Pelvic Upslip in Horses: From Lameness to Soundness in Two Months

Pelvic dysfunction is one of the most overlooked causes of chronic lameness and movement asymmetry in horses. Yet, just like in humans, an upslip of the ilium—where one side of the pelvis shifts upward and loses proper articulation with the sacrum—can have profound effects on posture, coordination, and even cranial symmetry.

This case highlights how accurate assessment, species-specific rehabilitation, and a supportive environment can restore balance and function in a remarkably short period of time.

Understanding the Injury

The horse initially presented with marked pelvic asymmetry, visible both to the eye and through palpation/range of motion testing. The degree of displacement suggested a traumatic shear—the kind typically caused by a fall, flipping over, or becoming cast.

In human manual therapy, this would be described as an upslip of the ilium: a condition where the ilium is forced upward relative to the sacrum, locking the sacroiliac (SI) joint and disrupting normal biomechanics.

It’s important to note that muscles alone cannot pull joints out of their bony articulations or protective capsules—the nervous system simply doesn’t permit it. When the pelvis shows deviation beyond 3–5 mm, it almost always points to prior trauma and true joint-level injury.

Because the SI joint is desgined to only permit about very small degree of movement, any visible asymmetry typically indicates that the joint has lost mobility.

Key Findings

Initial assessment revealed:

• Right-sided ilium upslip with fixation at the SI joint

• Apparent left downslip (secondary compensation)

• Lumbar rotation toward the affected side

• Functional limb length discrepancy

• Shoulder and cervico-thoracic compensation

• Lameness at the trot

• Resistance and pain behavior during forward and backward movement

A functional limb length difference doesn’t mean the leg is physically shorter—it behaves that way due to pelvic orientation. The horse experiences uneven loading and altered joint angles, similar to a human running with one leg that won’t fully bend.

Despite prior veterinary intervention, including stifle injections, no one had evaluated the pelvis or spine. That’s where our assessment process began.

Treatment and Early Results

The focus of treatment was to restore joint mobility, normalize neuromuscular control, and create the right environment for functional movement retraining.

Each session included:

• Decompaction of the right SI joint

• Indirect joint mobilization of the right ilium

• Indirect joint mobilization of the left ilium (compensatory side)

• Decompaction of the L5-S1 junction and T8-T10

• Indirect de-rotation thoracic cage

• Passive range of motion testing and treatment (spine, pelvis, hips)

• Long- and short-lever spinal oscillations

• Diaphragm facilitation techniques (due to their connection with psoas group)

• Myofascial decompression along the spinal nerves

• Motor control exercises to reintegrate the new mobility neurologically

After just one session, the horse demonstrated improved posture and willingness to move forward. By the second session, the changes were visible and measurable: improved pelvic symmetry, better spinal flexion, and increased relaxation through the topline.

Static photos showed clear evidence of pelvic realignment and a softening through the forehand and neck. Perhaps most fascinating was the change in facial symmetry, even though no direct cranial work was performed. This indicated that tension from the pelvic shear had been transferring up the kinetic chain into the head and cervical structures.

Over less than two months, these combined interventions produced:

• Re-balancing of pelvic alignment

• More symmetrical limb loading

• Increased hip, stifle, and hock flexion

• Softer, more integrated spinal movement

• No observable lameness at the trot

The Power of Active Evaluation

Still photos tell part of the story, but movement tells the truth. In this case, before-and-after video comparisons revealed the most striking progress:

In these clips, you’ll see:

• More symmetrical limb loading

• No more limping or rushing off the right hind

• Increased flexion through the hip, stifle, and hock (less functional shortening of RH)

• Softer topline and reduced inversion through the spine

As the pelvis realigned, the limb returned toward neutral, eliminating the appearance of a shortened leg.

Pelvic shears like this one create a cascade of compensations throughout the body. Left untreated, they can lead to arthritic changes, joint sprains, and tendon strains over time. Correcting these imbalances early isn’t just about comfort—it’s about preserving long-term soundness.

The Role of Environment in Recovery

Manual therapy was only part of the equation. What truly solidified the progress was the horse’s turnout and lifestyle.

With access to a herd, 24/7 forage, and the ability to move, graze, and play freely, the horse engaged in natural movement patterns that reinforced pelvic stability and strength.

An unexpected but surprisingly functional factor also emerged: one of the herd’s mares came into heat, prompting the gelding to mount—an activity requiring bilateral hindlimb loading and repeated posterior pelvic tilts. In biomechanical terms, this was the perfect therapeutic exercise, naturally retraining the exact motor pattern we were seeking to restore.

It was a humorous reminder that sometimes, nature provides the best physiotherapy.

The Takeaway

This case is a testament to what can happen when we look beyond the surface and treat the horse as a whole.

Pelvic upslips are real. They’re serious. And they’re treatable—with the right combination of:

• Thorough assessment

• Thoughtful manual therapy

• Ongoing reassessment

• Supportive, species-specific care

When a horse presents with unexplained lameness, uneven hips, or what seems like a functional limb length difference, it’s worth investigating whether the pelvis might hold the key.

Healing isn’t just about relieving pain—it’s about restoring balance, coordination, and confidence in movement.

Because when the pelvis is aligned, everything else can finally start to move the way nature intended. 

If you’re a practitioner interested in learning how to assess and treat pelvic dysfunctions like this, explore our advanced training programs to deepen your clinical skillset and refine your understanding of equine anatomy and physiology.

If you are a horse owner who thinks their horse may be suffering from prior pelvic or spinal injury, connect with us to book one-one assessment and treatment sessions.