Part 5 of 5 of our blog series- 

Optimizing the Care and Management of Your Equine Athlete

Complementary Medicine/Early Screening for Injury

Acupuncture is becoming more prevalent as an adjunct treatment and diagnostic modality for various conditions in horses. Many sport horses have acupuncture performed on a routine basis to maintain and potentially enhance their athletic performance. An estimated 80% of elite show jumpers and dressage horses are treated with a combination of traditional Chinese medicine (acupuncture and chiropractic) and western medicine.

The use of complementary medicine in animals has closely paralleled its development in human medicine and is becoming more and more mainstream. The two most widely used are veterinary acupuncture and chiropractic. The American Academy of Veterinary Acupuncture, the International Veterinary Acupuncture Society, the American Veterinary Chiropractic Association, the Chi Institute, and the International Veterinary Chiropractic Association all work to promote excellence in the practice of complementary therapies through establishment of standards, educational programs, and accreditation exams.

Sarah le Jeune, DVM, Dipl. ACVS, ECVS, ACVSMR, CVA, CertVetChiro, a board-certified equine surgeon and board-certified specialist in equine sports medicine and rehabilitation at UC Davis, is also certified in both veterinary acupuncture and chiropractic. Le Jeune focuses on the treatment of various performance-related musculoskeletal injuries and lameness by an integrative approach including acupuncture and chiropractic. She received her acupuncture training from the Colorado State University and the Chi Institute in Florida and obtained certification in veterinary chiropractic by the International Veterinary Chiropractic Association. Because of her personal involvement with performance horses, particularly jumpers and dressage horses, le Jeune was motivated to pursue all possible treatment and management modalities to maintain and preserve soundness in athletes.

Acupuncture therapy could be effective as an adjunctive treatment in the following conditions:

• Musculoskeletal problems: Muscle soreness, back pain, osteoarthritis, degenerative joint disease, obscure lameness, tendon/ligament problems, laminitis
• Neurological disorders: Seizure, laryngeal hemiplegia, facial and radial nerve paresis
• Gastrointestinal disorders: Diarrhea, impaction, chronic colic, gastric ulceration, ileus
• Other chronic conditions: Heaves (chronic obstructive pulmonary disease, recurrent airway obstructions, asthma), anhydrosis, uveitis, behavioral problems, Cushing's disease, hypothyroidism, hyperthyroidism, infertility, renal failure, geriatric weakness, skin problems
• Performance enhancement and prevention of disease: Horses experiencing performance issues associated with musculoskeletal pain, who must comply with prohibited substance policies mandated by show associations, can benefit show-side from acupuncture and/or chiropractic treatments. This occurred at the 2008 Olympics, the 2010 World Equestrian Games, and the 2012 London Games in compliance with the FEI.

The physiological effects potentially induced by acupuncture include:

• Pain relief
• Promotion of microcirculation
• Anti-inflammatory effects
• Regulation of gastrointestinal motility
• Immunoregulation
• Endocrine and reproductive regulation
• Antipyretic effects

When performed by a trained and qualified veterinarian, acupuncture is a very safe medical procedure. Very few negative side effects have been reported in clinical cases and most horses tolerate the treatments well with minimal restraint and no need for sedation.

Photo: Anne M. Eberhardt

When performed by a trained and qualified veterinarian, acupuncture is a very safe medical procedure. Very few negative side effects have been reported in clinical cases and most horses tolerate the treatments well with minimal restraint and no need for sedation. Acupuncture is not usually recommended during pregnancy as it can cause uterine contractions. It is also not recommended as the sole treatment modality in cases involving fractures, open wounds or infectious conditions. However, it can easily be combined with other traditional therapies.

Veterinary acupuncturists and chiropractors can add valuable information to the physical examination of the horse and findings can be used to localize and treat sources of discomfort. In a recent study, le Jeune and colleague Jim Jones, DVM, MS, PhD, of the UC Davis School of Veterinary Medicine sought to obtain scientific evidence for the use of acupuncture scanning in predicting lameness in horses in a routine clinical setting. It was hypothesized that horses exhibiting a painful response during palpation of superficial acupuncture points along the neck, back, and rump (acupuncture scan) would also show signs of lameness as determined by a conventional lameness exam.

The study was conducted in 102 client-owned horses that were presented for routine acupuncture, reduced performance, or lameness. Each horse first underwent a brief (less than two minutes) screening scan of acupuncture points and was classified as positive or negative for acupoint sensitivity. Then each horse was evaluated in the conventional manner for lameness and categorized as lame or sound. In this study, acupuncture scanning had a high sensitivity, specificity, and accuracy (all around 80%) to detect lameness. The conclusion of the study was that an acupuncture scan could be a useful, quick screening tool during the physical exam to identify horses that should undergo a full lameness exam and other diagnostic testing.

Chiropractic care focuses on the health and proper function of the spinal column, although the pelvis, limbs and head are also considered. When a chiropractor examines a patient, he/she is looking for joints with a reduced range of motion. The common principle in all chiropractic theory is that joint dysfunction affects the normal neurological balance found in healthy individuals.

A chiropractic adjustment involves a high velocity, low-amplitude thrust that induces segmental spinal motion. This motion usually exceeds that created by normal locomotion. The adjustment activates muscle spindle cells and other local proprioceptive receptors, which provide stimulation to override the neurologically induced restrictions in that area and inhibit the perception of the painful stimulus.

The goal of any adjustment is to restore the optimal range of motion to that joint, which will subsequently alleviate inflammation in and pressure on surrounding nerves and soft tissue. The inflammation makes it difficult for nerves to transmit their messages accurately, similar to static on a telephone line. Considering that nerves coupled with the brain and spinal cord (the central nervous system) control everything in the body, improving their ability to communicate well enhances overall health. This is particularly important in the spine. Note that chiropractic is not recommended in cases involving fractures or infectious conditions.

To become fully accepted in the veterinary and scientific community, there is a need to perform scientifically sound clinical trials for horses undergoing acupuncture and chiropractic treatments for a variety of conditions, such as described for acupuncture scanning as a diagnostic modality earlier in this section. Other types of studies that would be very useful for performance horses include the following:

• Can acupuncture and chiropractic cause a horse to bear weight more evenly and to use its body in a biomechanically more efficient manner? Objective and noninvasive methods of assessing foot-fall patterns and lameness in horses can be performed with force plate analysis, which would be an excellent tool to quantify the response of different treatment modalities in clinical patients over time. UC Davis recently acquired a force plate to enhance lameness evaluation and research by providing objective information regarding limb loading and multifactorial lameness.
• To what extent do acupuncture and chiropractic promote gastrointestinal motility? Colic is a very common problem in horses and is frequently related to changes in gastrointestinal motility. Acupuncture and chiropractic are currently being used as adjunctive therapies to promote gastrointestinal motility. An objective assessment of motility in clinical patients could be performed with noninvasive monitoring devices such as the Smartpill. This could have significant implications for postoperative ileus, a common complication following colic surgery.

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Reprinted from The Horse Report (Spring 2014) with permission from the Center for Equine Health, School of Veterinary Medicine, University of California, Davis (UC Davis).