As you can see by the various comments there could be one or a number of “complicated” things going on. IME and experience even for a warmblood I don’t consider 5 as being young. I think you have been doing the right things by and large based on face value of what the horse is showing. Yes, “strengthening” which is usually the first “go to” and the first to be offered as a "treatment. It can and does change things but IME it shouldn’t take a year. IME letting this happen for such a long period of time is counter productive.
It can exacerbate what ever is causing him to do this. Most horse if not all horse will “look for” pain relief by using, compensating with other parts of their body. This can and does stress other things which will go south given time and needed to be address at some point and could add significant more down time and expense. You also run a high risk of the horse’s compensation to become a habit, ingrained. This can and does time a lot of time for them to get over. A real PITA, ask me how I know.
Keep in mind that bone scans, aka nuclear scintigraphy is relativity new. It is not like taking an x-ray, where things are usually visibly cut and dry to the well schooled eye. X-ray imaging has been around for many decades The “learning curve” has been pretty much eliminated. Bone scans only reveals “hot spots” for lack of a better way of putting it. What it show has to be interrupted. The cause and effect is subjective. The value of any bone scan is entirely based on the expertise person/s reading them. Not that much different than an US As with both at times IMO and expensive education. I feel it is always worth spending a few extra dollars to send the digital file to another vet team for a second opinion. I send direct with no comments included from the attending vet/s.
I have had 2 horses who’s bone scans were misdiagnosed. Adding considerable time and expense to the process of getting them to come right. I don’t blame the vets I understand it is not an exact science and no one has the prefect crystal ball. But IMO they should rebate some money, give credit toward other work/treatments that were needed to sort things out. An apology would be nice to.
When considering a bone scan IME the attending vet generally will only perform it on a specific “suspect” area of the horse. IMO and expensive experience ask how much more it will cost to have the entire horse scanned. Esp with a horse that has had long term issues. The team may think the issues being shown are in a certain area. Good chance there is something going on in that area. But it maybe the result of “compensation” as I talked about above. So the real problem will not be looked at. IME the first horse I had scanned this turned out to be the case. It shouldn’t cost that much more to scan more of the horse. The clinic doesn’t have to block out anther time slot, the horse is already “nuked” etc. So it is not double the cost. I know, I found this out after the fact. IMO/E worth asking.
IMO and expensive experience it is worth spending the money early on for mysterious issues. Going down the list of possible inexpensive “treatments” adds up. Yes, I understand the term, “no foot, no horse”. But IME I have found there can be too much emphases put on correcting subtle feet issues. IMO and expensive education I have learned to bite the bullet and pay for a complete work up. Before spending hundreds of dollars on corrective shoeing, bone scan and a multitude of other “ideas” that can take a considerable amount of time to find out if who is right or wrong.
IMO take the horse to the best sports vet in your area. For a complete series of “block and ride”. Stem to stern. Preferably a clinic that has really good riding surface to work with. A clinic that has the size and type of an US machine needed if it is determined that blocking for a possible SI condition is warranted. This can take a few hours to all day and possibly a follow up the next day. IME the entire process is videoed so things can be looked at, reviewed closely. The cost for a stem to stern examination would vary depending on location, clinic, time, etc. Around $1,500 2,000±.
After this is done the team should be able to decide if the expense of a bone scan would be worth while. Or any other diagnostics. Down time is expensive, esp if the owner is paying board. Down time is boring and frustrating. But far more so of both if things don’t come right in 6-12 months. IME if you spend the money early you have a far better chance of things coming right quickly. Not having to start all over again 6-12 months later.
IMO/E I leaned a long time ago not to rely on my general practitioner. No disrespect to vets that fall under that category of vets. I seek out and spend my money only on those who are highly specialized with the issues that are going on. Ones that have spent YEARS of acquiring that level expertise.
Va Equine is/was a well respected clinic. Haven’t use them in years so I don’t know anybody there anymore. I am in the Unonville Pa area and have the New Bolton Clinic and my backyard. My go to sports vet there is Dr Elizabeth Davidson who is also a H/J rider. Love using vets that own and ride horses. NB also had an excellent indoor with perfect footing to perform visual under saddle examinations and “block and rides”. My favorite sports vet is Dr. Kevin Keene straight forward no nonsense and a great guy to work with. One of the most respected in the country. His clinic is much smaller in size and scope. But there is a decent area for lunging and riding,doing routine blocking etc. He works with the folks at NB and has no problem saying it would be better to take the horse there if he feel is would be better for all concerned. Esp the owners bank account, lol. Kevin is a top armature Event rider also.
OP I am not one to say what you have going on. I never get into that sort of thing unless the horse is in front of me or between my legs. Just throwing out my experience over the years of working with LOTS of horses and lots of “mystery issues”. Mine and clients. Used to do a fair amount of sorting out stuff, re-hab for clients. Good luck!! Give me a broken bone, pulled tendon any day. So much easier to figure out, lol.