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ADVICE FROM THE VET


UNDERSTANDING PELVIC PAIN


By Director of Avonvale Equine Practice, Claire Sawyer BVet Med MSc Cert AVP ESO MRCVS


WHATSTRUCTURES DO WE WORRYABOUT IN THE PELVIC REGION?


The sacroiliac joint is the joint between the pelvis and spine.Itisdeep within the hind quartersofthe horse.Thereisone on each side of the pelvis. The jointsare afibrousconnection rather than ajoint capsule containing joint fluid, this differsfrommost other jointsaround the body.Theyare engaged inall paces,but under moststrain during canter. The lumbosacral joint is the junction


between the lumbar spine and the sacral spine,this joint sitsjustinfront of the pelvis behind the saddle.This joint is the area that has to flexand extend forhorsestolift and lowertheir back, or bascule over afence. The hip jointsconnectthe hind limbs to


the pelvis. Similar to humans these areball and socket joints. Theyare deep within the musculatureofthe hind quartersand luckily rarely cause aproblem in horses. Miniaturehorses cansuffer with hip problems similar to dogs.


WHATCAUSES PELVIC PROBLEMS?


Often sacroiliac joint pain and lumbosacral pain are secondary to other problems. It is very common to get muscular pain in the lumbar spine due to anykind of hind limb lameness as aresult of irregular limb movement. The same thing can manifestassacroiliac pain or lumbosacral pain. This is very similar to humans who have lower back pain or pelvic pain due to flatfeet or knee problems. Horsescan also develop pelvic pain secondary to primary back problems such as kissing spine.Ifthe spine is not as flexible as usual due to pain then the pelvic region again has to tense up to cope with deficienciesinmovement. If your horse has anykind of deficit in hind limb


action then theyare notable to work overtheir back and through their hind quarterseffectively. If youadd the weight of arider to this scenario it generally results in horsestensing up through their pelvic region to try and cope.This results in poor posturewhich ultimately causespain. If left long enough then bonyabnormalitiescan develop resulting in morepermanent problems. It is possible forhorsestohaveprimary


sacroiliac or lumbosacral problems. The sacral region canbemisshapen due to growth defects


Photoofhorse trotting showing the location of normal pelvic structures


or the sacroiliac region canbedamaged in falls, though these scenarios arequiterare.


HOW IS PELVIC PAIN DIAGNOSED?


Athorough clinical examination and dynamic assessment arethe first steps in diagnosing these problems. All horsesshould be able to lift and lowertheir backs when asked, as well as flex side to side through their lumbar spine.They should not be resentful of pressureapplied to their tuber sacrale (bonyprominences at the top of the rump). On astraight trot up viewedfrom behind theyshould not placetheir hind limbs wider than their forelimbs, and on astraight trot up viewedfromthe side their back should go up and down as theymove.Onthe lunge (without anyside reins or aids)theyshould willingly stretchtheir head down and lift their back once relaxed. All horsesshould be able to maintain a nicerhythmical canter on alunge circle without disuniting, bucking, stopping or rushing. These clinical problems canbedisplayedwith other


conditions too, but theyare agood indication of pelvic pain, often in addition to other issues. The pelvic region canbeviewedinpart


by ultrasound scanning. We can’tviewthe whole pelvis, but we canviewthe lumbosacral joint and some of the sacroiliac joint via trans-rectalultrasound. We canalso use ultrasound to accurately medicatethese regions as theyare located deep within the hind musculatureand noteasily palpable. Agamma scintigraphyscancan givemore


information about pelvic pain. This is ascanthat involves injecting the horse with aradioactive marker that travels to areasofinflamed bone.This inflammation is then picked up on abody scan.


HOW DO WE TREAT PELVIC PAIN?


Mostofthe time pelvic pain is secondary to other problems so the toppriorityistoidentifythe under lying issuesand addressthem. Sometimesthe pelvic issueswill settle entirely with no treatment if the underlying problems areresolved. Alot of


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WINTERSPECIAL2020


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