Sacroiliac Injuries

For some reason, I have three horses on my books currently rehabbing from sacroiliac injuries. One fell over in the field being moronic. Another, actually another did his in the field when he arrived at a new yard. And another has come to me for help after a year of battling with SI problems.

Not that I’ve become an expert, but I’ve definitely picked up a few nuggets of information about sacroiliac injuries and rehabilitation.

Symptoms of a sacroiliac injury aren’t particularly obvious – there’s no limpy leg. There is often a positive reaction to palpitation of the SI area (and by positive, I mean that the horse reacts to pressure, even in an ears back, angry way). Although some horses can be incredibly stoic and barely flinch when palpated. There’s slight shortening of the hindlimb stride, usually both, but many riders won’t notice it. I’d almost describe it as a “flat” movement. They’re going through the motions of moving their legs, but are saving themselves and not using their back muscles. Mostly, horses show unhappiness in the canter – bucking, going disunited, falling out of canter and general reluctance. A horse may find jumping harder, put in the odd refusal, or not bascule as well as normal. I think often sacroiliac injuries are noticed after a period of time, when the horse’s posture and muscle definition have deteriorated so that the saddle doesn’t fit, or the physiotherapist notices a change in posture.

The usual treatment for a sacroiliac injury is to medicate the joint, and then a rehabilitation programme to stabilise and strengthen the area. The medication lasts for six months, so there’s a good stretch of time to build up the work and improve their way of going without the horse being in pain, and then hopefully once the six months is over the SI area is strong, stable and pain free.

Vets usually recommend two weeks of box rest and then a six week rehab programme working up to introducing canter in the last fortnight. I always find that the typical vet’s programme is quite ambitious and based on the perfect scenario of seven days a week and a perfectly behaved pony in the field! If you can only work the horse five days a week, stretch out the rehab programme to factor this in. If the weather’s awful or you’ve been ill and haven’t progressed through the week, then just repeat that week of the rehab programme. My vet friend told me that the worst thing you can do when rehabbing a sacroiliac injury is to work a horse more than their fitness. So I work on the basis that if in doubt, plateau the work load for a few days and take more time. Besides, the owner usually knows their horse very well so can tell if their horse is ready for the next step of the rehabilitation programme, or if they need more time at their current stage to build their strength.

The first couple of weeks of the rehab programme is walk only. Long reining is often recommended, and hugely beneficial as the horse starts to work in a long and low frame without the weight of the rider. The horses that I’ve worked with this year have both done at least a week of pure long reining; in the arena and out on little hacks. Then we’ve introduced walk poles on the long reins and then riding. Initially, it’s been a ride every three days, and then after another week or so, alternating riding and long reining. The poles start off as only one or two every other day, to more poles, then more frequently, and then raising the poles. We make the workload harder by one factor at a time so as to develop the horse’s strength steadily. Again, if the horse seems to find it difficult then they can have an easier following couple of days, perhaps going back to just walking with no polework. We also introduced hillwork on hacks, again with small hills, and then steeper hills and more frequently in each week.

The first long reining session, where stretching long and low is quite an alien concept.
Within the first long reining session, this horse started experimenting with moving his head into different positions. Within a fortnight he stretched for the majority of his time in a long and low frame.

After two or three weeks of walking, we introduce trot in straight lines. On the long reins and under saddle. With the same approach – introduce the trot without the weight of the rider, then under saddle, then increase the number of trots, the duration of the trots, adding in polework and then hillwork. If the horse ends up feeling particularly tired when a new level is introduced, such as trotting up a hill, then the next day they can do slightly less. I like to maintain long reining a couple of days a week, and vary the work so that the horse’s brain is engaged and they don’t become bored.

Once the horse is feeling strong enough – I go on the basis that they should find three or more raised trot poles straightforward, and have their neck low, back lifting throughout – then it’s time for canter.

The day of the first canters I’m not worried about the transitions, I’m just looking for the horse to feel comfortable in the canter; and for it to be fairly rhythmical and three time. One or two canters on each rein is sufficient the first time, and the following day have an easy ride or long rein session. Once canter has been introduced I don’t think it’s necessary to canter the horse daily over the first week or so. Canter is the hardest gait for horses with sacroiliac injuries, so introducing it very slowly and steadily minimises the horse regressing or overdoing it. In the canter the horse’s pelvis moves in more of a sideways motion, whilst in the trot it’s a forwards-backwards motion so there’s new muscles being recruited and needing to strengthen. The whole pelvic area should also become more supple after canter is introduced and the horse begin to feel much more comfortable trotting in a long and low frame, with the back swinging nicely.

At this stage, whether it’s taken six weeks or ten weeks, the basic rehab programme from the vets is essentially over. But that doesn’t mean it’s back to pre-injury work. Especially if the pre-injury workload caused the injury. Time needs to be spent on the canter, getting the horse to better use their back and develop the muscles over the sacroiliac area, using canter poles, both on the ground and raised, before recommencing jumping. Realistically, it’s another month before the horse is back at their usual level of work and able to stay sound.

I find it really satisfying rehabbing horses, and enjoy reflecting on the changes to their posture, muscle tone and way of going. Although I don’t think I’d have the patience I have with client’s horses with my own!

The Future

I apologise if this becomes a bit morbid, but I think the last twelve months have made us all more aware of our mortality. I think most people have been affected by Covid-19. For some, it’s taken an ill or elderly relative sooner than anticipated. For others, there’s been the shock death of a seemingly healthy friend or relative.

When faced with a life deadline, illness or old age, you can get your affairs in order. Ensure family know your wishes with regards to horses and pets. But as a young, healthy person, it’s not the top of my mind, for sure. But perhaps we should all take five minutes to let our closest know how we want to care for our four legged friends. Just in case.

Someone once told me that their will stated that their horse should be euthanized upon their death, on the basis that no one else could keep him in the manner she did. I felt that was egotistical, as we all try to give our horses the best care possible. But begrudgingly, I feel there is a point to be made here.

It sounds callous, to have your horse put down when you die, when they may have plenty of life left in them. But horses are a luxury, an expense. And if the family you have left have neither the time nor money to care for your horse after you’ve gone, then it is better to have them euthanased than for them to suffer neglect, or to be sold to an unsuitable home, or to end up in a rescue centre. I recently saw a fiery debate on social media about two horses who’s owner had died and the family couldn’t afford to keep them, so we’re having them put down. Initially, it seemed that there should be an alternative for two apparently healthy horses. But upon closer inspection, both horses were in their mid twenties, very attached to each other, and had some management issues. Reading that, I soon changed my mind to agree with the family, and thought it more responsible of them to take this route rather than abandon the horses to a charity.

There are several options when planning your horse’s next stage of life. Horses are financially taxing, so perhaps leave some money to help support them. Or ensure the person you’ve entrusted their care to is financially stable and able to afford to feed an extra mouth. Be realistic about your horse’s future. If they’re old, or retired with injury then they have very little resale value. A friend or family may want a companion, but otherwise my gut feeling is that it is better for everyone, if you leave clear end of life instructions. Those left behind don’t feel obligated to struggle to care for the horse, or have to morally wrestle with themselves to make a decision for you.

I do think that a young, healthy, fit horse, who still has much to give, should be given the chance to adopt a new family after you’ve gone, but again it’s worth ensuring family know your wishes in selling – whether you want them to sell via a dealer, or have a type of home in mind, etc.

A few years ago my parents told me they were leaving Matt to me in their will, but had decided that it was a back handed gift because of the costs and time involved. Which means my brother doesn’t get an equivalent “gift”. Unless he gets the family tortoise, who has so far been passed from my Uncle, to my Grandad, to my brother, to my parents…

It’s hard putting decisions like this in writing (I can’t even write my decision on here!), but verbalising your thoughts is easier, and it’s something that needs to be discussed with loved ones so they know what to do in the worst case scenario; to safeguard their future as well as your horse’s.

So apologies for the slightly depressing subject, but the last few weeks I’ve felt that it’s a topic that needs addressing, particularly with all the uncertainty in the world right now. To lighten the mood, enjoy these photos of Otis being his usual lovable, cuddly self, and long-suffering Phoenix allowing a toy to ride her.

Safety Stirrups

I’ve come to realise that I have a couple of hang ups when teaching. One is chin straps being tight enough to stop the children talking. I joke. But they mustn’t be able to get the strap in front of their chin as their hat becomes loose. Or spend their time chewing the end of the strap.

My other hang up is stirrups. I hate seeing kids riding in non safety stirrups. I prefer to see adults using them too, particularly when jumping, but I understand that they can make their own informed decision. Kids though, have far less control at keeping their stirrup iron on the ball of their foot, with the iron often getting close to the ankle. So I’d much rather have the option of the foot coming out sideways in an emergency, particularly when jumping.

The traditional peacock stirrups are my usual go to for kids as they are affordable and as soon as pressure is applied to the outside of the stirrup iron the rubber pops off, freeing the foot. Of course there’s always the odd band with a life of it’s own which is forever springing off.

For adults, there’s the bent leg stirrup irons, which I have on my jump saddle. Stronger because they’ve iron on both sides of the foot, the shape means the foot is able to come out easily. I bent a pair once, whilst hacking Matt out. He spooked, slipped on some mud at the side of the lane and fell onto his side. My leg was between him and the tarmac. I survived with just a bruised foot, but the stirrup iron was bent. When a similar incident happened a month later when I was schooling without stirrups my foot had much more of a squash injury.

Anyway, I digress. Bent leg irons are still popular, and I definitely prefer to see my riders in them as opposed to fillis irons.

You may remember a month or so ago Harry Meade had a fall cross country, which resulted in his foot getting caught and he was dragged along. Regardless of his stirrup irons (I have no idea what stirrups he uses so not passing any judgment) if a rider as good as Harry can get their foot stuck in a stirrup it should serve as a warning to all of us. Use safety stirrups!

The two safety stirrups I’m familiar with have been around for donkeys years. Incidentally, did you know that donkey originally rhymed with monkey when it first came into general usage in the 18th century because it derived from the word dun, describing the colour? I.e. It was dunkey, not donkey.

More digression, apologies. Since hearing about Harry Meade’s accident I’ve done some research into safety stirrups on the market now because technology has moved on in recent years and there’s bound to be more modern alternatives which I’d like to be more informed about.

Modern safety stirrups, such as the Acavello or Equipe, have a release mechanism on the outer strut. When pressure is applied to the outside the strut pops out and the foot is released. The strut can then be clicked back into place. Some makes have magnetic clips, others have springs, others have a silicon outer strut. From what I can tell, it’s important to keep the stirrup irons clean and free of grit as this might cause the mechanism to become stuck. And to monitor the condition of any springs or magnets so they don’t weaken and damage the integrity of the product.

I’ve a couple of clients starting to use Acavello safety stirrups, attracted also by their grippy tread, and they certainly seem to have been extensively tested for safety. Definitely some for me to consider when I need new jump stirrups, or am asked for my opinion.

I think in light of Harry Meade’s accident, it’s worth checking our own stirrups. Do they need new treads, peacock rubbers etc? Are they the best design for our foot? Are they the right size for us? Are they safety stirrups?

Times A Changing

The last thirty six hours has thrown the British equine world into disarray. Covid-19 has been coming a while, infringing on all areas of our lives, but now we’ve moved into unchartered territory.

We’d discussed it at Pony Club and Riding Club – talking about reducing the risk of infection at events and providing hand washing facilities. But it was business as normal with just a couple of adjustments to our routines.

However, on Monday the PM released a statement bringing more stringent methods into daily life – minimising social contact, reducing unnecessary travel, self isolating. This was closely followed by statements from British Eventing and Pony Club stating that all competition and training has been suspended. On Tuesday, British Dressage, British Showjumping, and British Riding clubs followed suit.

It’s incredible to think that there will be no equine competitions for the majority of this year, and is very disappointing for those who rely on it professionally, and who plan their training with a particular competition goal in mind.

Disappointing as it is, at least we are still allowed to ride. Italy has banned riding and high risk sports to reduce the number of accidents needing treatment in their overstretched hospitals. Phoenix was going to have a go at her first novice test this weekend. No matter; we will keep up the training so that she will be working at elementary level by the summer, and I’m still able to take her out schooling to get some cross country practice in and keep up her jumping training. The important thing is to find some alternative goals and aims to keep us motivated and to keep spirits up.

I made the suggestion to my riding club committee, that we should run our spring dressage competitions online. It’s not the same as going out to a competition, but it’s better than nothing and I think there will be lots of interest. Of course clinics are also being cancelled, so I think we will have to put our heads together to come up with some challenges we can give to members to help everyone keep in touch and motivated. Perhaps get everyone to share a photo or talk about their riding that day. There’s no restrictions on hacking, so perhaps we should make a hacking challenge?

With the Pony Club, I already have some ideas for the kids. They’re going to have a lot of extra time on their hands, so it would be good to give them some ridden exercises – a bit like online lessons – or stable management quizzes to keep up their knowledge. I’m keen that those working towards an efficiency test don’t regress or lose motivation due to tests being delayed and training cancelled. But we’re going to let everyone acclimatise to this new, strange normal, and then get our thinking caps on.

I judge for Demi Dressage – an online dressage competition for under 16s – and I think that will become really popular in the coming months, as a way to focus children on developing their riding. Already I’ve seen more and more online competitions cropping up, including jumping competitions. They’ve been in the pipeline for a while I think, but this current climate has brought them to the fore.

Finding the fun that we can do safely, will help us survive the emotional challenges the coronavirus brings. We’re lucky that equestrianism is an outdoor activity as even if competition venues close, we still have our riding areas at home.

With everyone being encouraged to work from home, I was starting to dread enforced time with an energetic toddler in an enclosed space. But we’re lucky enough to have a garden at least, and I’ve drawn myself up a list of jobs to do. Regardless of any quarantining, we will be spending more time at home, so it’s an ideal time to do the jobs you never get around to doing. Maybe that room will get painted, and the garden will be perfectly manicured?! Or perhaps we’ll actually eat those emergency tins of soup at the back of the cupboard?

I was very relieved when the BHS released a statement saying that coaches should continue to work where possible. I only interact with fit and healthy people outdoors, not getting too close to them; and by following the suggested hygeine and social distancing guidelines, as well as both sides reacting to the first symptoms, the risk should be minimal.

I think it’s important to maintain as much of a normal life as possible for our own sanity, whilst being sensible and sensitive to the situation. Of course, my work may not be vital to the infrastructure of the country, but horses are many people’s saviours. Their down time in a busy world; the thing which turns their day from doom and gloom to sun and laughter. Their coping mechanism for the rest of their life. It’s easy to overlook the importance of a good riding session (or any exercise) to someone’s mental health.

Just like many hobbies; gym classes, book clubs, sports clubs, social clubs. Not only do the clients need these to balance out their lives, but those who run them need the financial reward in order to feed their families. So yes, let’s reduce close contact with others, but in a world where everything’s at a click of a button, let’s make sure we continue to stay in touch with ingenious ways. Summer is coming; move clubs outdoors if possible; use online videos, conference calls, and social media to keep this side of life going.

It’s the start of a new normal, which will take some adjusting to, but hopefully by everyone being sensible (you’ve bought all your toilet roll now, haven’t you?!) and by keeping an eye out for others (we don’t know many at risk people locally, but I’ve offered to organise online shopping for my Granny, and plan to send her bits and pieces in the post over the next few months as well as regular emails to stop her feeling so isolated), we will survive.