etc is all done with the aids of the hands. So it’s not about that.

It is about the way the horse works. Energy, rhythm, balance and collection are generated in the quarters. The quality of the work of the quarters influences the quality of work of the whole horse. The influence of the rest of the horse on the quarters is literally non-existent, unless the horse is working correctly behind to start with. So training should start with, and continue to concern the quality of work of the hindquarters. Without that, one can bend and twist, stretch and loosen every part of the horse, and the quality of movement will still not improve. Most proficient rollkur riders know that. That is why they extend the trot and canter explosively forward, frequently, and also the reason for rushing around in medium trot working to get “active hindquarters”. Since the horse has to contract his underneck muscles in this work, and since the attention goes backwards to the chest or between the knees, these horses have to be chased forward for them to become active behind.

Signalling Submission

A horse shows his inferiority to another horse by lowering his head. The lower the head the more submission. It also works the other way around; if you lower the head of the horse he feels inferior. It can be a way of managing the relation between horse and rider. It can also be a way of robbing the horse of his pride, depending upon the extent to which it is done.

Field of Vision

The horse is very dependent on being able to adjust the head to focus his eye-sight at different depths. A horse that looks for something at the horizon lifts the nose to almost horizontal level, and looks along the back of his nose. When a horse focuses on something close, he changes the angle to approach the vertical, and looks at it straight out in front. 90 degrees to his nose.
Alison Harman, University of Western Australia, rider and neuroscientist:
“The field of view runs in the direction of the nose. Instead of it being in front of their head the way it is for us, it’s actually down their nose and sort of towards the ground. Above and below the nose, the horse simply couldn’t see.” Catalyst: Riding Blind – ABC TV Science >>
When the horse is made to hold his head well behind the vertical in deep or rollkur, this means that he, at the most, sees the ground immediately before his feet, in focus. You can clearly see that on showjumpers approaching a fence with the neck curled in. As the rider finally lets the horse up, he realises there’s a fence ahead. Ears point forward and he seeks the fence. If the rider were to keep the horse curled in, the odds are that the horse would not clear the fence because he cannot see it and because it restricts his freedom of movement.

There is much talk about riding forward when riding deep. The trouble is that the horse cannot see forward, and therefore has trouble thinking forward.


Buck Brannaman on a Centered Horse

“On my horses I am continually fixing and releasing. You can’t hold them in the center. I have been teaching clinics for 20 years, so my observations are based on fact; the least centered horses that I come into contact with are dressage horses. (Now don’t think for a minute that I am bad-mouthing dressage, because when it is done correctly by a good hand, it’s beautiful, it doesn’t get any better.) I am talking about the rider who does not let their horse find center and choose to be there; I am talking about the one who over confines the horse and tries to hold him in the right spot. Their horses blow right through the front line, and if it’s an oppressive enough rider, they go right through the line in back and get their horse dull to the leg. It can happen with any horse in any type of gear with an oppressive rider.

Where riders get into trouble is that they don’t give their horse enough room to find the center. They are going to make him do it, by being oppressive in the way that they ride. They think they can force the horse to the center and then hold him there. But the horse has to hunt it, you can’t make him be there. It doesn’t matter how you dress a horse up, it’s all the same. Getting a horse organized and on the spot is the same no matter what you are doing.” – Buck Brannaman

Leave the Head and Neck Alone!

Lena Wedenmark is a dressage instructor based in Wellington, Florida. I love this quote from her:

Do yourself and your horse a favor and stop trying to control his head and neck. Just let them do what they’re going to do, including coming up and out from time to time. Just because you’re doing dressage does not mean your horse has to first be round in his neck. His head and neck are the last part of the connection, and trying to pull him in is the very thing that sets you on the wrong path and damages your ability to learn how to ride. Work on yourself according to the rider’s training scale, and connection and control will come naturally.

Case Study of a 9 Year Old Holsteiner

I had an interesting case today: an upper level warm blood dressage and event horse. This horse is stunning and balanced, but quite large. He is over 17 hands, has a long neck and back, and big bones. His owner sent me video of a recent dressage lesson and pointed out that he was a bit stiff behind and not coming through over his back. I watched the video several times. The ride was lovely, but the horse seemed uncomfortable. I saw slight twisting of the head, occasional gaping of his mouth: just little signs that something was not quite right.

When I started working on the horse, I noticed one side of his neck was more hollow than the other. I also found big spasms in the rhomboid and brachiocephalicus. These muscles are in the neck, and even though the owner felt that jumping had left the horse stiff in the hind end, I thought that if I could release the spasms in the front end, the hind end would be able to connect and the back would come through. The brachiocephalicus muscle needs to contract properly for jumping and collected work. With the spasm on the left side of his neck, this horse appeared stiff behind because he wasn’t working through his back as well as he could. The big spasms in the rhomboid muscle also were preventing him from reaching and arching his neck.

I also worked on the splenius, a muscle that attaches at the poll, the atlas, and three vertebrae in the neck. As I worked, the hollow looking space in the neck started to match the fuller side. The splenius muscle must be functioning properly to have the flexion necessary in the upper levels. I then did some myofascial release on either side of the neck and there were audible snap,crackle, and pops!

This wonderful horse seemed very relaxed and happy by the end of the session. He will be competing this weekend and I expect to see more connection, balance, flexibility, and freedom of movement.

Send me a message if you would like to know how he places in his championship division!

I Love My Job!

A client of mine is at a three day event. I had decided to stay home, but sometimes plans change…After her dressage test she called and said her horse felt like he had a flat tire in the left hind. He just didn’t feel quite right, and she was concerned that maybe going cross country was not a good idea. Could I come check on him?

So I got up early and drove to the show early enough that there would be time to work on him before he had to be tacked up for his preliminary cross country. The horse had several tight spots on his left side, but when I reached inside his left hind it felt exceptionally tight and flat. It didn’t do much good working directly on the muscle, so I got to work on the gluteals, standing on a stool so I could push down into the muscles. He let me know I was on the right track by changing his stance a few times, licking, closing his eyes, etc. When I got off the stool to re-check his inner thigh I was amazed (so was his owner!). The muscle almost seemed like it had been inflated: it was plump and pliant and matched the right hind.

I’m happy to say the pair had a great ride, with just a couple of time faults. I don’t know if it would have been any different without the bodywork, but the horse made it clear to the three humans with him during his massage that he felt a whole lot better and was ready to run and jump.

How Flexible is Your Horse?

A surprising thing about a horse is that its spine is almost completely rigid. The backbone of a horse was originally designed for a very different environment and activity than it needs in modern times. It amazes me that with the limited range of motion of the femur (hind thigh bone), along with the inflexibility of the spine, that our horses are able to lift their heavy bodies over big fences, or perform the lateral movements of a Grand Prix dressage test. When you see how awkward a horse is as it lies down, gets back up, or attempts to roll over, the stiffness of the back is apparent.

When you see an advanced horse that appears uphill, it is because it has lowered the haunches. The bulk of the spine remains fairly rigid. Where the pelvis is attached, the vertebrae are welded into a solid mass: the sacrum.

The tail and neck are the exception to flexibility in the vertebral column. The neck moves up and down freely, but is still limited in sideways movement.

Humans and dogs have spinal disks with a soft center.  The horse has disks that are made of tough fibers.

What Problems Occur in Dressage Horses?

Dressage horses are required to perform accurately with flexibility and muscle control. The entire body, but particularly the hindquarters and the neck, can be stressed. The hips, hocks, stifles, and back should receive regular attention from a Sports Massage Therapist.

Lateral work can cause stress in the costarum (side flexor running parallel to the back muscles), the pectoral muscles, shoulders,and inner and outer thighs.

Collection can cause tension in the jaw, throatlatch, and neck. Dressage horses work hard, and should be given relief from muscle stress on a regular basis! Many injuries can be avoided by maintaining the health of joints, ligaments, muscles, and tendons.

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