01/15/2026
The United States are the only country where I've ever seen joint injections being sold to horse owners as "maintenance". When I ask horse owners if they go to an annual visit with their primary care physician and have all of their joints injected they typically say "of course not", but why do they think it needs to be done on their horses?
Joint injections with cortisone are a common method for pain relief in osteoarthritis, but they should be considered critically, as repeated or high-dose applications can cause cartilage and bone damage, tendon shortening or rupture, and an increased risk of infection, making the long-term consequences riskier; therefore, they are often used for a limited time and with caution.
Risks and critical thoughts:
Cartilage and bone damage: Repeated injections can promote cartilage breakdown and even accelerated joint degeneration, especially in joints that are under more pressure.
Tendon and ligament degeneration: Cortisone can weaken tendons and ligaments, increasing the risk of tears (never have I seen that many suspensory injuries anywhere else!).
Slowed healing: Inflammation is important for healing; cortisone interrupts this process and can delay healing.
Side effects at the injection site: Skin discoloration and infections are possible, but infections are rare.
Systemic effects: In metabolic horses blood sugar levels may rise; ACTH levels in cushings horses rise, increased appetite and weight gain are possible.
In humans steroid injections have found to be the cause of Rapid Destructive Hip Disease. Injections in horses are a huge money making factor, so there aren't pharmaceutical companies who are willing to invest money into studies that prove this "maintenance" causes more harm than good.
Regular bodywork that strengthens the musculoskeletal frame and breaks up compensation patterns is the only thing that should be called "maintenance".