🐴 Sacroiliac Pain in Horses: Diagnosing & Managing Back Issues in 2025 🧠🦴

By Dr Duncan Houston BVSc

Back pain in horses is one of the most elusive and frequently misdiagnosed conditions in equine practice. Among the most complex sources is the sacroiliac joint (SIJ)—a deep structure at the base of the spine where the sacrum meets the pelvis. In 2025, we're improving at identifying SIJ pain, but it still requires careful observation and diagnostic finesse. This guide explains how to recognize sacroiliac pain, what gait signs to look for, and how veterinarians confirm the diagnosis. 🧠🐎

📍 What Is the Sacroiliac Joint?

The sacroiliac joint is located in the very lower back and links the horse’s spine (sacrum) to the pelvis. It transfers the powerful hind limb drive through the spine and into forward movement. 🦵➡️🧠

It’s composed of:

• 🦴 The sacrum (part of the spine)
• 🦴 The ilium (part of the pelvis)
• 🧵 Ligaments and fibrocartilage

Because of its deep location and the overlapping pelvis, this joint is not directly palpable or visible, making diagnosis difficult. 🧩

🔍 Why SIJ Pain Is Often Missed

Unlike lameness in a limb, sacroiliac pain often presents with vague performance issues. Many horses are misdiagnosed with generic “back pain” and treated with acupuncture, chiropractic, or injections—sometimes unnecessarily. 🩺

Common misdiagnoses include:

• 🧠 Behavioral resistance under saddle
• 🏇 Poor impulsion or collection
• 🐌 Fatigue or reluctance to canter

Without a correct diagnosis, treatments may fail to address the actual source of discomfort. 🎯

🚨 Gait Clues That Suggest SIJ Pain

Dr. Rob Nan Wessum and other researchers have identified key gait abnormalities associated with sacroiliac dysfunction:

🧠 1. Narrow Hind-End Tracking

• 🐾 Horse places hind feet very close together, sometimes in a “single-file” fashion
• 🔄 Often seen at the walk or trot

🧠 2. Synchronous Hind Limb Movement

• 🐰 Hind limbs move together in a “bunny hop” pattern
• 🎠 Especially noticeable at the canter or when transitioning gaits

🧠 3. Abnormal Tail Position

• 🎯 Horse carries tail consistently to one side while walking
• 🪢 Often accompanied by tight gluteal muscles or hip tension

🧠 4. Asymmetrical Circle Work

• 🔄 Hind limbs do not follow the path of the front limbs on a circle
• 🚶 Hindquarters drift wider or collapse inward

These signs are subtle but crucial—especially when multiple signs are observed together. 🕵️‍♂️

🧪 How Vets Confirm SIJ Pain

There’s no single test for SIJ dysfunction, but veterinarians use a combination of techniques:

• 🔍 Gait observation—straight line, serpentine, circles
• 💉 Diagnostic SIJ blocking—injecting local anesthetic into the sacroiliac area
• 📊 Monitoring response—does the gait or performance improve after blocking?

If the horse improves after blocking the SIJ, it's a strong indicator of joint involvement. ✅

💉 Treatment Options for Sacroiliac Pain

Once diagnosed, treatment can be multifaceted:

🔹 Injections

• 💉 Corticosteroids into the SI joint region to reduce inflammation
• 🧬 Regenerative therapies (PRP or IRAP) in chronic cases

🔹 Physical Therapy & Rehab

• 🧘 Hill work to strengthen pelvic and core muscles
• 🔁 Lateral work (leg yields, serpentines) at walk and trot
• 🧍 Core strengthening—pole work, raised walk paths

🔹 Complementary Care

• 🧲 Chiropractic adjustments
• 🌀 Acupuncture or massage
• 🦶 Corrective shoeing to improve limb alignment

📆 Recovery Timeline

Recovery depends on severity and chronicity. Typical recovery ranges from:

• 📅 4–8 weeks for mild inflammation
• ⏳ 3–6 months for chronic or performance-limiting SI pain

Improvement should be monitored with physical exams and consistent gait evaluations. 📊

📲 Ask A Vet for Tailored Support

Suspect sacroiliac pain in your horse? Don’t guess. Visit AskAVet.com or use the Ask A Vet App for gait analysis, diagnostic guidance, and exercise planning. 📱🐴

Dr Duncan Houston and the team can help you spot subtle signs and create a customized rehab plan based on your horse’s specific biomechanics. 🧠💬

🏁 Final Thoughts

Sacroiliac joint pain may be hidden, but it isn’t hopeless. In 2025, improved diagnostic techniques and better rehabilitation programs are allowing more horses to return to soundness and peak performance. 🐎❤️

Trust your observations, investigate odd gaits early, and don’t overlook the role of the sacrum. For comprehensive help, reach out today at AskAVet.com 🧠🦴