Written by a Medical Acupuncture for Veterinarians Course Graduate. Author’s name available upon request. Signed release obtained from client/author.
Shiva, a 24-year old heavy Warmblood presents with a stiff neck to the left side after a paravenous injection with Finadyne about six month ago. She experienced an immense swelling midway of her left jugular vein and wasn’t able to bend her neck to the left for about four months. Since about two months, she is able to move it a slight bit to the left, and with the dry needling therapy she is almost back to normal.
Shiva has been used to pull a carriage in eastern Germany. She was reluctant to pull after the heavy inflammation around her left jugular vein about six months ago. She has been treated with heparin creme for about four weeks in February without changing muscle stiffness. Her owners asked me if I could treat the stiffness of her neck to give her a better quality of life and bring her back to work.
Physical Examination and Clinical Assessments
On her physical examination, she presents with BAR and is interested and calm. She carries heavy horseshoes typical for carriage horses. Most of the time she grazes on a large pasture with three other horses. She has difficulties bending the neck to the left shoulder, slight difficulties to the left front hoof, but is able to raise the head normally. I can see a slight stiffness to the right, and she needs a bigger circle when she walks in a left bend. There are no obvious neurological deficits.
On the myofascial examination, I can find a very tender m. brachiocephalicus and sternocephalicus muscles, especially on the left side, but also slightly on the right side. I can see a reaction when I try to palpate deeper into the m. rhomboideus and splenius. There are some trigger points around the upper neck in the area of BL-10. At the beginning, she reacted on palpation of the lumbosacral region and gluteal muscles, which improved with the treatment.
Medical Decision Making
Shiva is still needed to pull a carriage, so the main goal is to get her relatively pain free with an increased range of motion of her neck. I will treat her neck and back to release some of the muscle tension.
The treatment plan involves the main acupuncture points relating to tense muscles around the neck and shoulders, as well as the lumbar region. On some warmer days, she reacted to the needles like flies would sting her.
I used red and blue Seirins without electroacupuncture or laser (reason: I don’t have one or the other). She has been needled every three-four days for about two weeks. She also got walked in smaller circles every now and then.
The following points have been used in almost every session (depended on the ‘fly’ status):
LI-16 – local pain and well accepted
LI-17 – local trigger point
LI-18 – close to the area of the old thrombophlebitis area
ST-10 – close to problem area, stiff neck
SI-11 and 12 – tender areas
SI-16 – tender, trigger point, stiff neck
TH-16 – neck pain
GB-21 – local trigger point
BL-10 – tender, trigger point
BL 11 and 12 – local trigger points
BL 23 and 25 and 54 – tender lumbar region
Bai Hui – lumbosacral tenderness
Shiva’s condition improved after about three treatments. She was able to bend her neck further to the left and after about two weeks, she was willing to pull the carriage again with more enthusiasm.
With this case I learned that horses need a calm and fly-free area for best relaxation and acupuncture results. Electroacupuncture and laser would have also been a good addition to speed up the comfort and healing. There will always remain a slight stiffness to the left due to the scar tissue, but the comfort has improved.