# PSD and SI pain - please help



## Kelpie (21 September 2013)

Well, I'm gutted.  My beautiful 5yo warmblood mare was diagnosed this week with PSD in both hind limbs and SI pain, causing her to be bilaterally lame. I don't understand it - I've not pushed her, she has good management, etc, etc   Maybe accident related? who knows  

Vet is suggesting the neurectomy & fascioctomy (excuse spelling) but apparently the official statistics are that when there is both PSD and SI pain the chances of a return to work after the op are just 40% (as compared to about 14% coming right with "conservative" management) so I am desperately undecided as to whether the op really is the right thing.  I hate putting horses through surgery, and to be honest it scares me  

So, I'm looking for experiences anyone might have on PSD & SI pain/ how you've managed it/ if you've had the op/ if so how it went, etc, etc.

Someone has already kindly pointed me in the direction of the PSD group on FB, which is great but I guess there may be people on here not already on the PSD FB group?

Thank you for any help.


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## molly7886 (22 September 2013)

I don't post very often so quick synopsis- 14 year old TB gelding, not lame but not 'right' behind, lacking power and jump, not his normal obliging self. Initially found lots of pain/stiffness in SI treated by physio but no significant improvement. I suspected spavins in hocks but much (expensive) diagnostic work later found that he had thickening in one hind suspensory and a lesion in the other with counter rotation of pedal bones. Cue a very depressed owner. In conjunction with fab vet decided against surgery and had a course of shock wave therapy and cartrophen injections teamed with remedial shoeing. Approx 6 weeks of paddock rest, then last couple of months been walking out and long reining in school gradually increasing time spent on board. 
Now the update - Went to vets this morning, had a good work up & he's moving so so much better-better flexion in hock, no toe dragging and no soreness at all in SI. Vet re-scanned legs and they show a HUGE improvement (it all looks like an untuned TV screen to me but vet assures me all those white dashes are good ;-) ) So still a way to go and have to continue with the slow progressive fittening/strengthening work but it looks hopeful that hacking/schooling and even some RC events could be back on the agenda next year.
I've seen several posts on here discussing treatment and prognosis so just wanted to offer some hope to anyone struggling with similar injuries. It's taken some time but hopefully it'll be worth it.

OP- above is a copy of what I posted a couple of years ago. Since his treatment I haven't had a single problem. Due to his age I chose not to event him any more. He moves as well (possibly better!) than he ever did on the flat so we do some u/a dressage, le trec and some low level jumping (I'm careful about being on good even surface) the jumping is extremely low level and just for fun because he enjoys it. We don't know for sure how my boy injured himself. He certainly didn't have any falls/slips etc whilst ridden so we are just assuming from the skid marks that were by the gate in his field that he tried to do an emergency stop whilst hooning around and hyper-extended the ligaments causing the damage. The SI was a secondary injury where he was carrying himself oddly trying to be a brave soldier! He sees the physio once or twice a year for maintenance and he has not had any recurring SI problems. He still has pads under his hind shoes  on the basis that he's comfortable with them so why change anything.
It may be that your vet doesn't think shock wave is suitable for your horse but it may be worth a discussion as I'm over the moon with how my boy is going. Good luck


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## molly7886 (22 September 2013)

Just wanted to clarify the physio bit as reading back it may be a bit misleading! he initially had physio for the SI pain before the PSD was diagnosed..no improvement(at that point we didn't know for sure that there was an underlying primary cause) AFTER the shockwave treatment etc he had a couple of "deep" treatments under sedation and lo and behold sound horse with huge walk and fab trot (canter took longer to get back as I think both of us were a bit cautious about it!)


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## Katah (22 September 2013)

PM'd you


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## skint1 (22 September 2013)

Molly7886, I am very interested to read your post, my 13yo Tb gelding is kind of in the middle of this type of thing- SI?back pain apparently caused by hocks and the vet wants to do shockwave therapy, I am resistant at the moment though I have the appt booked for Wednesday, I just felt it was a bit much,  he's having weekly physio and acupuncture and daily TENS machine sessions, but reading your post is making me think again. 

I also want her to ex ray his back feet/fetlocks as there are a couple of people I know who have Tbs with similar issues and a lot stemmed from the back feet.


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## Kelpie (22 September 2013)

oh, Molly, your story is very encouraging  

I've heard mixed reviews on the shockwave - how did you find the process of that to be?


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## HD15 (23 September 2013)

Kelpie said:



			I don't understand it - I've not pushed her, she has good management, etc, etc   Maybe accident related? who knows 

Click to expand...

Definitely would not worry on that point!  

I had a bit of a slow unraveling of the same problem yours has.  For a variety of reasons it took about 6-9months to get the full picture.  But he is also lame up front - navicular changes.  He initially had an SI injection.  And now he has had shockwave behind, injection of front coffin joints and super shoes.  He is a tough one as the shear number of problems all play on one another, so for him surgery doesn't really seem worth it.  So probably a more extreme case than yours.  I guess what I've always wondered with the surgery is if you aren't actually fixing the injury but just taking away the pain what happens in the long term if the weakness/injury is still there and you continue to work on it?   Guess it depends on the individual circumstances of each case??

The process of shockwave in our case was pretty easy.  3 treatments spaced 2 weeks apart.  Needed sedalin or sedation for it as the machine is LOUD.  

Good luck!!


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## wiz07 (23 September 2013)

Could you please post nme in the right direction of the PSD group on face bnook - has a little look but cant find it.

My 8YO tbx has been diagnised woth Off Fore PSD and contracted heel.  Having his 2nd lot of Shock wave therapy on Wed.  He is also receiving Cartrophen Inj and remedial shoeing.  He is currently in on box rest with 5 mns 2 x a day in hand walking. So far not noticed much difference - but its only been three weeks.

Does any one have any good news re recovery from front limb chronic PSD?


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## Dab (23 September 2013)

Wonderful resource group on FB where you can discuss and pick the brains of many owners with horses suffering and recovered PSD, some have gone the surgey route, some barefoot...and various other treatments. 

https://www.facebook.com/?ref=tn_tnmn#!/groups/255267791160904/


if link doesn't work it is called PSD discussion group


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## wiz07 (23 September 2013)

https://www.facebook.com/?ref=tn_tnmn#!/groups/255267791160904/


if link doesn't work it is called PSD discussion group[/QUOTE

Thanks Thats great - found it


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## Primitive Pony (23 September 2013)

Hi, have had very similar problems with my horse this year and I feel your pain - I don't think one can ever know the cause, really, but I think that horses are much like us - how many of us suffer from lower back pain? - I have osteopath treatment for much the same problems as my horse...!

Have had a chiro and physio both tell me they have horses which have had similar problems, brought back successfully into work with the right management, and a friend now has a mare on loan with SI problems managed - eventing very succuessfully!

My boy had a steroid injection to the SI joint in May, plus shockwave treatment to the hind suspensories (very straightforward process with sedation - minor damage there but treated as the insurance claim was open....) - I then gave him a month off at grass and have spent the summer bringing him back slowly into work, mostly straight lines so far but now cantering which is the only gait that really had problems and so far so good, just about managing a 3-time beat now on a large circle! He is slightly short in one hind leg but I think this can be managed with physio and so on and the right work, and perhaps he'll have another steroid injection again and maybe even regularly eg yearly.

My chiropracter has said I need to focus on his core strength so we do a lot of pole work, mostly in hand, along with carrot stretches and I'm having a lesson this weekend with said physio who rehabbed her own dressage horse..

(As for the operation, I can't really comment although know of a friend's horse that had it and all was fine but with limited work afterwards, I understand - what someone suggested to me was that it only really stops the pain rather than curing the problem..? - please correct me if that's not right, my horse was never a candidate anyway.)

In short, I was completely confused and very worried about it all a few months ago and now things look a lot more positive, so don't despair!


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## Kelpie (23 September 2013)

Thank you so much everyone.

Peh - that's a very reassuring story, I'd love to know how you get on as things progress?

For now I'm thinking maybe just rest and also give Roger Meacock's Scenar a go (looking at buying one myself) - on the basis that if needs be I can then do the opp as a last ditch effort if all else fails - but I do keep swaying between doing the opp and not at the moment.  If only I truly knew what was best I'd do it but there seem to be so many variables....... though it's good to know all the stories as otherwise I might blindly do one the or the other out of ignorance alone......


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## Primitive Pony (24 September 2013)

Delighted to keep you posted, will let you know what physio/instructor says this weekend. Which area are you in and I can send you details of practitioners if you're interested.

Rehab advice varies wildly. My vet told me initially to lunge for 6 weeks in a Pessoa which I didn't feel was right at all, and physio and instructor agreed. Also thought about giving my horse a full winter off but have been advised that it's important to keep the core muscles active, likewise muscles round SI joint so light work better than none.

Am also keeping him out all winter - poor thing hasn't realized this yet...! - as out and moving around is better for the SI joint, it seems. Intestinal health apparently important too, due to close proximity of guts and SI joint area (that's really rubbish explanation in terms of the science, sorry...) - feeding linseed and a probiotic gut supplement for that.

Have also had shoes off - luckily my horse has good feet and seems to be doing well on this. I have done a lot of reading and research on this - do pm me if you want more details!


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## Kelpie (24 September 2013)

peh, thank you so much - and I am in Kent, if you know anyone in the area?


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## Primitive Pony (24 September 2013)

Sorry, no - I'm the opposite side of the M25 with both chiro/physio coming from north and south of me - I'll ask this weekend though and see if she know anyone.


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## Kelpie (25 September 2013)

Thank you again


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## digitalangel (25 September 2013)

Kelpie said:



			Thank you again 

Click to expand...

HI OP - just to say youre not the only one - mines also been diagnosed and ive joined the PSD group on facebook as well. My poor man had an op for OCD in april but it as a red herring. His damage is severe. I just picked him up today from the vet where he had PRP treatment in both back legs. we have 3 weeks full box rest, 3 weeks handwalk, 3 weeks turn out in small pen and 3 weeks turn out in small field before we re-scan. 

Here if you need me.


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## BeckyD (25 September 2013)

I'm afraid my experience wasn't a good one but I learnt a lot along the way and there might be something helpful amongst it, or not.  But I'll write it down anyway.  Horse was a 5yo TB, who had twice in quick succession done a forward roll down a minor slope in his paddock (he was utterly useless in a field, never ever settled).  After the second fall, he was 3/10ths lame behind, with a suspected fractured pelvis.  He was referred for a bone scan and was in so much pain over the pelvis they didn't even trot him up - literally did the scan.  The scintigraphy showed that he had an high uptake over the SI joint, and some lower down the hind legs (which they x-rayed but hocks were "fine").  He was injected with corticosteroids into the SI joint twice, a month apart, whilst on total box rest.  At this stage I had his shoes taken off (first mistake, probably) as he was struggling a bit for the farrier.  We then started controlled exercise of hand-walking (heavily sedated; he was SUCH an idiot!), then walking in a Pessoa, and then pole work to get him to strengthen his core.  He was shod again and then I was able to start riding him.

As soon as I started trot work I knew he was still lame, so we went through numerous referrals back to the vet school to try to figure out why.  Eventually, diagnosed with bilateral PSD (first thing I had suggested! Vets didn't believe it was to start with).  Recommended for surgery rather than anything else (second mistake), but unfortunately we had a few complications.  He didn't come round well from the GA, and kept going down.  That caused trauma to the incisions, as did his repeated tearing the bandages off.  He still kept lying down constantly, and the wounds broke down.  He then developed a severe infection that was feared to be MRSA but thank god wasn't.  A course of Baytril sorted that out.  He spent 5 weeks cross-tied to stop him lying down, and had pressure bandages over the wounds to try to get them to heal.  He then got pressure sores from the bandages.  After several months the wounds and the pressure sores did heal, but we still had problems with him being in quite severe back pain.  At his first checkup he was still lame behind, so we were referred for Equine Physio (ACPAT).  She worked on him and gave me lots of exercises to do at home, which I did.  She saw him roughly monthly for a while.  It was felt that the back pain was caused by the SI/PSD interaction.  

Vets recommended I slowly brought him back into full work, to see if he got better or worse.  6 months later he was now in full work (flat only) and went back for next check, and got given a resounding thumbs' up.  I cried buckets.  They couldn't believe his improvement.  The amount of physio work I was doing with him had strengthened his core so much that his back was under less pressure.  All was looking rosy.  

Then had an unconnected period of forelimb lamaness which required box rest.  Suddenly he was in severe back pain again, really suffering.  Once sound in front, I managed to get him back to normality through lots of physio and core/back stregthening work for a month or two before he went lame behind, literally during one ride.  That was the last time I ever rode him.  Vet came out and scanned hinds; both suspensories had been torn apart from inside.  Had he been a different horse, he may have been able to be a field ornament until the ligaments snapped, but given it was autumn and would get muddy, putting strain on the ligaments, the amount of back pain he was in when not in full work, and his capricious nature when turned out, I had to have him PTS.  He was 7.

If I had the time again I would look into non-surgical routes (shockwave, or even natural methods - I found one online last year).  Surgery is always there as a back-up plan, but I couldn't bring myself to put another horse through what Ronnie went through, without having explored alternatives.  I will never, ever forgive myself for that.  It cost Ronnie his life.  And he was my dream horse, my soulmate.  

And it cost me nearly £10k as the £5k insurance money ran out days after the surgery, and all those pressure banadage changes cost £250 a go, every other day (gulp), for weeks, plus physio, checkups, sedation, re-scans etc etc.  He was worth every penny but it would be a happier ending if I had a horse at the end of it, rather than an empty stable.

In terms of supplements, I had Ronnie on Tendonease, Comfrey, Cortaflex HA, Rosehips and some others probably!  Used to take ages to sort out his supplement tubs.  

Good luck!  And please, don't do what I did and rush into surgery.


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## Kelpie (25 September 2013)

digitalangel, thank you so much, I think I recognise your story from a recent post on the PSD forum?? fingers crossed for you the treatment works though I'm still a little unclear about why the AHT think I should go straight for the opp....... seeing my regular vet next week to discuss further, though.  

BeckyD - OMG, I could cry for you   Thank you for sharing.  Worrying about my mare not handling the surgery well is something that is playing on my mind greatly (she was apparently very sharp to nerve block and I imagine just being left at the vets for the lameness work-up was quite stressful for her). So I am seriously thinking about trying to see if we can avoid the surgery.  May I ask, what were the physio exercises you were doing?


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## digitalangel (26 September 2013)

Kelpie said:



			digitalangel, thank you so much, I think I recognise your story from a recent post on the PSD forum?? fingers crossed for you the treatment works though I'm still a little unclear about why the AHT think I should go straight for the opp....... seeing my regular vet next week to discuss further, though.  

BeckyD - OMG, I could cry for you   Thank you for sharing.  Worrying about my mare not handling the surgery well is something that is playing on my mind greatly (she was apparently very sharp to nerve block and I imagine just being left at the vets for the lameness work-up was quite stressful for her). So I am seriously thinking about trying to see if we can avoid the surgery.  May I ask, what were the physio exercises you were doing?
		
Click to expand...

Hi OP - they may be recommending the op first off because his damage is not so bad? My boy had PRP because its a severe case and the vet explained to me that if they did the op now his tendon would probably snap. the goal with mine is to heal the tendon first as best we can then look at the operation to see if he still needs it. im currently looking into investing in an arc equine unit or a microvet, i have a reiki expert on the yard and we are also doing deep oscillation therapy as well. throwing the book at this boy as i feel it really is his last chance. 

BeckyD - This is what im terrified about with the op and why we went for PRP first to see if we can heal the ligament - ive heard good things about PRP so keeping fingers crossed.


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## BeckyD (26 September 2013)

Kelpie said:



			BeckyD - OMG, I could cry for you   Thank you for sharing.  Worrying about my mare not handling the surgery well is something that is playing on my mind greatly (she was apparently very sharp to nerve block and I imagine just being left at the vets for the lameness work-up was quite stressful for her). So I am seriously thinking about trying to see if we can avoid the surgery.  May I ask, what were the physio exercises you were doing?
		
Click to expand...

Ronnie was also a nightmare to nerve block.  We had to sedate him, wait, then nerve block him, wait for sedation to wear off, then check for lameness quickly before the nerve block wore off.  He was trying to kick the hell out of the vets though, so it was the only way.

I do think it's pot luck re the GA. Most horses are fine.  For some reason Ronnie took ages to come out of the GA, much longer than is normal and I gathered afterwards they were very worried.  Once he was round, he couldn't stay up, just keep going down heavily.  There was a risk of accident again at this stage but thankfully there was nothing catastrophic - hmmm welll, not immediately anyway.  I blame his ultimate breakdown on having to be cross tied when he should have been handwalking.  It caused terrible scar tissue to form non-linearly inside the ligament, with attachments being made to surrounding bones and tendons.

Physio involved the basics of:
*  Carrot stretchs to the hip bone each side.  5 times each side, trying to hold the stretch for as long as possible - preferably 10-12 seconds (or until your hand got bitten off I found!).
*  Carrot stretches between front legs to get back to lift.  This one was hard to do correctly.  You should see the spine rise in an upward arc.  Ronnie couldn't do this for a long time as it was too painful, and I had to have him on bute to take the pain away enough to do the stretch, until he was strong enough to do it pain-free. 
*  Scratching (hard) his haunches sort of either side of his tail - again achieved a back arc like above.  Be careful; Ronnie double-barrelled me to start with when it really hurt.  If it's too dangerous then you can tickle the midline under their tummy.  
*  Long reining in a pessoa twice a week, straight lines.  I continued with this throughtout his ridden work (I did 3 or 4 days of ridden work, 2 days of long-reining in a pessoa, and one day of pole session, alternating each week between ridden or in hand).
*  His ridden work was targeted to stretch out his back, so 15 minutes of walk to warm up, gradually introducing curves and large circles.  He was kept in an outline either LDR or long and low, with short periods in a more up/competition frame.  He wasn't allowed for the first few months under saddle to slouch along.  His ridden work we had to avoid small circles (for the rest of his life, I was told).  Lots of transitions, correctly done, to strengthen him up behind and ensure that the musculature could support him.
*  I also had to do massage work on his front half to try to stop that half of his body from compensating.  Lots of neck rolls, mane-rocking, shoulder muscle pulling, poll releases etc.  I was taught all of these.

I learnt so much.  Throw everything you can at it; I saw first-hand how much difference it made, following vet and physio instructions to the letter. It made me think that I may have been able to manage the initial condition without surgery.

ETS:  And, the physio told me she thought so many problems/injuries were caused by insufficient walk warmup and cool down in horses the world over.  She said I should warm up every/any horse in walk for at the very least 10 mins, and preferably 20 mins.  Cool down must be no less than 10 mins of walk, and more would be better.


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## digitalangel (26 September 2013)

interesting. my boy also was a nightmare to block and had to  be sedated.


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## mjcssjw2 (26 September 2013)

actually with the nerve block so was mine and he is usually lovely. One of the reasons the vet sent him to the specialist unit.


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## Kelpie (27 September 2013)

Thank you again, Beckyd, that's very helpful.


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## Primitive Pony (30 September 2013)

Hi

Post-lesson update for you from this weekend - had a very positive session with a dressage rider who rehabbed her own horse from SI injury. 

My horse is now ok - more or less, sound, although always has been more or less - only canter was really the problem, and now it's just that he is about an inch in his left hind leg, still tracking up but not evenly. So all we worked one was transtions, really - very simple, just asking him walk/halt and vice-versa, and walk-trot and vice-versa, and briefly trot-canter - the idea being that this will strengthen said hind leg, and I really felt a difference in one lesson. 

All the other physio advice I have had chimes with what's been said above - carrot stretches, poles, long reining etc and certainly for my horse this has been effective. It's now just a question of pushing him enough to build strength again without over doing it. Still unsure about jumping but I'm not thinking that far yet - instructor's advice was patience and perseverance basically.. 

I hope that helps to some degree too - another positive outcome at least. Didn't hear of anyone local to you but I'm sure if you can find a recommended physio/chiro they will be very helpful.

Good luck again!


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## Kelpie (1 October 2013)

Thank you PEH - I need all the positive stories I can get at the moment!


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## BeccaMare (28 February 2016)

Kelpie said:



			Thank you so much everyone.

Peh - that's a very reassuring story, I'd love to know how you get on as things progress?

For now I'm thinking maybe just rest and also give Roger Meacock's Scenar a go (looking at buying one myself) - on the basis that if needs be I can then do the opp as a last ditch effort if all else fails - but I do keep swaying between doing the opp and not at the moment.  If only I truly knew what was best I'd do it but there seem to be so many variables....... though it's good to know all the stories as otherwise I might blindly do one the or the other out of ignorance alone......
		
Click to expand...

Hello Kelpie - I know this was a while ago but I am where you were with psd diagnosis....would dearly love to avoid the op.....Please would you share your experience if possible? 
My 8 year old is on week 3 of box rest using arc equine. Turning away no problem as he's more like my pet than anything....frustrating as lightly ridden past 4 years  . Any advice much appreciated. Thank you. Becca x


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