Injured SI/stifle protocol

I’m hoping to get any extra tips or rehab ideas for my horse that is currently lame with what the vet thinks is an SI injury. He also has some swelling near his stifle, She said she thought it was the patella. Based on her exam she really feels the culprit of the lameness is the SI. He had been living in some pretty deep awful mud. The thinking is that he either slipped and injured himself or kind of got stuck and really tweaked/tore something.

This was a new to me vet and kind of a last-minute appointment. There was no flexons or nerve blocks done. Just walk/trot on a straight line and then W/t/c on lunge. And a body palpitation. I do have clean stifle, hock and fetlock x-rays from a PPE (March.)

The protocol suggested right now is living in a paddock (not muddy as he has been moved) and do light work, mostly at the walk. Straight lines mostly and some light pole work. She wants him on equiqox for now for inflammation. She wants me to reevaluate in 20 days. If he is not improved she thinks we should try some shockwave. She said we could inject but would rather not since he’s very young.

He does flare out a bit on the right hind. So we want to try and get that more under control too. It will be getting him on a shorter trimming schedule for now.

In the meantime, I have a friend who does PEMF and was thinking if seeing if she could come out. I know it won’t cure anything but I wonder if it might feel good to him?

I hope we can get him feeling better and that this isn’t career ending. If things don’t improve I might take him to the local vet hospital (CSU.) Maybe after the shock wave.

Do you have x-rays of that stifle?

If not, I would ask the vet if it makes sense to start there.

I would ultrasound the stifle to see if there is inflammation. If so, consider IRAP.

For SI, movement is good, but keep in mind that the canter is hard on the SI and the walk is a closer gait to canter than trot. So, while walking is good, for strengthening the stifle and building fitness, long and low trot work is also good.

Depending on how lame/sore, incorporate the Equicore system to improve symmetry. That could help with the flare also.

I find shockwave to be not worth the money for SI. I would rather inject. If this is an acute injury, I wouldn’t worry so much about age; just getting the inflammation under control. You can also use a biologic like ProStride in the SI. I do like PEMF and acupuncture as complementary therapies.

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I have x-rays from the middle of March on the stifle, hocks and fetlocks.

IPEsq, thanks for the info. I injected an SI but that was years ago…

I agree that ultrasound of the stifle sure seems like a good idea.

I’m wondering why your vet didn’t suggest any imaging? STEM and PRP work better on fresher injuries and work particularly well with younger horses. If you’re wanting to preserve a performance career for this horse, then I’d want to see exactly what’s going on in the SI or stifle so you can put together a proper treatment plan. Not just wait and see and “maybe some shockwave”.

Is there a teaching hospital that you could consult with? Budget is certainly a factor, so if you’re not interested in spending $$$$ on STEM then the imaging may not be worth it’s own significant expense. But I would personally want to find out exactly what’s going on internally because it’s hard to put together a rehab plan without being able to track the actual lessons as it’s healing.

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So this was not my vet. He was just moved to a training barn… So I used their vet. I’m not sure why she didn’t want to do diagnostics. I almost wonder if she did not have her equipment with her ( She had just gotten back in town.)

But I agree and it makes me a little nervous to not know 100% what we’re dealing with here. There is a local teaching hospital down the street that I’ve had pretty good success with. So I make call and see how far out they are for an appointment.

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I swear I speak English ha ha. Sometimes I use the talk to text and things come out a little crazy

I would not wait too long or put too much effort into treatments without getting a diagnosis, if getting diagnostics is an option. It provides such peace of mind to know what you are dealing with and what you should be doing for it!

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Agree on getting a diagnosis.

Some parts of the stifle are not imageable by ultrasound, at least as of five years ago. Skipper’s stifle lit up via scintigraphy but we never found anything via ultrasound or radiographs. The vet said you have to do exploratory arthroscopic surgery to find some things. It was one of many problems with this horse, including neck, so I didn’t pursue.

I just saw this podcast which may be of help: https://podcasts.apple.com/us/podcast/the-horse-first-a-veterinary-sport-horse-podcast/id1435735981?i=1000524259093

Good luck with your horse.

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CSU just looked at my horse this morning to assess his hematoma/muscle tear. They are hopeful that he didn’t actually tear anything but the hematoma has just sort of displaced the muscle. Anyway, I asked them to do a chiro adjustment because he was due, just had a long haul, and my regular chiro is booked till the 28th. They felt he was still pretty sore in the SI region (which we have spent all of this year working on/treating after an acute injury). And they recommended shockwave. LOL. But I’d also taken him off methocarbamol due to the haul and him not getting consistent meals and getting settled back here in CO. So, he’s going back on that and then will be rechecked in a month. He’s also been cleared for a little more work, radiologist’s opinion pending. So I’m thinking maybe in a month they won’t suggest shockwave. When the injury was acute, they didn’t think it would be worth the money, and my other vet in SC that was treating him this winter/spring also felt it would not be that helpful after the initial analgesic effect wears off (pretty quickly). However, it is probably important to mention that we did not find any SI ligament or other soft tissue injuries which might push the opinion more towards shockwave. And today, the vet felt that it was really more muscle soreness, which is why they agreed to try having him live on methocarbamol a bit longer as we get over the latest injury.

Edited to add - we found a specific site of injury to the SI, causing a bone spur to try to form on the right side. After doing a lot of diagnostics and other things over some months last fall/early winter. Took a while to nail down. Also sometimes appeared to present as stifle, but he has clean xrays, and stifle flexions/extensions didn’t change the gait.

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My mare is currently retired (at 10yo) due to a SI “issue.” I agree with the person that said SI issues make canter especially difficult (canter performance issues was her primary “symptom” even though she was never lame and her natural walk overtrack decreased significantly). Her SI injury was undoubtedly before I got her (at 4yo) and she passed a full PPE (still would - she just has slightly less ROM than expected during certain, specific flexions). The lameness expert I took her to agreed with the poster who said shockwave wasn’t likely to be much help - the only treatment he recommended was injections. We did the injections and they, unfortunately, had no impact whatsoever (probably because the problem was chronic rather than a recent injury). We did a full bone scan to check for any other problems and none were found (the SI was the only thing that lit up). What helped her most was long and low lunging.

What also struck a chord when I read the OP was the right hind “flare” - my mare’s right hind turned out fairly significantly. It was manageable with good trimming on a 5-6 week schedule and it was never the cause of any lameness, but both the vet and my farrier thought it likely originated in the SI.

All that to say, I’m not sure a walking-focused, wait-and-see approach is a great idea. I think I’d be pushing for stifle imaging and SI injections. I think is my mare’s SI issue/injury had been addressed when it happened (and it may not have even been noticeable then), maybe she would have not needed to retire so young.

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I would take him to the vet hospital and have diagnostics done. I can’t believe she didn’t do any imaging of the stifle given that you say he has some swelling there.

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Yeah I’m calling CSU tomorrow. I just won’t be able to not be worried to death without some actual diagnostics. Too much at stake especially given his symptoms.

And maybe we will do a similar rehab protocol but either way I want to know more details.

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I am waiting to hear back from CSU from the Sports Medicine department.

I did reach out to my vet (not the one that has seen him regarding this injury is she lives too far away from where he is in training.) She said she thought that protocol sounded reasonable. But of course she hasn’t seen him maybe her mind would change if she saw him in person. Regardless I think it’s worth the peace of mind. Honestly I don’t think I’ve ever regretted getting a second or even third opinion and all my history with horses.

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I’m so sorry to hear about all this.

Hopefully you can get answers and a successful treatment plan

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Hoping you get answers. I myself put off images and injections in favor of laser, etc when I should have bitten the bullet on imaging and that led to injections for.my particular horse. Maybe this vet being new to you they were aiming for cautious vs doing more diagnostics. It’s a tricky vet/client relationship sometimes to know budgets and overall philosophy. Best of luck to you!

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CSU is coming out on Thursday (soonest appointment I could get at the moment.)

For now we are just keeping him moving in a low key way.

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