Every time I get Kingsley out of his stable I hope for some miracle to happen. I hope to see him moving with no sign of discomfort, loose and supple like any healthy, sound, happy 5 year old horse would. But of course, it's not as easy as that.
After a lot of lost time with previous vets we went for a completely different Veterinary practice and Kingsley is now in hands of a back/spine focused vet.
Richard thinks Kingsley shows very classic signs of Sacroiliac (SI) disease/strain but because of high level of pain in the poll area as well as neck muscles and rather distinct way he carries himself over the back (extremely one-sided) he needed to rule out Kissing Spine disease first.


The Poll

These showed a tiny bone chip just behind the poll, in between the ears. On the image it looked like one of those little cork board's pins pinned onto the bone. Apparently some horses' polls do look like that though and it could be a normal thing to have. However, it could also be a result of rearing and hitting the head and any similar trauma injury. Considering how sore Kingsley is on palpation and the only a very slight abnormality of the x-ray, the vet concluded it is probably mostly a soft tissue problem after an old injury.
We will be treating this with physiotherapy sessions under sedation in about 4 weeks time.

The Back

All his thoracic and lumbar vertebrae look great. There are wide spaces in between them and all looked nice and healthy from radiographic point of view. The sacral area cannot be X-rayed with a portable machine as it's not powerful enough. The amount of muscle tissue in the loins and hindquarters doesn't allow the rays to penetrate deep enough.
However, Kingsley is mildly back sore and extremely one-sided and if allowed to stand in preferred position he will always move one or the other hind leg underneath his barrel and if you look at his spine from above he holds himself in a bit of an 'S' letter with a lot of body mass bulging to the right.
A bit like in the below photo but the other way round:

This we will also treat with physio in several weeks time.

The Sacro-iliac/pelvis

To be able to X-ray this area we would have to transfer Kingsley to Vet clinic. The soreness of the area is not a secret (he almost goes down as you prod around the pelvis). He also displays following clinical signs: unlevel pelvis (ever so slightly but still - apparently can be normal but not if pain is present), intermittent hind leg lameness, the stance with one hind leg always propped forwards, avoiding square stance, strong reaction to palpation, unbalanced movement, rushing in all gaits or refusing to move properly forwards, dropping into four beat canter, back soreness, and the list goes on.

The diagnosis

The current diagnosis is: sacroiliac disease/strain, poll and neck soreness due to an old injury and way of going caused by sacroiliac (i.e. front leg unlevelness shows up as a result of a horse compensating for the pain in the back and pelvis).
The sacroiliac problems could have been a result of competition/ridden/field injury in the past, been unnoticed when horse was in rest and resurfaced when horse was brought back into work.
I was also told by someone who exercised Kingsley in between the day of the vetting in Aug to the day we picked him up in Spt that he was always ridden in draw reins and lunged in pessoa. Now, I am not going to get started on both of these but as I have spent a while reading up all I could find on sacroiliac injuries it seems that they do become aggravated by pessoa lunging gadget. If he was sore in the back and pelvis but had his neck snapped down by draw reins could he have developed muscle soreness in the neck in an effort to alleviate the back pain?

The Treatment

Either way, Richard the Vet suggested cortisone injections which are basically steroids injected into sacroiliac area in between tendons, soft tissue and joint. Their role is to kill the inflammation and pain and help the healing process. It seems that even if he was taken to the clinic for bone scan to fully confirm the severity of the problem, the first thing that is being done now in cases like his is to inject anyway.

Injections are basically both the treatment and diagnostic tool in one. If the horse improves, it definitely has sacroiliac strain/disease/problem whatever you want to call it. If it doesn't then the bone scan is the only way to take diagnosis further.
So we went with injections.
However, they are steroids...and some horses might develop laminitis due to injections. That and various allergic reactions too.

The Rehab

So we are now on (providing he doesn't get worse):

3 days of box rest post injections followed by
2 weeks of limited turn out daily followed by
1 week of slowly bringing back to work on the lunge followed by
Richard coming back to assess the level of improvement before walking under the saddle starts.

Providing all goes well with that he should be ready to have more rehab done on his muscles and will have physio work done under sedation on his neck, poll and back.

So I stayed with little man until he was fully awake from sedation, munching on his hay. He's got a dressing on where the mahosive needles went in and it's to stay on for 48h. There is a slight possibility of infection as always with any under skin invasive procedures so I asked friends to keep an eye on him as I am not there tomorrow.

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