Written by a CuraCore Veterinary Medical Acupuncture course graduate. Signed release obtained from client/author. 10L2018025
Abstract
Poor performance is a common complaint in our horses. Temporomandibular joint (TMJ) pain and neck pain, particularly poll pain can be a significant cause of reduced athletic ability in equine athletes. This can cause stiff or abnormal neck carriage, resistance of the bit, reduced rideability, difficulty bending and sometimes forelimb lameness. Poll pain can be a difficult area to treat and with increasing demands for alternate therapies to get the horses performing to the best of their ability with zero withdrawal times acupuncture can play a huge part.
The aim of this study is to demonstrate how effective acupuncture is at treating poor performance and reduced rideability issues related to temporomandibular joint pain and neck pain particularly from the poll area in performance Horses.
Acupuncture alone is highly effective at solving poor performance due to temporomandibular joint pain and poll pain providing there is no underlying issue.
History and Presentation
Biblou is a 2010 bay warmblood show jumping gelding. The owner complained of a head tilt to the right and stiffness through circles.
Physical Examination revealed discomfort to palpation of the right masseter muscle distal to the temporomandibular joint (ST 7). There was significant adverse reaction to palpation on the right as compared to the left. Pain was also found at the poll region. There were myofascial trigger points through the brachiocephalicus and splenius muscles found by localizing tender palpable points within these taught bands of muscle. This pain to palpation and generalized stiffness led to reduced range of motion through the head and neck when I asked Biblou to horizontally and vertically bend.
Neurologic examination was within normal limits. Lameness exam was within normal limits. When ridden and cantered in circles to the left instead of bending round the turn he tilts his head, pointing nose inwards without bending his whole body and drifts to the outside. He was significantly better circles to the right. This becomes a problem when in a jump off situation making a tight turn after a fence to the left or bending related distances where Biblou drifts out to an outside line.
The problem is a decrease in performance from a decrease in rideability due to an unwillingness from pain and not behavioral.
Clinical signs of disease of the temporomandibular joint include signs of pain during manipulation of the mandible or palpation of the joint, atrophy of one or both masseter muscles, a fistulous tract over the joint, bony enlargement of the region of the temporomandibular joint, abnormal prehension and mastication of feed, dental malocclusion, and restricted range of motion of the mandible. Less obvious problems associated with disease of the joint include abnormal behavior, such as a change in head carriage, bitting problems, headshaking, and quidding. Disease of this joint may be overlooked in horses because clinical signs are often nonspecific.
Differential diagnoses include muscle and bone pain along with vertebral abnormality. Routine dental care is imperative for proper TMJ functioning as referred pain from the teeth can cause TMJ pain. Performance stress on the TMJ caused by over flexion of the head and neck when using a particularly strong bit or training aid or bad riding can also cause TMJ pain.
It may be from how the horse is being ridden in a false collection and hollowed back outline, an ‘inverted frame’ where the legs trail out behind pulling back in the form of behavioral or local injury. It may also be from pulling back on cross ties or when tied. Emotional stress and stable vices can also cause TMJ problems. Cribbers work their jaws constantly as they bite on railings or other objects. Horses in stressful conditions may grind their teeth. Pain could even be from a front-end lameness issue or shoeing issue. Stomach 7 reaction from one side only may indicate ipsilateral sacral or hip pain (Dr. Tim Holt)
Even though Biblou has regular dental work a speculum was placed and teeth inspected. They were found to be within normal limits. Cervical and temporomandibular joint radiographs and ultrasounds were performed and were within normal limits also. Lameness was ruled out, leaving the definitive diagnosis as myofascial pain from taut muscle bands.
Dry needling was performed once a week for one month of January with 0.25 and 0.20 x 30mm Seirin acupuncture needles. The owner was also taught how to perform carrot stretches, bringing Biblou’s head past the shoulder maintaining the face perpendicular with the ground. At first Biblou could not perform this without poking his nose, by the end of the month he was able to maintain his face perpendicular with the ground and showed increased flexibility. These were completed three times a week. Draw reins were only used loosely. Biblou was lunged in a Pessoa Lunging System once a week with his head low to round his back.
During the weekly acupuncture sessions. LI 16 was placed first for anxiety, followed by LI17 and LI18 for throat and neck problems, BL10 for cervical pain, headache and pain near the poll and upper cervical region, TH16 for neck pain, TH17 for facial nerve, GB20 for head and neck pain and local cervical points, GV 14 for neck pain, ST 7 for TMJ pain and SI16 for cranial neck pain.
Outcomes, Discussions, and References
Biblou responded well to treatment. His myofascial exam improved, exhibiting less pain and adverse reaction to palpation of the head and poll area. He no longer fought as much approaching the fences and was altogether more rideable. Acupuncture was extremely helpful in relieving the inflammation, pain and tension associated with temporomandibular joint and poll pain. Acupuncture resolves the origin of the condition, ultimately eliminating the pain and discomfort of the symptoms. So, in using acupuncture we are treating the root cause – stress, muscle tension, system imbalances, as well as the pain in the jaw area. Acupuncture relieves muscle spasms and decreases pain and swelling, releasing the jaw naturally for the joint to move freely. If there had not been such a notable increase in improvement the next step would have been to inject the temporomandibular joint and cranial cervical facets with steroids. Moving forward Biblou is going to receive acupuncture once a month and additionally before he enters a big show jumping class.
References;
Rosenstein DS, Bullock MF, Ocello PJ, Clayton HM, Arthrocentesis of the temporomandibular joint in adult horses, Am J Vet Res, 2001; 62:729-733
Moll, H. D. and K. A. May. A review of conditions of the equine temporomandibular joint, in Proceedings. Am Assoc Equine Pract. 2002;48:240-243.