Treatments for a stiff neck

[champagnetaste]

My 17 year old big warmblood has been on hock maint for a while, but the most recent treatments lasted only about 2 months as opposed to a year as we have done in the past. He’s already showing the telltale signs, stiffness and reluctance to use himself in a dressagey way. Based on a physical exam and lunge line observation, the vet (who has known my horse for 10 years) recommended neck injections, using ultrasound to guide where to inject – over $1,000.

While I am certain his neck is stiff I am not certain it is the locus of the problem for my big guy. I’m trying to find more conservative options focusing on either the neck or “whole body.”

Anyone have any personal experience with successful treatments?

[Feathered_Feet]

Did you radiograph the neck? You may have more problems in there than you realize. Neck arthritis is surprisingly common, and can radiate and manifest as pain in all sorts of distal places (i.e., what looks like SI pain or hind end dysfunction might actually be from lower cervical pain, etc.). If I were you, before spending $$$ on various massage/PEMF/whatever, I’d radiograph and see what you’re actually working with.

[champagnetaste]

Thank you – the vet was going to do ultrasound which may give a similar picture, but as a precursor to the spendy injections… I’m nearing retirement and have spent money like a drunken sailor till now (on horses, of course), so I am just not ready to spend $1200-1500 on something that may not work, or work very long.

The hock injections showed significant improvement, as it always does, but for a shorter time. I don’t know what that means diagnostically, I know that the treatment tends to improve the whole body…

[Feathered_Feet]

Well, the ultrasound will show you soft tissue, but not hard tissue (i.e., bone), so it won’t show you arthritis the way a x-ray would. Although this varies wildly, radiographs in my area are about $50 a view, for what its worth. Something to think about.

[joiedevie99]

I’d talk to your vet about putting something else in the hocks (assuming you do steroid/HA now). Something like Pro-Stride or Noltrex or Arthramid or Anicell might get you relief for a longer period of time.

[theresak]

Did you do HA in the hocks or just steroids? HA would be my first step, but for me that’s about $700 total for both hocks on a big horse. I’ve also successfully used Osphos to stretch out the time between joint injections and since it’s systemic, we figured it might help anywhere else there’s some arthritis starting.

I tried Arthramid for a very arthritic knee and did not get good results, but we only did one injection and my vet is finding that sometimes they need a second one within a few months to get the improvement.

[champagnetaste]

HA/steroids – we had been throwing osphos in for the last two years, but this go-round I left it out b/c it seemed to have diminishing returns. Maybe I was wrong.

My trainer has said (after the vet mentioned the neck) that he seems blocked at the base of the neck, which I believe, but not sure if it is really the source of the primary issue. The vet made that diagnosis b/c he was holding his head and neck stiffly and to one side. I had an old TB that did that and a different vet (at the time) said that that was his way of protecting a weaker hind leg. That makes a lot of sense to me.

This vet is exceptional and if I had unlimited funds I’d go that direction (I may anyway, at least by Christmas). It would kill me if it doesn’t help.

[hoopoe]

If you are looking for long term care I would invest, first, in diagnostic neck radiographs.

Arthritic changes in the neck will transmit as gait disfunction particularly in the hind end. Local pain can show as guarding.

Joint injections is short term palliative care and not going to correct or transform anything.

It sounds like you might need more solid information to make reasonable choices for the short and long term health of your friend

[atr]

I’d strongly recommend you xray that neck. Big warmbloods are prone to cervical/neck arthritis and once you know, you can manage it quite successfully with thoughtful riding and therapeutic maintenance.

If you xray you can target the area that needs treatment. (Betting its somewhere between C5 and C7.) Neck injections are a bit brutal so you want to do as few as necessary rather than a scatter gun approach.

(The ultrasound is used to guide the needle to the right spot, not as a diagnostic tool.)

[staceyk]

Hah! Thanks, that is what the vet recommended. Useful to have the confirmation, but I’m dying inside when I think of the bill. Thanks for responding.

[IPEsq]

@Feathered_Feet

Well, the ultrasound will show you soft tissue, but not hard tissue (i.e., bone), so it won’t show you arthritis the way a x-ray would. Although this varies wildly, radiographs in my area are about $50 a view, for what its worth. Something to think about.

Ultrasound absolutely shows bone. That’s how you find the joint doing ultrasound guided injections. And it would show if there’s effusion on the joints, and if there are OA changes. I prefer using ultrasound if there’s a question about needing to inject something in the neck because xray can’t tell you how angry an area is (or isn’t), just if there are bony changes.

[Feathered_Feet]

Oh, you’re absolutely right. That was not a technically correct thing to say, especially since my horse has had how many ultrasound guided spinal injections and a transpelvic ultrasound of the SI in the last year, so I should know better

I guess what I meant was, typically for looking at bony detail, you want radiographs, not ultrasound. And if that’s not the case, I have some serious questions for my vets about why we did both ultrasound and radiographs on 1/3 of my horse over the last year (as in, duplicatively over the same areas). Barring locations that are difficult to radiograph (e.g., SI, stifles from what I hear), radiographs are prefered for looking at bony changes.

[2tempe]

Agree with hoopoe…my old horse was unable to hold a lead at the canter, and actually had some neuro symptoms. Not great on the tail pull, etc. (We actually tested for EPM also.) Xrays first, then ultrasound guided injections. Horse improved noticeably after a couple weeks and maintained for over a year-maybe 15 months or so before I noticed some changes. I was told that the second round would not likely work as well, or for as long so I did not do them. Others have said this also, though I dont think there are actual scientific studies.
(Also worth noting, in spite of the hind end comments, you will find articles that frequently reference front end lameness. You will also read of significant behavioral issues from some horses)
BUT I would hope that your vet is indicating pics first and then injections if there is evidence of a problem.
It sucks dealing with this stuff…

[IPEsq]

Some of the reason for both is that you are looking at different planes. Some things you can see better/easier/from the right orientation with one modality vs the other. The spine is not the easiest area to image in a horse. But I generally won’t repeat X-rays whereas I will repeat ultrasound to see if things are stable or getting worse.

[eponacelt]

Neck injections (after we did diagnostic radiographs) have been life changing for my mare. We went from barely able to do First Level to knocking on the door of 4th/PSG in about 2 years. We now do A2EQ in the neck, which is VERY spendy, but she’s solidly mid-career and it seems to last longer than just steroids.

I’d say the injections are worth at least one try to see how it goes.

[Bonnie2]

@atr

tool.)

Neck issues are a common performance horse issue. Probably always have been but the ability to do good imaging is relatively new. Routinely the neck is xrayed and problem areas identified. Then the neck is injected with a steroid guided by ultrasound. If this provides a good result, the next time the neck is injected with prostride. Which is more expensive but will provide longer duration relief.

[Bonnie2]

atr, not sure why my comment shows as a reply to you. I agree with everything you said. Just adding my two cents.

[kaya842]

How old is your horse if you don’t mind me asking? Curious if this is something that, if found later, can improve as much as your horse did (1st to 4th/PSG is amazing!).

[SillyHorse]

@champagnetaste You might find some useful information here:

Neck Pathology and Dysfunction in Sports Horses: Diagnosis, Treatment and...

[staceyk]

Thanks all for the advice. I will probably suck it up and do the injections. What is the downtime after the injections, similar to hock injections?