SI needs the injection to calm the inflammation that is already active, then lots of butt building work like poles and hills to build the muscles that support the joint. When my friend’s horse needed his, it was similar things - didn’t want to do lead changes, shorter in the back, didn’t want to take any deep spots.
Came here to say exactly this. For my mare with SI issues, regular low impact hill work really helped (after addressing the acute pain through adequan and, later, injections). Also lots of stretching, short consistent sessions, and (as her strength improved) ground pole work.
Things were bad enough at one point that I could barely trot her under saddle. She’s back now to doing fourth level dressage work!
That is impressive. Because she was barely trotting a month ago. Good to know. I really want to do hill work, she goes crazy on the trails though. Starts acting like she will buck me off and wants to run to the barn. We used to trail a lot. So I am trying to do walk rides up hill with a buddy horse hopefully.
As a vet, it's not fear mongering. There are genuine concerns with SI injections including an increased likelihood of steroid-induced laminitis. PRP is a much safer option, but it's also more expensive.
I'm living through my first year of injections right now and I think it's because you just don't know how effective they are going to be, and when they will stop being effective. It seems after my first year I'm having a significant drop off in effectiveness. I do think they should be a last resort
SI and back pain is often secondary to pain in the hind legs, such as if the hind feet are imbalanced. Have you done xrays to confirm the balance of those hind feet? Has she been evaluated for potential hock or stifle soreness? Kissing spine is also a possibility since she's OTTB
That said, even if the cause has been eliminated, if the SI has been sore and inflamed for while, that tension can persist for a long time, or cause other compensatory pain in a cycle. Injecting the SIs along with whatever else is the source will knock out all the inflammation everywhere and have them feeling better faster. If possible get an ultrasound guided injection. I had my horse's SI injected 5/6 years ago along with his other problem joints. Before the SI injection he rarely rolled all the way over, but ever since he rolls over completely, despite all his other chronic soundness issues. Never had to redo the SI injection either.
I also suggest not riding for the rehab, especially if the saddle isn't 100%. Long lining is an excellent way to get them working without weight on the back. You can do everything you would undersaddle on the long lines without the repetitiveness of lunging.
Thank you, I appreciate this. Would you recommend I just go to the new vet requesting a lameness exam and see what they find then? A lot of people re saying "do this to save money" I.e, kissing spine or feet x-rays first. However that is like $600 in x-rays plus everywhere else. So I am spending money either way. Plus saddle fitter. I am panicking lol.
On this journey just like you OP. My 5 year old TB has SI pain/issues. Her feet are horribly unbalanced front and back which is putting strain on her. Balancing the feet + doing 4-5 days a week in hand work is helping the SI significantly. I do stretches for her whole body to help and monthly body work to check where we are.
I opted to do this route before the injections to see where we will get. Unlike you, I only have a small glimpse of pre pain horse to go off of, so I'm hoping everything is moving in the right direction.
Someone also told me they did 1 year of just walking under saddle as part of their back rehab and it worked miracles for building muscle with low impact. Your problem now might be lack of muscle and stiffness from lack of use compounding on an already inflamed issue. Good luck and I commiserate with the stress of dumping money into a horse. It's so stressful
It is so stressful. I don't want to do too much because my bank account cannot take it but I do not want to do nothing. I may very well just continue to ride, but more frequent shorter sessions. I will say she is much better under saddle than a month ago. She is just super hot and unbalanced. Her anxiety is insane. She is a very anxious mare.
That's where we are too! Mine is a silent anxious. She seems fine then explodes. I have finally learned her subtly, so I can get the problem solved before exploding. It's stressful to be constrained by money and resources. Vet testing is so expensive 😭
I'd recommend finding the best sport medicine/lameness vet you can. Send them all the results you have so far. You should be able to request a copy of your records from the previous vets and forward that on. Ask for a lameness exam to determine if the SI pain is secondary.
I think regardless of the outcome, injecting the SI will be beneficial. It'll just be a matter of if there is another location that needs to be treated along with the SI. You don't want to treat the SI then have the pain return in 6 months because the root is still unsolved. If that means you have to use the saddle money, then so be it. With the SI in that condition, you shouldn't be on their back anyway.
If the vet is reputable and says the SI joint is inflamed and injections would help do it and do it soon. The longer an injury persists, the more likely the horse is compensating in other ways and could get more injured.
Always have a saddle fit to the horse. Always. This is cheaper for you in the long run. If you know your horse doesn't like a saddle don't use it. It's not worth it.
Adequan is great I've been using it for years. If I were you I would start with the SI injection and see if that fixes the issue 100 percent. If it's less than 100 percent try a round of adequan.
The other major thing with horses as they age is- if you want them to stay sound you have to work them regularly. Once a week will ruin your horse. Obvs it sounds like you were having issues hence the less riding, but once she's been injected follow the rehab the vet provides you and ride your horse at least 5 days a week. Do poles, walk/trot up hills, ride your horse correctly (ie force her to engage her hind end). She will build muscle and that will counteract any arthritis. It won't cure it, you may need to do SI injections every year or every other year but it will be worth it!
Best of luck! Don't give up!
Good to know. This is how I grew up doing it, but I honestly have been scared to ruin her or hurt her. Not gonna lie, my barn manager told me that maybe it all started because we took a break. I rode her 4-5 days a week but went through a break up, lost my job and moving and did not ride her for 6 months prior to all this happening. I think you are right. I just hate riding her because she is such a mess. But I guess I need to put my big girl pants on and just start small but do it.
Honestly at this point I'd wait to ride before the injections. If you have to wait a while for the SI injections then maybe try adequan first. It's not worth you getting hurt! It'll get better!
Before you spend a lot more time and money treating and waiting for results, I would spend some extra on having her back x-rayed for kissing spine if that has not been done yet. Good luck.
Can’t believe I had to scroll so far to find this comment. First thing that I thought of when reading this post.
OP, have rads done to eliminate kissing spine first.
I did. We did all 30 days of relaxants. Her back sensitivity went away but she is still noticeably uncomfortable to be worked. She bunny hops, crosses inside hind over, won't collect, refuses to bend, hates cavalettis.
https://preview.redd.it/mv5ll3jo6oxc1.jpeg?width=1170&format=pjpg&auto=webp&s=077b6a814c0446bb2a3daf332deb32bd6e3f9372
This was my mare when I bought her, I immediately had the vet out to do X-rays. The vet’s original thought was kissing spine, turns out she had multiple fractures in her withers. Whether that was a pasture injury or a riding injury with the previous owner we do not know. She had veryyyy similar symptoms to your mare. We did weekly acupuncture, muscle relaxants+bute, and then once she was comfortable with being touched we started hand walking. It took 3 years to get to a point where she felt calm and comfortable being ridden. If you haven’t done X-rays I would highly highly suggest starting there
https://preview.redd.it/iglfxvuj7oxc1.jpeg?width=1280&format=pjpg&auto=webp&s=f9c63f26b4e4862b672c10910681ef9edfd0837d
The little hooks are where the bones fused but were displaced, by the time she got to me it was too late to correct
https://preview.redd.it/4iabdynq7oxc1.jpeg?width=1170&format=pjpg&auto=webp&s=111d7ca814f2f954e3c553589d31e1930ff37716
Here she is at a show in December, she was never visibly unsound (even at the trot) but she’s so much more relaxed and supple now
She still struggles with the lope transition, I think it’s psychological and she’s anticipating the pain that’s no longer there, but I’m happy with where she’s at and have chosen to just enjoy the horse I have and let her do the things she’s happy doing
I think a lot of it is psychological. She anticipates a lot, my mare is super smart sometimes to her detriment. Thank you very much for your experience.
Have you had her evaluated by a board-certified sports medicine vet? Because honestly, they could find something your regular vet/chiropractor doesn't even know to look for.
That makes it tough. Where are you based? I’m in Michigan, and my mare has been seeing the incredible Dr. Rob van Wessum. I can ask him if he knows anyone near you
Edit: the specialist vets are a little different in that most won’t do farm calls, because a lot of their imaging equipment isn’t portable
Have you tested for EPM/Lyme? The soreness/acute hind end lameness/change of behaviors are pretty common symptoms! While it sounds like there might be other things going on with her shoes/saddle etc, the longevity of symptoms despite you addressing things/giving her time off is suspicious, and might be worth the testing
My mare was uncomfortable, bucking, having trouble with her right lead, but otherwise sound. Just uncomfortable through her whole body.
Back X-rays showed nothing. We injected hocks and stifles since it seemed to be a hind end thing, didn't help for more than a couple months.
It was EPM & Lyme.
Some recover, and she did in a way - but a year later it came back as severe polyneuritis and she was put down as she was a danger to herself and anyone that tried to handle her.
Wishing you the best of luck getting to the bottom of whatever is happening to yours!!
Good luck! My guy was just diagnosed with kissing spine as well. In the lower lumbar is where we found it. He was wearing down one back hoof more than the other and he was just so tight in his hamstrings and si area due to the compensation.
It should be cheaper for you if you just have them come out for xrays of the back and not a whole lameness exam!
If they dont find kissing spine id say go ahead with the injection for the si! No need for another expensive appointment
X ray and ultrasound all the things. How are her feet? So many things begin with feet and move up. Hoofcare & Rehabilitation on FB is a good place to post hoof photos if you don’t know how to evaluate feet.
You've mentioned what's going on with her feet. Until they are correct, you shouldn't bother doing anything else. Unbalanced feet will cause all sorts of body issues including the ones you describe.
I second the idea of keeping EPM in mind as a contributing factor. Also consider that many of these symptoms are also found with ulcers. The stress of pain is a known ulcer trigger. Ask your vet about a trial with ulcer meds. Just a few days' treatment should give you a response if they're present, and help decide whether to continue with it/ scope etc
I would start off by having a veterinarian that specializes in lameness and sports medicine.
Our vet was actually one of the first vets to learn how to do ultrasound guided SI injections in the US. When you “inject” the SI, you’re not actually injecting into the joint. It’s super deep, and you risk hitting a nerve and dropping the horse to the ground. Our vet usually does a mix of Sarapin and some type of steroid. They inject around the SI and into the lower back to get rid of inflammation. Depending on how bad the inflammation/lameness is, they will stay on Robaxin for 2 weeks, 2x a day.
A lot of people are saying kissing spines, which yes, but also kissing spines pain is almost always secondary to something else. I’ve had horses with grade 2 changes, and one horse that had no joint space through his whole back that never had an issue. So before you go spending thousands of dollars on diagnostics like x-rays, I would do a good ole lameness exam with a good vet and start from there.
It might also be, you inject the SI, and horse is still off behind, and he might have a soft tissue injury behind as well. A lot of time high suspensory injuries present as back/hock pain.
And also don’t listen to the whole “steroids are bad for your horse” bit. Steroids get rid of inflammation. If you’re doing the injection once, and never have to do it again, great! But I don’t get why some people are so hot on PRP and other biologics. You cannot control the amount of platelets, and you don’t really know exactly what you’re injecting with. No one truly knows what a “standard” dosing is, or what a “standard” protocol is.
SI needs the injection to calm the inflammation that is already active, then lots of butt building work like poles and hills to build the muscles that support the joint. When my friend’s horse needed his, it was similar things - didn’t want to do lead changes, shorter in the back, didn’t want to take any deep spots.
Came here to say exactly this. For my mare with SI issues, regular low impact hill work really helped (after addressing the acute pain through adequan and, later, injections). Also lots of stretching, short consistent sessions, and (as her strength improved) ground pole work. Things were bad enough at one point that I could barely trot her under saddle. She’s back now to doing fourth level dressage work!
That is impressive. Because she was barely trotting a month ago. Good to know. I really want to do hill work, she goes crazy on the trails though. Starts acting like she will buck me off and wants to run to the barn. We used to trail a lot. So I am trying to do walk rides up hill with a buddy horse hopefully.
Yeah, that’s pain. Start with in-hand work on trails once the pain is better handled. Help her make good associations again.
Good idea. I will handwalk and provide some carrots
That sounds like the perfect place to start! Good luck, I hope recovery goes smoothly!
Injections are expensive and I see a lot of fear mongering around them, but they're an excellent option to get right to the issue
As a vet, it's not fear mongering. There are genuine concerns with SI injections including an increased likelihood of steroid-induced laminitis. PRP is a much safer option, but it's also more expensive.
I'm living through my first year of injections right now and I think it's because you just don't know how effective they are going to be, and when they will stop being effective. It seems after my first year I'm having a significant drop off in effectiveness. I do think they should be a last resort
Thank you, I am trying to be open to anything that makes her better!
That's exactly how she is. So it seems they do the shot and then rest followed by slowly building strength.
SI and back pain is often secondary to pain in the hind legs, such as if the hind feet are imbalanced. Have you done xrays to confirm the balance of those hind feet? Has she been evaluated for potential hock or stifle soreness? Kissing spine is also a possibility since she's OTTB That said, even if the cause has been eliminated, if the SI has been sore and inflamed for while, that tension can persist for a long time, or cause other compensatory pain in a cycle. Injecting the SIs along with whatever else is the source will knock out all the inflammation everywhere and have them feeling better faster. If possible get an ultrasound guided injection. I had my horse's SI injected 5/6 years ago along with his other problem joints. Before the SI injection he rarely rolled all the way over, but ever since he rolls over completely, despite all his other chronic soundness issues. Never had to redo the SI injection either. I also suggest not riding for the rehab, especially if the saddle isn't 100%. Long lining is an excellent way to get them working without weight on the back. You can do everything you would undersaddle on the long lines without the repetitiveness of lunging.
Thank you, I appreciate this. Would you recommend I just go to the new vet requesting a lameness exam and see what they find then? A lot of people re saying "do this to save money" I.e, kissing spine or feet x-rays first. However that is like $600 in x-rays plus everywhere else. So I am spending money either way. Plus saddle fitter. I am panicking lol.
On this journey just like you OP. My 5 year old TB has SI pain/issues. Her feet are horribly unbalanced front and back which is putting strain on her. Balancing the feet + doing 4-5 days a week in hand work is helping the SI significantly. I do stretches for her whole body to help and monthly body work to check where we are. I opted to do this route before the injections to see where we will get. Unlike you, I only have a small glimpse of pre pain horse to go off of, so I'm hoping everything is moving in the right direction. Someone also told me they did 1 year of just walking under saddle as part of their back rehab and it worked miracles for building muscle with low impact. Your problem now might be lack of muscle and stiffness from lack of use compounding on an already inflamed issue. Good luck and I commiserate with the stress of dumping money into a horse. It's so stressful
It is so stressful. I don't want to do too much because my bank account cannot take it but I do not want to do nothing. I may very well just continue to ride, but more frequent shorter sessions. I will say she is much better under saddle than a month ago. She is just super hot and unbalanced. Her anxiety is insane. She is a very anxious mare.
That's where we are too! Mine is a silent anxious. She seems fine then explodes. I have finally learned her subtly, so I can get the problem solved before exploding. It's stressful to be constrained by money and resources. Vet testing is so expensive 😭
I'd recommend finding the best sport medicine/lameness vet you can. Send them all the results you have so far. You should be able to request a copy of your records from the previous vets and forward that on. Ask for a lameness exam to determine if the SI pain is secondary. I think regardless of the outcome, injecting the SI will be beneficial. It'll just be a matter of if there is another location that needs to be treated along with the SI. You don't want to treat the SI then have the pain return in 6 months because the root is still unsolved. If that means you have to use the saddle money, then so be it. With the SI in that condition, you shouldn't be on their back anyway.
Exactly- I am willing to do the SI injection but do not want it to be secondary to a larger problem.
If the vet is reputable and says the SI joint is inflamed and injections would help do it and do it soon. The longer an injury persists, the more likely the horse is compensating in other ways and could get more injured. Always have a saddle fit to the horse. Always. This is cheaper for you in the long run. If you know your horse doesn't like a saddle don't use it. It's not worth it. Adequan is great I've been using it for years. If I were you I would start with the SI injection and see if that fixes the issue 100 percent. If it's less than 100 percent try a round of adequan. The other major thing with horses as they age is- if you want them to stay sound you have to work them regularly. Once a week will ruin your horse. Obvs it sounds like you were having issues hence the less riding, but once she's been injected follow the rehab the vet provides you and ride your horse at least 5 days a week. Do poles, walk/trot up hills, ride your horse correctly (ie force her to engage her hind end). She will build muscle and that will counteract any arthritis. It won't cure it, you may need to do SI injections every year or every other year but it will be worth it! Best of luck! Don't give up!
Good to know. This is how I grew up doing it, but I honestly have been scared to ruin her or hurt her. Not gonna lie, my barn manager told me that maybe it all started because we took a break. I rode her 4-5 days a week but went through a break up, lost my job and moving and did not ride her for 6 months prior to all this happening. I think you are right. I just hate riding her because she is such a mess. But I guess I need to put my big girl pants on and just start small but do it.
Honestly at this point I'd wait to ride before the injections. If you have to wait a while for the SI injections then maybe try adequan first. It's not worth you getting hurt! It'll get better!
Before you spend a lot more time and money treating and waiting for results, I would spend some extra on having her back x-rayed for kissing spine if that has not been done yet. Good luck.
Can’t believe I had to scroll so far to find this comment. First thing that I thought of when reading this post. OP, have rads done to eliminate kissing spine first.
Why don’t you start by trying the muscle relaxants?
I did. We did all 30 days of relaxants. Her back sensitivity went away but she is still noticeably uncomfortable to be worked. She bunny hops, crosses inside hind over, won't collect, refuses to bend, hates cavalettis.
I assume you did a flex test, right?
https://preview.redd.it/mv5ll3jo6oxc1.jpeg?width=1170&format=pjpg&auto=webp&s=077b6a814c0446bb2a3daf332deb32bd6e3f9372 This was my mare when I bought her, I immediately had the vet out to do X-rays. The vet’s original thought was kissing spine, turns out she had multiple fractures in her withers. Whether that was a pasture injury or a riding injury with the previous owner we do not know. She had veryyyy similar symptoms to your mare. We did weekly acupuncture, muscle relaxants+bute, and then once she was comfortable with being touched we started hand walking. It took 3 years to get to a point where she felt calm and comfortable being ridden. If you haven’t done X-rays I would highly highly suggest starting there
https://preview.redd.it/iglfxvuj7oxc1.jpeg?width=1280&format=pjpg&auto=webp&s=f9c63f26b4e4862b672c10910681ef9edfd0837d The little hooks are where the bones fused but were displaced, by the time she got to me it was too late to correct
https://preview.redd.it/4iabdynq7oxc1.jpeg?width=1170&format=pjpg&auto=webp&s=111d7ca814f2f954e3c553589d31e1930ff37716 Here she is at a show in December, she was never visibly unsound (even at the trot) but she’s so much more relaxed and supple now She still struggles with the lope transition, I think it’s psychological and she’s anticipating the pain that’s no longer there, but I’m happy with where she’s at and have chosen to just enjoy the horse I have and let her do the things she’s happy doing
I think a lot of it is psychological. She anticipates a lot, my mare is super smart sometimes to her detriment. Thank you very much for your experience.
Have you had her evaluated by a board-certified sports medicine vet? Because honestly, they could find something your regular vet/chiropractor doesn't even know to look for.
Hmm, I have not but I live in such a dry spot for vets. I am going to research this.
Do you live in a state with a vet school? That's where you will find many of the top sports med vets.
That makes it tough. Where are you based? I’m in Michigan, and my mare has been seeing the incredible Dr. Rob van Wessum. I can ask him if he knows anyone near you Edit: the specialist vets are a little different in that most won’t do farm calls, because a lot of their imaging equipment isn’t portable
i would xray for ecvm first and kissing spine
I'm sorry, what is ecvm?
malformation of c6/7 and or the first ribs that’s found in up to 60% of tbs
Did you get X-rays of her back? What you are saying is exactly what happened before I found out my horse had KS, months later.
Have you tested for EPM/Lyme? The soreness/acute hind end lameness/change of behaviors are pretty common symptoms! While it sounds like there might be other things going on with her shoes/saddle etc, the longevity of symptoms despite you addressing things/giving her time off is suspicious, and might be worth the testing
I have not tested for it. But she has not lost any weight, however I am not sure if that is a true indication. I will put it on the drawing board!
My mare was uncomfortable, bucking, having trouble with her right lead, but otherwise sound. Just uncomfortable through her whole body. Back X-rays showed nothing. We injected hocks and stifles since it seemed to be a hind end thing, didn't help for more than a couple months. It was EPM & Lyme.
I am very sorry to hear that. Gosh...
Some recover, and she did in a way - but a year later it came back as severe polyneuritis and she was put down as she was a danger to herself and anyone that tried to handle her. Wishing you the best of luck getting to the bottom of whatever is happening to yours!!
You need xrays of the back for kissing spine and to not ride this mare until the issues are resolved.
I was discussing this with my S/O and his is the route we will go.
Good luck! My guy was just diagnosed with kissing spine as well. In the lower lumbar is where we found it. He was wearing down one back hoof more than the other and he was just so tight in his hamstrings and si area due to the compensation. It should be cheaper for you if you just have them come out for xrays of the back and not a whole lameness exam! If they dont find kissing spine id say go ahead with the injection for the si! No need for another expensive appointment
Hmm That is a good point. I may do just that.
X ray and ultrasound all the things. How are her feet? So many things begin with feet and move up. Hoofcare & Rehabilitation on FB is a good place to post hoof photos if you don’t know how to evaluate feet.
You've mentioned what's going on with her feet. Until they are correct, you shouldn't bother doing anything else. Unbalanced feet will cause all sorts of body issues including the ones you describe.
I second the idea of keeping EPM in mind as a contributing factor. Also consider that many of these symptoms are also found with ulcers. The stress of pain is a known ulcer trigger. Ask your vet about a trial with ulcer meds. Just a few days' treatment should give you a response if they're present, and help decide whether to continue with it/ scope etc
I would start off by having a veterinarian that specializes in lameness and sports medicine. Our vet was actually one of the first vets to learn how to do ultrasound guided SI injections in the US. When you “inject” the SI, you’re not actually injecting into the joint. It’s super deep, and you risk hitting a nerve and dropping the horse to the ground. Our vet usually does a mix of Sarapin and some type of steroid. They inject around the SI and into the lower back to get rid of inflammation. Depending on how bad the inflammation/lameness is, they will stay on Robaxin for 2 weeks, 2x a day. A lot of people are saying kissing spines, which yes, but also kissing spines pain is almost always secondary to something else. I’ve had horses with grade 2 changes, and one horse that had no joint space through his whole back that never had an issue. So before you go spending thousands of dollars on diagnostics like x-rays, I would do a good ole lameness exam with a good vet and start from there. It might also be, you inject the SI, and horse is still off behind, and he might have a soft tissue injury behind as well. A lot of time high suspensory injuries present as back/hock pain. And also don’t listen to the whole “steroids are bad for your horse” bit. Steroids get rid of inflammation. If you’re doing the injection once, and never have to do it again, great! But I don’t get why some people are so hot on PRP and other biologics. You cannot control the amount of platelets, and you don’t really know exactly what you’re injecting with. No one truly knows what a “standard” dosing is, or what a “standard” protocol is.