Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. 10D2017016

Abstract

A rescued, 11 year old Thoroughbred gelding used for dressage and jumping with poor performance and behavior issues. Examination revealed severe sacroiliac dysfunction. Dry needling and rest improved mobility, however he was re-homed before treatments could continue.

History and Presentation

MS, an 11 year old Thoroughbred gelding, used for entry level dressage and jumping presented for poor performance and negative behavior. He kicked the farrier when he attempted to lift his hind legs, refused jumps, could not hold collection or drive with his hind legs correctly, and reared under saddle. MS was a rescue horse who suffered from starvation and neglect in the beginning years of his life. Approximately a year and a half prior to presentation, with a different owner, he fell over backwards on a trail ride. No known specific diagnoses were made after that trauma. At the time of presentation, MS was being leased by an individual seeking veterinary care to rule out any medical causes for his poor performance and behavior issues before pursuing
more rigorous training. He had never had an acupuncture treatment before although had “body work” done by a layperson and seemed to enjoy it per the leasee.

Physical Examination and Clinical Assessments

On Physical exam MS was bright, alert, and responsive with temperature, pulse and respirations within normal limits and normal gut sounds in all quadrants. He was easily distracted looking around at the other activities in the barn and unwilling to stand still. According to the leasee he was needy for attention, mouthy with people and liked to play with his lead-rope. MS demonstrated traits typical of a “fire-type” horse. Joint mobility exam/Myofascial palpation elicited the following abnormalities:
– Unilateral reactivity to ST7 palpation, with right more severe than left.
– Decreased left shoulder abduction and decreased scapular lift bilaterally. Trigger
points in the supraspinatus and infraspinatus muscles.
– Mild reaction to laterally manipulating the spinous processes at T2/T3
– Decreased lateral and dorsoflexion at the caudal lumbar spine with hypertonic
iliocostalis and middle gluteal muscles.
– Pressing at BL26 and BL27 yielded no hip drop whatsoever, the entire hip/gluteal
area had moderate to severe fascial restriction
– Circling each hind limb with the hoof a few inches off the ground caused a strong
negative reaction with “sewing needle” response, kicking, and jumping away
– No ataxia or peripheral lameness was observed at the walk or trot in-hand although
he was short-strided in the hind with decreased/rigid hip excursion.

Assessment:

– Dental pathology common in a middle aged horse that hasn’t had routine dental care.
– Decreased mobility in the shoulders due to overuse compensating for severe sacroiliac (SI) and lumbosacral (LS) dysfunction with psoas pain. He pulled more with his front end since he couldn’t propel himself correctly with his hind end.
– Severe SI/LS pain likely contributed to his poor performance and behavior issues.

Medical Decision Making
Initial treatment intended to assess his tolerance/acceptance of needles and accomplish overall relaxation while earning his trust. If well tolerated, the goal was to then work to improve shoulder mobility and relax the back before delving into the most painful, reactive hip area especially given his history of negative, dangerous behavior. I would’ve liked to start with laser as it would provide a less intense stimulation in this sensitive horse but I didn’t have a mobile unit on my truck so I chose to start with dry needling before escalating to electroacupuncture.

Differential Diagnoses
– Chronic pain secondary to previous trauma (fall on the trail), exacerbated by being asked to engage hindquarters for impulsion and jumping
– Caudal lumbar vertebral disc disease
– Vertebral spondylosis
– Poor posture resulting from rider posture or poor saddle fit
– Sacroiliac ligament desmitis

Definitive (or Putative) Diagnosis (or Diagnoses) 

Advanced diagnostics including radiographs and ultrasound were unavailable so disc disease, spondylosis and any other orthopedic/ligamentous abnormalities could not be ruled out. Observation of current rider and saddle fit were appropriate although he had been ridden by multiple other people recently with varying skill levels and different saddles that may have been less appropriate.

Medical Acupuncture and Related Techniques
Each treatment was 1 week apart for a total of 3 treatments. Needles used: Seirin J type 0.25mm diameter (purple), 30mm length; I started with a smaller gauge, coated needle to assess his acceptance of dry needling with less intense stimulation.
Points used (all with dry-needling):
GB 21, LI16, LI17, BaiHui – systemic relaxation
BL 28 – local sacral pain
BL 26 – pelvic limb and back pain
BL 11, 12, 13 – local shoulder pain
BL 21, 20, 18 – local back pain and deactivation of taut bands
GB 29, 30 and BL 54 – local hip pain
ST36 – systemic anti-inflammation and local pelvic limb pain
LI 15, TH 14 – local shoulder pain

MS responded well to treatment. His eyes relaxed, he dropped his head/neck to a neutral, horizontal position, and stood quietly. With subsequent treatments I kept the same needle type and size since he responded so well to it the first time. In addition to the relaxation points used in the first treatment I added more direct hip/SI points and more intense systemic pain relief points (ST36) as well as local pelvic limb points that were not attempted on the first treatment due to safety concerns.

Outcomes and Discussion 

Throughout the course of treatment I advised that MS not be ridden considering the severity of his hip pain and his history of dangerous behavior when in training. I recommended stall rest with hand walking 5-10 minutes 2-3 times daily to prevent stiffness and facilitate relaxation and recovery. MS’s short-strided gait improved and according to the leasee he seemed like a happier, more relaxed horse in general. Deactivating local muscular tension, relieving pain, releasing myofascial restriction in the hips and allowing his overworked strained muscles to relax let him to move in a more physiologic manner. As he was able to use his hind end more correctly, he didn’t have to compensate with his shoulders as much and his shoulder mobility
improved. Unfortunately, MS regressed after he started being ridden again. There was an incident where he reared and the rider came off, suffering a concussion. Another incident where he pulled back while tied hard enough to break his halter, which struck his handler in the head. MS was returned to his previous owner and further treatments could not be performed. However, given the improvement accomplished over a few weeks with acupuncture and rest, I feel confident that with additional treatments and compliant, appropriate rehabilitation he could become a more comfortable, happier horse. With the amount of impulsion required with dressage and the hind quarter power needed for jumping I do not feel either of these disciplines are appropriate for MS.


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