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PRP for Sacroiliac

Conditions which affect the Sacroiliac joint can be difficult to diagnosis. Most often, a diagnosis is made only after other conditions have been ruled out. The sacroiliac area is located where the spine and pelvis attaches at the lower back. Indicators that a horse is performing poorly because of a Sacroiliac condition or injury, include, but are not limited to bad muscling in the muscles along the spine on the lower back and the hindquarters, a loss of flexibility in the back when stimulated and uneven pelvic bone height.

Oftentimes, at least initially, a Sacroiliac-related condition is often misdiagnosed as something else. It may, therefore, take some time before a proper diagnosis is made. Horse owners and vets will oftentimes have to be patient as other conditions are ruled out, as difficult as this may be at times.

The Sacroiliac area may develop problems as a result of ligament injuries and fractures. When ligaments are the cause of a horse’s Sacroiliac-related pain, the ventral ligaments are typically to blame.  They may be strained or damaged. Arthritis could be the source of the problem as well, as could subluxation. Other ligaments which may cause problems with the Sacroiliac joint are the ones that connect the sacrum and the tuber sacrale. Stress fractures may also be to blame, particularly, micro and stress fractures.

Racehorses are most likely to develop stress fractures in this part of the skeleton. Overstressing of the joint, which can occur when a horse is traveling at a high result of speed, or because of extreme hind leg movements can result in pain, discomfort and injury. However, horses that aren’t used for performance or racing are at risk as well. Any time a horse slips, whether it be due to icy, wet or muddy conditions or the result of a slip on the pavement, the Sacroiliac joint could possibly be injured.

There are a number of ways to treat Sacroiliac related injuries and conditions. The particular method chosen will depend on what has caused the injury and the extent of it. After making a diagnosis and thoroughly examining the area, the veterinarian will come up with an appropriate treatment plan.

 Causes

Issues with the Sacroiliac joint and surrounding area can develop as a result of damage to the ventral and dorsal ligaments. The former are stabilizers while the latter connect the sacrum and the tuber sacrale. The ventral ligaments can become strained or arthritis may develop in them. Micro-fractures and stress fractures of the ilium wing can cause problems with the Sacroiliac joint and are sometimes common amongst racehorses.

The sacroiliac joint doesn’t give a lot. It wasn’t designed for a great deal of movement, therefore, sudden and extreme movements can cause problems, sometimes very serious ones. For instance, a hard slip or hard hind limb extension can result in the sacroiliac joint and/or the surrounding area, to become damaged. Racehorses as well as those that regularly engage their hind end are at an increased risk of developing Sacroiliac problems.

Ligament Damage: Damage to the ventral and dorsal ligaments may cause problems with the sacroiliac joint.

Fractures: Fractures (micro and stress) of the ilium can result in pain in the sacroiliac area.

High End Engagement: Horses which engage their hind legs a great deal may experience Sacroiliac problems. Though it is no way to prevent these types of injuries, being aware of the risks and whether or not a particular type of horse is susceptible to them, may help trainers and owners more quickly make a diagnosis. The sooner a correct diagnosis is made, the faster appropriate care can be given.

Extreme Movements: Extreme movements of the hind leg can result in Sacroiliac injury. This could possibly occur if a horse were to slip, for instance, on ice, mud, pavement, etc.

 Symptoms

The symptoms commonly associated Sacroiliac injuries are similar to other diseases, conditions and injuries. Poor performance, inflammation, tenderness of the sacroiliac joint and hind leg lameness are amongst the most oft seen symptoms. Poor muscling is another. The latter typically occurs in in the hindquarters and the muscles which surround the spine toward the lower back. Uneven pelvic bone height is still another, though not everyone is convinced that this symptom is necessarily indicative of Sacroiliac injury.

There isn’t a long list of tell-tell symptoms, which is what makes making a diagnosis difficult. Even still, there are a number of tests which can be administered to determine the location and the extent of the injury or condition.

Symptoms, alone, are not enough to determine if a Sacroiliac injury is the reason for the problems a horse may suddenly develop or a decrease in their performance. Therefore, it is necessary to rely on other diagnostic measures. We will discuss what some of those are in the next section.

Diagnosis

As mentioned above, making a Sacroiliac injury diagnosis generally involves ruling out other conditions. Vets will need to definitively determine whether or not diseases and/or injuries which may cause lameness in the hind limbs, is affecting the horse and not one related to the Sacroiliac joint.

One of the primary reasons it is so difficult to diagnose a Sacroiliac injury is because it is difficult to reach the joint. In most cases, joint injuries can be fairly easy to diagnose because they can be palpitated. If there is a great deal of inflammation, heat and a pain response from the horse chances are the joint is injured.

A vet can normally test for lameness by flexing the joint or with the use of an anaesthetic solution which is injected into the joint. This solution makes it possible for vets to determine what degree of lameness an animal is suffering from. X-rays are another diagnostic tool normally used by vets. These diagnostic tools can’t be used to check the Sacroiliac joint, which makes things much more difficult.

Because of where the Sacroiliac joint is situated in the horse’s body, it is hard to reach. The injection of a local anaesthetic is not usually possible either. There is no way to check for heat, at least not manually. Thermography is an option but largely considered ineffective. X-rays don’t provide a lot of information either because of where the joint is located. Bone scans are more promising. However, it can be hard to read them. Due to these difficulties, a horse is diagnosed with a Sacroiliac joint injury only after other conditions have been eliminated as the cause of the pain or discomfort.

The following diagnostic options are also available to vets, though their effectiveness up for debate, radiography, bone scans, thermography, diagnostic ultrasound and rectal examination. As stated above, the aforementioned, may or may not be effective but they are available to vets who may choose to use them.

Treatment

Problems with the Sacroiliac joint can be treated a number of different ways. Rest, acupuncture, and corticosteroids are the most common. PRP (Platelet Rich Plasma) therapy is another option, though one that is not used as often as the aforementioned.

Platelet Rich Plasma Therapy uses a horse’s own blood platelets to speed up the healing of tissue and bone. It has proven to be an effective way to treat both people and animals with these types of injuries (bone and tissue). Whether a horse’s Sacroiliac injury is due to ligament damage or a bone fracture, PRP can help expedite the healing process.

PRP therapy makes use of a horse’s blood platelets. In order to retrieve them, blood (roughly 52 mLs, (though this amount may vary) is drawn from the horse and then spun in a centrifuge machine. Spinning helps to separate the blood’s components, which consist of red and white blood cells, plasma and platelets. Once all of the components are separated, the platelets are removed and then re-injected into the site of the injury. Multiple applications may be needed. Whether or not they are will depend on a vet’s assessment.

After a course of PRP therapy, a horse will be required to rest, though not for too long and not completely. The procedure is not painful and typically is administered in a clinic, though some vets are more than willing to make house calls. The horse is sedated and given a nerve block so that it doesn’t feel any pain and so it’s easy to control.

In addition to autologous PRP therapy, vets have the option of using PRP gels and sprays. The latter two may be used if they make application easier or if the vet has a preference for one over the other.

One of the best things about PRP is that there are few complications associated with it. This is because it utilizes a horse’s own bodily fluids, its blood platelets. As a result, there is no possibility of rejection. The primary complication of concern and it’s not much of one, is that an injection could possibly develop at the injection site.  The risk, however, of an infection developing is small and is the same risk that any horse faces that receives an injection of any type.

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