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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!


The Importance of the Rhomboid Muscle

The rhomboid muscle is very important for several reasons:

The shoulder blade hangs from the withers by the rhomboid, making it responsible for the swing of the shoulder.

The rhomboid goes from the withers all the way up the neck to the poll, making it responsible for the ability of the neck to stretch.

If a saddle is placed too far forward it will put pressure on the rhomboid, interfering with the muscles’ function. If the saddle is too narrow, it will pinch the rhomboid muscle, eventually causing it to atrophy. If a saddle is too wide, it will sit directly on the withers, eventually causing lameness. If you see a hollow looking spot behind the scapula, there is most likely muscle atrophy.

Where the rhomboid attaches to the withers it is very thick and strong. When there is a problem with the rhomboid, you may notice tightness in the shoulders and a loss of coordination in jumping. Massage to the stress points in the rhomboid is extremely effective, and improvement in the horse will be immediately apparent.

The Rhomboid Muscle Has a Big Job!

The average head of a horse weighs around 20 pounds. One of the muscles that has the task of holding the head up is the rhomboid. The rhomboid covers the withers and travels all the way up the crest of the neck to the poll This powerful muscle not only has the job of lifting the head,  but also attaches to the scapula and pulls it forward and up. I usually start body work sessions by checking the rhomboid. Feeling the health of that muscle can give me a good indication of what is going on in the neck and the back.

Since the rhomboid is so strong, it is not easy to change. Any constriction in the neck, especially right in front of the withers, can take many massage sessions to relax. I always show owners/riders/grooms how to continue the work I do on the rhomboid on their own. Balancing the muscles of the neck is crucial to athletic performance: when the rhomboid is very tight you will see the horse swing his head sideways at each stride. By flinging his head and neck away from the shoulder that is working, he avoids feeling the discomfort of a very tight rhomboid.

It will take persistence to free the rhomboid, but the rewards are many: jumping ability will increase. The horse will feel more elastic in dressage. The stride will feel longer and less choppy.


Cold Laser and Show Jumping

I was working at the Twin Rivers Horse Trials this past weekend. One of my clients asked if using the cold laser on his horse’s legs might help him be tidier over fences, as he tends to knock rails with his hind legs.  I used the laser on him and also on a pony who is always the smallest in his division. I was amazed when I watched their stadium rounds. Both tucked their hind legs way up and jumped beautifully. Next show I am going to use the cold laser on all four legs of a big warm blood who is sometimes a little tired and slow in show jumping after flying around cross country. I’m hoping this discovery will help him win. He is always in the top five, but he is due to get the blue!

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 Makes a Good Jumper?

Horses were not designed to be jumpers. The horse’s body is heavy, as is the entire front end. A good jumper needs long, light legs and a streamlined body. Ideally, the front end would be light and the hind end would be very strong (does a kangaroo come to mind?).

When the horse makes its jump effort, the feet push hard against the ground in order to suddenly straighten hocks which have flexed during take off. The strain upon the muscles and tendons during landing (one foot at a time, no less) is great.

A good horse combined with a good rider and a well-designed course may sometimes allow a horse to jump without altering stride or rhythm, but often adjustments have to be made very quickly, further stressing the body of the horse.

Equine sports massage can alleviate the soreness and tension created in the course of  jumping. Massage is also a way to ensure that muscles stay strong, healthy and supple. A good massage therapist can identify a potential or developing problem before it becomes chronic.


How Does a Hunter’s Bump Form?

The sacroiliac joint is the only moving joint between the backbone and the pelvis.

When this joint becomes dislocated, the bump will appear. When the horse lands from a jump, the rear foot may reach too far forward under the horse, or slide forward. The entire weight of the horse (and rider) is being supported by that one leg. The movement of the leg coming too far forward rotates the sacroiliac joint so far that the supporting ligaments (usually just on one side) tear. This causes the front of the pelvis to move up and forward out of its normal position, creating the bump.

There may initially be pain and a reluctance to use the leg on the side of the injury. The horse may refuse to jump at all for a while. Strides may be short. Eventually the pain subsides, but unless the dislocation and muscle tightening is corrected, the movement of the leg will always be limited.

In the past, it was believed there was no treatment or help for hunter’s bump, but more recently it has been shown that cold laser, chiropractic, and massage therapies are effective.

Does Your Horse “Camp Out”?

When standing, does your horse stand square, or do his hind legs appear to be trailing out behind? When trotting or cantering, does your horse feel strung out? The cause could be that the pelvis has rotated. This can happen when a horse jumps a jump that is too big for his fitness level. Also, if the horse lands with his feet out behind and the rider sits down hard at the same time, the pelvis can be shoved into a position that causes pain in the stifle, hocks, croup, lower back, and even the withers. Myofascial release and stress point therapy can reverse this condition. Hand walking down a steep hill will encourage the horse to maintain the position after it is corrected. It may be necessary to include chiropractic treatment if the condition is severe.

The Important Long Back Muscle

The top line of a fit equine athlete should appear to be a continuous flow. Angular areas are where I go first to find soreness. Most common areas for breaks in the flow are in front of the withers, behind the withers, and behind the saddle. Today I’ll focus on the area behind the withers. This is where the long back muscle attaches at the back of the withers.

The longissimus dorsi is a complex muscle, and very important to riders. It is where you sit, where the saddle sits, and it is used in lateral flexion. I often find the forward attachment to be sore after cross country day, especially in upper level horses that have big drops to navigate. But any horse that jumps and lands hard can become tight   The resulting spasm is usually easy to find, and fairly easy to release.


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