SI pain or something else....

[GPjumper]

I have an appointment with the vet on Wednesday, but wanted some other ideas from the chronicle gurus.

Symptoms,
Refuses to balance. Wants to run around on her forehand on the lunge line. Can’t stretch down without running off. Under saddle, trot work can be okay to a point. Wants to be very down hill. When you ask her to sit (just to the point of being balanced, not the collected sit of a dressage horse, she’s not there fitness for that) you get hollow. When you close your leg and ask her soften and bend around your leg, you get her leaping straight in the air. The canter, especially to the left wants to be heavy, balled up and stabby. If you push for more forward, she has no balance, falls on her forehand and runs. She has difficultly halting square. . One leg is always cocked funny out to the side, either up under her or out behind her. She also carries her tail out like a corn cob
In the stall, she wants to make little banks of stand her hind heels on and wants to lean her butt against the wall.

Things we have done:
negative for Lyme disease
Injected low neck/shoulders/left stifle in June. Marginally helped
Injected SI in July.
Inject hips and back in September.
ovaries ultrasounded and are normal. No tumors nothing.

at this this point, I’m at a loss. Horse is becoming more dangerous to ride, but looking at her, you would never know she’s unsound.

What I’m thinking for the vet on Wednesday
I want to x Ray her hind feet to just be sure.
Recheck SI.

Is there anything else I could be missing? TIA and sorry for the monologue. I wanted to get you guys all the information.

[kashmere]

Any reason why you want to x-ray just hind feet? I would take a look at all 4. I have seen some very non-obviously-foot-seeming issues come down to problems in feet. Would also look at hocks.

Hock pain can cause them to overload their front feet which can then cause or exacerbate any issues going on there - for example, caudal heel pain (whether bone issue like changes to the navicular, soft tissue inflammation in the foot, or even thrush in the frog). Then you have two pain issues at once, which can make for some very odd lameness in that they may never look uneven or “off” in the traditional “ouch I have a stone bruise in one specific foot” way.

When she is standing on solid ground (ie not deep footing like a stall or arena), if you push on her knees does she stand solidly? or does she have “spaghetti legs” - meaning her knee is not locked solidly into place and will wobble if you push it from the front or back. Assuming the horse doesn’t naturally wobble at the knee (like some horses who are extremely over at the knee), this is a pretty good indicator of pain in the foot, generally in the caudal/heel region.

[GPjumper]

I’m actually tempted to x Ray all four feet. She tends to get very sore if the farrier trims too much. I almost put her in pads all the way around but decided to wait for the vet to look at her.
As for jocks, she has always flexed soundly on them. I could have them X-rayed as well. (At this point I’m tempted to do a bone scan on her)

she does stand solidly up front although at times she wants to be a bit base narrow as if her shoulders/withers hurt.

[jennycash]

I would definitely x-ray all 4 hooves just to make sure.

Have you discussed EPM with your vet? With the stumbling and imbalance thats the first thing that pops up in my mind.

[GPjumper]

She passes all neuralgic tests. She’s not stumbling but it has crossed my mind as an option.

[MyDarkPassenger]

I practice equine myofascial release as well as on humans with an occupational therapy license.

I’ve found that pelvic imbalances often show up more obviously in the walk and canter as the pelvis has to have greater multidimensional range of motion. In contrast, the pelvis moves more up/down in trot, while the symptoms continue they tend to not be as obvious or limiting.
Often if the pelvis is shifted in an up slip or in flare, the horse will drop their front end to unweight the hind end to allow the leg to come under to pick up the lead with a shortened stride once achieved.

[Dutchmare433]

I would be looking at hind suspensories and hocks.

[Schatzi09]

My mare has issues at the canter. We have found it to be her hocks causing her pain which lead to her moving even closer behind and hitting her fetlocks. I never thought she moved like a “hocky” horse and had her SI injected first. That helped her lameness but didn’t fix it. Injecting the hocks fixed it. (We blocked her suspensories first to try to rule those out as causing her lameness. She was equally lame after they were blocked.)

Now that she’s about due for another hock injection I’ve noticed her getting heavy in the bridle and not wanting to sit at all behind. And she’s back to crow hopping in the canter too.

[GPjumper]

I’ll add hocks to my list as well. Thanks all. This is so frustrating to deal with. The mare genuinely wants to work but has complete melt downs when asked to use herself. Could it be a low neck issue too? (The dreaded C6, C7 T1 malformation?)

[findthedistance]

IIWM, and assuming you can swing it financially, I’d be getting serious about that bone scan. It was 100% worth it for my little mare who was having all sorts of issues under saddle (turned out to be KS + SI + hocks – the hocks were a known quantity) and really focused where we spent money on x-rays. A friend had a similar result with her mare who practically quit being able to canter – the bone scan lit up the exact problems and focused the diagnostics and treatment moving forward. In both cases, we’d be chasing various things for some time – Lyme, repro, saddle fit, etc. – and it was worth the money to just have an answer and be able to move forward.

I’m sure there are horses for whom nothing pops and the diagnostic frustration continues, but when the list of possibilities gets long, I think “bone scan.”

[IPEsq]

Hind suspensories. And check angles behind. Banking up the back feet make me think suspensories first but could be other hind end pain especially if there is NPA in the hind feet.

[BoyleHeightsKid]

I think films of the feet are a good idea… I’ve seen them start to refuse pretty much everything, first it was a good jumper starting to refuse, then escalate to bucking etc. When they couldn’t figure out what was wrong after hock injections, custom saddle etc, took him for a nuke scan. All 4 feet lit up as well as front shins. Videos of him walking showed toe first landing. The horse wasn’t mine and I don’t know how he’s doing now… This thread reminds me to ask.

[stanza]

I have a horse that I’m leasing have some of the same problems with hopping in the canter and swapping leads. She dragged her hind legs and had problem putting weight in the hind legs also. Had a lameness expert come out and diagnosed her with very tight deep flexor muscles in both hind legs. He then explained how the tight muscles can cause the problems that you’re seeing. He did one round of shockwave therapy and thinks with proper exercise that it should be a one and done situation. I’m keeping my fingers crossed!

[GPjumper]

This is all so interesting! I’m also adding in neck radiographs. I’ve noticed she’s built up a HUGE neck, almost looks like an Andalusian stallion. (Probably from pulling herself along for the past year) but she also seems reluctant to stretch her neck out. She wants to walk with her nose behind the vertical even while turned out.
I’ll keep you posted as to what we find out/are going to do and what we did. Fingers crossed it’s something simple and she’s not retiring at 8/9 years old.

[joiedevie99]

@GPjumper PSA, talk with your vet about the pros/cons of neck x-rays v. neck ultrasounds. The detail of the ultrasound (in the hands of someone who knows what they’re doing) can sometimes be more useful.

[Jealoushe]

I have read the banking for the feet and leaning against things can be from sore heels. Does she have low heels? Have you done anything more basic, like a good massage through the back to find any area of soreness?

[IPEsq]

@joiedevie99

@GPjumper PSA, talk with your vet about the pros/cons of neck x-rays v. neck ultrasounds. The detail of the ultrasound (in the hands of someone who knows what they’re doing) can sometimes be more useful.

I agree and sometimes it can be less expensive than a full set of X-rays. Ultrasound will show effusion on the joints and ligament issues and things that you can’t see on X-ray.

[Gumby80]

Had a horse show similar symptoms from neck arthritis/kissing spines. Like some others above, I would also check hind suspensories. Good luck!

[GPjumper]

Sorry it took my so long to update. Life got super busy.
Vet watched her move and did a full lameness. He said her body looked and felt great. He couldn’t find anywhere where he would inject. We ultrasounded her neck to be sure, nothing come up on the ultrasound that would cause the symptoms. Suspensories looked good as well. It came down to the the feet. X rays of her hind feet reveal NPA behind coupled with a bit of a thin sole. Upfront her angles looked good but her soles were a bit thing. The end result: she’s getting rim pads up front so we can continue to toughen up the front soles with durasole or keratex. He wants 1 degree wedge pads behind. My farrier, being the awesome farrier he is, decided he would come to the vet with me this week so we could x Ray her with the new pads on to make sure the correct angle had been achieved.
Hopefully this works and makes her feel better! The vet said it could take 6-8 weeks before we see improvement because her muscles need to time to adjust. Told me start her in work slowly, as if she just had 6 months off, since she will be using new muscles.

[BoyleHeightsKid]

Bingo on the NPA… I would only let farrier use a wedge shoe or pad if the rest of the foot (collateral grooves and frog) were supported by either DIM or pour in like Equipak. If not, the pressure from the wedge will only crush heels further.

Is the NPA from excess sole depth at the toe or a crushed underrun heel behind? Many times that is caused by quarters/bars and toes left too long.