Your horse is working hard, and your trainer has recommended you sign him up for next week’s hock injections. Of course, your barn buddies all agree—they all have their horses injected at least three times a year for maintenance. Reluctantly, you go along with the plan even though your horse seems sound and has been working well. If you want to win, you figure you’d better do what everybody else is doing. That’s just how things work in a big show barn, right?

Not necessarily! In fact, “routine joint injections” and show-day medications might not be the healthiest choice for your sound, hard-working horse. A “magic pill” might sound appealing, especially if it could make your horse slide farther, turn a barrel faster, or take the edge off for a rail class. But rarely does it take the place of good old-fashioned horsemanship.

In this article, I’ll share five common scenarios where medication-heavy plans are relied upon to maintain health. You’ll learn why a quick fix might not be the best answer and what alternatives you can consider to replace that “magic pill.” In the end, you’ll see that although medications have their place in keeping your horse sound, healthy, and performing well, proper management is your most important tool.

Scenario #1: Flex and Inject
The subject: Sam is a 12-year-old reining horse that campaigns hard with his owner in the youth division. He’s always been quite sound and healthy, and competes almost every weekend during spring and summer months.

The plan: Two weeks before competition season starts, Sam is scheduled to have his hocks, stifles, and coffin joints injected with steroids and hyaluronic acid. Sam’s trainer says it’s just like changing the oil in a truck—because Sam’s a little older, he needs to be lubed up to remain sound. Sam also gets two grams of bute every night during competition. All of his medications are carefully planned out to avoid rule violations. →

Why not?: There’s absolutely no justification for injecting “healthy” joints to help maintain soundness; in fact, this practice could actually be harmful. A normal, healthy joint is constantly replenishing its own joint fluid—a very different scenario than the oil in your truck. Every time a joint is injected, there’s risk of an acute inflammatory reaction called a “flare” that can take your horse out of action for weeks or longer, or of an infection that can be life-threatening. Repeated injections into joints can weaken bone over time, increasing the risk for catastrophic fractures.

Non-steroidal anti-inflammatory medications can also be hard on your horse’s system, especially when given frequently to a hard-working horse that lives a stressful lifestyle. Stomach ulcers are a risk as well as kidney failure.

The alternatives: When it comes to joint injections, consider hard if your horse really needs them. Instead of signing up for “maintenance” injections, schedule a soundness exam. Your vet will palpate your horse’s limbs, watch your horse move, perform stress tests on his joints, and possibly watch him work.

If she identifies areas of concern, she’ll likely recommend additional diagnostics such as radiographs or ultrasound. With this information, she can recommend a management plan.

Does that mean a joint should never be injected with medication? Absolutely not. For diagnosed conditions where joint inflammation is involved, a joint injection is probably the most effective treatment available and may be a necessary part of the solution. Injections might be recommended to help manage chronic arthritis in an older performance horse. They might also be used to treat an acute injury, often followed by a period of rest to allow for healing.

When it comes to longevity in a performance horse, the worst thing you can do is inject a joint and continue work if your horse has an acute injury requiring rest. By opting out of “routine” injections, you’ll avoid this risk. You’ll also eliminate unnecessary risks associated with injections if you just say no to injecting a perfectly healthy joint.

Use the same careful consideration with anti-inflammatories. If your horse is stiff and sore all the time, find out what’s wrong and correct the problem. Evaluate his shoeing, pay close attention to footing, and consider adjusting your training schedule to allow for better conditioning and less intense work. If you’re on the road chasing points every weekend, consider a less rigorous competition schedule.

Scenario #2: Extra Energy
The subject: Bubbles is a 10-year-old Quarter Horse mare that competes in Western pleasure at breed shows. She’s feisty, and often has too much energy in the show ring. While she does well when ridden by her trainer, she’s difficult for her novice owner to handle without lots of preparation.

The plan: Bubbles is on a magnesium supplement, and on several occasions she’s been given intravenous magnesium prior to especially important events. She’s given a dose of dexamethasone every evening during horse-show weeks. In addition to her meds, she gets longed for 45 minutes every morning at the horse shows.

Why not?: Her magnesium supplement won’t hurt, but intravenous magnesium certainly can. In fact, you’re risking Bubbles’ life with this calming strategy. Intravenous magnesium can impact your horse’s heart and lead to sudden death. Even oral magnesium violates the rules in many disciplines, where any supplement given with the “intent to calm” is forbidden.

The same is true for dexamethasone. Although this corticosteroid is allowed in competition if used as a legitimate treatment for an allergy, when given with the intent to calm, it’s against the rules. Dexamethasone can have negative impacts on Bubbles’ health, including suppressing her immune system and causing laminitis. These health risks are further compounded when she’s stressed during travel and competition. Additionally, there’s absolutely no scientific data that substantiates a calming effect associated with dexamethasone. All risk, no benefit.

Finally, the “longe into the ground” method of calming may avoid medications, but it certainly doesn’t fit into the category of “better management.” Horses that spend hours on the longe line every week are more at risk for orthopedic problems.

The alternatives: Bubbles’ extra energy is much better managed through training—both for her and her owner. If she does well with the trainer, it’s possible her owner’s lack of experience feeds her nervous energy. Sometimes this means asking tough questions: Is Bubbles really the right horse for her owner? Or would the mare be more successful in a different situation? Along the same lines, perhaps her energetic personality isn’t the right fit for a pleasure horse, and she’d be better suited to a different discipline. Those are tough things to think about but are the kind of horsemanship decisions that can make life better for both horse and rider.

If Bubbles’ owner is committed to helping her horse be a successful Western pleasure mount, she might consider multiple long hand-walks every day in place of sedating medications and endless longeing. A 30-minute hand-walk around the show grounds three to four times a day can go a long way toward controlling nervous energy, plus allow Bubbles to better connect with her owner.

Scenario #3: Allergy Sufferer
The subject: Splash is a 15-year-old Paint gelding used for Western dressage. He always coughs a couple of times when he starts to work, and sometimes the cough persists throughout the ride. Splash’s owner doesn’t have a lot of time, and just wants a medication to keep the coughing under control.

The plan: Splash gets a dose of dexamethasone every other day, which seems to keep his cough at bay. If it gets really bad, his owner increases him to daily dosing.

Why not?: Dexamethasone is effective for treating a wide variety of problems, but it isn’t without risk. Its effect on Splash’s immune system puts him at risk for developing infections, and long-term use of this corticosteroid can lead to a life-threatening founder episode.

The alternatives: Don’t overlook management of the environment. In fact, careful environmental management could eliminate the need for medications at all.

Splash’s owner should pay close attention to hay quality and consider watering Splash’s hay at feeding time, as well as choose bedding carefully to reduce dust. Studies show that dust in a barn is as much as 16 times higher when stalls are being cleaned, indicating turnout during cleaning time is an important management step. This will also minimize lung damage from ammonia that pervades the air at cleaning time. Improved barn ventilation with fans or by installing cupolas that allow dust and air to escape the barn can help, and Splash should be moved to a stall as close to the outside of the barn as possible. Finally, supplementation with an omega fatty acid can be quite effective for controlling allergies.

While management may not completely eliminate the need for medication in a coughing horse, it can reduce it significantly and can make it easier to control symptoms with less risky medications than dexamethasone.

Scenario #4: Belly Ache
The subject: Marley is a 5-year-old Arabian gelding in training for endurance. He and his rider recently successfully completed their first 25-mile ride. He gets a little colicky from time to time and had a full-blown colic episode two days after his last ride.

The plan: Marley’s owner is sure he must have ulcers and has decided to start administering omeprazole. Her endurance buddies recommended omeprazole powder from a local compounding pharmacy, which will save money over using a brand name.

Why not?: It’s true gastric ulcers are a common problem, but there are many other things that can cause colic symptoms. And although omeprazole is the most effective treatment if Marley does have ulcers, it’s destroyed by stomach acids and must be formulated in a buffered paste or enteric coated granule to be effective. Plain, unprotected powder—as from a compounding pharmacy—doesn’t work. In this situation, Marley’s owner is administering a medication that won’t work even if this presumed diagnosis is correct.

The alternatives: Gastric ulcers require an accurate diagnosis, which is easily done with a simple and relatively inexpensive diagnostic test called gastroscopy. It allows your veterinarian to look directly at your horse’s stomach lining. If ulcers are confirmed, treatment with a buffered form of omeprazole such as GastroGard is likely to be recommended. However, when it comes to ulcers, proper management is critical for long-term success. Even if your vet doesn’t see evidence of ulcers in your horse’s stomach, many of the following management strategies will help reduce risk of colic from other causes.

To prevent ulcers and keep Marley’s belly comfortable, his owner should provide plenty of turnout time, ideally in the company of other horses. Feeding from a slow feeder or at frequent intervals of six hours or less is also beneficial, along with a minimal amount of grain, fed after hay. Studies have also shown that feeding a small amount of alfalfa hay can also help reduce ulcer risk.

Scenario #5: Oh, My Aching Back
The subject: Toby is a 15-year-old Appendix Quarter Horse gelding used for trail riding. His owner rarely rides during the week, but loves to go on trail rides on the weekends and usually schedules several overnight camping trips each summer. Toby’s back gets sore after almost every ride.

The plan: Toby’s owner gives him two grams of bute every day, starting the day before each ride and ending two days after. For multiple-day rides, he gets methocarbamol (a muscle relaxant) in his grain twice each day.

Why not?: Although it’s an effective pain reliever, chronic bute use can contribute to problems including stomach ulcers and kidney failure. And although many people administer methocarbamol to their horses, there’s not much solid evidence supporting its effectiveness—especially when given orally.

The alternatives: Back-pain management is especially important. Toby’s owner should start by examining saddle fit and taking a serious look at Toby’s fitness plan. It’s just not fair to let a horse stand around all week, and then work hard on a weekend trail ride. Toby needs a plan that includes more consistent exercise, with a focus on stretching and abdominal-muscle strengthening. Incorporating a set of carrot-stretches designed to help strengthen your horse’s core muscles can be really helpful when it comes to back pain. If Toby still gets sore, acupuncture or massage therapy could help keep him more comfortable and avoid the use of medications.

Is There a Time for Medication?
Does all of this mean you should never medicate your horse? Of course not. In fact, joint injections and medications prescribed by your veterinarian for a problem that’s been diagnosed are crucial for maintaining your horse’s health. But it does mean you should turn away from medications for a quick fix—especially when a little good old-fashioned horsemanship is what your horse really needs.