By:
Dr. Angela Holland
Chester, UK
Abstract
Acupuncture therapy was successfully used to treat a 7 year old dressage horse (Dutch Warmblood) who was failing to move with propulsion in canter and had no energy. A 2 week course of dry needling acupuncture therapy was used. The horse was kept in light work whilst the treatments were carried out and ultimately the owner reported the propulsion and performance of the horse was significantly improved.
History
Prior to my appointment, the owner had thought that the horse lacked energy and that was why it was not moving forward for the previous couple of months. She had tried increasing and changing the feed given to improve the situation as she had no idea there was any pain in the lumbar region. The changes in feed had provided no significant results. The owner thought that for work the horse was in that it also should have more muscle and topline.
The horse was on no medication and had no history of medication other than routine vaccinations.
There were no other past problems noted in the history
Clinical Signs/Diagnostics/Diagnosis – Convention (Western)
On examination, the horse was quiet and relaxed in the stable. Heart rate was 45 beats per minute. Respiration rate was 12 breaths per minute. Temperature was normal. The horse was of body condition score 7/10. The owner had not called their vet to investigate the horse and so there were no additional diagnostics to analyze. The owner was upping the horses concentrate feed to include more cereals to “give the horse more energy”. The horse was sound at walk and trot in a straight line but struggled maintaining canter on the left rein choosing to fall back to trot whenever he could. He was negative to hind limb flexion. There was general tightness in left lumbar region and he dipped his back on palpation just to the left of the left tuber sacral.
Clinical Signs/Diagnosis – TCM (Eastern)
The horse was quiet and relaxed in the stable. His eyes were bright but he was quiet in all his body movements. There was no discharge from eyes or nose. His coat was bright and shiny however there was loss of hair over the point of his left shoulder over LI 15 with no change in temperature or pain on palpation. Whilst he had some muscle on his hamstrings he was in work 5 days a week and there was not as much as I would have expected, he also had a weak topline. There was body symmetry in his musculoskeletal system. His ear temperature was slightly cold. On palpation of his Mu and Back Shu points there was discomfort over BL 21, BL 22, BL 23, BL 24 and BL 25 but this was only found on the left-hand side. There was slight discoloration of the hair over the Spleen Back Shu point BL20 but no response to palpation. All the Mu points were normal. Palpation of the ting points was normal and hoof quality was good.
The owner reported the horse had was eating but could take or leave his food. There was normal faeces with no odour on the floor and the owner reported normal urination.
His tongue was slightly pale in colour but there was no change in shape or cracks and moisture was normal.
His pulse was generally weak and slow.
On palpation of the horses’ indicator points he was positive on LI 16 on the right and the bladder points listed above on the left. All the others were negative. It was also observed that the horse was consistently resting his left hind leg and when he did stand on it it was toe out. His medial thigh muscles on the left were tight.
An Eastern diagnosis of Muscle Bi with Spleen Qi Deficiency was concluded.
Western Treatment
I advised the owner that in addition to the acupuncture that the horse may benefit from seeing a chiropractor to rule out any underlying cause. He was on no current treatment.
Eastern Treatment
The basis of the treatment protocol was to remove the pain in the muscles by moving the stagnant Qi and blood and to tonify the Spleen Qi.
The points used were:
Bai hui, Bl18, Bl 40, Bl 25, St36, Sp 6, Qi Hai Shu
Immediately post treatment there was improvement in the horse, the muscle pain along his left side of his back had gone and the indicator point on his right LI 16 was no longer painful. The owner was advised to keep the horse in the light work and I would return the following week
The owner reported that the horse had been much improved for the first four days working well however he had then started to feel not quite right again. She reported that his appetite had improved and that he had not been resting his left hind leg as much as he normally did. She said that he was still quiet in himself.
On repeat examination, his pulse was generally stronger and his tongue was now normal in colour. The muscles on his left hand side were not as painful but there was still some discomfort on palpation of the Back Shu Points BL 22, BL23 and BL25. The discoloration of hair had improved at BL 20. All the Mu Points were normal. The above treatment was repeated however Moxa was also used at Bai Hui with this treatment. I also added in Qi-Hai-Shu.
Again, immediately post treatment there was a significant improvement in the horse with the painful points diminished. The horses pulse was also much stronger.
I advised the owner to continue with the low level exercise and that I would see the horse again the following week.
The owner rang and cancelled the appointment as she said the horse was doing really well , was much brighter and she was pleased and wanted to see how the horse went.
Discussion
Flanders is a 7 year old warmblood gelding who was presented with a history of poor performance, lethargy and lack of muscular condition. His role was a dressage horse.
On exam Flanders was found to be quiet in his demeanor but bright with it and eating. He had a bright shiny coat but did not appear to have great muscle quality or quantity especially over his gluteals. The Spleen “Dominates the Muscles….” Skoien J (2015). His tongue was difficult to get out and pale and his pulse was generally weak and slow which Skoien J (2015) details are all indicators of Spleen Qi deficiency.
As per Craig D (2015) the “soreness and ….pain” he had in his muscles on his left caudal back region indicated a Muscular Bi Syndrome . The pain seemed to run along the Bladder tendinomuscular meridian BL 21, BL22, BL23 and BL25. Van den Bosch E (2016) states that with BL21 “There is a chiropractic connection here to hindlimb pain..”, BL 23 “Reactivity here may indicate local lumbar pain/subluxation” and BL 25 “Reactivity may indicate hock and/or hip pain”. Therefore, it was important that I advised the owner to get a chiropractor to see the horse as well. There was also pain at LI16 on the right side only. All meridians were checked over but no other sensitive points were found.
The way Flanders was standing with his hind legs underneath him “stresses not only the hamstrings and medial thigh muscles but croup and sacroiliac areas” Henneman K (1997) and “Spleen, Kidney, Large Intestine, and Triple Heather meridians are compressed (obstructed)” Schoen (2001). This fits with the finding on Flanders.
Based on the diagnosis the treatment was decided upon with the aim of tonifiying the Spleen Qi and moving the Qi and blood stagnation, therefore removing the pain.
Bai Hui was used as it the point where all yang channels merge and is beneficial to the caudal back. It was used with Moxibustion (mugwort leaves) at the second treatment by a warm needle technique to move the Qi and blood and for warmth as explained by Puertas Navarro D (2015).
BL 18 was used as a proximal point to the pain and additionally so it would benefit the Liver Qi. One of the Livers main functions is to move the Qi and therefore it is vital that is working well to help with the Bi Syndrome or treatment will not work so well. BL 25 which is the Large Intestine Back Shu point was used as the local point. BL 40 was chosen as the distal point but also because it is the Master Point Of The Caudal Abdomen And Hips. SP 6 was used to tonify the Spleens function of transformation and transportation and to benefit the muscles.
Qi-Hai-Shu was added on the second treatment to benefit the Qi and help with the weakness and poor performance.
“Most acupuncture points are located at areas of low electrical resistance and high electrical conductance….. there are free nerve endings; small arterioles, veins and lymphatics and; tissue mast cells” Clemmons (2015). Acupuncture needle insertion causes micro trauma which produces a local inflammatory reaction (Ridgeway, 2005). This inflammatory reaction causes vasodilation which increase nutrients to the area, remove metabolites and speeds up homeostasis therefore supporting healing. It also releases local Substance P and CgR P which in turn increases vasodilation. The inflammatory mediators released stimulate C fibers and block pain through the descending inhibitory pathways. Acupuncture also has effects centrally and peripherally to lessen pain. Centrally its work segmentally, blocking pain at the spinal cord, modulating the autonomic nervous system and influencing motor output. Suprasegmentally by activating the descending inhibitory pathways and modulating the adrenergic system so together they achieve the maximum and most sustained results. Following acupuncture a significant increase in beta endorphins has been found in plasma and cerebrospinal fluid in horses (Xie et al 2001) and electroacupunture results in a greater beta endorphin release than needling (Scarda et al 2002). Beta endorphin is useful as it increases T Cells and Natural Killer Cells. Other effects are to inhibit Prostaglandin E which sensitizes the spinal cord to pain and to regulate neutrophils and cytokines which are involved in neurotrophic pain.
Overall the initial progress was good with Flanders however it would have been better to continue to have seen him again. I am expected the owner to call me as I don’t anticipate two treatment is sufficient. Le Jeune et al (2016) states that it usually takes at least 3 consecutive (weekly) treatments to obtain long lasting clinical resolution of back pain…..then regular monthly acupuncture treatments”. The owner informed me that she did have a chiropractor coming out to see him which is good as le Jeune et al (2016) state that the “duration and quality of effect of acupuncture treatments may be improved by incorporating chiropractic treatments.”
Without acupuncture I think Flanders would have continued to deteriorate and possibly ultimately developing Bony Bi. Back pain in performance horses is very common or horses that are underperforming but are not lame and is often therefore missed by the owners. I would like to try electroacupuncture on a back pain case but do not currently have a machine. The benefits are clear in the literature for example Xie et al 2005 showed that horses that had electroacupuncture verses phenylbutazone and 0.9% NaCL had a significant decreased pain score, however there is still much more research needed to be carried out.
Overall I feel Flanders benefitted from the treatment of acupuncture. The owner is going to keep in touch with me and let me know how she gets on with the chiropractor. Hopefully I will see him again and together the treatments should give the optimum results for the owners and horse.
References:
Clemmons R. IVAS Course Notes: Certification in Basic Veterinary Acupuncture (2015) Chapter 39, Page 746
Craig D. IVAS Course Notes: Certification in Basic Veterinary Acupuncture (2015) Chapter 15, Page 383
Henneman K: TCM and biomechanics in the performance horse. Salt Lake City: Choices in Health, 1997
Le Jeune, Sarah, Henneman, Kimberly and May, Kevin. Vet Clin North Am Equine Pract Volume 32/Issue 1. (April 2016): Pages 73-85.
Marcus, Alon. Foundations for Integrative Musculoskeletal Medicine: An East-west Approach. California: North Atlantic Books, 200
Puertas Navarro D. Acupuncture & Moxibustion Techniques Lecture Notes: BEVAS Basic Acupuncture Course 2015/2016 (2015) Page 82
Shoen A. Veterinary acupuncture:ancient art to modern medicine(2nd Edition). Missouri: Mosby, 2001
Skoien J. Zang Fu Pathology. IVAS Course Notes: Certification in Basic Veterinary Acupuncture (2015) Chapter 13, Page 283
Skarda, R, Tejwani, G: and Muir, W. American Journal of Veterinary Research Vol. 63, No. 10, October 2002, Pages 1435-1442
Van den Bosch E. Indicator Points Lecture Notes: BEVAS Basic Acupuncture Course 2015/2016 (2016) Pages 25,26,27
