Arthritis isn’t the end
Is your horse displaying signs of pain or lameness? Maybe your vet has recommended hock injections for your horse, but you’re unsure what they are or whether there are risks.
Hock injections are a common treatment for arthritis in the complex joint located in the rear legs of your horse. This post breaks down all of your biggest questions about hock injections, including indications for their use and what type of medication is injected. We will also explore whether there are alternatives and specifics about which horses are at the greatest risk for developing arthritis.
Being the caring horse owner you are, you’re looking for answers to make sure you’re doing right by your horse. Regardless of your reasons for researching “hock injections” today, you’ve come to the right place!
Hock Injections: The What
To understand why your horse may benefit from hock injections it’s important to have a basic knowledge of joints and how they are ideally supposed to function.
What joint is the hock? How does it function?
Joints connect two or more bones and facilitate movement. The hock is a joint in your horse’s hind leg. There are different types of joints throughout the body, and they all have varying degrees of movement and complexity.
The hock is a major shock absorber, but also extends and flexes the hind leg. Its function is similar to the ankle joint in a human.
Although the hock is referred to as “a joint,” it’s actually made up of 4 joints and 10 bones. The bones involved in a joint have a thin layer of cartilage to prevent excessive rubbing.
Joints also have a joint capsule, or small space between the bones, filled with fluid for lubrication.
Over time and with repeated stress on a joint, the cartilage can break down, leading to pain and inflammation. This is commonly referred to as “osteoarthritis.”
Of the 4 joints making up the hock, the uppermost joint of the hock, the tarsocrural, has the most motion and is the largest. It seems counterintuitive, but the 2 joints that are smallest and have the least movement are usually responsible for the majority of arthritis in the hock.
These joints are known as the distal intertarsal and tarsal-metatarsal joints.
What are hock injections?
Arthritis in the hock can cause pain and inflammation. Hock injections involve injecting medication directly into the space of the hock to relieve pain and reduce inflammation.
Hock injections can be a short-term solution, but are not a cure, in cases of advanced progression of joint damage.
Injections are also sometimes done to temporarily anesthetize a joint to make a definitive diagnosis in evaluating lameness.
Horses can have pain or develop muscle, tendon, and ligaments issues, which can complicate a definitive diagnosis. By anesthetizing the joint, a problem specific to the joint can be ruled in, or out.
To set the stage, let’s look at a few of the pros and cons for injections:
|Pros to Hock Injections||Cons to Hock Injections|
|Reduces inflammation||Risk of infection|
|Restores prior level of performance||May cause laminitis in certain horses|
Hock Injections: The Why
Conformational issues with the hock may predispose a horse to arthritis, as can repeated stress on the joint. This may present in several ways, including lameness or pain.
If your horse displays signs of lameness, your first call should always be to your vet.
Your vet will perform a lameness exam, x-rays, and possibly an ultrasound. It’s important to have a clinical and radiographic exam because, although x-rays may indicate abnormalities, your horse may not display issues. And vice versa.
It’s always best to get a complete diagnosis before discussing valid treatment options. If you are formally competing, you should discuss your plans with your veterinarian to avoid disqualification due to restricted substances or modalities.
Treatment options depend upon the extent of the damage.
Why might you consider getting hocks injected?
Horses with evidence of active inflammation in their joints typically respond best to joint injections. Radiographic findings indicating inflammation include distention of the joint capsule and a positive flexion test.
Keep in mind that there are many reasons why a horse may be lame, and a joint issue isn’t always to blame.
An accurate diagnosis is therefore essential for confirming the appropriateness of hock injections.
Signs Your Horse May Need Hock Injections
Depending upon your horse’s level of athleticism and your discipline, signs that they may need hock injections can be subtle. Sometimes there is a slight change in the quality of gaits. Your horse also may have swelling in the joint. At other times, a horse may not look completely sound, but it’s difficult to pinpoint the location of the issue.
Below are other signs that a hock injection may be recommended in your horse’s near future:
- Your horse resists using his hind legs during activities like jumping or collection
- Your horse displays behavioral issues when asked to do specific movements
- Your horse initially seems stiff but improves with a bit of exercise
- Your horse’s stride seems shorter than usual
- Your horse’s gait quality changes
What alternatives are there to hock injections?
Oral pain relievers, such as non-steroidal anti-inflammatories (NSAIDs), can relieve inflammation and ease pain.
NSAIDs such as phenylbutazone (or Bute) can be very effective, however may pose risks with long-term use, such as kidney damage and stomach ulcers.
There are a variety of supplements on the market aimed at promoting joint health. Some research suggests that supplements with resveratrol may be more effective than others.
Many experts agree that more research in this area is needed, so ask your vet for specific recommendations if you’re unsure which one to try.
One supplement in particular that seems to be effective is Cosequin. This product has formulations for dogs as well as horses and comes with excellent reviews. I’ve personally used this product for both horses and dogs and have seen great results, especially in conjunction with other joint therapies.
If you’re concerned about your horse’s joints, consider starting with a supplement and moving to injections later if the supplement isn’t enough.
Physical therapy offers a few non-medication modalities to treat joint pain.
Consider switching up the horse’s routine. If the horse is being worked hard 7 days a week, they’re likely to undergo physical and mental stress. Throwing in a lazy trail ride a couple of times a week desensitizes your horse and gives him a mental break.
Alternating rest and work for your horse is a best practice whether or not there are current joint or lameness issues.
A cold water hose-off or ice packs applied to joints after each workout can reduce inflammation. Regular care from a farrier ensures optimal hoof angles to further reduce stress on the hock.
You also could consider giving your horse a complete break from work to see whether function returns with rest.
If you have repeatedly been injecting without results and/or the horse’s condition is advanced, joint fusion may be a possibility. This procedure stabilizes the joint and reduces discomfort. Fusion is done by either injecting the joint with alcohol or through surgery.
Regardless of your decision, discuss recommendations and all possible alternatives with your veterinarian before deciding whether hock injections are the best choice.
Are certain disciplines more likely to need hock injections?
Because the hocks are part of the hind legs, sports that create stress on the hind legs are more likely to cause hock issues. Dressage is a sport that requires a horse to move off his hindquarters, meaning more stress is placed on the hock joint therefore increasing risk for arthritis.
Other sports with increased risk include jumping, racing, and reining.
Any sport in which horses are started hard at a young age, before they’ve had a chance to fully mature, increases the risk for hock issues. Barrel racing and cutting both involve high-speed turns on the hindquarters, thus increasing the risk for arthritis.
Driving sports are another culprit in hock stress due to the change in center of gravity and weight distribution for the horse.
Hock Injections: The Who
Now that we’ve explored the ideal function of the hock and how issues evolve, let’s dive into the “who” of hock injections.
Who should inject horse hocks?
Hock injections may look simple, but there are risks involved. You should only trust your licensed veterinarian with the task.
Should you get a second opinion before getting hock injections?
Getting a second opinion is always a reasonable option, especially when it involves the comfort and soundness of your horse. Just as there are specialties for human medical conditions, there are veterinarians who are experts in various aspects of horse physiology.
You may want to consider seeking out a veterinarian with a special interest in lameness, if in doubt about a diagnosis.
Hock Injections: The How
A variety of medications can be injected to improve hock issues.
What is injected into the hock?
Steroids such as triamcinolone are the typical medication injected into hocks. They work by decreasing inflammation. Sometimes hyaluronic acid is combined with a steroid because it lubricates the joint.
Some anti-inflammatory medications such as ProStride, PRP, and IRAP can also be injected into the joint. Other injections improve joint health, but are not injected directly into the joint.
Additional injections may include hyaluronic acid/sodium hyaluronate (Legend), polysulfated glycosaminoglycan PSGAG (Adequan), and a variety of biologics. Each product works a bit differently, but all aim to lubricate the joint and repair cartilage.
Legend can be injected directly into the joint or given intravenously, while Adequan is an intramuscular injection. Reducing inflammation and pain are the primary goals for these types of injections.
What should you expect during the hock injection process? What does after-care look like?
It may come as no surprise, but horses are not particularly fond of having their hocks injected. The procedure must start by adequately restraining the horse to prevent injury to horse and human. Sometimes horses must be sedated to assure safety for all involved.
Once the horse has been restrained, hock injections start with a thorough cleansing of the joint with antiseptic soap.
The veterinarian will then cleanse the area with alcohol to further reduce bacterial presence and infection risk.
A needle will then carefully be inserted into the joint. Sometimes placement is confirmed by the presence of joint fluid in the needle.
At this point, a syringe with the medication to be injected is attached to the needle previously placed in the joint. The medication is then administered into the hock.
Plan for plenty of rest in the first 3 days after an injection. It’s important to give the medication time for maximum effect before resuming normal activities again.
How often should a horse get hock injections?
It’s not unusual for a young horse to display early signs of inflammation in the joint. The horse may not need another injection for many years. On the other hand, older horses with existing joint damage may need an injection every year, and sometimes even sooner.
In this situation, injections are sometimes tried as a preventative measure to reduce inflammation over time.
There is a myth floating around that horses need hock injections as part of “routine joint maintenance.” There is no research to support this thought, and the decision to inject again depends upon your horse and a thorough examination by your veterinarian.
Hock injections should not be done to enhance a horse’s performance. They should only be used to keep a horse as comfortable and sound for as long as possible.
Reducing the risk of developing joint issues in the first place requires a variety of interventions, such as adequate rest, proper care from a farrier, and regular pasture turnout.
How long does it take for hock injections to work?
You can expect to see results in 24-48 hours.
How much does it cost to get a horse’s hocks injected?
Hock injections can range anywhere from $65 to $250 per joint. Depending on your geographic location, prices may be higher or lower.
Frequently Asked Questions
Q: What other horse joints may need injections?
Injections to other joints such as the coffin, sacroiliac, and stifle are sometimes recommended by your veterinarian.
Q: Do hock injections help with arthritis?
Hock injections are a short-term solution to the pain and inflammation commonly seen due to arthritis. They are not a cure as damage due to arthritis is permanent.
Q: Are hock injections safe?
Any time your horse receives an injection, there is a risk of infection. Your veterinarian will thoroughly cleanse the injection site, but infections sometimes happen. Steroids themselves reduce the immune response, increasing the risk for infection.
When repeatedly injected into high-motion joints, steroids can break down cartilage and make the joint even worse. This is typically a more significant risk when high doses are repeatedly injected into multiple joints.
Steroids can also trigger laminitis; one reason to consider avoiding this type of injection in horses with metabolic issues.
An injection can stimulate an inflammatory response in the joint. This type of reaction usually occurs within 24-48 hours after the infection and causes or worsens lameness. The damage is not typically permanent, but it can delay expected recovery.
Q: Do barrel horses need hock injections?
Barrel racing involves tight circles and asking a horse to move off its hindquarters repeatedly. These types of movements undoubtedly increase the risk for arthritis to hock joints.
Regardless, keep in mind that not all horses in sports such as barrel racing develop arthritis. Still, it does increase the likelihood of joint breakdown over time.
Q: Are there ways to prevent joint damage from occurring?
Although conformation can play a role in developing joint damage, there are ways you can promote healthy joint health in your horse. Maintaining your horse at an ideal weight minimizes stress to its joints. Keeping your horse active through regular pasture turnout and exercise also is helpful.
Alternate strenuous exercise and rest. This is especially true when your horse is involved in sports such as dressage and jumping, which inherently puts more stress on the joints.
Olympic medalist dressage rider Charlotte Dujardin strongly advocates switching between arena workouts and hacks across the countryside.
Horses are athletes and, as such, need time to recover after strenuous workouts. Providing ample time for rest is a practice that keeps your horse mentally and physically sound for years to come.
Many horse owners believe strongly in supplements for joint health. And there are a bunch of different ones currently available.
Most veterinarians agree, however, that more research needs to be done to determine their effectiveness. Nonetheless, there are several ones felt to be beneficial and commonly recommended. Talk with your veterinarian for the scoop on their personal favorites.
As with most things in the horse world, the decision to treat with hock injections is an individual one. Hock injections are a common procedure, but not one without risks. Obtaining an accurate diagnosis is key to improving the odds that an injection will be successful. Working with your veterinarian is always the best way to ensure what you decide will ultimately benefit your horse.
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Dujardin, C. (2018). The girl on the dancing horse. Trafalgar Square Books