A Common Problem: Sacroiliac Joint Pain in Horses
The sacroiliac joint.
Chances are, if you have owned a horse, or been around them long enough, you have observed a horse with pain or dysfunction in their sacroiliac (SI) joint.
In order to understand how SI pain presents itself, it is important to understand the role of the SI joint. The horse's vertebral column is composed of 5 main sections: cervical, thoracic, lumbar, sacral and caudal. The sacroiliac joint is the site of articulation where the sacrum and pelvis interact. As the hind leg propels the horse forward, it is vital that the energy and forces generated are able to effectively travel through the spine and the rest of the body. If anything is out of alignment, dysfunction occurs and lameness can ensue.
Knowing the horse's anatomy, it is now important to be able to identify when a horse is exhibiting SI discomfort or potential misalignment. Key symptoms include:
Bunny Hop canter
Cross cantering (cross-firing)
Breaking out of the canter
A hard mouth in the contact
Reluctant to work on the bit
Lack of topline in the lower back
Muscle atrophy in the lower back/sacral area
Hunter's Bump
Shortened hind leg stride
Difficulty lifting hind legs (including to pick out feet)
Anxiety and a disconnectedness to all four feet
Pushy/protective behavior as they try to guard the SI area
If asked to do a back/belly lift, may try to kick out in pain
Reluctance to move forward
Reluctance to engage evenly
Hollows back in movement
Bucks and kicks out
Keeping all of that in mind, the next step I recommend for owners is to determine the root cause of the SI pain. Get in touch with your veterinarian, and ask them to come and do some diagnostic work to try and narrow down the origin. However, be cautious of simply injecting the joint. Often, this serves as a short term "band aid" instead of a true solution to the actual underlying dysfunction. Many performance barns routinely have injections done on their horses as a "preventative." If you research further, you will actually find that this can instead be detrimental and break down the function of the joint over time.
As an alternative to simply injecting the horse and going right back in to work, I think it is more important to ask why the horse is experiencing SI pain in the first place. When you inject a horse's SI, you temporarily make them feel better, and therefore they are able to perform and do what we ask of them, but once the injection wears off, the pain is often amplified because the pain indicators were not there telling them that their body should not be pushing through. It is the same scenario as if we sprain our ankle, take a bunch of pain medicines so that we can run on it the next day, and then once the pain meds wear off, we are in an even worse scenario than before. The logic just does not line up!
Be your horse's advocate. Do your own research.
The sacroiliac joint can be painful for a number of reasons, to include:
Incorrect training that does not take in to account the biomechanics of proper equine movement (The horse should move from back to front, allowed to stretch down long and low. When the horse is ridden the opposite way - from front to back and with the neck pulled in tight from the hands - the horse hollows his back and all of the forces from the hind end tear up the SI area as it cannot successfully move through the body).
Small fractures due to trauma (this is why it's important to always have a vet assessment done first, and have images taken if you are able)
Ligament injury or strain due to trauma
Lameness elsewhere in the hind end, and the horse is compensating in the SI joint
Structural misalignment that can be resolved with chiropractic or osteopathic work
If you suspect your horse has SI issues, here is the protocol I would recommend:
Schedule a diagnostic exam with your veterinarian. If you presume your vet will want to go straight to injections rather than determining the underlying cause, get a second opinion.
Once you have determined if the root cause is structural misalignment, trauma (old or new), compensation, or training using dysfunctional biomechanics, you can now settle in to a plan of action.
Structural misalignment - contact every kind of practitioner you can to get their hands on your horse. Chiropractor. Osteopath. Craniosacral therapist. Myofascial Release. Accupressure. Trigger Point Therapy. Massage. The true healers will be able to find the root cause of your horse's discomfort. I have seen it time and time again.
Trauma - Usually rest is going to be the key ingredient for healing of ligament injuries or fractures, although I would take very clear and specific direction from your veterinarian.
Compensation - If you have eliminated specific SI issues, then you can now free your mind to look elsewhere and determine what is causing your horse to compensate in their SI region. Usually a standard lameness exam is useful in this case, and sometimes the vets will decide to do a leg block to really localize the problem area and get you an answer.
Dysfunctional biomechanics - Now... this one may be hard for your veterinarian to tell you, as in this industry it often seems to boil down to personal opinion (though research would say otherwise). Learn the correct versus incorrect way to train a horse to come up over its back, as opposed to just pulling the neck in. Study true collection and loading of the hindquarters. If you suspect your trainer or instructor is uneducated about proper equine biomechanics, you should start looking for someone who is.
This was one of the most pivotal and understanding points of my career - When I saw an osteopath work on a horse that was having difficulty tracking one direction. His sternum was completely off center, and she was able to re-align it to center. The same can hold true if the pelvis and sacrum are misaligned - it can cause severe dysfunction that shows up as "SI problems." I can't encourage everyone enough to have body work done routinely on their horses!
I hope this article helps you and your horse, if you suspect they are dealing with a dysfunctional SI region! I will continue to add more information as new case studies and research come out.
Happy riding! xo
