Written by a Medical Acupuncture for Veterinarians course graduate. Author’s name available upon request. Signed release obtained from client/author/4908.
A 16 year old pet miniature horse was evaluated for gradually declining activity levels. Until this past year, effects of mild bilateral valgus, pelvic limb rotation, and uneven hoof wear were minimized with corrective hoof trimming and the horse generally appeared comfortable. Recently a significant decline in activity was noted and soft tissue pain was suspected. Weekly acupuncture treatments to address myofascial strain patterns were well tolerated and resulted in immediate and sustained increased activity levels over a three week period.
History & Presentation
‘Kahlua’ is a 16 year old, male, gelded, miniature horse who presented September 22, 2016 for decreased activity. He was purchased from a Texas farm auction as a young foal. Since purchase Kahlua has lived as a pet on an acreage in upstate NY, USA, with one other miniature horse companion. He has controlled pasture turnout during the day and his own full size stall in the barn.
Kahlua has maintained good health for most of his life. His parrot mouth requires frequent dental work. A recent moderate, but significant, decrease in activity has been noted. His people describe him as “slowing down, in the past year, especially this summer”. They are seeking acupuncture to improve his comfort level. He has frequent farrier work, with specialized hoof trimming, about every 6 weeks, to compensate for uneven hoof wear.
Physical Examination & Clinical Assessments
On examination Kahlua was bright, alert, and responsive with a body condition score of 6/9 and a pot-bellied appearance. He was friendly and easily accepted palpation. His general physical examination and basic neurologic examination were within normal limits. Orthopedic examination revealed a mild valgus deformity. Additionally, Kahlua stood with both hind limbs rotated laterally. At the walk he twisted his entire lower leg, rotating heels medially, more pronounced on the left side.
On myofascial palpation exam Kahlua was very sensitive to bilateral palpation of ST 7 and BL 13. Additionally, he was moderately reactive throughout palpation of his epaxial musculature, along both Bladder lines from the tenth through the seventeenth intercostal spaces. He was not reactive to hind end and limb palpation.
Medical Decision Making
Kahlua was treated with dry needle acupuncture once weekly for three weeks. The goal was to improve function and decrease chronic pain secondary to poor conformation and compensation for his uneven gait. Local, regional, and systemic points were chosen. Needle retention time was approximately 20 minutes for each session.
Pelvic limb points were chosen to regulate local pain signals, release muscle spasms, and improve circulation (Bowsher 1998, Song-Yi et al. 2016). Back points were chosen to influence nerves traveling from the spinal cord to the pelvic limbs (spinal segmental pathways) as well as for their local effects on compensatory back stiffness and/or pain. Systemic points were chosen to decrease inflammation, neuromodulate central pain signaling pathways via opioid and serotonergic mechanisms, and to calm the nervous system by promoting parasympathetic input (Bowsher 1998, Robinson 2013).
Many studies focus on acupuncture as a method of direct pain control (Nahin et al. 2016). While it does have this benefit, the larger treatment goal with chronic orthopedic pain is to allow new patterns of movement, freeing restrictions and chronic muscle tension that consistently generate and amplify pain (Lin et al 2016). Combining acupuncture with controlled movement and specific exercises to improve flexibility and increase range of motion may improve comfort and function despite persistence of underlying conformational challenges (Riedlinger 2015).
Table 1: Acupuncture Treatments
(silicon coated needles: 0.25 x 30 mm on neck/back, 0.20x 30 mm on limbs)
(uncoated needles: 0.25 x 40 mm on neck/back, 0.20 x 30 mm on limbs)
(silicon coated needles: 0.30 x 40 mm on neck/back, 0.16 x 15 mm on limbs)
|1.||LI 16 – R, L||LI 16 – R,L||LI 16 – R, L||Introductory point, calming point|
|2.||Bai Hui||Bai Hui||Bai Hui||Regional point, calming point|
|3.||BL 13 – R, L||BL 60 – L||BL 19 – R, L||Local points|
|4.||LI 11 – R||LI 11 – L||LI 11 – L||Central point – anti-inflammatory|
|5.||BL 40 – L||BL 40 – L||BL 40 – L||Local point – tibial nerve|
|6.||ST 36 – R||ST 36 – R||ST 36 – R||Central point: parasympathetic, anti-inflammatory; local point|
|7.||BL 25 – R, L||GB 29 – R, L||BL 25 – R, L||Regional & local points|
|8.||GB 34 – L||GB 34 – L||GB 34 – L||Local point – fibular nerve|
|9.||BL 62 – L||GB 39 – R||Local points|
R= right side; L= left side
Outcomes & Discussion
Kahlua responded well to acupuncture treatments. He was described by his people as ‘peppy’ after treatments, and reportedly “dragged them around the barn” after the first treatment. On second examination he was no longer sensitive at ST 7 or along his thoracic epaxial musculature. The only sensitive point found was GB 29. On the third exam he was reactive at BL 19 bilaterally. At the third visit, in addition to his acupuncture treatment hindlimb circles were demonstrated, so his people could begin assisting him with some synergistic therapeutic exercises.
Kahlua’s case demonstrates lifelong patterns of compensation due to poor conformation. Acupuncture targeted nerves in the pain pathway directly as well as releasing tightness in muscles and fascia which perpetuate and amplify the pain cycle. The treatment allowed for immediate relief of pain as well as improved functional abilities of working muscle groups, thereby minimizing the patterns of muscle tension which restrict mobility and exacerbate pain. While acupuncture cannot improve underlying structural limitations, it can address chronic pain by directly providing short term pain relief, but perhaps even more importantly by optimizing soft tissue functional capacity, therefore minimizing generation and perpetuation of the pain cycle.
Bowsher, D., Mechanisms of Acupuncture, Medical Acupuncture: A Western Scientific Approach, Eds. Jacqueline Filshie and Adrian White, Churchill Livingstone London, 1998, Chapter 6, pp.69-82.
Lin, X., Huang, K., Zhu, G., Huang, Z. , Qin, A., & Fan, S.; “The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis”, J Bone Joint Surg Am. 2016 Sep 21;98(18):1578-85. doi: 10.2106/JBJS.15.00620.
Nahin, R.L., Boineau, R., Partap, S. K., Stussman, B.J., & Weber, W.J., “Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States”, Symposium on Pain Medicine, Mayo Clin Proc. , September 2016; 91(9):1292-1306, http://dx.doi.org/10.1016/j.mayocp.2016.06.007.
Riedlinger, K., “Equine Physical Therapy and Rehabilitation”, (lecture) Medical Acupuncture for Veterinarians, 2015 One Health SIM – Scientific Integrative Medicine.
Robinson, N.G., Acupuncture, The Merck Veterinary Manual, August 2013, accessed 10/2016 from: http://www.merckvetmanual.com/mvm/management_and_nutrition/complementary_and_alternative_veterinary_medicine/acupuncture.html.
Song-Yi, K., Seorim, M., Hyangsook, L., Soyeon, C., Xiuyu, Z., Ji-Yeun, P., Taek-Jin, S., & Hi-Joon, P., “Changes of Local Blood Flow in Response to Acupuncture Stimulation: A Systematic Review”, Evidence-Based Complementary and Alternative Medicine 2016, 1-11. http://dx.doi.org/10.1155/2016/9874207.