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The SI joint and ligament

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  • The SI joint and ligament

    I bought my 9 yr old unraced TB mare in march with high hopes. She is lovely with outstanding movement. She has a free shoulder, great reach and impulsion from behind (until recently), an exquisite comfromation, legs and feet... She didn't have a lot of training and had the mind of a 4 yr old really. I bought her as an upper level dressage prospect. I had her vet checked and she "passed" with flying colors.

    She went straight into training with an FEI trainer and was doing beautifully but about 3 weeks into training she got a sore back. Ever since then she had a relatively sore back... She had developed ulcers and we did a course of gastrogaurd and I attributed the soreness to that.

    A month ago I had the vet out to look her over again bc her back was sore...again. She wasn't lame but wouldn't use her back at all. We had a nuclear scan done and her hips and SI lit up.

    We did steroid injection 3 weeks ago and she is on Robaccin (excuse the spelling). We are contemplating injecting again but before we do, I wanted to see what other people have experienced with this...

    If your horse has had SI problems and you have had them treated (or not) could you please tell me your experiences and possible suggestions?

    Thanks and I look forward to hearing your input!

  • #2
    The ones I am around with SI issues get lots of chiropractic work and acupuncture. It does help with them. And lots of suppling and strengthening exercises.


    • #3
      Originally posted by Parisian View Post
      She went straight into training with an FEI trainer

      .........is probably the problem.
      ... _. ._ .._. .._


      • #4
        I have a pony mare who had a SI problem. Had the nuclear scan before I knew that ultrasound does a better job of displaying the nature of the problem (using the right ultrasound, in the right hands). Her right SI lit up but what the problem was besides inflammation I did not know. Put her out 24/7 for 6 months and she was able to go back into work after that. She has been sound ever since.

        Others may disagree but I think quiet 24/7 turnout (not in a large group where they'll all start running) and time off is very important to recovery. Even if I'd had her SI injected, which as it turns out I didn't need to, I still would have given her the time off. Chiropractic work (she had two chiros work on her, one of which was a vet) did not help her. So in her case I don't think the problem was misalignment but a strain.


        • #5
          A dressage mare I own had, as a 4 year old, a similar strain to the one described by grayarabpony, above. I also did the nuclear scan to diagnose. I stopped all riding for 4 months or so; gave daily turnout with the mare band; then, brought her back with lots of slow strengthening work, including lots of walking hills.


          • #6
            I've been through SI problems with my youngster. Vet thinks he got a stain from playing too hard (because God knows I'm not riding him all that hard!) The vets recommendation was regular accupuncture and steady work, focusing on a good stretching warm-up and using cavaletti.

            What I've found is that my guy gets less sore the more days he gets work in a row. So on the fourth day of work, he's hardly sore at all. On the first day after a day or two off, the more sore he seems. Over time though, he is improving and using himself better. He's less cranky and generally happier.

            Good luck. SI strains are really no fun and can be frustrating.
            Here Be Dragons: My blog about venturing beyond the lower levels as a dressage amateur.


            • #7
              I have a gelding who after I bought him just wasn't quite right. I took him to my local vet and he thought he was foot sore. He abcessed out and seemed better, but later I realized it was the rest he had. Back into training and he would go fine for a while then, NQR again. We showed some at training level and he got scores in the 70's so I figured I was being overly protective and hypocondriac about it all.

              But, 1st level he was markedly not engaging in canter and different on each lead. By then, a vet check resulted in positive flexion tests and we rested him even though x-rays showed nothing. He was better after rest.... then he'd go back to training and NQR.

              We thought ulcers and scoped, but that wasn't it. The whole time I was trying different trainers because most just wanted to draw-rein him up and make him go forward. I wasn't willing. Finally, I tried a different person, and he saw it right away. He said it was his back and/or neck which I had always suspected but even with chiro it just never seemed resolved.

              This led me to an orthopedic surgeon, Dr. Tom Yarborough who grinned when I gave him the story and told me to jog out my horse anyway, but he already knew what it was. I jogged him out. I even rode him and he felt very confirmed that we need to ultrasound the SI.

              Severe tears, subluxated pelvis and a very wait and see progrnosis. Dr. Carol Gillis did the ultrasound and gave the recommended stall rest and rehab program that I followed to the letter! Dr. Yarborough injected the SI to help it along as we began our stall rest. It took a full year of stall rest and beginning with hand walking, gradually building up to ridden work first at walk, then adding trot by 5 minutes at a time over two week intervals before he was able to do a full hour of regular w/t/c on straight lines and circles without starting to look NQR again.

              It took another year to get him fit enough to try to move past 2nd level and this year we developed third. He's got his changes and doing working pirouettes. At our last clinic we rode the trot work of the PSG, started some half-steps and he can now do 2 clean straight changes on a quarterline.

              We think he'll make it to FEI. His injury was severe. When the ligaments began to heal the subluxation of the pelvis leveled out, but the left ilial wing is flattened. He obviously fell on it, but not since I've owned him that I know of. I bought the horse days after he was imported and he was banged up. No one really could have known and a standard pre-purchase was not going to show it up as he was never actually lame as a result.

              As a result of my experience with him I know for myself
              1. SI is WAY to important. You simply can't inject it and ride on. You have to rest and rehab.
              2. Ultrasound is a good diagnostic in this case and can let you see improvement and/or regression in the fiber pattern and density of the ligament as it heals
              3. If I feel my horse is not quite right I will investigate it aggressively. I won't let a trainer try to push me into not taking it seriously. I am SO glad I stuck to my guns. Even as it is, my horse lost confidence and developed a pretty hefty rearing evasion about asking him to engage more, get active and sit behind.
              4. Take the time to heal it thoroughly and rehab/rebuild properly. My horse is 10 now and we started this process when he was 7. I have friends who think I should have given up on him long ago, but I couldn't replace him for what I had in him. He'll be showing 4th next year easily. My goal when buying him was to have a horse to train to FEI. I think he can do that. How long that was going to take is just ending up longer than I planned, but I've probably learned more. He's the right horse for me, so the time factor has never mattered.

              I hope that helps. Please, if its SI- really get it ultrasounded and know what soft tissues are involved the extent of the damage and get a baseline to follow a healing protocol and tell if its working.

              Here's a video of me and my boy in August.


              • #8
                Once a bone scan confirmed my horse had a "hot" SI and stifle, my vet asked me if I was willing to think outside the box on a course of treatment. He asked me this becuase he knew I had been dealing with a "cranky" horse for a long time before I did the baone scan.

                His reasoning was that even after you do the injections, which they know provide pain relief, the horse mentally may not know his back no longer hurts. In other words he may continue his current behavior, which in my case was violently opposed to picking up right lead canter, maintaining the canter and then he really got pissed when collection, even a small amount. Let me make this cllear, in my case the horse was becomming dangerous. So.....after the injections we sent him to the VA swim center for 6 weeks of swimming. The price was reasonable, compared to full dressage training. The idea of swimming for a dressage horse, is it develops all the muscles you try not to develop i.e., hollow back, under neck muscle etc. When he came back we started work on a loose rein in a big field just asking for walk, trot and canter. We did this for 4 weeks before we brought him back in to the ring and asked him to work for us. The story goes on and on and on but as of today he has a strong back and does not appear to be in any pain. We have had him in for one more set of SI injections 6 months after he returned form the swim center. When I brought him in recently just for a follow up, the vet said at this time he would not recommend doing the SI injections because after a thorough exam he could not find any area of soreness. He also said the horse's back appears so round and solid that at this moment if he is sore we need to look at other areas. A long story but with a happy ending.


                • #9
                  what were the symptoms you all found with SI problems?
                  In my opinion, a horse is the animal to have. 1300 pounds of raw muscle, power, grace, and sweat between your legs - it's something you just can't get from a pet hamster.


                  • #10
                    My pony would swing her hind leg out while holding the croup level, but still manage to track up and use the hind leg below the hip well. The more activity the worse she got, indicating that she had a soft tissue injury. Had vet out, all flexion tests were negative but her back was extremely sore on the right side just behind the saddle. Testing accunpucture pressure points showed a lot of soreness in her croup. So she got two weeks off with bute and muscle relaxer, then to vet partner who was also a chiro. The vet/ chiro worked on horse and pronounced her cured. By the third day of work she was off again. So we went to NCSU. She got a full lameness work-up by Dr. Redding before the scan.


                    • #11
                      Originally posted by TropicalStorm View Post
                      what were the symptoms you all found with SI problems?
                      SI- is major- my guess now is that at least 20% of all dressage horses have some SI issues...not diagnosed of course. It can manifest itself in many ways:

                      Horse launches you after 30 minutes of peaceful riding - sudden sharp pain- and reaction...
                      Horse is NQR in the rear or front if there are already damage points in the neck...
                      Horse absorbs with the front- NQR in the rear and very short in the front
                      Horse SURELY can not really sit or lower croup...
                      Horse has crankiness that is not really explainable at all...
                      Horse's weak side/strong side tends to switch

                      You can tell I have had some exposure to this...I believe the SI is the core of the dressage horse...the neck is the result of issues in the SI- and the lack of health in the SI can manifest itself in MASSIVE and MANY issues...sudden explosiveness that is not explainable, sudden shutting down- not going forward, weird offness, etc.

                      My recommendation is assuming unlimited funds- go downwards from there:

                      full body scan
                      ideally ultrasound of SI area
                      if neck inflamation is diagnosed- go back to the sacrum-
                      get 1st class chiro - usually skeletal issues are part of the problem (i.e. hips are uneven- old injury created uneven hips that ascerbate the problem)
                      get first class body worker- someone who has training in most all disciplines, physiology, muscles, connective tissues, etc. then get specialist for acupuncture, massage, Feldenkrais etc...depending on what supposedly caused the injury. This is like reconstructing a crime- it takes patience and constant attention to the problem- but you can heal it and work with it and make a great athlete after all.
                      "the man mite be the head but the woman is the neck and the neck can turn the head any way she wants..." -smart greek woman


                      • #12
                        My mare has this. Its because her pelvis; especially on the right; wants to tilt forward. I have had her since she was 2 and she's always had this issue. Her SI was so bad it caused her back over her loins to hump up and a huge deep dip to form at the top of her croup. Its gotten much better with lots of chiro adjusting and a lady here uses electrical stimulation (tens unit) to help quickly strengthen her muscles after she is adjusted to keep the pelvis in place. One excersise in particular has seemed to REALLY help.
                        I have her walk over vertical jumps that are just under the height of her knees/hocks. She really has to reach up, stretch out over and down. Not alot ever like maybe I take her twice over 4 of them after we work. Hill work done collected has helped as well. Then of course very correct dressage work.
                        When she is starting to get sore I loosen her back up before we work with a heating pad.
                        WalMart has a wonderful one with a 9' cord and the pad is 2'x1'.
                        We started in April doing treatments as I call them every week then the end of May we were doing them every two weeks and by the middle of June it was just when she needed them. Since June she's only needed to be adjusted 3 times so a little less than once a month now. The adjustments are not as major as they used to be and we don't need electrical stimulation afterwards.


                        • #13
                          Originally posted by Parisian View Post
                          I bought my 9 yr old unraced TB mare in march with high hopes. She is lovely with outstanding movement. She has a free shoulder, great reach and impulsion from behind (until recently), an exquisite comfromation, legs and feet... She didn't have a lot of training and had the mind of a 4 yr old really. I bought her as an upper level dressage prospect. I had her vet checked and she "passed" with flying colors.

                          She went straight into training with an FEI trainer and was doing beautifully but about 3 weeks into training she got a sore back. Ever since then she had a relatively sore back... She had developed ulcers and we did a course of gastrogaurd and I attributed the soreness to that.

                          A month ago I had the vet out to look her over again bc her back was sore...again. She wasn't lame but wouldn't use her back at all. We had a nuclear scan done and her hips and SI lit up.

                          We did steroid injection 3 weeks ago and she is on Robaccin (excuse the spelling). We are contemplating injecting again but before we do, I wanted to see what other people have experienced with this...

                          If your horse has had SI problems and you have had them treated (or not) could you please tell me your experiences and possible suggestions?

                          Thanks and I look forward to hearing your input!
                          With a new training regimen you can expect sore muscles. The ulcers, or anything else your TB may be experiencing now may be coincidental and can mistakenly be thought of as the cause. That still could be, but it's not likely.
                          What you should do is first rule out musculo-skeletal disorders with both superficial and deep digital palpation and range of motion (ROM) evaluations (i.e. carrot tests for the cervicals) flexing each hind leg up to see which leg comes up less, and SI joint ROM tests. The SI ROM tests are only good until age 10 since the SI joints are fused by then.
                          Daniel Kamen, D.C.
                          The Well Adjusted Horse


                          • #14
                            My horse tore his SI ligament last year and no amount of rest would heal it. I ended up doing stem cell therapy in January of this year, and it's worked perfectly. We combined the stem cell with a regimented program of work in hand and under saddle, daily treadmill sessions, and doses of fluphenazine to control the crazies. At the end of July, his second bone scan didn't light up at all and the vet clinic pronounced him fully healed.

                            We've brought him back to fitness very carefully and he's now comfortably doing 3rd level work. I'm careful to inspect his back every day and if he starts tripping (one of his earlier symptoms), he gets a little bute and a day off.


                            • #15
                              Good overall mover (often 8 on gaits) but cranky on canter departs and resistant when not in regular work. SI lit up on nuclear scan. Two rounds of back injections, no prolonged rest but steady slow building up of condition. Eventually showed upper level on no maintenance. I agree that horse doesn't easily forget the resistance issues associated with the pain, but again steady progress in the training and conditioning are key.


                              • #16
                                My boy is in month 4 of rehab for a subluxated right SI and inflammed hind suspensories (diagnosed by scan, ultrasound and blocks). For us, it seemed that once we started treating the SI the suspensories were fine. I'd say the biggest key is patience. It just seems to take time for everything to really heal. It is always a balance between bringing them back so that the ligaments and tendons can stretch and build correctly, and not overdoing it and reinjuring.

                                We injected his SI in July, and that made a noticeable difference right away. It was so inflammed, however, that both the regular vet and chiro figured he would need to be re-injected. So far, things are going well and we haven't done that yet. He has been gradually increased with workload and turnout (just in case b/c of the suspensories- if it were just SI, he probably would be back out 24/7 by now). He also has had regular chiro visits that I coordinate after certain treatments like the SI injection (things seem to "hold" better once you've had a treatment for the inflammation). He is not quite 100% yet IMHO, but he has definitely made a lot of progress and I still notice improvement.


                                • #17
                                  My mare had an SI injury several years ago that manifested in a grade 3 lameness in the left hind that did not improve with three weeks of stall rest. The worthless vet I was using at the time would not block the leg because he "didn't want to get kicked" (sorry excuse for a vet, if you ask me). I ended up sending the mare to UGA, where they started blocking at the foot and ruled everything out until they got to the SI. She also had a nuclear bone scan, which was mostly negative. They injected her SI, she went to a different barn for another week of stall rest, then started light turn-out and was back in light work two weeks later. She has had no chiro or other body work for the past two years but is staying sound in a 5-6 day/week dressage program with daily turn-out.

                                  Gigi, who are you using for chiro and body work? We are a bit disenchanted with a certain chiropractor who works in our area.


                                  • #18

                                    Can you elaborate on "damage points in the neck"?

                                    I have a horse that has had lameness issues for the last six months (although fingers crossed, he is starting to look sound again)

                                    Three vets have had three different opinions as to what was wrong with him, ranging from SI to nerve damage in right shoulder to damage in the neck.

                                    Your comment is the first time I have heard anyone reference the neck in an SI issue

                                    To the OP,
                                    my horse's issue seemed to come on suddenly, we believe he fell in an icy paddock. The vet who thought the SI was the issue did two courses of shock wave therapy and acupuncture. He was, upon examination, back sore, in addition to being off in front and his hips seemed to be unlevel. After the shockwave courses he was no longer back sore but he was still NQR in front.

                                    No result with any flexions and he did not block out sound, no other diagnostics done (as they are not available anywhere near where I live).


                                    • #19
                                      a good holisticvet

                                      good holistic vet acupuncture and chiro; massage therapy, /telligton touch, or laser to quiet themuscle spasms.
                                      breeder of Mercury!

                                      remember to enjoy the moment, and take a moment to enjoy and give God the glory for these wonderful horses in our lives.BECAUSE: LIFE is What Happens While Making Other Plans


                                      • #20
                                        My horse took a bad fall after a fence accident and damaged his SI. His symptoms showed up as balking and eventually rearing. Once diagnosed, injections into the SI joint took care of the problem. I think it is probably one of the most common missed diagnoses.