Case of the Month
3 yo TB gelding in training.
History of back pain that responds moderately to muscle relaxants (Robaxin/methocarbamol), rest and NSAIDS.
Trainer has utilized acupuncture therapy in the past, and wants to see if acupuncture will help horse stay comfortable longer without medications.
Gelding is sound at a jog with no rider.
Scan- LI-18? Back/SI Hocks- BL-39 +5
Back sensitivity is most likely local stagnation in this case. The extreme sensitivity over hock points leads me to the conclusion that horse is quite sore in his hocks, even though he jogs sound.
Plan- the best course of action for this horse is to inject the hocks with cortisone and hylauronic acid to combat the inflammation. Due to horse’s constitution and discussion with trainer about training/racing time frame, it was decided to utilize aqua-acupuncture on several points while horse was under sedation for the hock injections. The points chosen were BL-54, Master Point for the hind limb, BL-40, Master point for the hips and back, and Yan-chi- a general performance enhancing/qi boosting point. Gelding’s distal intertarsal joints and tarsometatarsal joints were injected bilaterally with triamcinolone and hylauronic acid (DIT) and triamcinolone only (TMT). BL-40/54 and Yan-chi were injected with 5cc B12 (1000mcg) bilaterally. Training was resumed after 3 days of hand-walking post injection.
10day follow-up scan
Hock sensitivity had completely disappeared and gelding was back into regular training. Some back pain was present, but sensitivity had diminished significantly.
There are several key points to discuss with this case.
- The use of the acupuncture scan to assist with lameness/poor performance diagnostics. In this gelding’s case, hind limb flexions were not the safest choice due to horse’s attitude and constitution. The trainer felt that horse was not utilizing his back end efficiently on the track. We were not sure if back pain was a primary cause, or the result of hind end pain.
- The acupuncture scan is putting pressure on certain meridian points that correlate to certain parts of the body. The horse reacts due to qi stagnation over the points, or along the meridian. If qi cannot flow freely, this results in stagnation and pain. These points can be responsive or positive to scanning due to several factors- local pain or trigger points (like the gelding’s back), the specific body region/part the point correlates to (like BL-39 for hocks), or to organ system issues (BL-18 associates with the Liver organ system). The scan is a very efficient method for pinpointing issues, and is minimally invasive. If there is a chronic issue, or multiple issues going on, the scan is not as cut and dried as this gelding’s. It is still a valuable asset for localizing pain/qi stagnation.
- The type of TCVM treatment utilized. In this case one could have done more traditional acupuncture techniques- dry needling and electro-acupuncture, but many times if the joint is that reactive on scan, a combination of Western medicine (joint injections) and Eastern Medicine can be used to achieve the best possible result as quickly as possible to keep gelding’s training schedule on track.
- Aqua-acupuncture is the injection of a liquid substance into an acupuncture point to provide longer stimulation of said point. There are various substances that can be injected. The most common being vitamin B12, but the holistic preparations Traumeel or Zeal are also used. In certain cases the horse’s own blood can be used. This is most effective if there is an immune based issue occurring. The advantages of aqua-acupuncture are it provides longer stimulation of a point, and it can be performed with sedation. Sedation can dampen the effects of dry needling, so it is usually avoided if, possible. In situations where the horse would not be amenable to dry needling- attitude, constitution, or sensitivity of points, aqua-acupuncture can be utilized to minimize stress on horse, and optimize safety of everyone involved. It should be noted that the more sensitive a horse is on scan, the more likely the points will be quite reactive to treatment. If a needle is placed in a reactive point, the horse can feel some discomfort and react accordingly.
- This leads to the final point of discussion- will this horse be amenable to dry needling? Based on TCVM Five Elements personality constitutions, some horses will react stronger to dry needle or electro-acupuncture therapy. The wood and fire constitutions usually tend to be more explosive- bucking, striking even with mildly reactive points. Safety of all parties- veterinarian, handler, and horse is extremely important in any treatment situation. If it is determined that a horse will not tolerate dry needling, then back up treatment plans should be used. This does not mean horse cannot be treated, it simply means that treatment must be conducted a bit slower in pace and more carefully. In these cases either aqua-acupuncture with sedation or twitch is used with or without herbal medications. In some cases herbal medications can be used to treat horse for a period of time before re-scanning and attempting dry needles.
This case was a very good example of the use of a combination of Eastern and Western medicine to reach a diagnosis and formulate a treatment plan. TCVM works very well with Western medicine, and the herbal formulas can be given alongside most traditional medications (bute, banamine ect.) to work synergistically. Not all situations can be or should be treated with Eastern medicine alone- infections, wounds, fractures to name a few. TCVM is focused on bringing balance to the body, allowing it to function at its best. This means that the reaction to treatments and time of treatment is a bit different than Western medicine. Some cases respond quickly, others take more time. Like every horse is an individual, each case is also an individual and will evolve differently than others depending on the cause of imbalance.
I am excited to be able to offer our clients a different manner to approach cases, and offer a drug-free method of pain control that can be utilized with current pharmaceuticals. I hope that with TCVM I can help our patients be their very best, whether it is in the show ring, therapy camps, on trail,or enjoying a relaxing day of retirement.