CASE REPORT 7 (the auther NN is known by NoVAS board)
Acupuncture was used to treat cervical stiffness in a Danish Warmblood dressage horse.
Abstract:
Acupuncture was successfully used to treat a young dresasge horse with a left sided cervical stiffness. Three treatments were given and the problem resolved afterwards letting the horse return to a normal exercise level.
History:
The horse was a 4½ year old Danish Warmblood gelding, which the owner recently had bought. The owner, a proffesional rider, had bought the horse without any clinical prepurchase examination. However there had been done a full prepurchase x-ray exam. with no significant findings. He had started riding and lunging the the horse approx. 4 weeks prior to my first visit.
The owners complaint was that the horse did'nt feel quite right when being ridden, especially on the left side/rein. When lunged the horse did'nt flex properly in the neck on the left side. The horse was according to the owner a talented horse and pleasent to work with but did have a temper if there was a confrontation between the rider and the horse. This was especially when the owner tried to flex the neck to the left. The owner had noticed that the horse seemed more sensitive when groomed on the left side of the neck. Also the horse was not to keen on having the tack placed on the head. The owner was somewhat sceptical towards acupuncture and was keen on x-raying the cervical verterbrae at once.
Clinical exam. - Western diagnosis:
The horse had a good body condition, good symmetrical muscle mass along the neck, back, loin and hind legs. Lameness exam. revealed no lameness as flexion tests on all four limbs also were without any reaction. When lunged the horse moved freely in all three gaits, good on the right side, but with a stiff neck and the head turned out on the left side. On the left side there was also an exaggerated right hind limb flexion, which could not be observed on the right side.Back reflexes were normal and the horse did not seem to be sore in the back. Saddle fit was good. Palpation of the neck revealed pain upon palpation of the muscles (moderate pressure) on both sides, but the horse seemed to be more painful on the left side. An oral exam. was also performed which revealed enamel points on the upper and lower arcade aswell as a small ramp on P2 upper jaw, both sides.
Two possible diagnosis were most probable to be the cause of the cervical stiffness.
- Cervical muscle stiffness due to training (untrained horse and prof. rider)
- Cervical instability (started training 1 month ago and therefore may not have been noticed before)
Possible worsening of (or contribution to) the problem due to enamel points/ramp P2.
It was decided to postpone x-ray exam. of the neck and possible blood work until after treatment with acupuncture. The owner commited himself for three acupuncture treatments beforehand.
Clinical exam. - Eastern diagnosis:
Observation:
The horse was in good body condition with a shiny haircoat. Good conformation. Interested in its surroundings. Normal eating habits, urinaton, faeces, defecation. Walked and trotted willingly. Unwilling to turn left in the stall. Would much rather turn right, also in the stocks. Carrot test revealed a unwillingness to turn left. Right side no apparent stiffness of the neck.
Horse seemed like a LIVER/fire constitution.
Tongue and pulse not evaluated.
Palpation:
The following points were sensitive to palpation:
Diagnostic points on the head and neck: ST6, GB20, BL10, TH16, LI16, SI16 (GB20/BL10 esp. tender on the left side)
Trigger points: SI9
Ting points: LI, GB (swampy feeling - excess)
Back SHU points: BL16 (GV), BL 18 (LIV), BL19(GB), BL28(BL), BL28-BL40 on the right side were tender .
Mu points: Possibly LIV13 (SP), LIV14 (LIV) Horse disliked palpation in this area (true sensitivity?)
TCM diagnosis:
8 Principal: Exterior, excess, (heat), Yang
6 evils: Wind invasion
LIVER constitution
5 Element:. Excess Qi with stagnation of Qi and blood in Wood element
Muscle channel invaded by wind resulting in an imbalance in the element wood. Excess Qi is stagnated in the GB/LIV meridians resulting in the cervical muscle stiffness. Also imbalance in the BL meridian. Pain at BL 18/19 indicate wood (GB/LIV) imbalance. There were no signs og organ pathology and with the subacute onset indicating wind invasion of the exterior (muscle channels) the goal was to disperse wind and excess Qi and promote the free flow of Qi and blood.
Treatment Western:
Teeth were floated with hand floats and P2 both sides in the upper arcade were rasped by means of a machine float. This was performed the day before the first acupuncture treatment.
Treatment Eastern:
All points treated bilaterally using Huanqiu 0,3*40 mm, except LI1 and LU7 0,3*20 mm dry needling for 20 min.
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All points listed in the following order: Acupuncture point Chinese name Point action Function Point location LU 7 Lieque Masterpoint of head and neck Expels exterior wind Prox. To styloid process, 1½ cun prox, to transverse crease og carpal joint BL 10 Tian Zhu Local point neck Local point, diagnostic point: C2-C3 sublux., soreness in contralat. Limb Caudal to the ear, depression caudal to wings of atlas BL 12 Feng Men Influencial point for wind Eliminates ext. Wind, regulates defensive Qi 1 cun lat. To spinous process between 4. And5. Thoracic vert., at the highest point of the withers BL 18 Gan Shu Back Shu for LIV Benifits liver function of patency of flow of Qi 3 cun lat. To ventral border og spin. proc. in the 13. (and 14.) intercostal groove BL 19 Dan Shu Back Shu for GB Benifits liver function of patency of flow of Qi 3 cun lat. To ventral border og spin. proc. in the 15 intercostal groove LI 1 Shang Yang Ting point Expels wind, removes obstuctions in excess paterns On the mediofrontal area of the coronary band on the front hoof LI 16 Ju Gu Local point neck Moves blood locally, removes obstructions in the channel, benifits the joints halfway betwwen LI15 and LI17 in the impression between both paths of the m. brachiocephalicus |
Second treatment 4 days later:
Trainer had been told to go slow with the horse. He was told to lunge the horse moderatly and ride the horse with a deep head and neck attitude. The rider was not to force the horse to flex the neck to the left.
After 4 days the horse seemed better. Much less painfull and was willing to flex the neck moderatly to the left. The right hind limbs exagerated gait when lunged was also much less obvious. Acu points which still were reactive were: BL 10, GB 20, TH 16, LI 16, BL 19, BL 28 and still some reactivity at BL 28-40 on the right side. The owner was satisfied so we preceeded to the second treatment.
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All points listed in the following order: Acupuncture point Chinese name Point action Function Point location LU 7 Lieque Masterpoint of head and neck Expels exterior wind Prox. To styloid process, 1½ cun prox, to transverse crease og carpal joint BL 10 Tian Zhu Local point neck Local point, diagnostic point: C2-C3 sublux., soreness in contralat. Limb Caudal to the ear, depression caudal to wings of atlas BL 19 Dan Shu Back Shu for GB Benifits liver function of patency of flow of Qi 3 cun lat. To ventral border og spin. proc. in the 15 intercostal groove BL28 Pangguangshu Back shu point for Bladder Strenghtens KI yang, stops pain, claears heat 3 cun lat. to the ventral border of the sacral processes between the 2. and 3. sacral vertebrae BL60 Kunlun Jing river, fire point Expels wind, clears heat, removes obstuctions from the channel. Relaxes tendons, strenghtens caudal back, alleviates pain. Between the lat. condyle of the tibia and the tuber calcaneus GB20 Feng Men Local point neck Eliminates exterior and interior wind, subdues liver Yang Bellow the occipital bone, medial of the upper portion of the trapezius muscles Jui Wei local points Eliviates pain and stifness in the neck 10 points on the nuchal ligament with equal distances between BL10 and BL11 treated with aquapuncture using Becoplex (vit B compound) 1 cc at each point at a depth of 2 cm using a 21 G needle |
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Third treatment after 1 week:
The horse was reevaluated after 1 week. The horse was significantly better, being able to flex its neck to the left without any resentment. No pain upon palpation of the neck musculature. When lunged it moved evenly on both sides, with its exageraed right hind leg flexion having disappeared. The GB/LIV back Shu points were not sensitive to palpation. Slight reaktion wad found at BL 28.
It was decided to give one final treatment.
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All points listed in the following order: Acupuncture point Chinese name Point action Function Point location LU 7 Lieque Masterpoint of head and neck Expels exterior wind Prox. To styloid process, 1½ cun prox, to transverse crease og carpal joint BL28 Pangguangshu Back shu point for Bladder Strenghtens KI yang, stops pain, claears heat 3 cun lat. to the ventral border of the sacral processes between the 2. and 3. sacral vertebrae BL60 Kunlun Jing river, fire point Expels wind, clears heat, removes obstuctions from the channel. Relaxes tendons, strenghtens caudal back, alleviates pain. Between the lat. condyle of the tibia and the tuber calcaneus GV14 Dazhui Sea og Qi, Meeting point of BL,ST,GB Dispels wind, releases the exterior, regulates defensive and nutritive Qi In a depression on the dorsal midline between the spinous process of the 1. And 2. Vertebrae Bai Hui Point where all the Yang meridians merge Any lameness, liver disorders In the lumbosacral place LI 16 Ju Gu Local point neck Moves blood locally, removes obstructions in the channel, benifits the joints halfway betwwen LI15 and LI17 in the impression between both paths of the m. brachiocephalicus |
Discussion:
Acupuncture was effective in treating the cervical neck stifness. The effectiveness was probably also due to an altered riding habit. Muscle pain in general is usually difficult to treat conventionaly and is often done by the means of NSAID's. Acupuncture offers itself as an alternative way of releaving pain and easing muscle tension. In this case the muscle pain and neck stifness was obvious, and was not due to any deeper internal disorder. Therefore the acupuncture therapy was aimed to move the Qi and blood in the stagnated area by primarily by means of the Yang meridians. The points chosen were meridians that ran through the area of muscle pain, local points and points which are known to help alleviate certain specific conditions. Distal points were also used.
Referances: Material handed out at the IVAS course, and "Acupuncture points and meridians in the horse" by Emiel Van Den Bosch and Jean-Yves Guray.
