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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.
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.
Preventing Injury in Your Riding Horse
What would your horse be like if all his muscles were in a state of relaxation, free from tension? Deep tissue massage, stress and trigger point therapy, and myofascial release
will help the connective tissue become more elastic, thereby allowing the muscle to return to its natural shape.
It is very important for horses to maintain a comfortable and free range of motion. If certain muscles are tight, other muscles in the body will compensate and take up the extra workload. They may be ridden like this for weeks, months or years, until the body can no longer call on extra resources because it does not have them. This ultimately leads to ruptures of soft tissues and thickening of the tendon and ligaments, which eventually can cause permanent dysfunction of the affected area.
Muscles attach to bones in pairs of opposites, and cross one joint or more. Muscles free from tension will carry out the function of keeping joints in alignment. This allows joint fluid to flow evenly within the joint, and this reduces unnatural wear and tear of joints.
Each muscle is attached to bone by tendons. Muscles are designed to take 90% of workload and tendons the other 10% The muscle is where the elasticity is. If the muscle is not functioning properly then the tendons will take more load and can eventually tear.
Equine massage therapy is a very powerful tool in injury prevention for horses.
More Benefits of Equine Massage
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.
What is the Secret to Horse Show Success?
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.
Using the Cold Laser to Prevent Injuries
Alberto Salazar is a running coach to Olympic medalists and many other successful runners. Observers have noted that Salazar’s athletes are not only fast, they seem to avoid the injuries that plague others in the sport. An article in the Portland Business Journal reveals the latest Salazar method: the use of laser therapy to prevent injuries, or speed healing.
“We use the lasers at the first sign of injury to limit an exaggerated inflammatory response that can delay healing and help the athlete return to training more quickly,” Salazar says in a short interview.
Proponents believe that laser treatments can reduce pain, and speed healing of all body tissues–muscle, tendon, ligament, and bone. Some studies have found it superior to ultrasound.
Before tendons become inflamed and swollen causing pain to the patient (whether two or four legged) and causing a loss in strength and motion, low level laser, or cold laser, can be a very effective therapy.
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.
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.
Where is the Problem?
Myofascial release is a technique of applying extended pressure to the complaining body part. Normally fascia is relaxed, but any kind of trauma, scar, or emotional tension can create kinks in the fascia. This not only impacts the problem area but can spread throughout the body. Think of the fascia as webbing or a sweater that encases all of our muscles, bones, veins, nerves, ligaments and more. Pulling one thread in the sleeve will send shock waves throughout the sweater. Everything is connected.
If you try myofascial release on your own body, you may wonder why I am still alive! The animals, mostly horses and dogs (though there have been pigs, llamas, and goats in the mix) seem to recognize that I am there to help. The process of balancing the structure of the body is not always pleasant. Animals seem to be better than we are at not avoiding hard stuff! Maybe it is more natural for them to let go.
By offering our animals the healing that massage and alternative bodywork therapy can give, we can give something back to them for all that they have given to us.