Written by a Medical Acupuncture Course for Veterinarians Graduate. Author’s name available upon request. Signed release obtained from client/author/4922.
Abstract
Back pain is relatively common in riding horses. Underlying etiology may be due to vertebral osteoarthritis, desmitis, vertebral fractures, disc disease, strain from competition or other use, conformation, poor saddle/tack fit, rider inexperience, and/or secondary issues, such as forelimb or rearlimb lameness. In the case of this patient, moderate chronic back pain in an aged schoolmaster lesson horse was managed by acupuncture alone.
History
Harley, an approximately 18-year-old Quarter Horse gelding, presented for chronic, non-specific discomfort (“moving differently than he used to”) and wincing/flinching when mounted. No bucking, “girthiness,” or other signs of pain were reported. Harley is primarily used for children’s and beginner riding lessons, including low-level competition and introductory jumping. He is stabled in a well-bedded stall with access to an outdoor run. He is usually ridden six times per week, with one rest day. No major medical history was reported. He receives a glucosamine/chondroitin supplement, but no medications. Recent lab work and radiographs were unavailable.
Physical Exam/Clinical Assessments
Pulse and respiration were within normal limits; temperature was not assessed. No obvious lameness was noted, but stride appeared subjectively shortened in all four limbs when patient was trotted. Cranial nerves appeared intact, and no ataxia or paresis was noted. No other abnormalities were present on physical exam. Saddle fit was apparently acceptable, with appropriate wither clearance and no pressure points noted, though no evaluation was performed by a master saddler.
Myofascial exam revealed bilateral supraspinatus muscle atrophy, with the right side more marked than the left. Stiffness was noted between C-3 to C-5 when the patient’s neck was bent to the left and between C-3 to C-6 and C-7 when bent to the right. Trigger points were present at GB-21, the dorsal aspect of the trapezius, and in the long and lateral bellies of the triceps, all bilaterally. The patient was sensitive to palpation in the thoracolumbar region, most notably in the iliocostalis muscle and at the dorsal processes of the thoracolumbar junction, with the left side being slightly worse and extending farther cranially than the right. Some lumbosacral tension was also noted. Trigger points were present in the semimembranosus and semitendinosus muscles bilaterally. An area of superficial dermal scar tissue approximately 6 cm in diameter was present on the right gaskin, with underlying fascial restriction deep and surrounding it.
Medical Decision Making
Without additional diagnostics, such as spine radiographs, the specific etiology of Harley’s back pain is unknown. Since he is an aged horse, vertebral osteoarthritis is likely a component, as is soft tissue inflammation and strain due to frequent rides, often with beginner riders lacking the balance and developed seat of a more experienced rider. Harley’s current level of discomfort does not currently limit his functionality as a beginner’s riding horse, but treating his pain with acupuncture and related modalities can make him more comfortable and may prolong his career as a schoolmaster. Myofascial exam results were discussed with Harley’s owner, and she elected to trial treat with acupuncture. Additional diagnostics were not performed at this time due to financial limitations.
Acupuncture has been shown to be effective to treat many types of pain, including pain caused by osteoarthritis and soft tissue strain. Needling causes micro-inflammation, leading to increased local blood flow and myofascial release. This results in increased nerve communication by releasing neurotransmitters and cytokines. This has anti-inflammatory and analgesic effects. While this initially happens locally, it initiates cascaded results in neuromodulation at the level of the spinal cord and brainstem, leading to an altered perception of pain.
Acupuncture Treatment
Points selected for the patient’s first treatment: Bai Hui; BL 11, 13, 15, 26-28, 54; SI 9; GB 21; LI 15, 18; GV 14, 20. Bai Hui and BL 26-28 were selected to address the patient’s lumbosacral tension. Shoulder area points were selected to treat local trigger points and supraspinatus atrophy, though SI-12 was not selected for this treatment to avoid overwhelming the patient. While the patient is generally a very calm, stoic horse, GB-21, GV-14, and GV-20 were selected to upregulate parasympathetic tone for his first acupuncture session. The painful thoracolumbar area was too tense to needle; BL-15 was the closest to the region that the patient was amenable to needling. Spindle cell techniques and massage were used instead on this region. Massage was also used on the right gaskin to help loosen the fascial restriction from the chronic scar tissue. Dry needling was utilized.
The patient returned the next week for a follow-up acupuncture appointment. Thoracolumbar pain was significantly less than previously, though still present. The patient was now more amenable to needling after a short massage. Lumbosacral tension was decreased on the left side, though still present on the right side. Points used were similar to the previous session, with the addition of BL 17, 19, and 20 to treat the thoracolumbar pain. BL 36 and 37 were added to treat hamstring group trigger points, and SI-12 was added to help with supraspinatus atrophy. Dry needling was utilized because electroacupuncture was not available.
The patient returned two weeks later for another follow-up. After the last session, the owner had noted an improvement in both stride length and apparent pain when mounted. Myofascial palpation and point selection were similar to the previous week, with the addition of BL 21 and 22 for more focused treatment of the thoracolumbar pain and BL-39 for hamstring group trigger points. Dry needling was utilized, and the patient remained relaxed throughout his treatment.
With noted improvement from the last two treatments, the patient was treated whenever his owner noted decreased stride length or signs of pain during mounting or dismounting, generally monthly. Point selection was similar, with BL-10 and ST-10, as well as local neck points used to address neck stiffness. The owner was also advised to use carrot stretches daily after rides to help with neck and back flexibility.
Outcomes/Discussion
The patient’s thoracolumbar comfort improved with every acupuncture treatment. During the initial treatment, his pain was marked enough that needles could not be placed directly in the area of pain. By the third treatment, he was comfortable enough that the area could be needled directly. By this time, his owner had noticed that the patient no longer winced/flinched when mounted and that his movement under saddled seemed more relaxed, with a longer stride length. Since the only changes to the patient’s care were the addition of acupuncture and carrot stretches, it is likely that acupuncture was the largest influence in the treatment of the patient’s back pain. This case demonstrates that acupuncture, as a single modality, can cause a demonstrable decrease in pain in some patients. Harley’s fairly dramatic response may be due to an attentive owner noticing early signs of back pain. A horse with more intense pain might need additional modalities, such as laser, additional nutraceutical support, gabapentin, and/or anti-inflammatories.