Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. A2017046

Abstract: An American Miniature Horse gelding rescued from a livestock auction, was treated for respiratory disease, stiff gait, and chronic neck pain. After just one dry needling treatment, his stiff gait improved and he became increasingly comfortable with subsequent treatments. Dry needling was also used as an adjunct to treat respiratory disease along with antibiotics.

History and Presentation: Jack, a 25 year old American Miniature Horse gelding, was rescued from a livestock auction 1 week prior to presentation. The chief presenting complaint was a stiff gait and an increased respiratory rate. No prior medical history is known. Jack currently lives in a grassy paddock and is being fed a mix of alfalfa and grass hay, and soaked Equine Senior pellets.

PE and Clinical Assessments: On physical exam, Jack was quiet but alert and responsive, with a CRT of 2 seconds, heart rate of 44 bpm, respiratory rate of 50 breaths per minute, and a rectal temperature of 101 F. His body condition score was 3/9. He had bilateral clear to white nasal discharge and evidence of dried ocular discharge bilaterally. He had harsh bronchovesicular sounds in all quadrants, but no crackles or wheezes ausculted. Aside from a slightly elevated heart rate, his cardiovascular parameters were within normal limits. He had a very dull hair coat, which was much longer than expected for the season. Musculoskeletally, he was ambulatory but had a mild 4/5 lameness in both front limbs. He had mild slipper feet in all four feet (which were being addressed by a farrier) and evidence of previous episodes of laminitis in both front feet. Additionally, he had moderate to severe weakness in the hind end and mild ataxia noted at the walk. On myofascial palpation, he was extremely sensitive to palpation of the left neck, specifically of the brachiocephalicus muscle and the region surrounding LI 16. In addition, he had multiple trigger points in the neck bilaterally, especially at the caudal bladder neck points. He was also sensitive to palpation of the pelvic region bilaterally, specifically at the hip triad. Blood work showed a mild neutrophilia and a mild eosinophilia, along with an elevated fibrinogen. Thoracic Ultrasound was conducted in Week 2 of treatment and showed mild comet tailing bilaterally.

Medical Decision Making: The first goal in Jack’s treatment was to make him as comfortable as possible by targeting his trigger points. Trigger points are caused by sensitization of peripheral nociceptors leading to increased local tenderness, referred pain, and sensitivity to lesser stimuli (Edwards and Knowles). Dry needling these trigger points has been shown to be more effective than just stretching the muscle alone (Edwards and Knowles). By dry needling, “A” delta fibers are activated, and “C” fibers, which convey pain, are inhibited through dorsal horn interneurons (Edwards and Knowles). Once the “A” delta fibers are activated, the taut muscle band releases thus discontinuing the sustained muscle contraction and local hypoxia, and thus diminishing pain (Edwards and Knowles). Dry needling these tender points also decreases tissue adhesion and promotes blood flow (Pyne and Shenker). Points were also chosen to wind down the cervical cord, specifically segments that receive trigeminal and cervical input. The second goal in Jack’s treatment was to aid in treating his respiratory disease. At the start of treatment, Jack’s definitive diagnosis was unknown, so a plan was made in order to support his respiratory system in general.

Differential Diagnoses: Differential diagnoses included chronic neck and hind-end pain likely secondary to osteoarthritis and laminitis. Differentials for his respiratory disease included Recurrent Airway Obstruction (RAO) and pneumonia.

Definitive Diagnosis: Chronic musculoskeletal pain and myofascial pain syndrome; referred visceral pain (pleurodynia) secondary to pneumonia.

Acupuncture Treatments: Jack was treated with dry needling with 0.25 x 30 mm needles at weekly sessions for 3 consecutive weeks. The first treatment consisted of treating Bai Hui, GV 14, bilateral LI 16, multiple bilateral neck trigger points, and the pelvic triad bilaterally (BL 54, GB 29, GB 30). GV 14 was selected as a respiratory point and to increase parasympathetic function. LI 16, pelvic triads, and trigger points were selected due to patient sensitivity at these locations. Jack was very reactive to needling, so the treatment proceeded slowly. For this reason, no further points were attempted during this first treatment. The next two weeks, Jack’s treatment focused more on respiratory points in addition to the points chosen during his first treatment session. BL 13 was added because of its innervation by the T3 spinal nerve, which is part of the sympathetic supply to the lung (T1 to T4). BL 13 is also the back shu point for the lung. LU 7 was chosen as a distal point because it is the master point of the head and neck. LU 1, the front mu point for the lung, was also chosen for its applications for respiratory disease but also for local pain. ST 36 was also chosen for its immune enhancing properties due to its parasympathomimetic effects. Massage of trigger point areas on the neck and pelvic region was implemented by the owner between sessions.

Outcomes: Immediately after Jack’s first treatment, he allowed for palpation of trigger points and LI 16 bilaterally, whereas before treatment, he would attempt to kick or rear when those areas were palpated. The night after the first treatment, Jack’s owner reported him lying down comfortably for the first time. After the second treatment, she reported a decreased respiratory rate and decreased respiratory effort. He also began to trot around his paddock. (Note: He was also started on antibiotics to treat pneumonia around Week 2 of treatment).

References:
• Cheng, KJ. (2009). Neuroanatomical basis of acupuncture treatment for some common illnesses. Acupuncture in medicine, 27, 61-64.
• Edwards, J., & Knowles, N. (2003). Superficial dry needling and active stretching in the treatment of myofascial pain–a randomised controlled trial. Acupuncture in medicine, 21(3), 80-86.
• Pyne, D. & Shenker, G. (2008). Demystifying acupuncture. Rheumatology, 47 (8), 1132-1136.
Address to send certificate: 24410 Rolling View Rd, Hidden Hills, CA, 91302


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