Sacroiliac Joint Pain, Treatments, and Recommendations

WHAT IS THE SACROILIAC (SI) JOINT?

The sacroiliac joint (SI) is a location where the horse’s back and pelvis connect. As the name denotes, there is an articulation (joint) between the sacrum and ilium. The SI joint and ligaments provide support during weight bearing and help to transfer propulsive forces of the hind limb to the vertebral column. The two SI joints (one on each side of the horse) connect these bony structures (sacrum and ilium) along with a series of large ligaments in the middle or central aspect.

WHAT DO WE SEE?

We as veterinarians can have difficulty identifying this area as a source of pain causing poor performance or lameness because your horse can have many different presentations. Usually there are 2 main clinical presentations of injuries to the SI region:

  1. Horses can have an acute, traumatic event, such as slipping or falling that causes pelvic rotation and damage to the ligaments and/or the joints.

  2. Horses present with a prolonged, non-progressive history of poor performance usually secondary to other hind limb lameness. Signs can include:

    1. Back stiffness

    2. Lack of impulsion from one or both hind limbs

    3. Resisting jumps

    4. Issues maintaining leads

    5. “Bunny-hopping” or even bucking while being ridden

An owner/trainer’s first complaint might be “my horse has stopped moving forward.” OR “my horse had a nice 3-beat canter, but then it became uncoordinated/offbeat.”

HOW DO VETERINARIANS DIAGNOSE SI PAIN?

It can be hard to diagnose SI pain in some horses, especially ones with a history of poor performance. Most horses won’t exhibit a true “lameness.” Because these joints are deep within the hind quarters, manipulation to elicit pain or discomfort can be tricky. Certain manipulation and palpation of the pelvis can elicit pain that can be attributed to SI disease. A bone scan can show changes in this region and this can sometimes be our most useful tool, however, not all horses with SI pain/damage will show changes on the scan. A detailed lameness evaluation is crucial. In some horses, it is important to evaluate the horse not only on the lunge, but also while being ridden.

HOW DO WE TREAT?

Dr. Mike performing ultrasound-guided sacroiliac joint injections.

Dr. Mike performing ultrasound-guided sacroiliac joint injections.

Because definitive diagnosis can be difficult, treatment recommendations are often based on the signs exhibited by the horse on physical examination and lameness evaluation. Treatments often include one or more of the following: rest, rehabilitation, strengthening exercises, and local injection of the joints and ligaments.

Core training is important; making sure to keep the horse’s topline as well as their gluteal region strong. Lunging aids, like the Pessoa or Equi-Ami stretch bands, help to develop important supporting muscles. Using water treadmill exercise or trotting poles and leg weights encourage the horse to pick up the hind feet in a more normal foot arc. This supports the develop of the appropriate muscles of the pelvis and upper hind limb.

OTHER THINGS TO MENTION

It is important to note that horses with chronic SI pain often have pain in other hind limb locations. For example, chronic pain in the hocks or stifles could lead to SI pain from chronic gait alterations. It has been implicated that horses with proximal (upper) hind limb suspensory disease can also have SI pain secondary to the horse’s altered hind limb movement.

REEDSDALE EQUINE CAN HELP

If you think your horse may have some discomfort or poor performance pertaining to the SI region, give Reedsdale Equine Specialists a call.  We are eager to help you and your horse to have a long and happy career.

Michael Caruso