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SI rehab

Looking to find a way to manage my OTTB’s SI injury. Been working with vets but i’m looking for people who have experienced SI injuries with their horses. How did you rehab, how do you maintain, and what can your horse do in terms of work.
My 6 yr old OTTB cannot hold a canter and is cross firing in both directions in any situation ( with or without rider )
He arrived to me directly from the track and they did not disclose the SI injury. ( did not do a PPE so it’s my fault but he has a forever home with me ) First vet believed he had pulled his psoas muscle and did shockwave treatment on his hind end and had chiro come out a month later. Did not see the results we were expecting so we brought him to a vet school where they completed bone scans and ended up injecting him (mesotherapy?) Saw some results but had to move barns last minute and horse did not do well with the transition so everything fell apart. I had two trainers come out and they did not want to work with us unless he was 100% sound. ( I really needed a professional to be there to rehab with me and help us along ) I lost hope for him and send him to a retirement ranch across the country where he hung out on 400 acres for 9 months.
I brought him back with the hopes of making him a trail horse. New trainer saw him playing and told me he looked sound and to start him back up. We restarted him in February 2022 and he was cross firing but we assumed it would stop once he built up the muscles around his SI. I leased him to the barn in the summer where he had a walk trot job for the summer camps. Lease ended in September, so I started to work with him again. We did hill work, lunging with the equiband system, lots of trot poles, and everything to build up his hind end but it did not help the canter.
New vet came out and put him on equioxx but we saw no results so now we are looking at adequan. I am trying to put off injections because my vet and I dislike the idea of injecting a young horse yearly for the rest of his life.
Advice, tips, suggestions?

I went through something similar. My OTTB had some behavioral issues and on/off hind end lameness in winter 2021. My local vet was convinced it was a torn ligament in his SI. My trainer and I weren’t on the same page with her, so I opted to send him to New Bolton for a full workup. NB’s diagnosis was severe gastric ulcers and thin soles/NPA. Fixed his trim/shoeing, addressed the ulcers, and he came back in fabulous shape.

Fast forward to August of this year. I left town for a week to visit family. Barn manager tried to rotate my horse and his buddy to a new pasture with more grass (awesome, right?). Except the two horses ran buck wild - his buddy nearly went through the fence and my horse wiped out, almost head over heels. He got back up and aside from a minor cut to his hip, appeared fine. I got back and went to work him and realized pretty quickly that something was not right. Had the vet out, she pinpointed SI. We ultrasounded - no evidence of soft tissue damage (new or previous). There was however a lot of inflammation in the joint that the vet thought was a result of the pasture mishap. We injected to relieve that inflammation and he’s been good as gold since.

Depending on the nature of the issue, breaking the pain cycle once with an injection may be enough. If the pain is gone and they can work effectively to strengthen the surrounding supportive structures, you may not need additional injections.


First, I am sorry for you. I know that SI issues really suck.

What vet access do you have? I ask because there are many options around injections. You don’t just have steroids, you also have PRP and others like it. Adequan is a joint product you inject IM, it’s not going to do anything for soft tissue damage. At this point it has been so long that he’s been like this… have you tried acupuncture? I’m thinking of something that would help loosen or relax muscles, beyond/in addition to medication (such as Robaxin). My thinking is whatever scar tissue he has from the injury is by now pretty ‘set in it’s ways’ and it’s going to be hard to encourage it to loosen.
I’d also be tempted to do a bone scan. Was the SI broke, or was it only soft tissue damage? Depending on the answer, he may never canter correctly again.
Also, be damn sure your hind feet are properly aligned - get rads of your angles. The hoof/pastern angle, the P3 angle - you do not want NPA (negative plantar angle). They contribute greatly to hind end problems.
Another thing, straight lines are your friend. Work the horses body equally on the straight, so that they use both sides as they work, circles sometimes they can avoid or compensate.
Honestly I’d be looking for a new vet - one with better “tools” and advice for you in regards to managing this horse.


^^^^what everyone else said about staying on top of the feet/angles. My horse doesn’t have an acute SI injury but for years had on and off chronic SI pain, which is often referred pain aka secondary to something else that’s wrong. They compensate for the primary pain with their SI/entire back, and that in turn gets really sore.

My horse has mild KS (2-3 points of impingement on xray), had NPA in the hinds, Lyme disease (chronic positive 3700 on Cornell test, two rounds of doxy and re tested negative two years later), all of the “things” that can make them sore all over with no obvious “ah ha!” point of discomfort. It also seemed seasonal. Winter time was very hard for him, and once it was warm in late spring, he would be back to his normal fairly quiet self.

Him being NPA made everything in his hind end 10x worse, and no matter how many injections/medications/supplements you try, if you don’t fix the source of the problem, it will only get worse and you’ll be throwing money into the toilet. I say this because I did this. We xrayed and corrected his angles with plain steel shoes and wedge rim pads, which did fix the angle problem but looking back now, we sent him into a spiral of caudal failure and heel pain due to the rim wedges and lack of sole/frog support. The two winters he was in that set up were the roughest of his life. So much mysterious discomfort despite everything we were trying.

This summer we put him in 3D half pads (hinds) and when I say I had a different horse 24 hours later, I am not kidding. All of his vague hind end soreness was gone. His mystery soreness was gone. I kid you not, a set of $20 pads and some DIM did more for him than the thousands and thousands and thousands I spent on injectables, joint injections, etc.

So. Long story short, feet are really really REALLY important but are often overlooked. Investigating your horse’s feet might be really helpful and while it might not fix an acute injury or damage to the SI, fixing/supporting feet better will definitely help.


The vet school’s bone scanned concluded that there are “areas of increased radiopharmaceutical uptake, which is indicative of active inflammation within the bone, were seen at the area of L6/S1 (mild diffuse).”
I worry that he’s stuck like this but when he’s fresh and has adrenaline going, he’ll go around beautifully and looks comfortable to be working, so I want to find a way to keep him how he feels when he’s fresh (if that makes sense? It’s like I can see all his potential but the next day it’s back to being stiff and uncomfortable) Acupuncture and checking angles of his feet have been brought up to me a few times because I’ve posted our story on a few platforms looking for answers. It’s something I want to explore, just wanted to see what people thought of adequan because i’m skeptical about it and I don’t want to pay for another thing that won’t help (I’ve invested over 10k at this point on an unproven green OTTB.

Interesting!! thank you for sharing. Something I will definitely bring up going forward

I hear ya. I’m in the same boat. Do you see him cantering correctly both leads when he’s on his own? When I first got my mare, she could not canter on the left lead on a circle, at all. Didn’t matter how big the circle was, she always defaulted to the right lead.

Adequan does/can help when used for it’s intended purpose. I would not be afraid to try it. At this point, it’s “only” another $3-400. Will it help for THIS situation? Who knows!

I don’t think Adequan will help this particular issue. It’s meant to help repair articular cartilage in joints and although helpful, I wouldn’t expect this to help a long standing SI issue. I would inject the SI and do some careful rehab and also not loan horse out again so you can ensure he’s ridden properly and not by kiddos at a camp. I would start with a steroid/serapin/ha injection, maybe roboxin short term for sore muscles that are compensating and work to keep his abs strong. Hope you can get him comfy soon!


Progressive Equine Services and Hoof Care Centre on FB has a lot more information/photos/graphics about it that can explain it better than I can, definitely a good resource to check out.

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I would ultrasound (rectal most likely) and inject if not contra-indicated. You’ve got to knock down the pain and inflammation. But you need to know what you are looking at. Abnormal LS disc? Fusion? Bone spurs? Other changes and where exactly? Robaxin helps sometimes with these horses, not all the time. Adequan also sometimes helps, sometimes not so much.

But I also have seen the cross firing behavior in OTTBs with neck issues–actually coming from the neck as the primary problem. Wouldn’t hurt to take xrays, including to check for KS. As well as checking the angles of the back feet. If the feet aren’t good, they’ll just make the SI sore again.

Time off is also not your friend, but the type and duration and intensity of movement needs to change. Turnout is good. Walks on hills, working up to straight line trotting up hills and then up and down. Arena work. Poles. Backing. Long and low. Butt tucks and belly lifts and other ROM exercises. You’ve already tried a lot of these things, so conditioning program itself isn’t getting you where you need to go.

Depending on the pathology going on, you may or may not need to repeat injections once you can build conditioning.


Apologies if I am misreading - it sounds like he was diagnosed with a vague SI issue via bone scan in mid 2021 and improved after meso but has since regressed but has not been diagnosed with anything else correct? With the horse being young + the time between the bone scan and now, I’d be inclined to dig more into diagnostics to make sure I’m still dealing with the SI and not something new.

Agree 1000% with others re: hoof angles especially hind hooves when presented with hind end lameness/ soreness/ unwillingness to sit and push from behind. Hooves can really make or break them and their ability to move correctly. Something as “simple” (ha) as NPA can have lots of “up horse” effects such as back soreness, hock soreness, lack of topline, ulcers, etc.

As to Adequan - when talking about injecting a joint, we (g) aren’t talking about Adequan. Injecting a joint is often referring to steroids/ HA or a combo. It may also include “regenerative” type applications such as ProStride, PRP, IRAP, etc. However, Adequan is in the same category as Legend, Pentosan, polyglycan and where it is not targeting a specific joint and is administered IV or IM. Often, there is a stronger/ quicker effect from the steroids/ HA/ regenerative group (which is also more expensive) whereas the Legend/ Adequan/ Pentosan group has a loading dose and the effect is noticed 2-6 weeks in and some have maintenance doses as well. All of this to say that when someone says they don’t want to jump to injecting a young horse they most likely mean steroids (which deteriorate the joint over time) and not Adequan so I would clarify with the vet there.

If it were me, Adequan would not be my first choice. It isn’t cheap and I’d rather spend the money getting a more clear diagnosis. If the DX is soft tissue, the only injection that would help is steroids (for the inflammation) and Adequan would be a waste.

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My guy tore his SI ligament in a trailer loading accident, and it was initially misdiagnosed. We eventually ended up doing stem cell, which helped a lot. He later developed kissing spines and we did the ligament snip.

My Enzo came off the track directly to me at 3. He was a mess, even with a PPE. A bundle of knots from poll to tail. Had chiro out to put both shoulders and both hips back in. Gave him about 1.5yrs off just to grow up and leave the track behind. His whole life changed and he was now living out, barefoot and in a small herd. Started him back slowly and did seldom longing. He was a chronic cross-fire -er in both directions. It was more like chronic skipping in the back - like he couldnt figure out which foot to land with. I stopped longing and just turned him loose to burn off his steam. Longing was too frustrating for us both and he was much better free.

Started to ride sporadically in his 5th year and i could feel all the tension. I started to learn massage. Vet was out and found severe SI pain. He was injected and put on 2 orals for a month while i did massage and stretching daily during this month. I considered it a great success the day i saw him walk away from me and his hiney actually jiggled instead of looking like a rock.

Massage has done wonders for him and being able to do it myself anytime i see/feel he needs it is a definite and cost effective plus.

He started in consistent 5 days a week work in Feb '22 and so much is improved. TBs hold a lot of tension naturally so i keep a close eye and feel of him. My hands are always on him to feel areas of tension. On lesson days i give him a dose of robaxin in his breakfast and it soothes him and we do slow stretches after when everything is warm. He is soooo much better but from time to time still cross fires. The more consistent his work, the better he is. He just had 4 days off with the snow storm so tonight i expected sloppy and sure enough thats what i got. Tomorrow will be better as he will be looser.

I dont know what this part plays, but when he was injected i got curious and looked up his race videos. What i found was interesting. A gallop is a 4 beat gait. Enzo didnt run in 4 beat. The back legs moved in unison like he was hopping. I noticed other horses in the videos doing that as well. I dont know his track health history so dont know if that was due to an accident, training, conformation,…?

The bottom line is that getting to know your horse’s body will be very important. The body has an amazing ability to heal, but it needs help from you via proper exercise, massage and maybe something to help on hard days. Enzo speaks to me when he needs my help so i have learned to listen well and give him that. He will be 7 in april and he is an absolutely wonderful, strong and healthy boy doing just fine on the day to day :slight_smile:


Thanks for sharing!! Do you use your hands to massage or do you use a device? Any suggestions on where I can learn how to massage?
What do you and Enzo do?

I like The Masterson Method and Equine Bodywork Online. I also belong to a few FB groups. Mostly i use my hands so i can really feel where the knots are but i do have an equissager i use.