# Sacroiliac Joint Problems - Advice needed



## jembo (8 September 2014)

I would appreciate some advice - 
6 yr old TB - had a issue in Feb where he reared up and went over backwards - whilst on schooling livery (whilst I was away)
When I collected him - 10 days later he was in a fair amount of pain and dropped weight. 

I got him checked by vet that evening, and he was given pain relief and the vet suspected a SI joint problem.
The following morning he was given a full workup, including nerve blocking, back, and hind limb x-rays.
The problem was in the SI area - so he was sent for MRI scan.
The  results showed he was "hot" in the SI area so was medicated.

I was told to build him up by lunging on bute which I did along with regular physio. All was going to plan, then a couple of other minor injuries in the field set him back by 10days. 
When sound, continued the lunging to find poor canter, disengaging behind, reluctance to move forward etc and about 2/10s lame in right hind. 
So call vets back out and start all over again, with nerve blocks and get second opinion on MRI results, which all results in another SI medication injection.
Start the lunging again and all going well, get on him and ride, all good, all on bute. (apart from his now sudden dislike to traffic)
Build up the ridden work with the lunging to 6 days a week, slowly wean off the bute, and find that he has gone stiff hind. - Then follows cut to back leg in field - so another 5 days off. 

Build up the lunging again to find we are back where we started - sore to touch right side of back, behind saddle. poor canter, downward transitions tripping over hind feet. But keeping weight on. 

I have a new physio coming thursday and vets on standby if he needs to be seen again. 
I am at a point where I do not know what to do? 7 months down the line, and still really no further forward. He is an ex racer, p2p, who I have re schooled and was going nicely. I thought I would at least be able to make a dressage horse out of him, and forget about the jumping. But not if he is needing his back mediated every couple of months and cant have any time off.

Any suggestions - feeling a bit stuck in a rut and lost!

Thanks - sorry for essay!


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## be positive (8 September 2014)

I am currently rehabbing my horse who was medicated 7 weeks ago, I know all horses are different and treatment varies but the one thing I am NOT allowed to do is circle, on the lunge or ridden, mine was a chronic issue, injury missed when other parts were treated, yours is getting to that stage now.
I am going very, very slowly, a few days off following injections, walking in hand, walking under saddle, 4 weeks on the physio said short trots could be introduced, we had a set back so have reduced the trotting , he does a tiny amount on a long rein/ lunge to do polework have a short trot over them but no more.
Physio is coming every 2 weeks or so, he gets twice daily stretches and massaging, the prognosis was very poor but he is responding fairly well, my hope is that he may do low level dressage, jumping which is his job is probably never going to be an option.

MY thoughts are that from my experience, limited to just this horse but with a lot of input from other people, especially on here,  that I would not lunge, it may help in theory to build the topline but it puts immense stress on them and you cannot feel when to back off, with mine if he feels tense I can come back to walk when lunging you are likely to be pushing them when they hurt which cannot be good for any injury, that constantly circling may mean even if they appear to be straight they will learn how to cheat and avoid using the worst areas fully, mine just goes slightly to the right to avoid using his right hind fully I cannot see this or correct it when lunging but can ridden before it becomes too established..  

Getting a new physio involved may help, I was looking at acupuncture as the next option, physio thinks it can work well, I would be taking a totally different approach if you start again, lunging was not helping look at other ways to rehab him.

Your post is slightly depressing for me as I may be in the same position as you down the line but does give some hope that doing the total opposite is possibly going to give a better outcome, just to add mine is barefoot behind, not sure if that is helping but instinct says it is, he is only shod in front as he was on his forehand last year doing his first rehab while he must have had the SI injury niggling so he wasn't coping without shoes in front, I plan on taking them off at some point but he needs to be taking more weight behind first.


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## GermanyJo (8 September 2014)

not sure if exactly the same as yours or be positives's .. Mine had SI combined with issues with his stifles -he does not lock up completely, but does a kind of stumble in downward transitions as the patella is not moving as it should .. some call it catching stifles / loose stifles -  it was very obvious on the RH. Not really sure which is the chicken and which is the egg with mine .. if the SI problem meant he was not using himself as he should .. lost / or did not gain muscle .. then the Stifle problem .. or he  has got problems with the SI due to moving strangely due to the stifle problem. 
Anyway .. our rehab has consisted of Physio / Chiro and Acupuncture - was always a bit of a sceptic about Acupuncture.. but would definitely recommend you give it a try , my lad loves it and you can visibly see him relaxing .. he is normally asleep after a couple of mins .. he had a treatment on Saturday and after 15 mins , he did an enormous stretch up with his back as if suddenly he was feeling a release. 
Our Rehab has been fairly basic, but appears to be working as my Chiro/Acupuncture was really impressed with how he was moving this weekend. 
For the first 2 weeks - 1 day walking hack out (building up to around 1 hour and a half by the end) .. really getting him walking fowards and swinging  and the alternative day working him from the ground, again only walk , over poles , bending etc.
Then, as he was showing some improvements we kept the one day hack .. starting to introduce small trots where the ground was good , making sure he was really walking forwards , getting him long and low where possible. The alternate day I started to ride in the school, slowly building up some of the trot.. but NO circles and not pushing into corners, just got him swinging in walk and trot .. NO sitting trot, even in downward transitions , basically doing anything which would get him to start to move over his back more. 
we are to the point where I can start to ask for some shallow leg yield .., we have started some very slight shoulder fore 
I tend to do ALOT of walking at the beginning, again , really getting him swinging and stretching. 
I have also put him on Gastro Plus .. sounds a bit odd as he is out all the time, but I read up alot and there seems to be some connection between SI issues / Strange RH lameness and hind gut issues .. I have had great results with it on other horses, so decided to throw that at him too. 
My Physio (who is working closely with my vet I might add) .. also recommended to feed him some extra MSM .. he is on Pro Hoof, so just feeding enough combined with what is in that. I have also got him on a Rice product (think it may be similar to Equijewel.. can't get that in Germany , so it was the closest I could get to it) mainly to see if that will support building muscle combined with the work we are doing. 
Mine MUST be kept in work .. we think the SI issues / Stifle were there last year .. I had an accident and could not ride for a year, so for 6 months he was being ridden by my instructer Y/O ... and then he had 6 months off , and since then has had 'niggly' issues which have then ballooned ... So .. obviously he lost muscle during that period and has made the issues much worse .. although to be honest, I was not that happy with how he was last year and everyone (including my vet!) told me there was nothing wrong , he was just an unbalanced young horse .. at least now , although it is crap that he is not fit , we know what the issues are and can start to address them


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## jembo (8 September 2014)

Thanks for the replies. I too questioned the lunging with all the vets he has seen and the head vet at the referral centre and they all said to lunge. Of course I understand that people have different ways of doing things. But it does worry me that some are 100% for it and others 100% against.
It has helped him and the stronger he gets the better he is, but still not great. It's frustrating when these little injuries occur and set us back.
However, there is no way I can keep him in absolute full time work. He is quite a stressy horse, and doesn't like changes to routines. All our horses usually have 6 weeks off after eventing / competing season. Perhaps he would now benefit from a complete rest??
Our hacking is crap, which is difficult anyway but it has made it worse with his new fear of cars coming towards him. So my options during the week days in the winter is schooling or lunging then hacking at weekends.
I guess seeing what the new physio says and thinks about him will show me a way forward.


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## Primitive Pony (8 September 2014)

Not much to add other than new physio might really help -assuming he/she is ACPAT registered and highly recommended?! - have had two horses with SI problems so I feel your pain, it's a very tricky area.

Managed the first one really well for some time with help of my physio and vet's advice was quite conflicting and if I could do it all again, I'd go with physio. 

Second horse, whose pelvic problems are related to his KS is responding really well to physio, chiro and acupuncture. Work regime at the minute is walking over poles and walking backwards (in hand) a few steps a few times each day as well as hacking, with increasing hill work - straight lines seem to be working.

Good luck with it.


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## be positive (8 September 2014)

You have done as you were told, just as I am, they probably both work for some horses but like most things no two horses are the same and for yours it may be that the lunging has proved detrimental or that there is still something going on that has not been picked up on. As far as I understand it is important to keep the muscles toned as much as possible to hold everything in place, my physio thinks that that will be the key to my horse, that once he is as fit and built up as possible then it will be down to managing and maintaining him, which I think will mean working full time, possibly reduced in the winter but certainly no time off unless there is no option, high maintenance for sure.

GermanyJo makes reference to the hindgut, my horse is still dragging his off hind toe, I keep thinking it may be something entirely unrelated to the SI, he had ulcer treatment ages ago but was never scoped as it was during his initial recovery period following an operation, serious stress and he started cribbing, a short GG course seemed to make him immediately more relaxed, he stopped cribbing and showed no more symptoms, I think this is something  I need to look into as it is puzzling my physio she can see no physical reason for him to still be dragging this toe, he only does it when turning in the school not in straight lines and not hacking.


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## Primitive Pony (8 September 2014)

Thanks for the input re: toe-dragging. (Not wishing to hijack the post!) 

My physio commented on this last week - very minor but she wasn't 100% happy with it. I have wondered about ulcers as my horse is currently prone to chewing on leadropes and headcollars at random - worth investigating...!


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## kinnygirl1 (8 September 2014)

be positive said:



			You have done as you were told, just as I am, they probably both work for some horses but like most things no two horses are the same and for yours it may be that the lunging has proved detrimental or that there is still something going on that has not been picked up on. As far as I understand it is important to keep the muscles toned as much as possible to hold everything in place, my physio thinks that that will be the key to my horse, that once he is as fit and built up as possible then it will be down to managing and maintaining him, which I think will mean working full time, possibly reduced in the winter but certainly no time off unless there is no option, high maintenance for sure.

GermanyJo makes reference to the hindgut, my horse is still dragging his off hind toe, I keep thinking it may be something entirely unrelated to the SI, he had ulcer treatment ages ago but was never scoped as it was during his initial recovery period following an operation, serious stress and he started cribbing, a short GG course seemed to make him immediately more relaxed, he stopped cribbing and showed no more symptoms, I think this is something  I need to look into as it is puzzling my physio she can see no physical reason for him to still be dragging this toe, he only does it when turning in the school not in straight lines and not hacking.
		
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Mine has had an SI problem and gastric ulcers....I keep coming across this link with right hind lameness and hind gut ulcers/acidosis, which are more likely if a horse has had gastric ulcers. I think you have nothing to lose by treating hindgut and seeing if the right hind lameness improves. Good luck.


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## be positive (8 September 2014)

peh1980 said:



			Thanks for the input re: toe-dragging. (Not wishing to hijack the post!) 

My physio commented on this last week - very minor but she wasn't 100% happy with it. I have wondered about ulcers as my horse is currently prone to chewing on leadropes and headcollars at random - worth investigating...!
		
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Interesting that you have a similar issue, my physio came twice last week, luckily she lives next door, she is really puzzled as it just doesn't tie in with how he moves generally, it is minor like yours, my boy is a quiet introvert type so not obviously stressy but he does worry, he also comes back from exercise and tucks into his net as if he is starved which has made me wonder if he is feeling uncomfortable.
A job for tomorrow I think, further investigation!!


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## be positive (8 September 2014)

kinnygirl1 said:



			Mine has had an SI problem and gastric ulcers....I keep coming across this link with right hind lameness and hind gut ulcers/acidosis, which are more likely if a horse has had gastric ulcers. I think you have nothing to lose by treating hindgut and seeing if the right hind lameness improves. Good luck.
		
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I agree there is nothing to lose and may just be the key to getting the hind leg working fully, investigating planned for tomorrow.


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## jembo (8 September 2014)

We do use the protein acid ease which is really brilliant stuff. Interestingly mine has his problems on the right. I asked the vet about ulcers and we did a ranitidine trail over 2 weeks and there was no difference. The trail is worth doing rather than scoping. Someone else said to me that they feed chaff/ chop before exercise and that has really helped their horse,no signs of ulcers anymore.


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## cellie (9 September 2014)

Im in same boat as well.Vet is back tomorrow as he thinks SI flared up again we also  have possible k/s . This week my lad is disunited in canter on right rein on lunge(Ive been told to lunge too) I also do pole work  with long reining. Like you I have 6 yr old tb . Im not  riding as he has started head bobbing in trot and is very sore in lumbar area. Im going to ask about acupuncture (without needles) hes bit phobic and will book mc timoni as well as normal physio. If we find out anything  new re treatment ill update . We should set up fb page for fellow SI  sufferers a self help group like ks page . Dreading diagnosis tomorrow although trying to keep positive


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## Primitive Pony (9 September 2014)

That's a great idea about SI problems and the FB page... I might do it!!


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## cellie (9 September 2014)

Ill be you first member


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## Primitive Pony (9 September 2014)

Fab - great idea, really - the KS one is really helpful! I'll get onto it tomorrow!


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## jembo (10 September 2014)

Great idea re Facebook I am sure there must be hundreds of us out there who all would benefit from chatting it through and getting advice. I will update on Thursday after the new physio has been. Hope today goes well cellie, and would be interesting to see what the vet says.


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## Primitive Pony (10 September 2014)

Group now exists..! = Horses with Sacroiliac Problems, hopefully you can find it. Haven't done anything with it yet other than create and hopefully it will get the ball rolling, the KS one has been so helpful for sharing experiences and info.


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## cellie (10 September 2014)

Yes I use that one too. Vet has been not looking very good, his back is worse and he expected  treatment to last longer. Hes going in for full body/bone scan where we go from here I dont know. Diagnosis first !!!!!!! feeling bit jaded by it all .


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## cellie (10 September 2014)

peh1980 said:



			Group now exists..! = Horses with Sacroiliac Problems, hopefully you can find it. Haven't done anything with it yet other than create and hopefully it will get the ball rolling, the KS one has been so helpful for sharing experiences and info.
		
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Not on there yet


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## stilltrying (10 September 2014)

Just to add as someone has already referenced....we have one who has SI pain which we believe caused by gut issues.  He steps short on his right hind, finds tight turns difficult, finds it very hard to strike off in left canter using that right hind and will dive / paddle his way through the transition.  Due to being wonky this is also giving him muscle pain down his left hand side under saddle / behind the saddle. 

His gut is being treated and we are keeping work light with plenty of massage to try and relax that area. Have also started walking over poles.


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## Primitive Pony (10 September 2014)

Hi, can I ask how you are treating the hindgut? - looking into options!


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## jembo (10 September 2014)

I have just found the fb page, so sent a request. I wonder what the bone scan will show on yours - mine didn't really show a lot other than hot on the si rhs area. But the vet who looked at the images said it wasn't that bad and he shouldn't be in too much pain. But you touch him in that area and he does an almighty buck in the stable. They think he has a very low pain threashold.


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## kinnygirl1 (10 September 2014)

peh1980 said:



			Hi, can I ask how you are treating the hindgut? - looking into options!
		
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Hi...can't speak for the others but I am using a product called equishure, it is basically an ant acid for the hind gut, highly coated so that it's anti acid properties aren't released until it reaches the hind gut....many other antacids are dissolved in the stomach. I think it is helping my boy, certainly he is not lame right hind at the moment.


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## cellie (10 September 2014)

Thats interesting Jembo as my  physio says my boy is bit precious as in wimp !!! vet agrees. So you have had  bone scan and it didnt really find much ? what are your options ? Im on fb page just posted  re bone scan if u prefer to answer there.


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## cellie (10 September 2014)

I forgot to question vet re  ulcers but  will ask i they show up in scans as hot area. How much is equishure and where did u buy it ?


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## kinnygirl1 (10 September 2014)

cellie said:



			I forgot to question vet re  ulcers but  will ask i they show up in scans as hot area. How much is equishure and where did u buy it ? 

Click to expand...

Hind gut ulcers don't show on a scope as the scope doesn't reach that far. I believe there are other tests tho...possibly blood tests that can indicate the presence of hind gut ulcers? My horse has had gastric ulcers confirmed by a scope...they are more prone to hind gut ulcers if they have had gastric ulcers.  Equishure is expensive I m afraid. I got a small tub for around £32 from pawsnclaws on line.


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## Primitive Pony (10 September 2014)

Thank you, will have a look at Equishure then - don't mind spending that to at least see if it works!


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## GermanyJo (10 September 2014)

I am using gastroplus and have used with success on another horse


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## stilltrying (11 September 2014)

Hi - same as kinnygirl1 we are using equishure.  We are also working with an holistic vet as he is also lacking certain bacteria.  He has now finished his treatment and will shortly be having another poo test to see what improvements have been made / what is still lacking.  He is heaps better, but still not right.  It is difficult to tell at the moment whether his gut is still causing pain, or the SI pain is just the last bit that needs to fall into place.  He has been so wrong for so long that it might be he needs a course of chiro type work to get him comfortable in that area.  I'm hopeful that is the case and not that the gut is still causing issues.


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## Primitive Pony (11 September 2014)

Thank you for the suggestions. I think it's such a complex area that it all needs treating before one thing or the other will completely heal, inside and out - good luck!


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## Primitive Pony (11 September 2014)

Just got a quote for gastroplus - eek! I'm sure it's good but that's so expensive, might go for Equishure!


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## GermanyJo (11 September 2014)

yep ..but still half the price of Gastro Guard (which did not work on my Trakehner) .. the Equishure is also not the cheapest I think..


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## paddi22 (11 September 2014)

my exracer had si issues and i found long lining him much better than lunging when we started rehab. Did long lining for a few weeks, and started gradually bringing in poles etc. Also did a lot of inhand work gently moving him over poles and turns. Eventually lunging was great, very important to watch the surface you are lunging on though. the yard i was in had a very deep sand arena, so it wasn't suitable when it got too deep. 

At the start my lad kept dragging a toe when ridden, but eventually he stopped once he had more muscle built up. It was really building up the muscle and topline that helped him the most in his recovery.


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