SI injection, if only someone had told me this five years ago, update post 102

[eventer_mi]

soooo incredibly glad to read this thread, as I think we’re going through SI issues with my Trakehner gelding.

Symptoms - within the past two weeks, he’s been increasingly cold-backed - the minutes I settle into the saddle, he started kicking out behind and humping his back. Within the past week, he’s been bucking in the canter, and horrible in the transition - something he’s never done before. I had the vet out and after some acupuncture, we definitely think that it’s SI, and pretty recent, too, as he is nicely muscled over the croup and he’s not lame at all. Next week we plan on doing a bone scan and probably injecting the SI. This is a horse that has been going incredibly well and jumping even better, so this sudden relunctance to use his hind end is unusual. So those are my symptoms - cold-backed, bucking into the canter transitions, reluctance to use his hind end.

if this thread is still active after I finish the bone scan and the injection, I’ll let everyone know the results

[short_strided]

I’ll chime in here, because I just had the ultrasound guided injections done on one of my horses a couple of weeks ago. I can’t tell you if they worked or not, because he promptly injured another body part right after he was cleared for riding, but that is another story.

Anyway, these are the symptoms that prompted the injections:

Reluctant upward transitions, with particularly explosive canter transitions and cross cantering. (This problem arose after a pasture accident, and the first time I asked for a canter after I started riding him again he literally felt like he could not canter.)

Inability to hold himself out when travelling in one direction.

Inability to hold a lead in one direction.

I could feel a drag in the affected hip when he was under saddle.

The vet would adjust him, his back would seem pain free and within 30 seconds on the lunge line he would start hurting again.

[HollBear]

I am really interested in this. My horse has a different canter to one side, will cross canter on the lunge (but not when riding), and noticable atrophy on one side. This just started after coming off an injury with stall rest for a front leg this past winter. The stall rest may have actually aggrevated this. He just had accupunture/chiro and they said his pelvis was really out of wack. I’ve ruled out all lower limb issues. This horse has a nice jump and is still a nice guy - no real crankiness. He’s also pretty young. I think SI is the direction we are heading in. I’m wondering about qualified vets that will work/investigate this. After reading some of the articles that were posted it seemed that you really need to find a good lameness vet.

[mroades]

well, we light-hacked ours today, and he was straight…and happy!

[HollBear]

mroades - please keep us posted!

[thatmoody]

I am very interested in this, as well, as I am having an excellent orthopedic vet out today to see my DD’s mare, who is having similar issues. Explosive bucking in canter transitions, cross cantering, lack of mobility. I didn’t want to lead him into a diagnosis, but I am sure suspecting some combination of SI/hocks.

[Bacchus]

Curious: Does one injection do it or is this something that needs to be done every few months, once a year, depends on horse?

[paintjumper]

What EXACTLY…

are they injecting? I’m sure it is a steroid but are they also adding a lidocaine or pain med too?
TIA

[Lieslot]

Most vets will inject with a combination of Sarapin, Depo-Medrol & Vetalog.

How often & whether it will help the horse hugely depends on what the SI pain is.
People talk about SI joints, SI injections, but really we are talking about something amiss in the SI region.

Here’s how I understand it and please correct me if I’m wrong.
The SI joints are more like articulations, not real joints, you cannot injects those articulations, via ultrasound (or competent vet) you try to inject as close to those articulations as possible. But the injected drugs will nevertheless diffuse in that general area, so they can never be as targeted as a hock or stifle injection for example.
I believe horses with chronic SI pain due to arthritis of the SI articulations work the best and may need to be repeated yearly.

Some horses have SI pain, -which can be diagnosed via exclusion or via palpation (not all horses with SI pain will palpate painfully however) or via bonescan or rectal ultrasound or (need a good vet, not without risk) via blocking the SI region-, have issues with the surrounding structures, like desmitis of the dorsal, ventral or sacro-sciatic ligaments or may even have sciatic or gluteal nerve pain. I think in those horses the injections may or may not help, but as with all soft tissues, rest will be of importance too and with nerve issues, nothing may be able to fix it.

Dr Sue Dyson describes it very well in her article. SI pain can be very complex.
I do think a lot of horses with mild SI pain and just a little toedrag here & there can nevertheless have very purposeful lives and SI injections are very worthwhile to try and like in the OP’s case precisly what the horse needed to feel great again.

[kiwifruit]

Hey Lieslot

Interesting that you mentioned that the SI may or may not show pain during palpatation.

I recently approached my vet about possible injection of the SI joint for more subtle symptoms. My horse is very resistent to being on the bit, difficulty, if not impossible to lengthen at the trot, bunny hoping into trot from the canter (if fact, it feels like he is throwing you out of the saddle when he canters), difficulty with flying changes,lacks impulsion from behind and would rather take a long spot than a tight one.Vet thought it was hocks since he was positive to flexion so we injected with little or no results. I did ask about the SI joint but he said he did not show the “classic” signs of SI pain under physical palpatation but was willing to explore it futher if hock injections did not work.

Its got me thinking and perhaps it would be worth a shot to see if he is more comfortable? Thoughts?

[eventer_mi]

kiwifruit - sounds like SI to me. My gelding also does not show negative signs to palpation, but definitely is reluctant to bring his hindquarters underneath him, and bucks in the canter as well. We are pretty sure his issues are SI (also diagnosed via acupuncture).

Your horse sounds like a long-standing issue. How is the muscle development over his croup? is it even on both sides, or atrophied? If the muscle development is abnormal and you’ve injected the hocks with little result, my guess would be SI.

[kiwifruit]

Hey Eventer MI

Yes, he does look weak in the hindend and has difficulty developing a topline, even with the proper conditioning. It almost seems like he has a hunter’s bump but then again, when I questioned my vet, he thought he was not a classic case for SI pain. The good news is that my vet was open to injecting the SI if hocks did not work so I think I will go back and have him take a look again. Thanks!

[Lieslot]

Yes kiwifruit, not all palpate sore, this is why chiropractors totally missed it with my horse. My vet had a suspicion but deep palpation showed no reaction. The bonescan results spoke for themselves, left side SI light up badly.

These horses will often feel worse than they look. I’d say that’s also a big give-away, the rider feels the horse is broke in the hindend yet when viewed from on the ground it doesn’t look all that bad and one would almost be more inclined to think the rider just can’t ride well enough.
Thinking back when it all started to go pearshaped, I used to think it was me, I just couldn’t ride, yet the problems I had with him, I did not run across riding my other horse.
People would tell me I wasn’t asking for a contact, hence he was evading me etc. I knew his attitude well enough to know evasion was not like him. It just went seriously downhill from there, until the point he moved like a horse with a broken back or very badly fitting saddle, but there was nothing wrong with back nor saddle.

[TN_Lilly]

Is Dr. Sue Dyson’s article online? If so, can someone please provide a link?
Thank you!

[Lieslot]

See history, clinical features & other clinical features for symptoms. And postmortem findings in discussion
http://www.igloo.lv/horses/harm/sacroiliac_pain.html

I don’t know if any vets on this board would still have access to this slide show. I found this one to be very informative with clear pictures.
http://www.savmasymposium2010.com/site/sites/default/files/proceedings/SAVMA2010-Sat_Equi-1100-Brounts.pdf
It was from the 2010 symposium and called SI pain slideshow. I wished I had downloaded it, but back then didn’t realize it would go offline. I’ll google a bit to see if I can find other articles with clear pictures. Sorry.

Another thing I learned about, the psoas muscle is attached to the SI articulations, often horses with SI pain will also have psoas muscle pain, which would explain the outward sign of a sore back.
The below is more from an acupuncture/holistic point of view, but also interesting : http://horsesforlife.com/content/view/1006/934/

[April_MD]

[QUOTE=Lieslot;5632638]
Some interesting literature :):

http://www.igloo.lv/horses/harm/sacroiliac_pain.html

http://www.thehorse.com/ViewArticle.aspx?ID=5445

http://www.ivis.org/proceedings/AAEP/2002/910102000257.PDF

http://www.myhorse.com/back-pain-and-sacroiliac-joint-horses.html[/QUOTE]

Thank you, Lieslot…great references. Love getting my hands on original peer-reviewed papers.

My mare has been having issues with a suspected SI for 1.5 years now. Due to my pregnancy she is sitting in a field getting fat, but I hope to do some imaging (and potentially injecting) of her lumbar spine/ SI region once I can actually help with her rehab.

Like most SI problems, the symptoms started gradually…I have now had 2 full lameness exams with no proper diagnosis. Why do vets always want to blame the hocks?? My girl will only be 6 years old next Monday, so this is really heartbreaking.

Even after giving her 6 months off she came back with the same stiffness and kicking out/swapping leads in the canter around turns. She also subtly drags her hind left toe. It is a testament to her courage and spirit that she never refused fences. I just hope this next investment will help us get to the bottom of this and alleviate her discomfort. This is a horse that WANTS TO WORK!

What sort of rehab work have your vets recommended after injection of the SI area? Work in straight lines on even ground? Long, slow distance work? For how long? Just curious what I have to look forward to!

[Bacchus]

How many of you have had to have more than one SI injection on your horse? How far apart?

[Lieslot]

You’re welcome April, you may want to check the many links I added in the other thread going at present (http://www.chronofhorse.com/forum/showthread.php?t=307327), it has some pictures of how to inject etc.

I also wonder why vets are usually quite late to assume SI pain, personally I think it’s underdiagnosed and more common than we would expect.

My horse had been dragging his hindtoes for years and reduced push-off. I do have to say with him it is suspected he also has sciatic nerve pain along with SI joint pain and ligament desmitis, because of his trouble being shod in the hindend.

We injected him in Nov last year and I had no immediate improvement, that’s why vets said to me if the surrounding ligaments are inflamed he will need rest regardless of what you inject. So we rested him over winter. Brought him back into work. I was told to get on him & do straight lines, but he was so unfit, I actually started by lunging him large, doing lots of stretches and cavalettis. There was a vast improvement and I thought it was going to work. I got back on, he was happy about the contact, trotting went good. We had also changed his shoeing to improve the angles behind. Then the weather got very wet, he did a sliding stop & hit the ground in the pasture. I could have screamed it out. He did not go visibly lame but was resting the left hind way too much imo. Back to vet, 1/10 lame LH via lameness locator and effusion found in left stifle, meniscus questionable. Because he already had steroid in the stifles in the past, we went for IRAP this time. He has stopped resting the LH and was just cleared for turnout again. I will resume the SI-rehab July 1st, provided his stifle is okay.
If you are interested, I can email you some SI stretches that another poster on here kindly shared with me. It’s too long to copy in here, but if interested, pm me your email & I’ll forward it. I would say you do have to expect at least 6 months to build back up to previous level of fitness, in some cases a year.

From the many vets I discussed this with, some were of the opinion that prognosis for SI is dire, however others say the reason SI treatment fails so often, is because the horse gets rushed too much, didn’t get enough time off and just wasn’t brought back into work slow enough. If you get an immediate improvement after injections, great, most likely an arthritic problem, if not, then give the horse sufficient time & slow strenthening. It sounds like your horse already had plenty of time off (provided she’s careful in turnout), so injections might very well gear her up for re-introducing work.

Pasture rest is great to help heal SI ligament problems, because you want them to keep moving, however one stupid galop, one slip & slide and you can be back to square one.

[TBrescue]

[QUOTE=Bacchus;5641290]
Curious: Does one injection do it or is this something that needs to be done every few months, once a year, depends on horse?[/QUOTE]

we injected SI on my horse 2 years ago and he is probably getting close to needing it again. Sometimes it is hard to distinguish between hock and SI issues, cause pain in hocks can be referred into other places. We injected his hocks first and he was better but suddenly the SI was really obvious once his hocks were not bothering him any more!

[Claudius]

Lieslot

could you pm or email me the SI exercises? I had one injected in april…think I am getting some improvement, but these problems are so subtly confusing that I am not sure. I worried about epm and am treating for that inspite of few real sypmtoms of that. at wits end…will try exercises. thanks.