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!