Unlimited access >

Cervical remodeling, SI pain, RF lameness, shoulder pain... pull me out of the rabbit hole

Hey all. Need some encouragement in my life, I’ve been really down this year trying to get my mare back to normal. If you like long reads and slow moving train wreck mystery lamenesses continue on. This is just a post to get this all out somewhere into the universe but maybe someone will have some positive input or advice too.

March this year my 10 year old draft cross mare started having some issues - first rushing jumps which was really unlike her, kicking out at right canter, more difficulty bending right (she has always been stiff to the right, with her right shoulder wanting to bulge out), and some soreness over SI. I had upped her work load this year and thought maybe we were asking too much physically so then I would try working her more conservatively but the behaviors kept coming back. She did not appear lame when I would lunge and video her, but she felt kind of off. Finally one day she did not want to go forward at the trot and was craning her neck oddly to the right. At this point I had my trainer take a look and he thought she had a high up right hind issue, but could only see her do anything out of the ordinary when I really had her bending on a small circle to the right (to which she reared as an answer).

I took her in for lameness eval end of April. Vet found: RF lameness, and right SI pain. She was lame ONLY to the right on a small circle on hard ground. Flexed mildly positive on RH spavin. Flexing RF did not result in increase in lameness, but mare highly resented them flexing this leg. Not lame on a straight line or on the lunge line in the arena; guess it wasn’t just me! Nerve block indicated something in the hoof, x-ray showed sclerosis where the collateral ligaments attached to the coffin bone, a thin-ish sole (11mm), and a slight lateral high hoof imbalance (.5 cm). No navicular changes, good PA angle. Ultrasound above hoof clear. Right hock x-ray clear. Right stifle x-ray clear. Her diagnosis was collateral ligament injury so we did PRP and shockwave, then stall rest w/hand walking and a specific rehab protocol. Vet suggested injecting SI if pain did not resolve with the foot rehab. Mare did slip and fall while running in the paddock this winter, late January and early April were ones I witnessed so I figure she must have strained the ligament at some point and it got worse with work.

End of May she was cleared for tack walking, had just a tiny bit of lameness remaining RF (.5/5). No SI pain. Told to continue small paddock rest until sound at canter. End of June she was cleared to add trot, sound on the foot. One week into July I add the trot. She seems relaxed other than being kind of put out that work might be back on the table because she’s a bit lazy by nature. A week later I come home from work to a broken fence next to her paddock and she has a couple minor scrapes and seems extremely agitated. Maybe cast? I hand walk her only for a couple days. Three days later I try and walk and gently trot under saddle and she feels just like she did before we went to the vet the first time. Doesn’t want to go forward, wringing head to right, threatening to buck. I put her on the lunge line and she looks weird but not lame anywhere specifically. She does trip a few times. I play phone tag with the vet for over a week, who tells me she might have just aggravated something if she got cast and I should should continue to work with her and then bring her in if she hasn’t improved in a week or two. We discuss possible ulcers and SI pain but she really can’t say what it might be.

August 10 I finally get an appointment because we have no improvement. Mare is not lame on the foot but has mild SI pain R/L and swaps leads only to right. We decide to rule out ulcers first because of some of her behaviors - she’s very right side problem dominated, kicking out at leg, not wanting to go forward, some eating issues, etc. She is found to have grade 2/4 glandular ulcers so I start a 28 day treatment with omeprazole/sucralfate (a mistake because then I’m immediately broke, GastroGuard pricing should be illegal). Vet says to continue working and add canter. At first I thought the ulcer meds were helping, the trot got a little more relaxed but still doing the head wringing. So I go ahead and add the canter and lo and behold it feels pretty good? Which boggles my mind that the lameness is basically 99% at the trot. Unfortunately after cantering twice the trot feels significantly worse so I just full stop riding. Vet thinks we should go ahead an inject the SI but I decide to get a second opinion because it doesn’t feel like an SI issue.

End of September I get into a second vet who is known for dealing with mystery lamenesses, because at this point, what even is going on. Is she continually injuring herself or is this something ongoing? At this vet mare palpates moderately sore at the base of her neck, both sides. She tries to sit back when he hoof tests her, especially the right, but is negative to the testers. She flexes mildly positive RH proximal - I think the same as the RH spavin from the previous flexion test. Isn’t lame on anything going straight, on a circle, on soft ground, or hard ground. He does make a comment that she is very flexible (she is draft cross and seems to have looser joints) and when I ask if she is too flexible in regards to DSLD, as she does have a straighter hind leg and lower fetlocks, he makes a comment with the gist being we aren’t going to go there yet. He is pretty positive her neck makes the most sense instead of an SI issue or anything else, and this does make sense to me as well considering what she feels like under saddle, so we x-ray it. He doesn’t find anything too exciting, but gives me several options on what to do next. I choose to inject the neck as it seemed the most logical place that the pain was coming from after discussing it with him and phoning a friend who had commented “looks like the neck” in a video I had sent previously. During the US guided injections, he was able to see some mild remodeling on c5/c6 and said there is possible sclerosis on c7/t1 but isn’t 100% sure because it’s such a hard area to see. Tells me we should see improvement in 3-4 weeks, and if not to let them know.

I did some light reading about cervical arthritis that night and wasn’t thrilled with what I found (mainly neurological symptoms and quick decline). So I told myself I would just get through the 4 weeks and if there was no improvement we could get a myelogram to see if she was safe to continue riding. I spent the first two weeks walking, doing exercises to get her to relax her neck muscles and stretch, and ground work to start to improve her sadly depleted topline. It’s now been just over 3 weeks, with 3 rides W/T/C and I would say we have little to no improvement from the neck injections.

I did get referred to an equine physical therapist (licensed and all), and she came out on Sunday. Apparently mare has less than ideal range of motion on her right shoulder, and has a very over developed underneck (the latter I was painfully aware of and had hoped one day would turn into proper neck muscles). She worked with me on the ground and in saddle with specific exercises to get mare to relax and use her neck properly. I would say that this has been the most beneficial part of trying to rehab my mare in the last 6 months.

My ride yesterday was okay. It started off feeling worse than the two previous rides, and I almost cried mid ride, but I was able to get mare to relax and flex correctly a tiny bit on both sides at the trot, not bronc at the canter (which happened when the PT was here) and halt without bracing her neck. I’m really grasping at straws though because I’m barely holding it together and have gone down all kinds of rabbit holes for what might be going on. But at this point there isn’t much I can do because, who am I kidding, I can’t afford a myelogram or additional major disgnostics at this point. When I got on again after the injections and she was pretty much the same, pretty decent canter, terrible and obviously uncomfortable trot, really my heart sank. I feel so down after these last 6 months and despite this not being a “dramatic” injury or occurrence, I have seriously considered retiring from riding. It’s all just so expensive, stressful, and heart breaking.

Looking back I think something has been going on for a while. She has always been difficult for the farrier in the 3 years I have had her - tries to sit back on at least one foot when working on fronts and mildly difficult with hinds. She will be super forward and relaxed one day then fussy and tense about taking contact another. Has had mild muscle tremors on her shoulder region (hair test 2022 - HYPP and 5 panel neg), added Vitamin E, thiamine with no change. Unsure if related to work intolerance, nervousness, nerve injury, or mineral imbalance. Vets just think the tremor is weird but no real concrete suggestions, first vet suggested PSSM2 biopsy if it got worse. Tremors seem to have subsided since she’s been on rehab.

Her personality is easy going, friendly and curious although somewhat withdrawn. Extremely food motivated. I was able to teach her to side pass on the ground in one go. She was range bred, so we still have to work on domesticated horse things, like, don’t kick at the hose on the ground when it moves. She’s generally really pleasant to work with and have around, and I appreciate her so much. I don’t know what to hope for though.

Dental January
Bloodwork normal January
Wormed March
Vaccines (5 way, WNV + rabies) April

Will update in 5 weeks at next PT appointment or with any significant changes.


Ugh I just want to say that I’m so so sorry you’re dealing with this. Mystery lameness is exhausting- just look at my posting history if you want commiseration :upside_down_face:

Firstly I think you need a break - it doesn’t sound like you’re getting any traction by throwing money at her. Is she happy and pasture sound? Can you turn her out 24/7 with some buddies and let her decompress? If I were you, I’d back off the work, get her on a good bodyworker routine, make sure her feet and diet are good, and then find other things to fill your time for a bit - for your mental well being.

As far as “what could this be?”: my first thoughts are back/spine issues, due to the canter being better than the trot. My second thought is PSSM due to the draft and miscellaneous intolerances. You might try a PSSM2 diet, and give it a good try, as it’s cheaper than a myelogram. These things tend to show up around this age, so it makes sense from that perspective.

I’m sure people with more experience than I will chime in, but I also think there would be no harm in some Dr Green and taking a break for yourself.

ETA maybe I missed it, but did you look into EPM? These symptoms could point that way as well.


I would test for Vitamin E instead of just dosing. My horse requires a massive dose on a daily basis to stay within normal range.

Also, I would look at adding an amino acid supplement for muscle support. From my own personal experience, so much body pain can come from not using the right muscles. I’d take a look at Jec Ballou’s book - 55 corrective exercises - and see if you can use the rehab back series. My downward spiral went from hind end discomfort, to frozen back, to tight withers, to very uncomfortable horse. We share many similar symptoms. PM me if you want more details about what I’m doing.


Have you had a proper neurological exam performed? If not, start there.


I am so sorry that this is happening. I’ve dealt with similar and so have others here and with different outcomes. It is so hard. If you want to PM me, please do. :pray:


If it were me and I could afford it, I’d consider doing the Equi-sec test for PSSM2 variant markers. There are quite a few different variants, and they all benefit from slightly different diet changes - and it can take a few months to see the full benefits once you get it right.

Barring that, turn her out for the winter, recove your finances, and see what you’ve got in the spring. Time is good for a lot of issues.


Thank you all for your kind words and thoughts.

Just to answer a couple things: We have not checked for EPM or Lyme, nor done a specific neurological exam. I would hope my vet considered neurological pathology when he looked at her, but you never know. I think Lyme is fairly uncommon here (PNW) but it’s not impossible, and I am assuming the EPM test is expensive - spinal tap? I think these are good things to consider and ask the vet about as I know EPM is on the rise in central Oregon which is where she came from.

I don’t think it’s necessarily a hoof trim issue although I would like to go to a shorter trim cycle. If I feel smarter next week I’ll try and attach some photos. Other than the slight imbalance on the x-ray the vet didn’t think there were any major issues.

She generally gets body work done about 4-5 times a year. If bodyworker finds anything major, it’s usually in the thoracic sling area and right hip.

While she is happy and pasture sound I do have a feeling just turning out isn’t going to improve the situation based on her history and how the rehab has gone. From what I’ve read this would also not be beneficial if she has PSSM2. My two horses are usually turned out 24/7 in the summer and brought in at night in the winter. She’s currently on about 12-14 hours turnout right now, and both my horses usually get 2-3 months off in the winter due to weather, so she will get time off regardless. But I would like to use the time when the injections are most effective to work on (hopefully) rehabbing her, if it helps any.

So I think I would like to consider:

Neurological inquiry/test at next vet appt.
Consider EPM, maybe Lymes if neurological positive
Supplementing with animo acids and higher vitamin E (had been on my mental list)
Continue with PT for 5 weeks to see if it makes any difference
Hind gut supplement
PSSM2 - soak hay, add fat? She doesn’t seem to tolerate orchard hay and that’s the only low NSC hay I can find

Just to add … around my way, ‘neuro’ is the catch all for ‘we have no idea’. Sure, sometimes it is … but I keep seeing horses tentatively diagnosed with some neurological issue, and then surprise surprise … turns out to be muscle soreness or other body soreness that makes it look neuro.

In all my conversations with vets, they freely admit that bones, joints, ligaments and tendons are areas of focus. Very little look deeply into muscle groups to understand their ‘health’.

So please take it with a grain of salt if that’s what you hear.


Bolding mine.

No! A truly neurological horse can become dangerous to handle/to itself very rapidly. The correct protocol for suspected neurological impairment in a horse is to be as cautious as possible until the root problem is found and then to proceed as appropriate for that root cause whether neuro or not.

I’m taking from the nature of the quote that the poster hasn’t ever seen a severely neurological large animal, let alone sudden onset or sudden worsening. It’s sure a wake up call when one sees a large animal staggering around with very little control of its own body.


I think I read in the first post that the OP. has seen this horse fall in the field twice this year (January and April?) is that correct? And that there are issues in the C5-6 joint and possibly C7-T1?

Ten year old horses shouldn’t be falling down.

I’m sorry OP. I have a 15 year old horse who I have seen fall at least twice a year since he was born. I have photos of him falling, and even a video. The falls never looked like much, just a goofball not paying attention to his footing. He’d jump back up and carry on as if nothing happened.

I began to wonder if it was normal a few years ago, and after seeing a webinar on EDM early last year I was growing more certain that something was wrong as we battled ulcers for the first time in his life. Last October he went down in the trailer on a straight highway at a consistent speed.

I had a neurological exam done and he was grade 1-2. All four legs affected. I had his neck x-rayed this spring, and the rads were sent for expert opinions. One said “Looks like arthritis. Shouldn’t be causing the issues.” and the other said “I think it’s a Wobbler.” My vet agreed with the second opinion.

The falls weren’t the only neurological signs my horse displayed, but I didn’t know they could be until the initial exam. The vet showed me and I said “He’s always done that.” so we knew iit wasn’t some new infection that could be treated.

I did get Jec Ballou’s book on postural exercises and my horse was doing really well in January/early February. Then he fell (probably) and was super body sore for a week before slowly improving. He had more bad days than good, telling me he couldn’t carry me every day (with one exception) right through April when I had his neck imaged.

Long term neurological issues often get worse and are finally diagnosed around age 10-13. The horses learn to compensate for their impairments and are fine until something happens to upset that compensation ability. In my horse’s case I suspect the arthritis in his neck was the upsetting factor.

It is a heartbreaking diagnosis, but I see a lot of familiar red flags in your first post. I’d spend my money on a neurological exam, good imaging of her neck, and expert assessment on the rads. I’d wait for the results before doing anything else. :worried:


I’ve had to insist on a neuro exam before. Vet looked at me crazy until she did it and then went “okay now I see why you were concerned”. He wasn’t bad enough to get a rating but he was funky enough to get her attention.

Lyme is a cheap test, do the one they send off not the “snap” test. EPM dx requires a spinal tap - but there is a blood test for exposure that some vets will treat if the numbers are high enough. Both of these things can cause your symptoms, and if they are the issue, nothing else will help until you treat them.

I would start there, and maybe restrict yourself to groundwork until you have some answers. Your horse sounds very uncomfortable, and I’m so sorry you’re dealing with this. Just remember to protect your sanity while you’re at it - don’t let this burn the passion for horses out of you entirely, and don’t let it start to impact the rest of your life.


I read @starsandsun’s post as talking about the horses graded 1-2, not the ones that are staggering around falling down. Those are obviously neurological and dangerous. I know exactly what she’s talking about and we’re in the same area. IME, some vets around here declare horses neuro based on extremely subtle gait characteristics, limb placement findings, or stiff/low head carriage. I asked one vet if she ever sees horses that she finds to be non-neuro and she said, “No…” Even Dr Johnson at New Bolton says that coordination is a bell curve and that the gait/limb placement findings could just show that the horse lands at one end of the curve, vs. having a pathology.

Using “neuro” as a catch-all is definitely a thing that happens. It sucks if your horse is insured and after a routine lameness exam there’s an exclusion for all illness/injury caused by neurological deficits, even if the “deficits” resolve because actually the horse was just ulcery or neck/back/footsore.


1-2 can very easily lead to staggering and falling down either slowly or suddenly. That’s why it’s foolish to brush it off and not delve further into causes.

You know what sucks worse? Having that horse actually being neuro, and not checked thoroughly because “catch all” and then having that horse injure you, or worse, itself, or even worse, someone else.

If a vet suspects neurological impairment, you need to ask for a referral to a neurologist, not just lump the vet into the “catch all” group and carry on blithely ignoring something that could very well turn into something dangerous.


I should clarify she fell while racing around - the paddock was slick. I’m in the PNW and we have very sloppy clay soil. I am certainly not dismissing the idea she could be neurological, as that is one of my main concerns, and I agree she has red flags, but wanted to clarify the circumstance because I do think it makes a difference. Horses aren’t always graceful and sometimes they eat it while playing.

She does have neck X-rays done from before the injections and I will ask if there is someone we can send them to for further assessment.


I don’t see where anyone is suggesting that—just to stay open-minded about what other than CA, ECVM, or degenerative neurological disease could be causing what look like minor neuro deficits.

And sometimes the vets grading horses 1-2 while acknowledging that the findings could be caused by something else ARE neurologists. Diagnosis of these things isn’t an exact science.


First, I admit to reading all this quickly. That said: I am in the midst of a challenging and unclear situation with my own horse. Reluctant to go forward. Reluctant to carry himself in collection. Looks sometimes lame, but not clear which leg. Had a workup done at vet clinic; neuro test showed mild negative responses to some things. We are leaning towards problems in the neck ( lyme negative, pssm negative, etc) Thinking its possible that C6/C7 may be malformed. Reading extensively on this in last week or two and adding that to an ultrasound that was “Iffy” makes me pretty sure that’s what I’m dealing with. Apparently this is really becoming “a thing” given ability do to better views and quite common across a range of breeds. Read this article. If nothing else its interesting. https://www.thirzahendriks.com/post/the-un-balanced-horse.
FYI, I’m also considering biopsy for PSSM2, but my gut is telling me neck. Also, edited to add - if problem is in the 6/7 part, it makes a difference as to how the xrays are done…


You said it’s been 3 weeks since the neck injections? Give it a full 4 weeks, minimum before letting yourself spiral too much. (Been there). Are you done with the ulcer treatment? Rescoped?

I would also consider acupuncture to try to unravel the neck muscle imbalance and /front feet connection. Ever tried pads on the feet? Done any trials of Robaxin or anything like that?

@IPEsq It will be 4 weeks on Tuesday. When you had injections done did you not see any difference until after 4 weeks? When did you start to see a real difference? What was injected?

Finishing 6 weeks of sulcralfate today actually. I swapped to esomeprazole for the last two weeks because gastroguard was too expensive. So will start to taper off that, although I think there was a study this might not be necessary. I don’t really want to rescope until I figure out the pain issue because I’m pretty sure I’ll have to treat again. The more I read about ulcers the more it sounds like glandular ones are (anecdotally) caused by undiagnosed pain, or possibly hind gut imbalance, instead of too much acid, which causes the squamous kind.

Robaxin sounds intriguing, I had never heard of it. Will ask my vet next week when I call in.

I haven’t tried pads, she’s difficult enough for the farrier I don’t think we could safely get shoes on at this point. I did try to buy some hoof boots (scoot boots) but I had the worst luck fitting her and they now belong to my other horse. I’m not sure if that would help in the same way?

I’m truly sorry you’re dealing with something similar, it’s so… exhausting. Thank you for posting this article- I had read about this malformation about 3 weeks ago. My vet did not take films at the 30° angle so something to discuss with them. What makes you think PSSM2?


Boots can make an incredible difference. They are worth a try and you may be able to find a hoof boot fitter in your area who will be able to recommend brand and sizing. Failing that, take an old shoe (that would still fit your horse) into the tack shop and jam it into boots until you find Cinderella’s rubber slipper. Yes, I have done this. Worked perfectly. Tack shop staff wanted to know wtf I was doing but when I explained, “Brilliant! So many people measure wrong and come back for a different size.”

1 Like