What are Sacroiliac Joint Abnormalities?
Injuries of the sacroiliac joint can be recent or chronic, involving the bone of the joints, or any of the soft tissues surrounding it. Injuries are often caused by trauma or overexertion from falls, strain, training, competition, or balance issues. Secondary injury to the joint can occur as a result of another condition, such as osteoarthritis. If the damage is not addressed with proper rehabilitation, the region can remain a source of weakness and pain, and create further dysfunction.
The sacroiliac joint is the place where the ilium of the pelvis joins the sacrum of the spinal column. This joint serves to join the hind legs to the spinal column and is supported by three sets of ligaments, and other adjacent muscles. If any of the parts this region become damaged, this crucial network needed for muscle balance and weight transference can become compromised, and can cause pain, stiffness, poor performance, and lameness.
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Symptoms of Sacroiliac Joint Abnormalities in Horses
Symptoms of a sacroiliac joint problem revolve around the pain in the muscles of the hind end and pelvic regions. This discomfort can affect gait and performance. Signs can include:
- Pain in the lower back or pelvis
- Stiffness in the hind end and in the muscles around the sacroiliac joint
- Lameness that can shift between legs
- Shortened hind leg stride
- A bunny-hop gait
- Lack of gait coordination, seen as disuniting at a canter and leg interference
- Poor performance
- Dragging of the hind leg toes
- Restricted movement of the hind leg
- Uneven or poor muscle development in the lower back and rump
- Muscle deterioration in the rump
- Increased prominence or an unbalance of the hunter’s bump, or the tuber sacrale bones at top of the pelvis
- When standing, horse favors one hind leg
- Continuous shifting of weight between legs
- Clicking or locking kneecaps
- Bucking or rearing when saddled
- Asymmetric pelvis movement
- Tender, inflamed, and itchy skin
- Patchy sweating
- Abnormal tail or body rubbing
- Riders report a lack of rear impulsion
- Holding tail to one side
- Reluctance to strike off, or use the wrong lead leg
- Difficulty holding up hind leg to be shod
Horses at a higher risk of sacroiliac problems are:
- Tall, heavy or older horses
- Harness racehorses
- Draft breeds
- Carriage horses
- Endurance horses
- Western pleasure horses
- Sports horses
- Dressage horses
- Show jumping horses
Sacroiliac joint injuries are generally placed into two categories.
- Primary sacroiliac injury refers to pain resulting from direct trauma to the bony structures or soft tissues of the sacroiliac region
- Secondary sacroiliac injury occurs in response to another condition, such as lameness in a different part of the leg
Causes of Sacroiliac Joint Abnormalities in Horses
The cause of a sacroiliac joint problem is often a trauma, which can be sustained during training or competition, or even in the paddock. Causes include:
- Direct trauma, such as a fall
- Sprains and fractures
- Tears and strain resulting from overstretching or excessive exertion, such as during an explosive start in a race
- Sacroiliac ligament desmitis
- Poor posture resulting from rider posture, poor saddle fitting, hoof balance, or even dental issues
- Birth trauma
- Hock arthritis
- Stifle pain
Diagnosis of Sacroiliac Joint Abnormalities in Horses
Diagnosis is based on symptoms and a physical examination. Palpation of areas may be performed to identify tears. It is important to rule out other causes of the pain your horse is experiencing, such as from pelvic fractures, sore feet, or intervertebral disc disease. Often, a nerve block is used to confirm the diagnosis.
Imaging techniques are used to assess and identify damage in the sacroiliac region. This includes ultrasounds, which are limited in that they are not able to image the entire joint. Better results can be gained from a bone scan, or nuclear scintigraphy, which uses an injectable dye to identify the location of the injury. Infrared thermography can also be used. X-rays are generally not helpful due to the location of the joint and the surrounding muscles.
Treatment of Sacroiliac Joint Abnormalities in Horses
The treatment of sacroiliac joint abnormalities in your horse usually includes a combination of rest, medications, guided exercise, and supportive therapies.
Rest can be recommended for as little as 1 to 2 months, or longer, after which time your horse should be gradually worked until he is back to normal.
Medications can be used to relieve pain and inflammation, but they are temporary, and should be followed by strengthening exercises. Anti-inflammatory injections, corticosteroid injections, and hyaluronic acid can be used in the sacroiliac joint region.
Working the main muscles in the pelvis, abdomen, and back can help to restore support to those areas, and manage pain and instability. Exercises can include the use of stretch bands, lunging aids, a water treadmill, trotting poles, leg weights, or physiotherapy stretches. Extended periods of hand walking, ridden work with a properly fitted saddle, gentle work on hills, and core strengthening exercises can be beneficial as well.
Other supportive therapies can include electro-acupuncture or aquapuncture, which involves injecting a substance into local tissues, gentle spinal manipulation, equine bodywork, shockwave therapy, muscle release therapy, and prolotherapy.
In cases of secondary sacroiliac joint injuries, your veterinarian will attempt to treat the underlying cause of the lameness or other condition present.
Recovery of Sacroiliac Joint Abnormalities in Horses
The best results have been seen when therapies are combined. Though improvement is generally seen after the first treatment, most stiffness and pain should resolve once normal movement has been restored.
While you cannot predict when an accident may occur, you can avoid them and keep your horse’s core strength stable through conditioning and strengthening exercises, keeping the hooves balanced with proper trimming and shoeing, maintaining a properly fitted tack, using correct riding techniques, and routinely scheduling veterinary care.
Sacroiliac Joint Abnormalities Questions and Advice from Veterinary Professionals
can you recommend a rehab program for a horse with Sacroiliac injury (she also has osteoarthritis of the hocks) she's off box rest as of next week and I'm not sure as to what the best program of exercise etc. to bring her back gently and correctly is ?
There is no set protocol for rehabilitation of sacroiliac injury in horses; generally gentle exercise to build the gluteal muscles is the best course of action (like slow canter), but the severity of the osteoarthritis in the hocks would determine the amount of exercise that would be tolerated. I would recommend having an Equine Physiotherapist have a look at Hatty to develop a tailored program for you. Regards Dr Callum Turner DVM
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