Advances in imaging the horse's pelvis have made it clear that the sacroiliac joint and its associated ligaments are important sources of lameness in sport horses. In the past, veterinarians treated this area by injecting the more superficial ligaments.

Researchers have devised minimally invasive techniques for injecting deep below the top of the croup into the sacroiliac joints themselves. We now use this procedure to diagnose sacroiliac joint pain and to treat saqroiliac joint

inflammation. It's a straightforward, effective procedure that is tolerated well by patients.  See diagrams below depicting the unique anatomy and injection placement.  Often a combination of corticosteroids and serapin are instilled in each side of the ligament.  In metabolic or cushings patients we often use orthobiiologics to relatively equal success.

Often starting the day after injection if no other appendicular lameness issues are present, horses are lunged in a large circle for 5-10 minutes once daily for the next three to four days to assist with diffusion of medication across the SI joint. Mesotherapy and/or acupuncture are often also recommended and synergistic with guided injections especially if  topline movement issues persist. 

Mesotherapy is a technique that has been used for over 30 years in France and consists of shallow (4-6 mm) injection of medications into tissue of the neck or back to block pain. Today, it is commonly practiced in the US and Europe to help our horses suffering from back pain.  This technique was introduced into the United States by French veterinarian, Dr. Jean Marie Denoix.

Mesotherapy is a treatment that stimulates the mesoderm, the middle layer of the skin, which will, in turn relieve a wide variety of symptoms and ailments. The treatment is used to stimulate the Giant nerve fibers. The technique involves the injection of substances to stimulate nerves that act as “volume controls” to nerves that transit pain signals.  The mesotherapy injections involve extremely small needles that penetrate the interdermal layer of the skin to a very shallow depth (4-6mm). We generally administer three rows of injections on each side of the horse’s spine resulting in 200-300 injection sites (see pict below). These injections, while many, only penetrate the skin about four to six millimeters, and extremely small needles are employed. The number of treatments needed depends on many

variables including the condition, the abnormal physiology causing the condition, as well as the chronicity of the problem. A minimum of one to two sessions of mesotherapy is performed generally to assess the horse’s response. Mesotherapy is effective for a multitude of conditions because it helps reverse the physiology of that condition, and stop the pain spasm cycle. Frequently these treatments may also be combined with chiropractic adjustments and/or para-spinal injections as noted above.

Since much of our focus with lameness often involves the axial skeleton back, it serves to reason that a non invasive method to help back pain is often necessary.  Other modalities include shockwave therapy and deeper anti-inflammatory injections and oral medications.

As seen in the above picture there are small skin bumps that appear as the medication is deposited just below the skin surface. These swellings will quickly dissipate and the benefits should be realized in 3-7 days. Patients will be out of work for the first few days, then depending on the condition they can begin ground work or light work under saddle.

The number of treatments required for a horse with chronic back pain is dependent on several factors: the overall condition of the horse, the cause of the horse’s back pain, the severity of the back pain, and how persistent the problem. Generally, you can expect a  re-evaluation post treatment in approximately 2 weeks with additional recommendations if necessary.