Pros and Cons Of Hock Injections

[MsJump21]

A couple months ago I talked with my vet about my new 8 y/o mare and she suggested that within the next 1-2 years I should consider getting my mares jocks injected. Currently she is only doing flat work to build up muscle and work on balance but over the next 3 years she would ideally be competing in the 1.20s in the perfect scenario. She’s never been lame even with having an injury to her DDFT (probably from jumping the out of the pasture) and doing flexion tests she showed no sign of lameness.

I’m curious as to how injections would help considering they tend to wear off after 3 months. I understand that jumping causes a lot of wear and tear on their joints but and that injections can help but are their any other benefits to them? And what are the risks?

[lcw579]

Unpopular opinion here since so many people swear by injections for everything, but any time you introduce anything into a joint capsule there is a risk of infection. Slight but it’s there.

I don’t see any reason to start injecting anything until the horse shows it needs it. I’m happy our vet, who also takes care of many horses competing at the top levels, agrees. Our jumper gets thoroughly checked out twice a year and so far has been fine with Adequan given Spring and Fall according to the manufacturer’s dosage instructions.

Honestly I think injections are a cash cow for a lot of vets.

[staceymc]

First off, you should get WAY more benefit than 3 months out of joint injections. If I have to do a joint injection less than 6 months apart I feel like I have a serious issue. And I like to get at least 12 months out of them ideally.

I don’t inject willy-nilly but I’m also a big believer in being proactive over reactive. If you wait until a horse DEFINITELY NEEDS those injections, then the joint inflammation has probably already caused a lot of damage. I would not do injections on a horse that flexes fine. But if one is flexes and we’re sort of like eh, it’s going to be time soon then I normally go ahead and do it. I want my horses to be comfortable doing the job I’m asking them to do.

For your horse, once you’re jumping regularly, I would consider putting her on a regular schedule of Adequan and Legend. Those two drugs are more preventative and also help treat joint inflamation without having to inject the joint itself. They’re both delivered IV. They are not cheap, but nothing in horses is.

As far as the risk of joint injections, infection is the big one. It’s not a likely risk, but any time you stick a needle into a joint space it’s a risk. And when an infection does happen it is not pretty.

[supershorty628]

Adequan is given IM, not IV.

I think injections have their place. My mare had some injections yearly when she was doing the big classes. There is a small risk of joint infection when you stick a needle in there, and I know that, but for her, it was worth it to ensure her comfort. I also agree with the above poster - I’d rather be proactive than reactive when it comes to inflammation. It does depend on the horse and what you’re seeing though; I wouldn’t take a horse that was 100% fine on all flexions and inject it, but with an older horse that I was noticing some stiffness in, I’d consult my vet about it.

You should be getting significantly more than 3 months of benefit from injections though.

[Redlei44]

What reason did the vet give for her recommendation?

[MsJump21]

@Redlei44

What reason did the vet give for her recommendation?

Our vet took x rays of her legs and said that one of her hind legs should signs that could develop into arthritis in the future but she doesn’t have it currently.

[Duckz]

@staceymc

First off, you should get WAY more benefit than 3 months out of joint injections. If I have to do a joint injection less than 6 months apart I feel like I have a serious issue. And I like to get at least 12 months out of them ideally.

I don’t inject willy-nilly but I’m also a big believer in being proactive over reactive. If you wait until a horse DEFINITELY NEEDS those injections, then the joint inflammation has probably already caused a lot of damage. I would not do injections on a horse that flexes fine. But if one is flexes and we’re sort of like eh, it’s going to be time soon then I normally go ahead and do it. I want my horses to be comfortable doing the job I’m asking them to do.

I’m going to second all of this. The way it was explained to me by a top sport horse vet is that joint inflammation is damaging over time and increases risk/severity of arthritis. It sounds like your vet saw something on the films indicating that you want to be proactive. I started injecting both my draft x and my ottb at the age of 9 and got excellent results. The draft did have a negative reaction once (swelling), but the injections were done by a local vet and when we consulted with aforementioned top sport horse vet, something about where she had injected was not recommended.

Generally I get 12+ months out of hock injections. I have found them to be the best bang for my buck in terms of effectiveness. Adequan and Legend both have their places. Adequan is meant to build up over time (loading dose then 1x month) and Legend is more short acting (give 36-48 hours before a competition). I would use either of those to supplement, not replace, hock injections.

[GoodTimes]

From what you describe it doesn’t sound like your horse “needs” injections. I would be interested to hear your vets reasoning and thought process. Why they think it’s necessary? Why specifically the hock? And which part of the hock? Is there a confirmation issue? Did you have x-rays done when you purchased the horse?

Personally I would wait. If you notice any performance issues like sticky changes, trouble with collection or downward transitions, etc than I would revisit.

You could look into Adequan or Legend, but I haven’t found the evidence to be very convincing.

[Bogie]

@lcw579

Unpopular opinion here since so many people swear by injections for everything, but any time you introduce anything into a joint capsule there is a risk of infection. Slight but it’s there.

I don’t see any reason to start injecting anything until the horse shows it needs it. I’m happy our vet, who also takes care of many horses competing at the top levels, agrees. Our jumper gets thoroughly checked out twice a year and so far has been fine with Adequan given Spring and Fall according to the manufacturer’s dosage instructions.

Honestly I think injections are a cash cow for a lot of vets.

I also believe that injections should not be given prophylactically. One vet that I follow says, “Finally, there’s no need to inject substances into normal horse joints, a disturbing practice referred to as “joint maintenance.” Normal joints aren’t don’t need routine injections, and there are risks associated with the procedure. Save joint therapies for joints that need therapy, and only inject joints in which there is a reason for them to be injected.”

When my horse was 16, he started to show discomfort in his hocks. This was a horse that suddenly started stopping at fences. I had his hocks injected and it made a huge difference to his comfort and performance. The results lasted about a year. At the time, I was also using Adequan.

My OTTB is 23. He has never had his hocks injected. Wait until your horse needs the treatment. There is always a small risk of infection when sticking a needle into a joint.

[OneTwoMany]

This article is worth a read…

https://aaep.org/horsehealth/lameness-joint-medications

[StormyDay]

I’d do adequan before I went to injections, especially in an 8 YO. There are still concerns that there are only so many good injections you get, so the first one last 12 mo, next 8, etc until you really don’t get a benefit at all.

[Trekkie]

Keep in mind too that early joint inflammation is a sign of overuse. Build in rest periods to your program and try to minimize unnecessary repetition. Often rest itself is enough to treat an injury that manifests early as inflammation. We have become so competition driven we sometimes expect our equine athletes to perform at levels their bodies cannot sustain. Their bodies hold out longer with less maintenance in programs that take their fitness, appropriate rest and joint health into account.

[MsJump21]

@GoodTimes

From what you describe it doesn’t sound like your horse “needs” injections. I would be interested to hear your vets reasoning and thought process. Why they think it’s necessary? Why specifically the hock? And which part of the hock? Is there a confirmation issue? Did you have x-rays done when you purchased the horse?

Personally I would wait. If you notice any performance issues like sticky changes, trouble with collection or downward transitions, etc than I would revisit.

You could look into Adequan or Legend, but I haven’t found the evidence to be very convincing.

My vet deems it necessary because she believes that her hock will develop arthritis and she would like to be proactive with slowing it down. I don’t know off the top of my head which part of the hock it was so I’d have to check her report. There’s no confirmation issue I’m aware of that the vet had specified. I had multiple X-rays done on all 4 legs.

[MsJump21]

@Trekkie

Keep in mind too that early joint inflammation is a sign of overuse. Build in rest periods to your program and try to minimize unnecessary repetition. Often rest itself is enough to treat an injury that manifests early as inflammation. We have become so competition driven we sometimes expect our equine athletes to perform at levels their bodies cannot sustain. Their bodies hold out longer with less maintenance in programs that take their fitness, appropriate rest and joint health into account.

She’s been given a month and a half off to help her DDFT and was ridden lightly for fun over the couple weeks and now she’s had a month off due to quarantine. I’m a firm believer in “less is more” so I would like to get her injections only if she needs them.

[GoodTimes]

If you want to hold off on injections for now I would place emphasis on management that is conducive to joint health.
Increase turnout as much as possible.
Always warm up for at least 10-20 minutes before asking for collection, transitions, jumping, etc.
Do not allow the horse to become overweight.
Mention it to the farrier, they may be able to tweak the shoeing to allow energy to dissipate and reduce the concussive forces.

It’s worth discussing with your trainer as well. There is theoretically more stress on the joints for a horse who is schooling over fences 2-3 times per week and showing 10+ times per year, vs the horse who only schools o/f once a week and shows 5 times/year. Assuming everything else is equal.

[findeight]

Second opinion. You can get a consult by just sending the x rays, no need for a personal visit. Assuming your vet will let you have copies or participate in additional diagnostics.

What leg is the DDFT in? Opposite front? Had one who got a DDFT and was sporadically off on it for over a year on complete rest and turn out (never did return to work, retired). What diagnostics and treatments on that DDFT and how ling since the injury.

And you need to read up and do more research. Just me, maybe, but I don’t like vets who make absolute predictions or promise anything about preventing arthritis in the future… And if horse is not bothered now and theres no definitive signs within the joint, what is it that would wear off in 90 days? And does your vet have any knowledge of studies showing it actually does delay the onset of arthritic changes? Most horses do get that eventually. So do people and dogs.

Happen to be pro injection. Have gotten them in three different horses over about 25 years, all over 12 years old with diagnosed arthritic changes. To make them more comfortable starting at once a year. In all three cases it gradually progressed to where it was twice a year, then 3 times and at each step workload was reduced etc. Never did or seen anybody inject just one hock for arthritis, its done bilaterally. And vets charge by injection site, think theres 4 per hock (?). Its not cheap for an unproven preventative. Very worth it for horse with actual need but if needed 4 times a year, horse needs another job.

With all due respect to the many wonderful vets out there, there are some that care more about their billing totals then what a horse actually needs or what us oriven to be effective.

If there was anything out there that actually prevented arthritis, we would all be on it. Not relieve symptoms, actually prevent it from occuring.

Your horse and your money but…

[RAyers]

@MsJump21

My vet deems it necessary because she believes that her hock will develop arthritis and she would like to be proactive with slowing it down. I don’t know off the top of my head which part of the hock it was so I’d have to check her report. There’s no confirmation issue I’m aware of that the vet had specified. I had multiple X-rays done on all 4 legs.

What is the specific diagnosis for what type of arthritis? Obviously she would know that different types of arthritis would require different therapeutic methodologies given there are around 100 different types/causes of arthritis in the literature. Does she think it is ischemic? Trauma induced? Genetic? Idiopathic?

There is NO preventative to osteoarthritis (arthritis due to normal use). It is a mechanical induced disease that is managed on onset, not prior (because it happens no matter what). The BEST preventative is conditioning and training of the horse from a young age to encourage the biologic development of cartilage thickness and quality.

Any vet who suggests that something should be done to prevent arthritis prior to diagnosis is not following the actual literature nor gold standard treatment for OA and other forms of arthritis. I would be very hesitant to follow said vet’s advice. Then again, I work in orthopedic research.

[MsJump21]

@findeight

Second opinion. You can get a consult by just sending the x rays, no need for a personal visit. Assuming your vet will let you have copies or participate in additional diagnostics.

What leg is the DDFT in? Opposite front? Had one who got a DDFT and was sporadically off on it for over a year on complete rest and turn out (never did return to work, retired). What diagnostics and treatments on that DDFT and how ling since the injury.

And you need to read up and do more research. Just me, maybe, but I don’t like vets who make absolute predictions or promise anything about preventing arthritis in the future… And if horse is not bothered now and theres no definitive signs within the joint, what is it that would wear off in 90 days? And does your vet have any knowledge of studies showing it actually does delay the onset of arthritic changes? Most horses do get that eventually. So do people and dogs.

Happen to be pro injection. Have gotten them in three different horses over about 25 years, all over 12 years old with diagnosed arthritic changes. To make them more comfortable starting at once a year. In all three cases it gradually progressed to where it was twice a year, then 3 times and at each step workload was reduced etc. Never did or seen anybody inject just one hock for arthritis, its done bilaterally. And vets charge by injection site, think theres 4 per hock (?). Its not cheap for an unproven preventative. Very worth it for horse with actual need but if needed 4 times a year, horse needs another job.

With all due respect to the many wonderful vets out there, there are some that care more about their billing totals then what a horse actually needs or what us oriven to be effective.

If there was anything out there that actually prevented arthritis, we would all be on it. Not relieve symptoms, actually prevent it from occuring.

Your horse and your money but…

The DDFT was sprained in the right front and the potential arthritis is in the right hock. Upon looking through the flexion exam she scored a 0.5/5 in both the right stifle and hock. We believe that she had sprained her DDFT a couple weeks prior to the exam and we think that it was a combination of jumping out of her pasture and being overworked by the previous owners since she was being ridden almost daily. Our vet took x rays and did an MRI and came back 2 weeks later to see how her leg was which she gave us the all clear to begin working her again but we gave her a month off due to having a personal injury and being unable to ride her.

It has been around 4 months since we last saw the vet. I’m not planning on getting injections for the next year unless absolutely necessary but I would like to get as many opinions as possible on what others would do.

[endlessclimb]

I am going to second whoever said to be proactive and not wait too long.

allowing hock arthritis to go on too long because I wanted to try everything before agreeing to injections is one of the major reasons my gelding was unable to continue jumping past 15. We couldn’t get anything in the joint at that point, and it refused to fuse. Tried bilateral surgical arthrodesis, which did not work.

hes still lame behind at age 22.

[findeight]

Theres too big difference between a low mileage 8 year old currently laid up and a veteran jumper in mid teens to conclude hock injections started immediately and continued for life would prevent osteoarthritis by mid teens in a performance horse.

Even the HA and steroids own guidelines say not a thing about prevention and they would be heavily promoting it as a preventative if it were proven to be true. It is proven to reduce inflammation and discomfort. , And I can assure you giving hock injections first annually then twice yearly and finally 3 times yearly over almost 10 years will not prevent joints drying out and fusing or bone on bone as age and mileage pile up. Not all joints completely fuse either, bothered one of mine to its grave even with 10 years of injections followed by 8 years of retirement, still bothered behind just short of its 30th birthday.

But as always, educating yourself with actual studies and getting more then one opinion on starting unproven, invasive therapies that will continue to need to be repeated, and paid for, regularly in perpetuity needs to be researched carefully.