SI Injections 2nd round?

[Ottbaxel]

So, my gelding has had a consistent canter issue. I outlined everything in another thread, but essentially he is great walk trot, 90% of the time decent for right lead canter, and awful for the left lead. With the left lead it is very very hard to get him to even pick up his left lead to begin with as he will pick it up wrong the first time, and then bend completely to the right and wing his hips left and right when you try at all after that. When he picks up the canter he’ll also frequently stick his head up and pop up a bit and leap through the air. If I hold my hands still and then keep my leg on, I can push him through it and then he’ll go around decently, but the issue has never gotten better.

Anyways, for this reason along with others I injected his SI in the fall, I noticed mild improvement, but not much. I’ve been doing a lot of strengthening exercises for his SI in the past few weeks, but my vet thinks he could benefit from the injections again. She said sometimes SI injections need to be done twice to really work well. I don’t doubt her and am considering the injections-I’m just having a hard time imagining it working any better the second time than the first, or how that works. It’s so expensive, and I’m running out of ways to justify spending this much money on this horse.

Has anybody had their horse need a second round of SI injections as a boost on top of the first one to get it to really work?

[fivestrideline]

No personal experience so I’ll default to those who have it, but I’ve had acquaintances that say they only got good results the FIRST time. Subsequent injections gave lesser and lesser results, which I guess is also common with neck injections.

It likely depends on the horse. Was the injection ultrasound guided (I believe they must be)? Did the vet note any changes or injury or anything in the SI? If you know what you’re dealing with in there you may be able to decide if further injections are likely to do anything.

[dmveventer]

What did you actually inject? I chose PRP for my gelding’s SI and it made a huge difference while I was getting him back into shape. I was told by my vet and a few other people I trust that SI injections are typically a “one and done” kind of thing, but maybe switching up the type would make it worth a second round? I probably wouldn’t spend money doing the exact same thing again if you only saw mild improvement that didn’t last, but hopefully someone who’s actually done it can weigh in.

[Bonnie2]

I have an OTTB that was just like yours when he was young. The first SI injection made some improvement but not a miracle. We injected him once a year until the vet couldn’t get the needle in any more, maybe 7 or 8 years. The last couple years there wasn’t much change pre/post injection. Around 14yo he started looking sounder and happier than ever before. Assumption is the SI fused.

The problem with the success of injections is it is completely dependent on the skill of the practitioner. Hitting the right spot is not a given, and the SI is difficult. It also depends what was injected. I would give it another go with a different medication or practitioner but don’t expect it to totally solve the issue. Good luck!

[NeedsAdvil]

My horse’s behavior sounds a lot like yours. Clinical exam findings were lower back and SI were compromised. We opted for mesotherapy and shockwave which helped tremendously. We did have to go back and have it redone after about a year and then I started using the equiband system along with regular bodywork and he’s holding strong!

[Ottbaxel]

Checking the notes now, it looks like he had a combination of Depo-medrol, serrapin and traumeel injected.

[NoSuchPerson]

My horse had an SI injection early spring 2023 at a good equine vet clinic. Kinda sorta helped.

In summer 2023, we took him to a Big Name Equine Hospital. [Insert thorough diagnostic process] They injected his hocks. We saw some improvement. One month later, they injected his SI. OMG. Miracle. His wonderful trot came back and he stopped fussing over holding his hind feet up for the farrier.

We’re headed back to Big Name Equine Hospital end of this month because farrier is once again having trouble and I can’t find that good trot anymore.

Sigh.

[Ottbaxel]

Interesting! When my guy’s SI was injected last time, there was a fairly new vet that did it, with the guidance of my regular vet standing right behind her walking her through it. I thought she did a great job and I don’t like to assume just because a vet is new that they may have done a shaky job, but perhaps if this is a much more difficult spot to inject, it just didn’t quite do the trick that time.

I can imagine that the SI injections should theoretically help him if done correctly-he cross canters on the lunge occasionally, has a dip in his lower back, and does palpate slightly in that spot. I’ve been doing lots of backing up, raised poles, hillwork etc. and while he has started to look a bit better (and frankly feels quite good over hills) the canter issue has not gone away. It’s just so odd that there wasn’t much improvement last time given how he acts!

[Amy3996]

What other diagnostics have been done apart from the SI (x-rays/flexions, etc)? I ask because we had a very similar struggle with my guy. It turned out that the SI issues were likely secondary to ulcers and NPA behind which caused a Pandora’s Box of physical and behavioral issues. Canter was difficult, he had episodes of crowhopping/bucking, struggled to work in a connection or engage his back.

We got him going better after addressing feet and stomach. He’d subsequently had a wipeout bombing around in turnout that prompted us to look at SI. We opted to inject with steroids based on some inflammation noted on ultrasound (presumably from the fall in turnout but can’t say for sure without prior imaging). Within 2-3 weeks we noticed improvement. September will be 2 years post-injection and he’s not had any recurrence of symptoms/hind end issues.

Long story short, I’d probably want to rule out hoof/hock/stifle issues before injecting again if you haven’t already looked at those?

[Ottbaxel]

Long story but-he was scoped for ulcers last year, had grade 2 and was treated. He seemed a little ulcery again this spring so he was treated again. Hocks showed a bit of OA last year when we did the PPE, so we injected his hocks this spring too to see if that helped. Shortly afterwards he went lame on RF, so we did coffin injections after doing rads and discovering a bit of OA changes in there, and changed his shoeing as well. He is sound again now, but the canter issue has persisted through all of this. Stifle and back x-rays were taken during his PPE last year, and they appeared fine. I had neck x-rays taken last week just in case it was a cervical issue and that was also fine. So theoretically, his stifle/hocks/hooves/back/neck/stomach should all be fine.

[Ryde_XC]

If you are finding you are seeing chronic SI pain, take some images of the hind feet and check for a negative palmar angle.

Negative Plantar Angles and Pathology Along the Dorsal Myofascial Line

I’ve known two horses that just changing the hind angles of the hoof was the solution.

[Ottbaxel]

Interesting! I have wondered this. We put a lot of time into fixing the angles of his front feet, but haven’t delved deeply into his hinds. I’ll bring it up with my vet!

[ndirish07]

I just had my horse’s SI and hocks done at the same vet appointment. My horse was rehabbing and I knew needed his hocks done, but due to the injury (suspensory) it can mask some issues so that was put on the shelf until he was further along. I wanted his SI evaluated because I thought he just felt blocked through his SI. 5 days later after those injections and that horse is floating. Make sure they’re doing ultrasound guided SI injections. Also, if they’re thinking he needs it done a second time fairly early on it might be most cost effective in the long run to do a rectal ultrasound so you can actually see if/where the issues are in the SI. I know I’m suggesting more diagnostics, but hind suspensory injuries can also cause the same feels where they struggle to engage the hind end, which makes the hocks sore or the SI gets sore and makes the hocks sore and makes the suspensory sore, a true chicken and the egg.

Quickest way to see that is to throw them on a longe line and see if the outside hip hikes up on a circle (best way I can describe it, but the image is seared into my brain). Hind suspensories show when the affected leg is on the outside of the circle.

[trakehners]

@Ryde_XC

I’ve known two horses that just changing the hind angles of the hoof was the solution.

Anecdotal but I can corroborate this, my horse was four degrees negative in his hind right hoof and it caused everything from back/SI pain to suspensory strain before we caught it and addressed the issue. He couldn’t canter normally for more than a few strides before he’d swap his hind end to the other lead. I have no idea if the suspensory issues came before or after the back/SI soreness but both problems disappeared when his feet were fixed.

About eight months out, he very rarely palpates in his SI region/back and the canter issues that we have are residual muscle memory that keeps getting better the more we work on it (including some lunging in (loose) side reins to help him find his balance and leads without me on him). Everything we did for his SI before investigating his feet was just treating the symptom, not the problem, and feet films are relatively cheap in comparison to SI injections so I’d definitely make that investment.

[Ottbaxel]

Interesting!

I believe I have hind feet rads from when I bought him a little over a year ago, but none since. I’ll have to take a look! That’s exactly what he did all winter (much more so while jumping)-swaps leads in the back.

[Ottbaxel]

Hmm interesting. I would think a suspensory issue would be something that would pop up suddenly one day though? I could be wrong.

Now that I double check the vet records, he actually got his SI done in August of last year. Not only was I thinking it was in the fall, but I totally was forgetting it’s already June! Time flies lol.

[ndirish07]

Not necessarily. Chronic strain can cause subtle lameness such as not holding the canter or just the hind end feeling weak or it can be quite obvious visible at the walk.

[trakehners]

@ndirish07

Chronic strain can cause subtle lameness such as not holding the canter or just the hind end feeling weak or it can be quite obvious visible at the walk.

Corroborating this as well—my horse was sound as could be in every conceivable way except for his canter leads. When we did the ultrasound of his suspensories there was no enlargement of the ligament and no major tear, but there was edema and signs of prior strains in the fiber pattern on both legs (due to NPA on the right and compensation on the left), which fit with several years of him being intermittently NQR but never truly lame. We’d make progress, his hind end would start feeling a little off, he was still growing so I thought it was due to that (because sometimes it really was), I’d back off, he’d start doing better because his body would calm down, we’d go back to work, rinse and repeat.

Two different vets over those years didn’t even think to consider the suspensories as an issue/put the canter problems down to him growing/his stifles being loose because that was a much more obvious thing. It wasn’t until my trainer’s vet (now mine) looked at him and threw suspensories out as a possibility last year that it even crossed my mind. I’m (really, my horse is) also the reason why half the horse people I know are suddenly checking their horses’ hind hoof angles with films, lol.

[Ottbaxel]

What was the rehab and recovery time like for his suspensory problems? Or was it a somewhat “quick” fix by fixing his hoof angles? (Quick meaning it alleviated the stress right away and thus allowed for the ligaments to heal)?

[trakehners]

He had a fairly “easy” rehab as far as suspensories go… aside from the fact that the six weeks of stall rest ended with me in the hospital with a broken rib and lacerated liver because the sedatives we had him on weren’t enough and he spooked and kicked me, oops.

For the first six weeks my instructions were to tack walk him for 30 minutes a day and stall rest otherwise. Clearly that didn’t work for us so we ended up putting him on reserpine and putting him out in a small mostly flat paddock for another six(ish) weeks. He’s usually a saint when he’s got enough turnout (especially 24/7) so he was a model citizen once he wasn’t trapped in his box. I probably still would’ve been taking him for walks during that period, but, y’know, I was broken.

I was cleared to ride a couple of weeks before he was and was allowed to bring him straight back to work last October after that second six-week set (my instructions from our vet were, and I quote, put him back to work and be serious about it) but it did take a couple months of shorter rides (30 minutes or so) to rebuild his fitness/strength, and we’ve been really deliberate about redeveloping his canter since we have multiple years of incorrect muscle memory to undo. It worked out well timing-wise since it was winter at that point and we were stuck inside doing flatwork anyway.

He’s been doing great since aside from developing a monster abscess in March that took multiple weeks to blow. We actually just stepped down his wedges this week but it’s definitely taken collaboration between our farrier and vet to manage his feet to get to this point. He’ll still do his swapping thing in the back occasionally but only when he’s totally disconnected (sometimes the horsey ADHD takes over and he forgets he has four legs/reverts to old habits). He’s a rocking horse at the canter otherwise.

ETA since I didn’t mention it: we started him in the wedges (with frog support) in late October after he’d been back under saddle w/t for a week or two. He was walk-only the first week after that on vet instructions to let his body adjust to the wedges and then normal work from that point on.