Written by a CuraCore Veterinary Medical Acupuncture course graduate. Signed release obtained from client/author. 10D2018043
Abstract: Kyle, a 25-year old Thoroughbred gelding presented for back pain, developed during re-introduction of work following a period of significant weight loss and rest. After two weeks in light work, the gelding was noted to develop back soreness under saddle. No medications were given to manage pain, and alternative therapies were sought to address soreness during the training period. Dry needling treatment was performed weekly for one month as work was continued and increased. Improvement in stiffness under saddle and gait was observed after first treatment, with continued improvement following repeated treatments.
History & Presentation: Kyle, a 25-year old Thoroughbred gelding, presented for back pain of two weeks duration. He had lost a significant amount of weight four months prior to presentation, and as such moved to a new barn where there was no competition for feed. Since then, he had been on stall rest and gained weight. He was brought back into light work two weeks prior, and with the introduction of light lunge-line, moderate back soreness had developed. There is no history of joint injections and he had not received any medications for pain relief. Prior to losing weight at the previous barn, the gelding had been in full work with no lameness issues noted.
Physical Exam & Clinical Assessment: On presentation, the gelding was bright, alert, and responsive. He was under-weight, with a body condition score of 3/9. Moderate muscle atrophy of epaxial and gluteal muscles was apparent, with lack of top-line extending along the neck. Vital parameters were within normal limits. Gait analysis revealed a 1/5 lameness on the left hind when trotted in a straight line on a hard surface. Distal and full limb flexion of the left hindlimb were negative, and hoof testers yielded no response. On the lunge-line, the gelding moved predominantly in a hollow frame with little forward propulsion. After a short period of lunge-line work, the grade 1/5 left hindlimb lameness resolved. Myofascial palpation revealed sensitivity over the epaxial muscles in the mid-thoracic and mid- to caudal lumbar region. Tight bands were palpable in the dorsal cervical region, in addition to dorsal to the scapula bilaterally. Ventral cervical flexion was adequate bilaterally, however mildly reduced flexion was achieved on the right side. Balance and hindlimb rotations were appropriate with no resistance noted. No hypersensitivity was noted on dorsal spinal root stimulation, however the horse appeared to guard when stimulated in the lumbar region. The remainder of examination findings were within normal limits.
Day One Lunge (4) Day One Straight Line (3)
Problem List: Grade 1/5 left hindlimb lameness, mild sensitivity to palpation of epaxial muscles in mid-thoracic region, and moderate sensitivity and tight myofascial palpation over epaxial muscles in the mid- to caudal lumbar region.
Differential Diagnoses: Differential diagnoses for the left hindlimb lameness include osteoarthritis of the distal hock joints, fetlock, pastern, or coffin joint, soft tissue injury, or solar bruising. Epaxial sensitivity differential diagnoses include muscular soreness from re-introduction of exercise, dorsal spinous process impingement, and ill-fitting saddle.
Definitive Diagnoses: Due to the history of weight loss, period of rest, and muscle atrophy it was considered that the most likely cause of epaxial sensitivity was muscular soreness with the re-introduction of work. Due to the rapid resolution of mild left hindlimb lameness with light work, it was considered most likely either mild underlying osteoarthritis or muscular strain with the reintroduction of exercise. Flexion tests and lack of response to hoof testers, owner declined further investigation of hindlimb lameness and chose to pursue alternative therapies to address soreness while work was re-introduced.
Medical Decision Making: Back pain was the owner’s main concern in this case, as the horse was planned to be brought back into full work. Further evaluation of the left hindlimb lameness was declined. With back soreness as the main concern, dry needling weekly treatments were initiated for three weeks, while the horse’s work load was increased to address arising myofascial strain and muscle fatigue. A period of 1-2 days of rest was recommended following every treatment. Photobiomodulation was not available to supplement therapy. GB 21, GV 14, and Da feng men were placed first in all treatments to assess response to needles and achieve calming effects. Autonomic neuromodulation was addressed by targeting Bai Hui and ST 36. For repeated myofascial tension and tight bands in the dorsal cervical region and rhomboideus m. region, TH 16, BL 10, BL 11, and BL 12 points were treated. A selection of BL channel points along the dorsum were selected based on sensitivity to palpation at each treatment to activate different spinal segments and release myofascial tension.
Medical Acupuncture and Related Techniques Used: Seirin coated needles (0.25 x 30mm) were used for acupuncture treatments. First treatment acupuncture points included: GB 21, GV 14, Da feng men, Bai Hui, TH 16, BL 10, BL 11, BL 12, BL 14, BL16, BL 20, BL 26, BL 27, and ST 36. Second treatment acupuncture points included: GB 21, GV 14, Da feng men, Bai Hui, BL 10, BL 11, BL 14, BL 16, BL 21, BL 23, BL 25, ST 36, and trigger point in the right triceps m. Third acupuncture treatment points included: GB 21, GV 14, Da feng men, Bai Hui, BL 10, BL 14, BL 16, BL 18, BL 26, BL 27, and ST 36. After each treatment, a period of 24-48 hours of rest from work was recommended.
Treatment Two Straight Line (1)
Outcomes: Kyle did well with all treatments, and showed no signs of adverse effects. Improvement was seen in back soreness after treatments, with improved behaviour and impulsion under saddle after the period of rest. Light exercise was increased from 20 minutes to 45 minutes over the course of the 3-week treatment successfully, with reduced pain response over the thoracic and lumbar spine on palpation. The grade 1/5 left hindlimb lameness resolved with increasing work, and no further evaluation was sought.
Discussion: From this case I learnt about the effects of placing calming points at the beginning of treatments. Kyle had a profound response to placement of Da feng men, with notably reduced anxiety once placed. The de qi effect was noted several times with needles in the thoracolumbar bladder spots where there was significant myofascial tension, and for the first time I had to employ the technique of “circling the dragon” to release a needle from being “stuck”. This horse showed noticeable improvement to the rider following treatments, and this allowed the horse to return to full work as planned, demonstrating the benefits of medical acupuncture in these cases. Overall, from this case I was able to experience using medical acupuncture as a means of regular maintenance for athletic performance, and the benefits that it can have for this purpose. Ideally, electrical stimulation and photobiomodulation would also be considered for enhancing treatment, however they were not available in this situation.
References
1. Curacore Clinical Intensive Notes
2. Curacore Equine Point Manual
3. Baxter, M. Manual of Equine Lameness. Chichester, West Sussex, UK: Wiley-Blackwell, 2011. Print.