Written by a Medical Acupuncture for Veterinarians course graduate. Author’s name available upon request. Signed release obtained from client/author/4901.
Abstract: This case report demonstrates the use of acupuncture along with current Western therapies in treating a barrel horse for lameness and overall poor performance. Previous joint injections would alleviate the lameness, but overall performance still declined. In an attempt to improve overall performance other integrative therapies, specifically acupuncture, were attempted. Various acupuncture points located across the hips, thoracic, lumbar, and sacral spine were treated during several different sessions. Improvement of myofascial palpation exam was seen as a decrease in response to stimulation of treated acupuncture points. Along with Western therapies and acupuncture an increase in overall performance was seen.
History Presentation: Coal Train, 15 year old black QH gelding-used for barrel racing, presented for signs consistent with lameness and overall poor performance. Over the years Coal Train has been seen and treated by multiple veterinarians. Previous diagnostics consisted of multiple nerve blocks, radiographs, and magnetic resonance imaging (MRI). Diagnostic results were most consistent with a bilateral front end lameness. Treatment has consisted of multiple bilateral injections of the coffin joint and navicular bursa. Further treatment of the right front lower limb has also included the injection of the tendon sheath and shockwave therapy. Other treatments that have not included the front end are bilateral injections of the distal intertarsal joint, tarsometatarsal joint, sacroiliac joint, and stifles. The most recent injections prior to presentation have included the right front coffin joint, navicular bursa, and tendon sheath.
Physical Examination and Clinical Assessments: Physical and neurological exams at the time of presentation were found to be within normal limits. Lameness exam, performed by the attending veterinarian, showed a 1/5 on both the right front and right hind. Flexion tests of the hind end showed a 2.5/4 right hock, 1/4 right stifle, and 1/4 left hind. Myofascial palpation examination showed multiple reactive acupuncture points bilaterally along the hip, mid-thoracic, caudal thoracic, thoracolumbar, midlumbar, and caudal lumbar spine. Affected acupuncture points along the hips and back included bladder 18-23 (3/5), bladder 54 (2/5), and gall bladder 29-30 (2/5). Following a lameness and myofascial palpation exam the distal intertarsal joint, tarsometatarsal joint, and epaxial muscles were treated with injections by the attending veterinarian.
Medical Decision Making: Horses competing in barrel racing use the lateral motion of the thoracic back and power/drive of the hind end to ambulate around each barrel. This increases the amount of stress placed on the back and hips. By understanding the mechanics of barrel racing we can see that those acupuncture points found to be reactive during the myofascial palpation exam of this horse are consistent with the activities he is being asked to perform. By treating these reactive acupuncture points and alleviating any pain associated with them we should see an improvement in his overall performance. The local effects of the previously described acupuncture points includes tissue matrix deformation and associated molecular cascades, reduction of myofascial trigger points, fascia release, increase in local blood flow and oxygenation, micro-inflammation, and nerve communication (Dr. Bonnie Wright, Module 2, Lecture 1 notes). After needle placement and bidirectional movement the connective tissue becomes wrapped around the needle which in turn stretches the connective tissue thereby pulling the fibroblasts. This causes a deformation increasing input to the mechanoreceptors and nociceptors as well as distorting the fibroblasts. These fibroblast then increase the release of growth factors and phosphorylation which in turn cause gene expression, protein synthesis, and additional regulatory molecules (Dr. Bonnie Wright, Module 2, Lecture 1). Furthermore, acupuncture points will cause an increase of endorphins, norepinephrine, and serotonin release in the central nervous system.
Acupuncture Treatment: Based off of history, previous treatments, and myofascial palpation exam acupuncture treatments focused on points along the hips (bladder 54 and gall bladder 29-30), thoracic (bladder 19-21), lumbar (bladder 25-26), and sacral spine (bladder 27-30). Other acupuncture points utilized during treatments included Bai Hui and stomach 36. Bladder points 19-21, 25-26, and 54 along with gall bladder points 29-30 were used to change or decrease the effects of nociceptors and pain. Bladder points 27-30 were not only used to increase local affects, but to also increase stimulation of the parasympathetic nervous system along with stomach 36 and Bai Hui. Similar treatments were performed a total of 5 times. Frequency in between each session was highly variable and ranged anywhere from one to several weeks depending on client/patient availability.
Outcomes, Discussions, and References: To achieve the best outcome in a challenging case it is important to collaborate and utilize different forms of therapy. This could be seen in this case as initially the lameness was improving with Western medicine, but there was still a decline in overall performance. However, when a myofascial palpation exam was performed other areas of concern along the spine and hips were noted. Previous to acupuncture treatments we could see that those points associated with the spine scored a 3/5 and those along the hips were 2/5. After the final treatment we could see an improvement with points along the spine as they scored a 2/5 and those along the hips were 1/5. One would also consider this case a success due to the fact that Coal Train start competing at a very high level as he had done previously. The success of this case was not only associated with acupuncture, but can also be attributed to various joint injections performed during the 3 months of acupuncture treatment.
While performing acupuncture treatments it is interesting to note how highly reactive points along the spine can be. Reactions during this case included anywhere from mild irritation to extreme agitation after placement of the needles. Because of this one must always keep in mind the safety of the handler, horse, and any others associated with the acupuncture treatments.
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