Run your finger along the middle of your horse’s back toward the tail and you should feel a dip just past the flanks. This the lumbosacral space, where the lumbar vertebrae end and the sacrum begins. The sacroiliac is the joint between the sacrum and the ilium of the pelvis.
Hidden under the large gluteal muscles on the top of the horse’s rump, the sacroiliac sits at the highest point of the rump. The bony tubular sacral is referred to as the ‘point of hip’ even though it has nothing to do with the hip joint. This area has two ligaments which, when damaged, can cause pain.
Most injuries in this region are thought to be due to uneven stress being applied to the pelvis. Here are some ways you can help minimise trauma to this area:
- Always work the horse an equal amount of time in both directions, at all gaits. Switch leads and diagonals frequently when riding cross-country.
- Every two to four weeks, check the horse from the side and behind for any evidence of uneven muscling.
- Watch out for any signs that the horse is not pushing off or using itself as well on one lead or diagonal as on the other.
- Check the wear of the hind shoes; uneven wear is a tell-tale sign of sacroiliac problems.
Consult a vet at the first sign of unevenness in shoe wear, muscling or gait. Identifying the cause early will save the horse from progressing to a more serious lameness.
Stress fractures along the wing of the ilium can cause sacroiliac area pain. The joint can be over-stressed by speed or extremes of movement of the hind leg. Racehorses are at risk, as are horses that work with a high degree of hind-end engagement, such as barrel racing, reining, jumping and dressage, and horses that work over sharp inclines.
A sacroiliac injury should be suspected on a horse with a hind-end lameness that cannot be traced to joints or soft tissues lower down the leg when the horse has local anaesthetic blocks up to and including the stifles.
X-rays are of limited value due to the difficulty in obtaining them (the horse must be under anaesthesia and on its back) and because there may be little or nothing to see in most sacroiliac area injuries. Scintigraphy (bone scan) is a better option, but it cannot pinpoint the problem if ligaments are involved.
Thermographic images of the back may reveal a ‘cold spot’ at areas of injury involving dorsal ligaments. Rectal examination can pick up asymmetry in the pelvis, localised swelling or thickening, sensitivity to touch, and fractures.
Because sacroiliac area injuries usually involve one or more ligaments, recovery will always be fairly prolonged, from six to eight weeks for problems that are caught early, up to many months.
The first task is to get the inflammation under control. Your vet may recommend a course of systemic anti-inflammatories or local injections. Next, the horse should be kept moving. Some vets will use periodic Traumeel or Sarapin injections to help with low-grade pain/inflammation during rehabilitation, as these may assist the horse to work through the rehab programme to achieve the best possible flexibility.
Ultimately, most horses with sacroiliac-area injuries, even fractures, can return to full use if given enough time to heal. Ligaments heal the slowest of all tissues, and nothing can change that. When you see the horse is sound again at all gaits at pasture, it’s time to gradually resume formal work.
Although severe injuries can certainly limit a horse’s future career, especially in demanding sports, many horses that reportedly fail to return to their original work do so simply because they are not given enough time to heal.
Kim Dyson breeds Arabians and Lusitanos, and has 22 years’ experience in holistic equine and human body work.