Your trusty steed has lost a little of the pep in his step, what do you do next? Most people talk to trainers, friends, barn mates and veterinarians. Generally at least one of them will say “maybe it’s time to inject the hocks.” Joint injections are starting to be considered maintenance for our athletic friends because they can increase our horses performance and are easy to have done. The results of joint injections can be seen quickly which is important to competitors in this fast pace world. The benefits of joint injections can be real and they can be a necessary tool, BUT, it may not be right for your horse and should not be done without the correct cause. Joint injections have risks and when done on a regular basis change the strength of cartilage and the health of the joint over time. It is important you are injecting a joint for the right reasons. So how do you know when it is time? By asking the right questions and doing the correct diagnostic testing.
There are different kinds of joint injections and you have to understand the benefit and cost of each. Some veterinarians will use only steroid to decrease the inflammation in the joint. These injections are inexpensive and if joint inflammation is the culprit may show immediate results. Great, lets do that! Unfortunately these injections do not improve the joint environment long term. Also because the results are shorter lived this type of treatment quickly leads to maintenance schedule injections. When the cartilage in the joint is exposed to steroid repeatedly the blood supply to the cartilage decreases and it becomes less healthy. In many ways it is a self perpetuating cycle. Next we can inject with Hyaluronic Acid and steroid. This type of injection addresses the quality of joint fluid and therefore tends to have longer action but is also more expensive. This type of joint injection is more appropriate for athletes in most cases but still should not be considered maintenance because repeated exposure to steroid is still not good for the long term health of the joint.
Any joint injection should be done because there is inflammation in the joint aka arthritis. Steroids are powerful anti-inflammatory tools and when a joint injection is done appropriately it will decrease the inflammation in a joint which can itself me damaging. So what is the harm in trying an injection? Why can’t we just treat and know that if the response is good the horse needed it? The answer is because the steroids we inject don’t stay inside the joint. The steroid we are injecting may be treating a problem in a tendon, ligament or muscle. So what? If we are masking a secondary issue we are creating a horse that is now predisposed to injuries and break down. Nobody wants to have a horse move around the ring better for a month and then come up with a suspensory injury or bowed tendon.
So when is the right time to inject? The correct time to inject a horse is when they are actually showing lameness that can be localized to a joint and or have radiographic evidence of arthritis. Your veterinarian can help you to determine this by doing a lameness exam. He or she may then suggest some diagnostic anesthetic blocks and possibly radiographs to be sure. Some signs your horse may be on a “maintenance schedule” that isn’t right for her include: young horses with no arthritic history, less than 2 years of comfort post injection and decreased efficacy of injection. The good news is there is always time to change and there are many great options out there. Please see the following articles for more information about risks, rewards and alternatives to joint injection.