Rehabilitation of Sacroiliac Injury in Horses:  A Complete Guide

The sacroiliac joint is one of the most important yet least understood areas of a horse’s body. Sitting deep in the hindquarters, this joint is the powerhouse that transfers impulsion from the horse’s hind legs through the spine and into forward movement. When it works well, you see strength, balance, and fluency in every stride. When it doesn’t, performance declines, behaviour changes, and injuries follow.

One of the most challenging issues for performance and leisure horses alike is sacroiliac injury. Recovery takes time, care, and the right approach.

In this blog, we’ll break down:

* What a sacroiliac injury in horses is

* How it occurs

* Key signs to watch for

* The most effective rehabilitation strategies, including in-hand work, treadmill training, and pole/cavaletti exercises

Whether you ride dressage, eventing, show jumping, or simply want your horse to stay sound for pleasure riding, understanding sacroiliac rehabilitation is crucial.

What is the Sacroiliac Joint in Horses?

The sacroiliac joint (SI joint) sits where the sacrum (the large triangular bone at the base of the spine) meets the ilium of the pelvis. Think of it as the engine mount of your horse’s body — it links the power of the hind limbs to the spine and allows the horse to push forward, lift through the back and carry weight.

When healthy, the sacroiliac joint provides:

* Power for jumping, collection, and uphill work

* Stability in the pelvis and spine

* Flexibility for lateral movements and transitions

When injured or unstable, the horse may lose power, become resistant under saddle, or even show sudden behavioural changes.

How Does a Sacroiliac Injury Occur?

Sacroiliac injuries are typically the result of strain, imbalance, or repetitive stress. They are not always sudden — many develop gradually until they become significant enough to affect performance.

Common causes include:

* Poor balance or posture – Horses that move on the forehand or lack core strength put unnecessary strain through the sacroiliac region.

* Repetitive jumping or heavy work – Especially when done without sufficient conditioning or correct technique.

* Slips, falls, or awkward landings – A single accident can cause SI strain.

* Weak core muscles – Without strength in the topline and abdominal muscles, the sacroiliac joint absorbs too much impact.

* Asymmetry in training – Overuse of one rein, poor straightness, or crookedness in the rider can all contribute.

Signs of Sacroiliac Injury in Horses

Because the SI joint is deep within the body, injuries are not always easy to diagnose.

However, there are some common indicators:

* Reduced impulsion or engagement from behind

* Difficulty with canter transitions

* Struggling with collection or lateral work

* Shortened stride or uneven steps behind

* Disuniting in canter

* Behavioural changes — reluctance to go forward, tail swishing, bucking, or resistance under saddle

* Sensitivity to grooming over the hindquarters

If you suspect a sacroiliac injury, veterinary diagnosis (including physical assessment, nerve blocks, or scans) is important before starting rehabilitation.

Rehabilitation: The Path to Recovery

Rehabilitation of a sacroiliac injury is not about quick fixes. It requires time, patience, and progressive strengthening. The goal is to restore stability, build balance, and retrain posture so that the horse can move comfortably and confidently.

Here’s a step-by-step guide to what works best.

1. In-Hand Work: Building Core Strength Safely

In-hand exercises are the foundation of sacroiliac rehabilitation. They allow the horse to rebuild strength and coordination without the added challenge of carrying a rider.

Key benefits of in-hand work for sacroiliac recovery:

* Encourages correct posture and balance

* Activates the horse’s core muscles (abdominals)

* Improves straightness and symmetry

* Reduces stress on the injured joint while promoting controlled movement

Exercises to focus on:

* Straight-line walking in rhythm, ensuring the horse tracks evenly on both sides

* Gentle lateral work (shoulder-fore, small leg-yield in hand) to mobilise the pelvis and improve flexibility

* Halt-walk-halt transitions for engagement and focus

* Backing up in straight lines — excellent for core activation and strengthening the lumbosacral region

In-hand training also reinforces boundaries and obedience, which makes handling safer during rehabilitation.

2. The Role of Treadmill Training

A walk (and later, trot) treadmill program can be a game-changer in sacroiliac rehabilitation. Unlike traditional ridden exercise, treadmill work is consistent, controlled, and progressive.

Benefits of treadmill training for sacroiliac injuries:

* Provides straight, balanced movement without rider influence

* Strengthens the pectoral and hindquarter muscles evenly

* Encourages symmetrical use of both hind legs

* Builds stamina gradually without overload

* Allows careful progression — starting at walk, introducing trot only when the horse shows stability

Treadmill work is especially helpful for horses that rush, fall in/out, or struggle to maintain a steady rhythm under saddle. It creates a safe, repeatable environment for healing and strengthening.

3. Pole and Cavaletti Work

Once the horse shows improvement and is cleared for increased activity, pole and cavaletti exercises become an essential part of rehabilitation.

Why poles help:

* Encourage hind leg lift and engagement

* Promote flexion of the pelvis, strengthening the sacroiliac joint

* Improve rhythm, coordination, and balance

* Add variety to prevent boredom and build confidence

Start with simple walk poles on the ground, then progress to:

* Walk poles once the horse is stable at walk

* Raised poles for more engagement

* Cavaletti exercises to increase range of motion and topline strength

Poles should always be introduced gradually, with careful attention to the horse’s movement and comfort.

4. The Importance of Correct Balance

At every stage of rehabilitation, **balance is everything**. Horses that are heavy on the forehand or crooked in their movement put undue strain on the sacroiliac joint, risking re-injury.

Balance training includes:

* Teaching the horse to carry themselves uphill rather than pulling with the front legs

* Developing both lateral (side-to-side) and longitudinal (front-to-back) balance

* Strengthening the horse’s ability to use their core and topline correctly

Balanced horses move more efficiently, stay sounder for longer, and are easier to ride.

Long-Term Benefits of Proper Rehabilitation

Rehabilitating a sacroiliac injury isn’t just about getting the horse back to work — it’s about creating a stronger, more resilient athlete. Horses that go through a careful rehab program often come back better than before because their balance, core strength, and posture improve beyond what they had pre-injury.

Benefits include:

* Greater soundness and longevity

* Improved comfort and willingness to work

* Enhanced performance in dressage, show jumping, and eventing

* Reduced risk of secondary injuries caused by compensation patterns

Key Takeaways

* Sacroiliac injuries in horses are common but often misunderstood.

* They occur from imbalance, strain, accidents, or repetitive stress.

* Correct rehabilitation focuses on in-hand work, balance training, treadmill programs, and progressive pole/cavaletti exercises.

* Patience and progression are key — rushing rehabilitation risks setbacks.

* A well-rehabilitated horse is not just healed but also stronger, straighter, and better balanced than before.

Final Thoughts

The sacroiliac joint may be hidden deep in the horse’s body, but its impact on movement, power, and performance is massive. Rehabilitation after injury takes careful planning, but with the right exercises, consistent balance training, and progressive strengthening, horses can return to work successfully — and often perform at an even higher level.

Remember: recovery is not about shortcuts. It’s about building the foundations for a

healthier, happier, and more athletic horse

for years to come.