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!

Rehab – a Secret Blessing?

Your horse picking up an injury and needing long term rest and rehabilitation is everyone’s worst nightmare, but sometimes it can be a blessing in disguise.

Looking after a horse on box rest is exhausting, but you do get a much stronger bond from so much time spent on the ground. Useful if you’re a new partnership.

But the bit about rehab that I find so interesting is when you’re bringing a horse back into work. Yes, it’s tedious. Yes, it’s time consuming. Yes, it’s a fantastic opportunity to really correct and improve the way your horse works.

Sometimes a horse may be tight in their neck and struggle, for example, to work long and low. Well being out of work atrophies those muscles, and weeks of walking is the perfect opportunity to establish long and low, and develop their topline.

It might be something you want to work on with your own riding, and putting some focus on you can often take the pressure off your horse, which slows your rate of rehab (it stops you rushing into canter work, for example) and gives your horse more time to strengthen up. There’s nothing to stop you having lessons whilst still in rehab; just be sure your instructor knows and understands your present limitations.

I’ve started helping some clients bringing their mare back into work after an extended time off with foot problems. Before I got physically involved, they did a month of walk hacking before a couple of weeks of short trots. The mare had been signed off from the vets, but her owners didn’t know how to bring her back into work so sensibly asked for advice. I suggested a prolonged walk only period because the mare is a bit older, and I think it’s always better to spend an extra week at stage one if in doubt. Plus it was the middle of winter so why not take it steady and not put pressure on yourself to do that daily walk when it’s dark, wet and windy.

Anyway, we started at the beginning of January with me riding twice a week, and her owners riding her in between. Prior to her injury, we had started working on relaxation, and encouraging the mare to lower her neck and stop being so hollow. I also wanted to encourage her to use her hindquarters, and take a longer stride, as she was a long way from tracking up in trot. This was the ideal time to focus on that because the bad muscles had reduced, and we could take the time in the slower gaits. Of course, she may have been compensating for any pain and not using herself as well as she could. In which case now, in theoretically no pain, she should be able to use herself correctly.

We started with short trots around the outside of the arena, and I was pleased to feel that the mare felt really sound, and was starting to take her head lower, but long and low was still a long way off. We walked over poles, which are always exciting for her, but she rapidly got the idea, and slowed down, lowering her head and stretching her legs. Afterwards, both her walk and trot felt looser.

It’s only been three weeks, but already I can see the difference in the mare’s posture on the yard, and she’s carrying herself in a longer frame – head lower and neck longer. The trots have gotten longer, still predominantly straight lines but now the odd 20m circle to help her rebalance. We’ve done raised walk poles, which are quite tricky for her and the distance between walk poles is getting longer as she’s getting stronger. Five walk poles is about her maximum at the moment, otherwise she tenses and tries to rush the last one instead of stretching a little bit more – as you can see in the video below. After doing this set of poles a couple more times she figured out how to stretch over all five poles and didn’t rush.

The plan for the next few weeks is to plateau really; no canter yet, but longer trots, more big circles, more walk poles of increasing difficulty, and a longer and lower frame. I also want her owners to get more involved so they start to do more of the work, and they develop the skills to help the mare into the longer, lower frame. We don’t need to push on with the intensity of work, and I really feel both sides of the partnership will benefit from time spent building this skill set and topline muscles. The canter also fizzes this mare up, so I’m concerned the canter may temporarily undo our trot work so I want the trot to be very established before taking this step.

Although a long rehab is not what anyone wants, I really believe this mare will come out stronger than before, with a much better posture, way of going, and musculature. It will be interesting to follow.

Find the silver lining of an injury and rehabilitation programme. Find the weakest areas for both of you, and use the loss of condition as a blank canvas for you to have another go, particularly as you’ll have learnt more about your horse, more about soundness, and more how a horse should work to prolong their working life. It’s tough, but so many horses and their riders come out of rehab better and stronger.