WHAT ARE ACUPUNCTURE AND CHIROPRACTIC THERAPIES?
Acupuncture involves the insertion of a needle through the skin at predetermined sites (acupuncture points) for the treatment or prevention of disease, including pain. Acupuncture is only one of the therapies that come under the heading of Traditional Chinese Medicine (TCM). The other TCM therapy most often used in veterinary medicine is herbal therapy, using Chinese herbs and herbal compounds.
Besides the use of solid, typically stainless steel needles, other means of stimulating the acupuncture points can be used. The effects of acupuncture therapy cannot be explained in terms of a single mechanism, but rather a series of interactions between the nervous system, the endocrine system and the immune system. Anatomical examination of classical acupuncture points has shown that most of the acupuncture points are associated with certain anatomic structures of the nervous system.1 Acupuncture needling causes micro trauma that in turn causes a local inflammatory effect. This inflammatory effect results in an increased local tissue immune response, improved local tissue blood flow, and muscle and tissue relaxation. Some acupuncture points are known as “trigger points”. These are tender areas found in skeletal muscle associated with a tight band or knot in the muscle. The principle trigger points in a muscle are located at its center in the motor endplate zone.2 This is where the nerve ends in a muscle and causes the muscle to contract. Besides using acupuncture points for treatment purposes, reactivity of acupuncture points can aid in diagnosis. When palpated, these points might show some sensitivity if there is a problem at that point or with the acupuncture meridian or pathway that is associated with the point.
Chiropractic care focuses on the health and proper function of the spinal column, however, the pelvis, limbs and head are also considered. Chiropractic uses controlled forces applied to specific joints or anatomic regions to cause a therapeutic response due to induced changes in joint structures, muscle function and neurological reflexes. The common principle in all chiropractic theory is that joint dysfunction affects the normal neurological balance found in healthy individuals.3 The spinal column should be considered from the standpoint of a “motor unit”. This consists of two adjacent vertebrae and all their associated soft tissue structures – muscles and ligaments, nerves, blood vessels and all the contents of the intervertebral space. Any disruption to the normal function of the motor unit is defined as a “vertebral subluxation complex.” Adjustments are then done to correct this disruption and restore normal joint motion. From a chiropractic standpoint, there is no “bone out of place”.
Acupuncture Techniques
Dry Needling
This is the use of the typical “Chinese” or acupuncture needle. The needle consists of a solid shaft with a handle. Needles vary in length (0.5 to 6 inches) and diameter (0.25 mm to 0.75 mm). The smaller needles are used in the lower limbs, feet, head and ear, while the larger needles are more commonly used in the neck, back and upper limbs. The needles may be disposable or reusable via sterilization. Needles with wire handles are used for moxibustion (described below). Most disposable needles now have plastic handles. They may or may not come with an insertion tube that aids in placing the needle thru the skin.
Aquapuncture
This is the injection of a fluid into the acupuncture point. While initially treating the point with acupuncture (needle being placed thru the skin into the point), this process also leaves behind a liquid that continues to stimulate/treat the point with pressure (due to displacement of tissue by the fluid) and/or irritation over a period of time as it is absorbed. The most commonly used fluid is Vitamin B 12. Some veterinarians who are acupuncturist may inject medications into an acupuncture point to try to combine the effect of both the acupuncture and the medication. This is done with antibiotics and hormonal medications, as well as with homeopathic solutions such as Zeel and Traumeel. Trigger points and “ashi” points may also be injected. I typically use 25 gauge, 1.5 inch hypodermic needles, but for some points 3 to 6 inch spinal needles may be used.
Electrostimulation/Electroacupuncture
This procedure involves attaching electrodes to the acupuncture needles and applying a pulsating electrical current to them. Stimulation can be achieved by varying the frequency, intensity and type of electronic pulse used on the acupuncture points. Research has shown that there are varying physiological responses to different types and frequencies of electronic pulses applied to acupuncture points. I utilize electroacupuncture primarily for neurological conditions such as facial nerve and radial nerve paralysis, and for non-responsive pain, especially in the lumbar area.
Moxibustion
This involves the burning of an herb either on an acupuncture point (direct moxibustion) or over the skin at an acupuncture point (indirect moxibustion) in order to stimulate that point. The herb used (Artemisia vulgaris) is commonly called “mugwort.” In horses, the most commonly used technique is “indirect moxibustion.” Indirect moxibustion is done by holding a burning moxa stick ½ to 1 inch above the acupuncture point or by attaching moxa to an acupuncture needle allowing the heat to be transferred down the needle into the acupuncture point. It is mostly used to treat chronic muscular and arthritic pain. It has also been used on lower back points when treating equine reproductive disorders and for use around chronic wounds to promote healing.
Hemoacupuncture
This is a procedure whereby the acupuncture point is bled with a hypodermic needle using a technique similar to the one in humans where a finger is pricked for a blood sample. It is most commonly used in the treatment of acupuncture points in the coronary band area (“Ting Point Therapy”) and other points on the extremities (head, legs, tail). There are TCM implications as to the characteristics of the blood that comes out. I mainly use Hemoacupuncture with cases of laminitis and as a distal treatment.
Cold Laser/Infra-red (IR) Stimulator
These units can be useful in stimulating acupuncture points that are difficult to treat any other way. In the equine, this is most commonly seen in the treatment of points on the extremities (head, legs). Caution should be taken with the use of lasers as damage to the eye can occur. The use of Infrared Stimulators such as the CEFCO model can be safely used for eye conditions and is especially useful with corneal ulcers 
EQUINE ACUPUNCTURE AND CHIROPRACTIC EXAM
As with any examination, I begin by getting a history on the horse. I especially want to know exactly what the horse is used for and at what level (weekend rodeos vs. PRCA; training level dressage vs. Prix St. George; occasional riding vs. full-time training, etc.). I then ask the handler to walk the horse in a straight line away and back. I want to watch how the horse tracks, as well as how the horse carries its head and neck, and how the pelvis moves. Does the horse carry its tail to the side? Does one hip move higher than the other one? Is there a “hunter’s bump” or high tuber sacrale? I then begin examining the horse on the left (near) side at the head and work my way to the tail. I palpate acupuncture points along the various meridians (channels) and will do chiropractic motion palpation as I go along. I will then do the right (off) side in exactly the same manner. I check for any sensitivity at certain acupuncture points that can aid in suggesting other areas of the horse to examine. I motion palpate the horse to check for any decrease in the range of motion and flexibility of the spine and pelvis, and for any sensitivity to the motion palpation. At this time, if I feel I need to see the horse move either on a lunge line or with a rider up, I have that done. I may then re-examine the horse to see if there is any change in either acupuncture point reactivity or in motion palpation. If I need to examine the horse with hoof testers or do flexion exams I will do that. Once I have determined which acupuncture points are reactive, and what areas show decreased motion, I will then discuss with the owner my findings. We discuss if further conventional diagnostics are needed and treatment options. If we agree that acupuncture and chiropractic treatment are warranted, I then begin to actually treat the horse. If we agree that conventional diagnostics or treatments are needed, I refer the owner back to their routine veterinarian.
Use of Acupuncture Point Reactivity as a Diagnostic Aid
Reactivity at certain acupuncture points can suggest areas of the body to examine more closely. This reactivity does not constitute a diagnosis, but gives the veterinarian an additional tool to aid in locating a problem and making a diagnosis. All of the points must be reactive for me to consider them to be suggesting an area for further examination. If not, then I feel that the reactivity is a local issue or that it is suggesting a meridian (channel) issue.
Some examples are:
Hoof/Lower Limb
Carpus/Tendons/Suspensory
Ulcers
Hock
Stifle
Teeth
WHEN SHOULD YOU LOOK TO VETERINARY ACUPUNCTURE AND CHIROPRACTIC?
Acupuncture and Chiropractic – Symptoms Associated With A Problem
Pain is the common symptom a horse exhibits that suggests acupuncture and/or chiropractic may be beneficial in its treatment. Reactivity of acupuncture points and trigger points can be sign of a local issue or be a sign of a referred problem. When palpating acupuncture points, the examiner is looking for any signs of reactivity or abnormal findings (sensitivity, hot, cold, firm, soft). After this examination, the examiner assess what points were reactive, and their relationship to meridians, organs, regions or areas of the body (foot/lower limb, head/neck, etc.), certain aspects of the body (from a Traditional Chinese Medicine perspective) or local anatomy.
Signs that can be associated with a vertebral subluxation complex and suggest the need for chiropractic treatment are:4
Abnormal or varied posture when standing.
Discomfort when saddled and/or ridden.
Extending head and neck or hollowed back trying to evade – stiffness in the neck and back.
Wringing the tail or pinning the ears.
Poor performance.
Development of abnormal behavior.
Facial expression of pain or apprehension.
Sensitivity to touch.
Unusual gait abnormalities – shortened stride in one or more limbs.
Muscle atrophy.
Rope walking.
Inability to engage hind end.
Inability to round the topline.
Inability of the rider to sit centered in the saddle.
Musculoskeletal Problems
All contributing factors leading to a musculoskeletal problem must be considered during an exam including environment, use, shoeing, rider and saddle fit.
Caudal Heel Pain/Navicular Syndrome
Studies have shown that acupuncture can be effective in controlling equine foot pain.5,6 These conditions can respond well to the use of acupuncture as part of an overall treatment plan. As in conventional treatments for these problems, contributing factors such as hoof balance and shoeing are extremely important. Addressing and balancing the whole horse with acupuncture and chiropractic will provide the best results.
Laminitis
Acupuncture can be very beneficial in acute laminitis. Signs of a decrease in local pain (change in stance) can usually be seen within minutes of treatment. The whole horse should again be addressed in order to achieve maximum therapeutic results. Acupuncture and chiropractic treatments may be needed to alleviate the back and pelvic spasms seen due to the significant change in stance (rocking back on hind legs) seen with acute laminitis. In chronic laminitis, acupuncture is usually more beneficial in helping with generalized body pain and addressing the individual’s underlying problems from a Traditional Chinese Medicine standpoint. Herbal therapy can also be very beneficial in both acute and chronic laminitis.
Arthritis
Acupuncture may be beneficial in all forms of arthritis. From a TCM perspective, arthritis is usually associated with what is termed Bony Bi Syndrome. This condition is another example where an acupuncture/TCM examination is beneficial because it examines the whole horse versus just focusing on the area of primary lameness. In many cases of arthritis, there are other problem areas that, if addressed, will improve the success of any treatment. An example would be a horse with a chronic fetlock problem that also has chronic hock problems. If the fetlock and the hock are both addressed (not just the one causing the predominant lameness that day) then the overall success of treatment will be greater.
Stifles
Acupuncture point sensitivity can aid in the diagnosis of stifle problems. At times, the stifle(s) may be showing signs of pain due to compensation from chiropractic issues in the pelvic area. By addressing the chiropractic situation and balancing the horse, the stifle(s) are not being stressed and the pain will subside. In the “loose stifle” syndrome (due to insufficient muscle tone in the stifle area) the stifle seems to “catch” and can result in pain. In addition to relieving pain, acupuncture seems to be useful in promoting increased muscle tone, and thus helps to stabilize the stifle.
Tendinitis/Desmitis
Acupuncture can aid in relieving the pain and inflammation in acute situations. Along with acupuncture, IR stimulation and the use of the new cold compression system can also be very valuable. Herbal therapy can also be beneficial in healing of the tendons and ligaments. Routine examination from a complementary medicine standpoint can be beneficial in recognizing possible conditions that may lead to excess loading of the tendons and ligaments. This would allow those conditions to be addressed and, hopefully, prevent injury.
Thoracolumbar Pain
Pain in the lower back area, where the thoracic and lumbar vertebrae meet, is usually secondary or compensatory in nature. Benefits of the use of acupuncture and chiropractic are the palpation and motion examinations that are utilized. Not only is local pathology better recognized, but sometimes pain in certain areas might lead the veterinarian to examine other areas that are the primary cause of the pain. The examination can often find that the cause of the pain is actually a poorly fitting saddle. Advising the client on changes to the saddle or the pads is often all that is needed to resolve the issue. Long standing thoracolumbar pain can become the primary problem if it persists after the instigating condition has been resolved. Acupuncture and chiropractic can aid in the treatment of all forms of thoracolumbar pain – primary, secondary or acute.
Lumbosacral/Sacropelvic Issues
Issues in the area where the lumbar and sacral vertebrae meet (the area of a “hunter’s bump”) and the croup area can benefit from both the palpation examinations and the use of veterinary acupuncture and chiropractic. Often good palpation in these areas can help narrow down the affected area, treat it and indicate whether further diagnostics or therapies are needed. Lower limb problems can play a part in causing pain in the lumbosacral and sacropelvic areas. However, problems in these areas can be primary (due to trauma) or have become primary after the lower limb problem that caused it is resolved. As was mentioned earlier, issues in the lumbosacral and sacropelvic area can also cause compensatory pain in the stifle(s) and sometimes hock(s). By resolving the problem in the pelvic area, the stifle and hock pain can be resolved.
Cervical Pain
Acupuncture and chiropractic can be helpful in many ways for problems in this area. First, the examination method of palpation helps in identifying where the pain is originating, and may even lead to further diagnostics of the local area. Second, there are certain acupuncture points that might be indicative of problems elsewhere and lead toward other areas of the body where there may be a problem resulting in secondary, compensatory soreness in the neck/poll area. Finally, acupuncture and chiropractic can be helpful in eliminating the pain in this area. This area is one where it is vitally important that a properly trained veterinarian do the acupuncture and chiropractic therapy.
Temporomandibular Joint (TMJ) Pain/ Myofascial Pain of Facial Muscles
Acupuncture can be very useful in treatment of this problem, but, as in people, this condition is usually secondary. An effort must be made to identify primary contributing factors. Palpation of acupuncture points in the head area, as well as over the temporomandibular joint itself, helps to identify the problem. In horses, the primary contributing factor is often dental problems. If certain acupuncture points are reactive, I will check the teeth. Usually I will find that the teeth need to be floated. Many times the sensitive acupuncture points will resolve with proper dental care. If they do not, then the horse should be re-examined for other contributing factors. The myofascial pain of the facial muscles may not involve the temporomandibular joint and acupuncture treatment can resolve the issue. Chiropractic problems should be considered, especially if there are no dental problems.
Neurological Problems
Wobbler Syndrome
Acupuncture, and, to some degree, chiropractic can be beneficial in all forms of this syndrome, but must be used with extreme caution. A complete diagnostic workup, including radiographs, should be done prior to initiating treatment. Acupuncture can be beneficial in controlling cervical pain and restoring some of the lost neurological capacity. It appears most helpful in cases of trauma. Again, a complete acupuncture and chiropractic examination can be helpful in locating and relieving compensatory problems, but this must be done by a veterinarian.
Facial Paralysis
The use of electroacupuncture can be very beneficial in the treatment of this condition for cases that do not resolve on their own.
Other Nerve Paralysis
Electroacupuncture is a helpful adjunct therapy to any nerve paralysis. Suprascapular and radial nerve paralyses are two of the problems that electroacupuncture may help. The use of high frequency (100hz) electroacupuncture appears to be more beneficial for nerve stimulation. The resulting muscle atrophy appears to be benefited more by lower frequency (5hz) electroacupuncture that causes muscle contractions.
Respiratory Problems
Heaves/COPD
In both Western medicine and TCM, this problem can arise from several etiologies and be a chronic problem. Acupuncture has been helpful in getting this condition under control and can be used in conjunction with Western medicine or replace it all together. Chinese herbal medicine is also beneficial.
Exercise Induced Pulmonary Hemorrhage
Acupuncture can be very beneficial in the treatment of this condition either alone or in conjunction with Western therapy. Chinese herbal medicine is also very helpful as an adjunct therapy.
Gastrointestinal Problems
Acupressure points for colic:
S-2 (Stomach 2)
S-36 (Stomach 36)
Colic
Acupuncture can be utilized as an adjunct therapy in all forms of colic. It is not meant to replace Western medical therapies or diagnostics. It can help control pain and normalize gut motility.
Post-Operative Ileus
Acupuncture can be a helpful adjunct therapy in this condition. Sometimes a single treatment will alleviate the problem.
Gastric Ulcers
Acupuncture can be helpful in treating this condition. However, in this case, I primarily use the reactivity of certain acupuncture points to suggest that gastric ulcers may be present. I then talk with the owner about other signs that may point to ulcers and about the options for further diagnostics to confirm the problem.
Poor Appetite
Acupuncture can be helpful in stimulating a horse’s appetite.
Reproductive Problems
Poor Uterine Tone/Urine Pooling/Endometritis
The use of acupuncture can be beneficial in all of these conditions and may be the only therapy utilized or used in conjunction with Western medicine. Moxibustion is often used when treating these conditions.
Anestrus/Persistent Estrus/Cystic Ovaries/Retained Corpus LuteumAcupuncture has been shown to be very helpful in the treatment of these problems, especially when they are non-responsive to Western therapies. Many veterinary acupuncturists use both acupuncture and hormones at the same time to achieve the desired effects. It has been shown that decreased doses of prostaglandin injected into certain acupuncture points had the same effect as full doses given intramuscularly.7 Moxibustion is also widely used in the treatment of these conditions.
Decreased Libido/ Decreased Sperm Count
Often these conditions are due to pain. Acupuncture, along with chiropractic, can be very helpful in determining where the pain is located and in treating it. Many times a stallion will be suffering from lumbar or pelvic pain that is causing a reluctance to mount the mare or the breeding dummy. Stress can also contribute to these problems, and acupuncture has been beneficial in reversing its effects.
Immunological Problems
Acupuncture has been shown to have an immunomodulation effect. Acupuncture can affect the immune system by enhancing immunity, increasing the white blood cell count, antibody levels, and interferon levels.8 Stress and immune compromise can lead to recurrent signs of chronic pain and lameness.9
Dermatological Problems
Many of these conditions are associated with the immune system. The immunomodulation effect of acupuncture can help in treating these problems by decreasing the amount of other therapies required for treatment.
Chronic non-healing or slow healing wounds can benefit from acupuncture. A technique called “Circle the Dragon” is often utilized. In addition, the use of IR stimulation and moxibustion is very beneficial in promoting healing of these wounds.
Ophthalmic Problems
Recurrent Uveitis/Conjunctivitis
These conditions respond very well to the use of acupuncture. It can be used as an adjunct therapy or it may be the only form of therapy that a chronic condition will respond to.
Non-responsive Corneal Ulcers
The use of acupuncture/aquapuncture and IR stimulation on non-responsive corneal ulcers can be extremely rewarding. Corneal ulcers that have not responded at all to Western medicine have responded to complementary medicine. Precautions should always be taken when using acupuncture/aquapuncture around the eye.
Behavioral Problems
Many behavior problems exhibited by horses are in response to pain. Horses react to pain by avoidance or by aggressive tactics if escaping the pain is not an option.9 As discussed previously, acupuncture and chiropractic can be beneficial in locating and treating the source of the pain.
Reference:
Ma, Ma, & Cho Biomedical Acupuncture for Pain Management: An Integrative Approach, Missouri, Elsevier, 2005.
Baldry, P. Acupuncture, Trigger Points and Musculoskeletal Pain, Elsevier, 3rd Edition, 2005.
Haussler, K. Equine Chiropractic: General Principles and Clinical Applications, in Proceedings. Am Assoc Equine Pract 2000; 46:84-93.
Willoughby, S. Equine Chiropractic Care. Port Byron, IL. Options for Animals, 1991.
Hackett, G., Spitzfaden, D., May, K., Savoldi, M., Dodd, M. Acupuncture: Is It Effective for Alleviating Pain in the Horse?, in Proceedings. Am Assoc Equine Pract 1997; 43:333-335.
Xie, H., Ott, E.A., Colahan, P. Influence of Acupuncture on Experimental Lameness in Horses, inProceedings. Am Assoc Equine Pract 2001; 47:347-357.
Alvarenga, M.A., Ferreira, J.E.P., Meira, C., Luna, S.P.L., Burns, P.J. Induction of Luteolysis in Mares Utilizing a Micro-dose of Prostaglandin in the Sacral Lumbar Space Space (Bai Hui Acupoint), inProceedings of the 24th Annual Intl Congress on Vet Acup. IVAS 1998; 24:169-171.
Steiss, J. Neurophysiological Basis of Acupuncture. In: Schoen AM, ed. Veterinary Acupuncture:Ancient Art to Modern Medicine, 2nd ed. St. Louis, MO: Mosby Publications, 2001:24-46.
Ridgway, K. Diagnosis and Treatment of Equine Musculoskeletal Pain. The Role of the Complementary Modalities: Acupuncture and Chiropractic, in Proceedings. Am Assoc Equine Pract 2005; 51:403-408.
