Barrel racing is a high-speed discipline, and horses put tremendous strain on their joints—particularly the hocks—to propel themselves around the barrels. With repetition, just about any equine sport can contribute to inflammation of the joints, and barrel racing is no exception. That’s why for many equine athletes, joint therapy is a critical piece of their overall health management. These experts unpack what hock injections can do for your horse and clear up a few common misconceptions.

Why Joint Therapy?

Marty Tanner, DVM, is a specialist in equine sports medicine for many Professional Rodeo Cowboys Association and Women’s Professional Rodeo Association competitors. He works out of Elgin Veterinary Hospital in Elgin, Texas. Tanner says the nature of barrel racing lends itself to hock pain, and hock issues are the most common issue he treats with barrel racers.

“Barrel racing is a high-speed sport associated with a high-speed turn, and that puts torque on the hocks. Those hocks will get a certain degree of soreness from time to time,” Tanner said. “You can alleviate that soreness so they can perform to the maximum of their abilities.”

For barrel racers, Josh Harvey, DVM, founder of Outlaw Equine Hospital and Rehab Center in Decatur, Texas, says he most often injects the TMT—the outer—and DIT—the inner—joints of the hock, which are the lower two of the four joints located in the area—also the two he says cause the most problems for performance horses.

“A lot of these horses are genetically predisposed to fusing in these joints, so sometimes we will have barrel futurity horses that are already fusing in the distal hock joints very early,” Harvey said.

Types of Medication

Our experts say there are three main types of medication used to treat the hock through injection: hyaluronic acid, cortisone and IRAP therapy.

Hyaluronic acid—Of the three, hyaluronic acid is the most commonly used medication for joint therapy. Naturally occurring in the joints when administered orally or injected into the horse, it mainly provides lubrication to the joints, cushioning impact. Tanner prefers Hyvisc because it has a high molecular weight, offering greater viscosity that holds up longer in the joint.

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If your horse shows signs of resistance or reduced ability, be sure to have your veterinarian evaluate its joints to see if hock injections can help. Photo by Abigail Boatwright

“I believe hyaluronic acid results in the longest-term alleviation of pain in the joint, unless there is extensive arthritis associated with the joint,” Tanner said.

Harvey says hyaluronic acid possesses very little anti-inflammatory effects, but it helps to improve the health of the joint.

“Hyaluronic acid has the building blocks for the cartilage and the joint capsule to help improve the viscosity of the fluid,” Harvey said.

Cortisone—Injectible corticosteroids mimic the cortisol that naturally circulates in the body when secreted by the adrenal glands. Cortisone steroids such as intermediate-acting triamcinolone and long-acting depo-medrol work to reduce inflammation in the joint, therefore returning the joint to a quiescent—without troublesome symptoms—state. Tanner says he uses cortisone on horses who have osteoarthritis. He says cortisone products are highly effective, but when repeated too frequently—particularly the longer-acting products—they can accelerate wear on the cartilage. He typically uses Vetalog and Betazone.

“[Cortisone injections] are very strong—it’s the strongest thing you put in a joint to alleviate soreness, but the downside is that you can’t use it too frequently because it can have a softening effect on the cartilage and can increase the wear on the cartilage,” Tanner said.

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Barrel racing puts a repetitive strain on horses’ joints due to the torque on the hocks generated by powering around a barrel. Photo by Verl Luppes

Harvey usually uses a compound of a corticosteroid, hyaluronic acid and an antibiotic to reduce inflammation, nourish the joint and reduce chances of infection from the needle entering the joint. The mixture is adjusted to suit the horse’s particular needs, and to address the amount of pathology in the joint.

“We do use cortisone in young horses to reduce inflammation,” Harvey said. “But they get a smaller amount than an older horse, with a greater amount of hyaluronic acid if they have more joint space. Horses with severe osteoarthritis are going to get less hyaluronic acid because there is less cartilage to nourish.”

IRAP therapy—IRAP stands for interleukin-1 receptor antagonist protein. It is a serum created from the horse’s own leukocytes—white blood cells, which are incubated for 24 hours, then centrifuged into a serum injected back into the horse, often at the hock joint. It acts as a natural anti-inflammatory. IRAP has been on the market for a couple of years, and it’s shown to be a good option for some horses. Tanner feels IRAP can help heal the joint, rather than only treating inflammation.

“The benefits are it is made from the horse’s own product, so it’s very kind to the joint itself, especially for horses who have to be managed long-term,” Tanner said.

The downside to IRAP is the cost—it is more expensive than the other therapies available for hocks, and Tanner says the effects don’t last as long.

“It’s very kind to the joints, it does a good job, but you’re going to have to treat more frequently with that product,” Tanner said.

Tanner often blends hyaluronic acid and IRAP products when treating hocks. He will also use IRAP in between conventional joint injections to spread out the need for the use of synthetic products.

Implementation

Before beginning treatment, Harvey always starts with a thorough exam to determine where the soreness is occurring and possible causes.

“What everyone needs to remember is a good thorough exam is the key,” Harvey said. “Check everything: check rear feet, check ankles, stifles, back, sacro-iliac, check everything on the horse before you settle on the issue being in the hocks. We know the repetitive nature of barrel racing does take a toll on horses’ hocks, so that’s usually where we start. Remember, horses are not vehicles. They don’t get regularly scheduled maintenance. You have to do a good exam before you just go and inject the hocks.”

The exam will give the veterinarian valuable information to treat your horse, based on how the horse responds.

“Sometimes, it’s low-grade pain and it could be showing up as anything from a small performance issue all the way to a lameness issue,” Harvey said.

Harvey says the proximal suspensory ligament is located near the distal joints, which can be confused with hock joint issues, so it’s wise to rule out other issues before injecting the hocks. Harvey says not all hock pain is due to osteoarthritis, which is the breakdown of joint cartilage and underlying bone.

“Sometimes, the horse can just be inflamed in those joints without osteoarthritis,” Harvey said.

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Hock injections can be beneficial for joint maintenance but are not a preventative treatment. Photo courtesy Wyatt Paul

When injecting the hocks, Harvey checks placement of the needle using a digital X-ray machine if there is any question to make sure the needle is in the correct location in the joint. After joint therapy such as hock injections, Harvey says it’s important to allow the horse’s body to rest before returning to work.

“I’m a firm believer that after you inject hocks, give them five to seven days’ rest and let those joints quiet back down again,” Harvey said.

He says it’s a mistake to run your horse too soon after hock injections.

“If the horse is lame enough to need joint injections, he warrants getting five to seven days off,” Harvey said. “The whole goal of joint therapy is to let the joint return to its normal state. You are trying to improve the health of the joint. You’re not just killing pain. All the medications you are putting in the joint are to help improve its health, so let them do their job. Let the cortisone quiet the joint down and the hyaluronic acid nourish the cartilage. Otherwise, you’re almost wasting that injection.”

Harvey says the horse’s body determines how often it needs hock injections.

“It goes back to how much osteoarthritis is involved, how much inflammation is involved and how much cartilage damage has occurred,” Harvey said. “Depending on how often the horse is running and the condition of the hocks, you can find a schedule that works. For some horses, that means injecting every four to six months. Other horses only require it once a year. But I think that is where the relationship between the horse, the owner and the veterinarian is pretty important to monitor the horse’s condition.”

Clearing Up Misconceptions

One common myth is that once you start joint therapy with hock injections, you will always have to inject them for your horse to be comfortable.

“The whole goal is to quiet the joint down and bring it back to normalcy,” Harvey said.

However, if a horse has a large amount of cartilage damage or osteoarthritis, to keep the horse at a comfortable level, maintenance injections will have to be administered.

“A lot of times, it’s just an inflammatory component. If you reduce that inflammation, let the horse rest and let the joints return back to normal, the horse will get better with therapy,” Harvey said. “Sometimes, if you don’t have any osteoarthritis, and you inject the horse, the therapy can be almost curative, because it returns the joint back to normalcy.”

Tanner says repeat injections aren’t a guarantee, but if you’re treating the joint pain because of osteoarthritis, for example, you will have to continue to treat the cause in order to address the symptom.

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Before having your horse’s hocks injected, it’s wise to have the horse thoroughly evaluated by your veterinarian. Photo courtesy Wyatt Paul

“You had to inject that joint for a reason, and that reason may persist,” Tanner said. “If that reason continues, you’ll need to inject again. Whether the job they have is hard on the joints or they have started to develop some low-grade changes to their joints—those aren’t going to go away. You may have to treat the joint again—not because you injected the hock, but because the horse has a condition.”

Harvey says some horse owners are fearful of using cortisone on young horses. He injects a compound of medication based on the horse’s needs, so a younger horse may not require the same amount of cortisone as a seasoned mount.

“For a young horse, I would definitely add hyaluronic acid to the mix, but if their radiographs are good and clean and there isn’t a lot of osteoarthritis like we see in older horses, we don’t need as much cortisone versus that older horse,” Harvey said. “But cortisone is not bad to use in the hocks. It’s almost a necessity. If you don’t reduce the inflammation, then there is no way to get the joint quieted down and returning to normal.”

Tanner says one misconception he’s come across is using hock injections as a preventative measure against soreness.

“It’s not a vaccine,” Tanner said. “It’s made to treat pain, but I wouldn’t go into a joint unless you need to. If you need to inject, inject, but if you don’t, then don’t inject. There is no guarantee that if you inject the healthy hock today, three or four weeks down the road he won’t get sore.”

When to Inject

Harvey says if your horse is having pain in its hocks, it may show discomfort early on by running past the first barrel, flagging its tail or trying to lean in to the barrel. James Barnes of Hamburg, Arkansas, trains futurity horses and was the reserve champion at the Old Fort Days Futurity. Barnes says he looks for sudden changes in the performance of a horse, particularly if the horse was previously easy-going.

“If a horse is doing really well, but suddenly quits working—it starts leaning on me going into a barrel or doesn’t want to stop on its rear end anymore—one of the first things I do is take the horse to the veterinarian at that point,” Barnes said. “Colts don’t normally wake up and run into the fence or try to knock a barrel over. So normally, when things are going good and smooth, and then all of a sudden you have an issue and it seems to be more than a bad day, I’ll have them checked out.”

Barnes says he’ll give the horse a day off to see if the horse improves, but if the horse is continuing to resist what it previously did well, he’ll take the horse to the veterinarian. Barnes says it’s not always the hocks—he’s had cases where it was something in the front end, a coffin bone or the navicular bursa. Once the horse’s source of pain was treated, the horse went on to compete to its best potential.

“Don’t be against taking your horse to the veterinarian,” Barnes said. “If you’re asking the horse to run for its life and it’s not performing like it was last month or last week, be considerate of the horse’s wellbeing. They are athletes. If your back was hurting, you’re going to do something about that pain. The horse can’t tell you it is hurting. You have to be a smart enough horseman to realize something isn’t right with your horse when its performance is not as good as it once was.”

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