Written by a CuraCore Veterinary Medical Acupuncture courses graduate. Signed release obtained from client/author. 4L2018049
Abstract:
Cactus is a 21-year-old, Quarter Horse gelding who presented for acupuncture treatments. Cactus was an active western performance horse but is currently used for light trail riding. He presented for being stiff and difficult to collect under saddle. After treatment, there was improvement in overall quality of movement. His owner reported that he felt improvements in his willingness to collect and his attitude under saddle.
History and Presentation:
Cactus is a 21-year-old, Quarter Horse gelding. Cactus had been used as a barrel racing and team roping horse for most of his life. For the last few years he has been used mostly as a trail riding horse. His owner reports that he has been very stiff under saddle for the last year or so. He has been reluctant to collect and turn tight circles and overall seems less cooperative when being ridden.
He currently lives in a small dry lot in Arizona with several other horses. Two to three flakes of Bermuda grass hay is fed 3 times a day and there is constant access to fresh water from an automatic waterer.
Other than the current issues under saddle, Cactus has not had any major previous medical issues. He is current on vaccines and has an up to date, negative coggins test.
Physical Examination and Clinical Assessments:
On presentation Cactus was bright, alert, and responsive. His temperature was 100.1 F, pulse was 35 bpm, and respiratory rate was 12 bpm. His gums were pink and moist with a CRT <3 seconds. No major wounds or abnormalities were noted. Mild atrophy of the musculature along the thoracic and lumbar spine was noted. When observed at the trot on both circles and straight lines he was very short strided with high head carriage.
A lameness examination was performed to rule out any underlying lameness that could have been contributing to the presenting complaint. The lameness exam included a gait analysis, hoof testers, and flexion tests. These all tested within normal limits.
Musculoskeletal palpation revealed sensitivity in the hips as well as the thoracic and lumbar spinal musculature. Manipulation of the spine showed limited movement in the lumbar vertebrae. When attempting to stimulate a belly lift and lumbosacral tuck, minimal responses were elicited. Cactus was also hypo-responsive to the flick test along the entirety of the spine. When circling the hindlimbs there was minimal drop to his sacrum. This was similar with both hindlimbs. Decreased range of motion was present when attempting to bend the neck to either side.
Differential Diagnoses:
Differential diagnosis for the patient’s unwillingness to perform specific maneuvers under saddle include chronic back pain, osteoarthritis, lameness, or behavioral issues.
Definitive (or Putative) Diagnosis (or Diagnoses):
Based on clinical findings it was determined that the definitive diagnosis was chronic back pain. Based on gait observation and exam it was apparent that Cactus lacked core strength and was painful in the thoracic and lumbar spine. The lack of response to manipulation and limited movement in the back are his way of guarding those areas due to pain. His lack of spinal musculature could be related to chronic back pain and resulting disuse of those muscles. This is likely what lead to his unwillingness to collect under saddle and short strided, hollow backed gait. Given the patient’s age and previous heavy work history, osteoarthritis is still a potential compounding factor but radiographs were unable to be performed due to financial concerns of the owner.
Medical Decision Making:
An acupuncture treatment approach was made using the information gathered from the myofascial exam, musculoskeletal palpation, and clinical observations. Most areas were stimulated directly by choosing points associated with the areas of concern. The back and hindlimbs were the main area of focus.
In choosing which points to stimulate I tried to focus on points that would help with back pain. The core of all treatments were numerous bladder line points to try and stimulate dorsal nerve roots and improve spinal mobility. Due to the resistance with circling the hindlimbs on exam, I also tried to add in some hip triad points and hindlimb points.
Acupuncture Treatments:
Three acupuncture treatment sessions were performed within a two-week window. During all three sessions different elements of the myofascial palpation exam were used to help encourage neuromodulation and act as physical therapy. These elements included flicking along the back, circling the hindlimbs, belly lifts, and lumbosacral tucks
All points were stimulated by dry needling using 0.25mm in diameter and 30mm long needles with the exception of GV14 and BaiHui. 0.30mm in diameter and 40mm long needles were used to stimulate GV14 and BaiHui. Seiren brand needles were used and were left in place for 15 minutes.
Session 1: The points used in this session were GV14, BL10, BL13, BL18, BL21, BL25, BL27, GB21, and BaiHui.
Session 2: The points used in this session were GV14, BL13, BL18, BL21, BL23, BL25, BL27, BL54, BaiHui, GB30, and GB29.
Session 3: GV14, LU1, BaiHui, BL13, BL18, BL21, BL23, BL25, BL27, BL54, and BL40.
Outcome:
Overall improvements to the patient’s quality of life and behavior under saddle were made. When viewing the before and after videos the changes in movement were subtle. Most of the improvement was measured by the client’s opinion of how the horse was working since the biggest issue was the way the horse acted under saddle. At this point, it is assumed that the improvements noted where due to the acupuncture treatments as no other medical therapies or environmental changes were made.
References:
Curacore Integrative Medicine and Education Center. “Medical Acupuncture for Veterinarians Equine Point Mini-Manual”, 2017.
Xie, Huisheng, et al. “A Review of the Use of Acupuncture for Treatment of Equine Back Pain.” Journal of Equine Veterinary Science, vol. 16, no. 7, 1996, pp. 285–290., doi:10.1016/s0737-0806(96)80222-x.
Describe Your Impressions of this Medical Acupuncture Experience:
At first, I was timid in trying new points that I had not worked with before. The more I worked with this patient, the more comfortable I became trying new points and branching out. This case also taught me to think about the big picture and consider additional therapies that may benefit the patient. Looking back, it would have been great to add in more stretches and exercises for the client to do with the patient daily. I think this would have helped add to the outcome of the case.