“What do you want to do to my horse? Oh, I don’t believe in joint injections. My grand prix jumper competed until he was 23 and never needed joint injections.”
I’ll go ahead and say it. Though I shouldn’t judge, my mind starts to go in all directions at such a bold statement. I can’t help but think that horse must have been a freak of nature to have felt so good for so long at such a high level of competition. Or… I wonder how lame that horse was while competing at 23 years old? Or… He must have had great success with other less invasive treatments… Or… So the horse was not injected, but how many painkillers did he get at the shows?
I hear something like this almost every day. I am an equine veterinarian who focuses on sports medicine. This controversial topic is not an easy or simple discussion with my clients.
So are they good or bad?
If you are an equine competitor, you have no doubt had a horse injected or know another who has. Most would agree that joint injections among the equestrian horse show community have become somewhat of a “in” thing. They have also received a bad reputation. Some would view the use of this treatment at the last minute or in the event as gaining an advantage over another competitor with a less “improved” horse. And in this case, I would agree, injections in the joints… very bad.
Most commonly, you hear the story of the horse that had corticosteroids injected into a joint every 2 months just so it could keep showing… yes, very bad.
Using this modality to mask pain when there is more serious underlying pathology forces the horse to work harder when the horse could otherwise protect this area and thus protect itself from further injury.
Comparatively, a competitor who schedules routine vet visits to assess condition, rule out injuries versus inflammation, and uses joint injections before an event like this…very well.
A horse does not have to be lame “shaking its head” to warrant routine soundness checks throughout the year. You’d be surprised how many horse owners don’t contribute performance problems to subtle lameness. More often it’s not that they don’t recognize it, it’s that they mislabel the condition. I know several horse owners who don’t recognize their horse is lame unless it moves its head or is unable to bear weight on one limb. Instead, they describe a horse that is “stiff” or unwilling to perform certain maneuvers. Let me be blunt, no matter what words you want to use to describe it, these issues are, in fact, a form of lameness.
Routine visits allow the vet to recognize slight lameness and subtle decreases in performance. I encourage owners to seek out a veterinarian with a special focus on equine sports medicine or a specific interest in horse performance. Systematically, the veterinarian creates a roadmap for future treatments. Whether you decide to treat that day or not, the area of interest can be monitored throughout the horse’s run. And specifically with regards to joint injections, reducing significant inflammation early on can decrease the risk of a more catastrophic injury later on.
Another point to consider is the medication used for an injection into the joint. Not all joint injections are the same. Rumors surrounding the use of corticosteroids and their deleterious effects on a joint have caused exceptional alarm. Although study has shown that frequent and inappropriate use of methylprednisolone acetate, a corticosteroid, in a joint can adversely affect cartilage (Colorado State University), alternatively, triamcinolone acetate, a different type of corticosteroid , could be chondroprotective (CSU Orthopedic Research Laboratory).
Also, joint injections can be done using regenerative medicine instead. IRAP (interleukin-1 receptor antagonist protein) has become a popular choice. IRAP manipulates the body’s biological mechanisms to stimulate healing by counteracting the destructive effects of inflammatory proteins such as interleukin-1 (IL-1) within the joint, thus halting the progression of joint disease.
It is obvious that any joint injection presents a risk of infection or joint flare. As with any invasive veterinary service, this is a risk that must be taken by the owner. Competent preparation, sterile care, and proper handling significantly reduce this risk. Many doctors, including myself, include antibiotics with the other medications used.
In my professional opinion, I do not think the incidence of risk is so unacceptable as to rule co-injection treatment out of a list of options altogether. While there are a multitude of alternative ways to treat joint inflammation, frankly, for some horses, joint injection has been the only treatment that has made a significant difference in comfort.
In summary, I believe that the benefits of joint injections, used judiciously, outweigh their bad reputation and low incidence of harmful effects. Coupled with frequent routine veterinary evaluation, proper conditioning and training, they can help reduce injuries, improve performance and essentially create more sustainable equine athletes.