Just wondering if anyone has had the opportunity to do a head-to-head comparison in the effectiveness of these treatments? My gelding has had persistent muscle pain over his hips/sacral area. He’s been chiro-ed & acupunctured (twice) and received PEMF therapy. As soon as he does 1 or 2 days of light or moderate work, the soreness is back. Vet is coming tomorrow. Suspect we will end up injecting hocks (he has a history of being “hock-y”) and I may be faced with the above choice so I want to be a little prepared. I realize this is all anecdotal, just looking for your opinions! Thanks!
Before you inject hocks, have you located the source of back pain? I think if I were you and the soreness was that consistent, I’d be x-raying the back, hocks, and stifles. It’s expensive, but it’ll run you the same as several chiro&massage adjustments, and if you locate the issue, you can fix it instead of just temporarily relieving it.
I have never done shockwave myself, but from an outside perspective as someone who has witnessed boarders do it, it’s kind of a shot in the dark especially if you haven’t located the source of the issue. I’ve seen it make tremendous difference in limbs, but not so much the back.
Mesotherapy is tissue injection - not spine or bone injections as some believe. I’ve seen it make a tremendous difference BUT!! You MUST isolate why the horse is backsore first. I’ve seen lots of boarders just go straight to mesotherapy without changing their saddle fit, or looking at x-rays - and then, it’s just another temporary balm that doesn’t solve the problem.
By muscle injections… did you mean joint injections?
IME Hock pain is usually almost always secondary to some other issue… time and time again I’ve had experiences that reinforce that - if the hock is bothering them, chances are their stifles are, or they have horrific NPA behind, or they have chronic back pain by way of an old sacral injury, pelvic injury, or KS.
Good luck and keep us updated. Whatever do, I hope your horse feels better ASAP.
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Without insurance, I’m not going straight to a bone scan. I have a full set of hock xrays from a year ago and I’m not adverse to taking new ones if the vet wants to. I also have very recent thermal images for what that’s worth. Diagnosis is great but a lot of times people opt to knock out some of the usual suspects (hock injections on a horse with known hock changes, for example) prior to getting into high-dollar diagnostics.
Muscle injections are just that. Vets use about a 3" needle to inject vitamin B & sarapin deep into the back muscles. There may be some diffusion down into the SI as well. (This is different from an ultrasound-guided SI injection.) It’s becoming pretty common and I know several friends whose horses have benefited from this, but I have personally never used it.
I would welcome more feedback.
Well, I wouldn’t do a bone scan either. But you can get a good idea for a reasonable cost if the horse’s spine is not the root of the problem - I’ve done a full-spine x-ray on a TB recently, all in all,rad set came out to less than $600. Lot cheaper than a bone-scan or thermal imaging. The problem with injection without a clear visual of the area being injected is that once injected you have to typically keep injecting the area - expensive - and also, a waste of money if the area you are injecting has secondary pathology caused by something else. Generally hock injections run about $800 - that’s a full set of spine rads or a full set of stifle&hock rads with my vet, with spare change.
I wonder if it’s the terminology you are using, but vitB/sarapin, that’s what I’ve had in the past for mesotherapy? Mesotherapy isn’t muscle injection though, which is why I am confused.
I’ve never had a vet recommend muscle injections, probably by virtue that it wouldn’t solve the issue, only mask it?
I guess one learns something new every day - for muscle pain, my vet always suggested robaxin.
What are you doing with him when you ride? Generally, my checklist for a horse with “sore hocks”
- Check saddle-fit
- Check hoof angles (including no NPA behind - VERY important)
- x-ray stifles & SI (ime, always the culprit)
Have the first two been done?
I will tell you. having had a horse that did mesotherapy and SI injection - the source of the problem was bad saddle fit, which we thought was a good fit as we had, personally, had it reflocked to the horse several times. A brilliant vet local to us was able to isolate the issue, which was saddle-fit, we found a new saddle and fitter, and had his back injected to manage the trauma and inflammation caused by the old saddle… and he never looked back.
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Beowulf I appreciate that you are trying to help but I’m asking a pretty specific question here and I don’t want to spend lots of time typing out all my reasons & justifications for asking. I have reason to believe that I may be faced with this choice and I’m just looking for people’s experiences with these specific therapies. I appreciate that you shared yours. Thanks again for trying to help. I would love to hear from others as well.
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sigh…um, ask me again in a few weeks. 
So far, we’ve done injections in between the dorsal spinous processes (as well as hocks) and 2 rounds of shockwave. Horse showed improvement at first but is back to objecting to a rider. Works fine on the ground, which vet has instructed I continue for another few days before trying to ride again. Next up would be a course of methocarbamol, and if that’s not enough, mesotherapy.
The bony inflammation is visible on Xray. But it’s also been there a couple of years now and did not seem to be clinically significant in the past–I was able to get him muscled up and he did fine. This behavior of also being fine on the ground but not with a rider is new (usually when he hurts he’s unhappy with all things). We wound up doing a bone scan, which directed us back to that area. I think in his case, the evasions from the backs caused the hock inflammation, but it could have gone the other way around. He was wearing his toes down an awful lot behind and needed to get shoes put on. His feet are looking much better now and he’s still having issues. He’s moving better as well, so I don’t think the hocks are continuing to contribute. Hence, the continued focus on the back.
We had some suspicions about the SI area as well, and the bone scan results showed no inflammation in the SI. So, if we’d tinkered around going down treating that area, we would have spent more money and not gotten anywhere most likely.
My horse has had back muscle injections (Sarapin), shockwave and intra-articular injections to the lumbar facets (steroid + Sarapin). Treatments were done at different times, for back soreness due to lumbar facet arthritis diagnosed by ultrasound. For him, the muscle injections were very effective, as were the IA injections (he’s had those twice). The shockwave didn’t help very much. He has not had mesotherapy.
He also gets relief from chiropractic with acupuncture and soft tissue work (all done by a vet, who is the one who did the muscle injections).
Keeping him comfortable is a challenge best met through the regular, correct exercise with a lot of stretching and suppling work and cavaletti, BOT gear, heated blanket, massage, pelvic flexion (butt tuck) exercises, saddle fitting, regular chiro/vet checks/needles, and the occasional chicken sacrifice.
His back is sort of a “Rube Goldberg” apparatus – any one thing out of place can throw off the entire machine.
I think the key is breaking the cycle of pain and spasm, as well as addressing the underlying cause (whatever that is) and an exercise/PT program to build strength and flexibility.
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I have had success with using shockwave to manage kissing spines. Mesotherapy did not agree with this horse and has not been repeated.
We did sarapin injections on a different horse with pain in the withers. It was a shot in the dark – no diagnostics done on that one – and it wasn’t the magic cure we were looking for. YMMV.
With all due respect, I guess I just don’t understand why people continue to inject things without actually figuring out the diagnosis. That’s treating the symptom, not the ailment.
NO one here will be able to give you any meaningful advice because the three therapies treat VERY different issues.Since you don’t know what is causing the back pain, a definitive answer on which will be most useful for you is impossible.
With mesotherapy and shockwave, it’s all for nothing if you don’t find the cause.
I guess what I am trying to say OP, is that without a definitive cause for your horse’s issues, you’re just throwing things against a wall and hoping they stick.
You can ask people for their experiences and I expect many of us would be happy to provide them, but without knowing the cause, their experiences are not going to be meaningful or even applicable because the three things treat very different pathologies, and have very different results depending on the issue. I could say that mesotherapy went SO well for my guy and let’s say you try it – it’s kind of moot if your horse has hind end suspensory desmitis and everything else is secondary, isn’t it? Or if your horse has kissing spine, depending on the severity, none of the therapies might even make a difference.
You mention the horse has “persistent sacral and back pain” - to me that is pretty significant, and worth extensive vetting before I start sticking the horse with needles.
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I have a horse that requires constant maintenance to keep his back from being sore. X-rayed every joint on this horse (thank goodness for insurance) everything came back clean. But he has constant soreness in his lumbar/sacral area. You could barely brush him without him dropping in pain. Did a bonescan and his SI lit up. He has a very slight dropped hip, while the bone has healed the scar tissue and muscle were a mess. BOT, PEMF and Robaxin were my best friend for about 6 months. We tried mesotherapy and muscle injections. I didn’t see a difference. I’ve also invested a lot of time in reading about stretches and massages, that has helped tremendously as well.
About 9 months post bone scan he started getting tight and sore again in lumbar. Went right back to vet before we ended back at square 1. About 20 min into exam they suggested X-raying his back hooves. He was negative on both. Adjusted angles and back pain was gone in less than a week.
My 2 cents would be to try robaxin first, its quite affordable, and second would honestly be to x-ray the back feet. I am interested in shockwave as well, but was told for the SI region it wouldn’t be as affective since it doesn’t go deep enough. I didn’t see any change with the muscle injections and mesotherapy. Good luck, back soreness is tough!!
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Hi guys, just an update. His back xrays came up clean (whew) and rectal ultra-sound of the SI also revealed nothing exciting but based on how he presented in motion and the obvious SI soreness, my vets opted to inject the SI and back muscles anyway. He will also have his hocks injected shortly, again based on how he presents in motion, previous hock xrays, and his history. Meanwhile he’s gets chiropracted and ultrasounded monthly, plus we’ve got a MagnaWave practitioner coming every other week. Hoof angles are all good and he’s already got hind shoes with a little extra support behind. I think this SI soreness is a result from a fall last summer (which I witnessed) after which he seemed to have low-grade soreness that he was able to work through so it didn’t seem like a big deal, but he worked all winter and may have irritated whatever he was dealing with. Thanks all for the answers.
Have you checked his feet? Sore backs are always caused by the feet until proven otherwise in my book.
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This has been my experience as well. Usually it’s the first thing I look at, especially if the feet present any sort of bull-nosed (NPA) profile.
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Don’t think it’s the feet in this case, but I’ll file that away for the future. Thanks.
We used sarapin injections, shockwave and mesotherapy for KS. All helped and the horse is still in fell work. Can’t say which one was more effective but shockwave is certainly the least invasive.
I’m another with years of practice experimenting on this subject. I have a TB x. Hanoverian gelding with a goose rump conformation. We do dressage and as soon as we started introducing collection, he began showing back soreness. Over the years, I’ve done it all: new saddle, lasers, massage, x-rayed feet, fetlock, stifles, back, and hocks. After hock and stifle injections failed to rectify the problem and robaxin did nothing, we used mesotherapy to break the cycle of spasms. From there, I was able to keep him pain free for about 3 years. Last year, he was sore again after the vet wanted to skip a 6 month hock injection since he looked so good. We skipped it and then a couple months later, his back started showing soreness again. We again did mesotherapy to break the spasms and, knock on wood, he’s doing well.
My horse’s hocks are pretty clean, but we now inject every 6 months and I think that his hocks are the root of the back pain. I also use a chiro every 2-3 months and that seems to help, too. Best of luck.
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Larkspur, does your horse have kissing spines? Lol’ed at the chicken sacrifice, I’m in a similar spot now kind of grasping at straws…
Not that I know of. But I think I have finally found the secret to success, at least for now. I doubled his magnesium and upped his vitamin e, and have not had any back soreness to speak of since. He now gets 5000 mg mag proteinate daily (Gateway product) and 4000 IU of natural e (varies depending on how much grass he gets). He’s been on these supplements for years but the bump has been darn near a miracle. My chiro thinks it’s probably more related to the mag. Horse weighs 1500 lbs.
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Retrofit, update on your horse and how he’s doing?
