Sacroiliac Pain in Horses by a Vet – 2025 Signs, Diagnosis & Management of Low Back Lameness 🐎🦴

By Dr Duncan Houston, BVSc

Introduction

Back pain in horses—especially involving the sacroiliac (SI) joint—is one of the most challenging conditions for veterinarians to diagnose accurately. In 2025, SI pain remains a frequent cause of poor performance and gait abnormalities in horses, particularly athletes, jumpers, and dressage horses. Yet it is often overlooked or misdiagnosed. This guide helps horse owners recognize subtle signs, understand diagnostics, and explore modern treatment options.

What Is the Sacroiliac Joint? 🦴

• The joint connecting the pelvis (ilium) to the spine (sacrum)
• Located at the base of the horse’s back, above the hindquarters
• Stabilizes the horse's core during movement and propulsion

Why SI Pain Is Hard to Diagnose 🔍

• Located deep beneath muscle and bone—difficult to access
• Signs overlap with other lameness or back issues
• Horses often mask discomfort with compensation
• SI joint cannot be reliably assessed on palpation alone

Key Gait Signs of SI Pain 🧠🐾

1. Narrow Tracking at Walk/Trot

• Horse places hind feet closer together than normal
• Avoids rotating sacrum by “tightrope” walking

2. Abnormal Walk Pattern

• Walk appears two-beat instead of four-beat
• Both hind legs move forward simultaneously (bilateral stride)
• Most noticeable on serpentine or zigzag patterns

3. Canter Bunny Hopping 🐇

• Both hind legs move together instead of in sequence
• Horse may struggle to strike off into canter

4. Circular Movement Faults

• When trotting in a circle, hind limbs don’t track evenly with front limbs
• May step wider or narrower on one side

5. Tail Asymmetry

• Horse consistently holds tail to one side while walking or trotting

Confirming Diagnosis: Nerve Blocks & Imaging 🩺

• Diagnostic analgesia: Numbing the SI region to assess pain response
• Scintigraphy (bone scan): Can identify inflammation or bone stress
• Ultrasound or rectal exam: Rarely helpful due to joint depth
• Diagnosis often based on elimination of other causes and gait signs

When to Suspect Sacroiliac Pain ⚠️

• Performance decline without clear limb lameness
• Frequent resistance to work (bucking, rearing, refusing jumps)
• Inconsistent gait, especially at canter
• Pelvic asymmetry or muscle loss over croup

Treatment Options 💉🛠️

1. SI Joint Injections

• Corticosteroids injected into the joint to reduce inflammation
• Often guided by ultrasound or bone scan findings

2. Physiotherapy & Rehab

• Stretches, core strengthening, pole work
• Long and low work to improve topline strength

3. Shockwave Therapy

• Improves circulation and pain relief over SI area

4. Saddle Fit & Rider Symmetry

• Asymmetrical riding or tack can exacerbate SI pain

Case Example: Dressage Mare with Refusal to Canter

1. 9-year-old mare began resisting canter transitions and drifting at trot
2. Showed narrow tracking, tail to one side, and bunny hopping at canter
3. Blocked SI joints → immediate gait improvement
4. Treated with corticosteroid injection and core rehab
5. Returned to second level dressage in 8 weeks

FAQs About Sacroiliac Pain in Horses

Q: Can SI pain be cured?

A: It can often be managed long-term with proper care, rehab, and injections—but not always fully cured.

Q: How long does recovery take?

A: Mild cases may improve within weeks. Chronic pain may require months of rehab and reconditioning.

Q: Can saddle fit affect the SI joint?

A: Yes. Poor saddle fit and rider imbalance can put stress on the lower back and sacrum over time.

Conclusion

Sacroiliac pain can quietly rob horses of comfort, power, and performance. It often goes undetected without a trained eye for subtle gait changes. In 2025, a combination of diagnostic nerve blocks, symptom pattern recognition, and thoughtful rehabilitation is the most effective path to restoring your horse’s athletic potential. If your horse exhibits unusual hindlimb gait, tail drift, or canter discomfort—ask your vet about sacroiliac pain.

Suspect SI pain or need help planning a recovery program? Visit AskAVet.com or download our app 📱 to consult directly with Dr Duncan Houston for low back pain diagnosis and management. 🩺🐴