Tag Archives: sacroiliac

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.

Analyzing Problems in the Trot

If the horses head bobs while trotting, the head will go down when the leg in pain hits the ground.

Watching from behind: the hip that looks higher is the side where the problem is, since the hip will come up to relieve pressure.

A hind leg travels inside: There could be hock pain, low back pain, or muscle spasms of the semimembranosus.

Throws hind leg outwards: There could be pain in the stifle or hip, or spasms in the tensor fascia latae.

The front leg travels inside: there could be knee pain, or tight pectoral muscles.

The front leg arcs out: there could be back or shoulder pain, or spasms in the spinatus muscles. (see first diagram)

Short stride in front: spasm in the triceps.

Short stride behind: if it is on one side, there could be a problem with that hip. If both hind legs are short and tight, there could be a problem with the sacroiliac joint, or the muscles surrounding that joint.

Many of the problems described here can be resolved through massage, cold laser, and/or chiropractic treatment.

 

 

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.

Another Cause of Chronic Pain

I talk about Stress Points a lot in this blog. Have you been wondering why I don’t mention Trigger Points much? Let me explain: Stress Points occur where muscle tendons attach to bone. Trigger Points form in the belly of the muscle. A trigger point is a knot about the size of a pea, deep in the muscle,  and it keeps the muscle both tight and weak. The constant tension of a trigger point restricts circulation to the muscle. The tricky part of treating the pain caused by these points is that the pain is often referred to another place, like a joint. Typically the joint pain is treated, but the cause isn’t.

With experience, I have found that there are some visual cues to many trigger points. I look for ripples in the skin, or just a difference in texture. When I feel a change in temperature during treatment, I know I am on the right track. Circulation has increased and the site feels warmer.

Releasing Trigger Points

  • Helps to relax muscles.
  • Improves range of movement and general body tone.
  • Helps relieve pain, swelling, and stiffness.

Once the trigger point has been worked on, cold laser can be very useful in bringing relief from the pain, especially those in the back and sacroiliac. Being able to eliminate pain without the use of injections or pills is a very achievable goal with these therapies.

Should I Be Concerned About Hunter’s Bump?

The sacroiliac is a joint that attaches the pelvis to the spine. When the three ligaments that surround and stabilize this joint are stretched or torn, the part of the pelvis called the ileum slips upward. That is the bump that you can see along the top of your horses’ rump. It is common in horses that jump, but it should be treated before it escalates into a career ending problem. The ilium is often broken when you can see this bump. Lameness may or not occur immediately.

Since I work a lot with event horses, I have seen many cases of this misalignment. Often, treatment will consist of calling a chiropractor for several treatments (count on about 6 spread over a year), stress point therapy (the muscles of the gluteus must be released in order for realignment from the chiropractic treatment to stick), cold laser, ice when the injury is new and painful, Traumeel rubbed into the area, and myofascial release.

A note of caution: Young horses who are jumped too high for their developing bodies are extremely prone to jumpers’ bump. No matter how talented your baby (under 6 years old) is, it is better to develop that talent on the flat than to jump big fences. A horse I work on regularly ran 56 races in his career on the track, but he didn’t jump until age 7. He is now 23 and still jumping (with great joy!) weekly and competing in eventing. His bodywork, excellent breeding, and good care are partially responsible for his longevity, but I also think the fact that he did not jump until a more mature age worked to his advantage.

 

Case Study of a Retired Show Horse

I recently went to a barn full of a breed that I don’t often work on: Saddlebreds. (I also got to work on a very handsome Morgan, one of my favorite breeds!) This is a show barn and the horses are all plump, shiny, and quite fit. I was asked to take a look at a retiree: a 19 year old who had a long and successful show career. He was suffering from arthritis in the lumbar area, and sciatica. He often lost his balance in the hind end and had had six injections to help him. As he walked into the barn, he appeared ready to fall over, but the owner assured me he would not fall on top of me as I worked!  I thought he might be a good candidate for cold laser therapy. After about 15 minutes he squared up his hind legs and seemed much more secure in his balance. I used the laser for another 15 minutes and then went on to the next horse. The owner and groom informed me that when the gelding was turned out in his pasture he ran and bucked! I wish I had seen that with my own eyes! Maybe next time I can get before and after photos.

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