Equine Integrative Sports Medicine
Recent advances in equine sports medicine and rehabilitation have made it possible for equine athletes to reach new levels of excellence. Client demand for superior diagnostics and innovative treatment strategies require equine practitioners to be more informed than ever before.
In addition to Western advances in sport horse medicine, complementary modalities such as acupuncture and chiropractic have become increasingly recognized as effective and valuable ways to treat equine athletes with musculoskeletal conditions associated with the demands of intensive physical conditioning and performance. Blending the best of traditional and complementary medicine provides an integrative approach to treating the whole horse, rather than focusing on a specific region or structure.
A 2008 survey conducted by the American Association of Equine Practitioners stated that 20% of equine practitioner respondents perform some form of complementary medicine treatment modality themselves (most commonly acupuncture and chiropractic). Of those that do not, 80% refer cases specifically for complementary medicine to veterinarians who have this expertise. Multiple veterinary institutions including the University of California, Colorado State University, the University of Florida, Oregon State University, and Virginia Tech, to name a few, are including acupuncture and chiropractic in their clinical services and veterinary curricula.
ACUPUNCTURE CAN BOTH TREAT AND DETECT LAMENESS
Horse owners are attracted to acupuncture because it is very safe, has minimal detrimental side effects, and is well tolerated by most horses. Horses experiencing performance issues associated with musculoskeletal pain, and who must comply with prohibited substance policies mandated by show associations, can benefit show-side from acupuncture and/or chiropractic treatments. This occurs at most elite competitions in compliance with the FEI.
Lameness is the most common cause of poor performance in sport horses. Lameness typically results from pain associated with the musculoskeletal system, including joints, bones, tendons, ligaments, muscle and nerves. The majority of lameness cases are localized to areas within the distal limb; however, the sources of lameness are diverse and the causes numerous; they include, but are not limited to, wear and tear, overuse and trauma.
Acupuncture can be used not only in the treatment but also in the detection of lameness in horses. It is interesting to note that most horse owners cannot adequately detect lameness until it is severe, that is, present at the walk. The author recently conducted a prospective study to answer the question of whether an acupuncture scan could be useful in screening for lameness in performance horses.1 The study population consisted of 102 performance horses (jumpers, dressage horses and Western performance horses) evenly distributed into lame and sound groups. These horses first underwent an acupuncture scan and then a routine lameness exam. The results of the study showed that when using an acupuncture scan, 78% (40/51) of the sound horses were negative, whereas only 18% (9/51) of the lame horses were negative (P < 0.001). This indicates that acupuncture scanning has a sensitivity of 82.4% in detecting lameness and a specificity of 78.4%. This suggests that horses with a positive acupuncture scan should undergo a lameness exam to identify if they are lame, and if so, the cause of their lameness.
Acupuncture can certainly be used to help relieve pain, particularly muscular pain, in many lameness conditions. But it is critical that the primary cause of lameness is also addressed with traditional methods. In the author’s experience, performance horses undergoing regular acupuncture treatments have a decreased necessity for joint injections, particularly of the distal hock joints. The author speculates that acupuncture helps the horse travel in a biomechanically sound manner, which may stress distal joints less than when the horse is compensating for muscle pain.
BACK PAIN – COMMON BUT DIFFICULT TO DIAGNOSE
Back pain is very common in riding horses and can be very difficult to diagnose and treat with conventional methods. “Back pain” is a good example of a term that encompasses a wide variety of conditions, with just as many etiologies. The clinical signs are non-specific and the most consistent feature of a back problem is a loss of performance. Acute soreness is often associated with falling or some other traumatic incident, but this is rarely the case. Horses experiencing back pain may have a multitude of non-specific clinical signs: difficulty posturing to urinate, a reluctance to lie down or roll, a reluctance to saddling, grooming or picking up their feet, an appearance of collapsing behind while ridden, apparent stiffness, trouble backing, or apparent unilateral or bilateral lameness when working, with stiffness in the hind end. Behaviorally, the horse may refuse to work on the bit, or to bend or perform certain movements while ridden, or may exhibit another form of evasion.
Horses experiencing chronic pain can also exhibit withdrawn social behavior, and possibly experience decreased appetite and nutritional intake. This is due to the effect of chronic pain on the emotional centers of the limbic system, which motivates the individual to withdraw from damaging situations, protect a damaged body part while it heals, and avoid similar experiences in the future.2-5
The human model of spinal rehabilitation includes a multidisciplinary approach in the management of back problems. Advances in the treatment of equine back pain incorporate some of the same philosophies. The difficulty lies in identifying the exact cause of back pain, as it is often multifactorial. Back pain is commonly associated with lameness, and it is critical to identify whether the horse is indeed suffering from primary back pain or if the pain is secondary to distal limb lameness. Horses with back pain should therefore undergo a full lameness exam, potentially with limb blocks to rule out lower limb lameness. In addition, factors such as saddle fit, shoeing, conditioning programs and rider ability should be assessed when dealing with such a case. Several studies report that acupuncture is effective in treating back pain in horses.6,7
In the author’s experience, it takes at least three consecutive (weekly) treatments to obtain a long-lasting clinical resolution of back pain, and these horses benefit from regular (monthly) acupuncture treatments. The duration and quality of the therapeutic effect may be improved by incorporating chiropractic treatments in addition to acupuncture, but clinical studies are needed to confirm this impression.
The anatomy of the horse has evolved to allow him to move as efficiently as possible, with as little stress as possible. Any imbalance in the system will cause asymmetrical loading of limbs, and over time, this asymmetrical and unbalanced use will cause the overloaded structures to become inflamed, thus creating lameness. Traditional methods of diagnosis and treatment rely on pain and inflammation to locate a problem. Gait analysis, blocking, palpation, hoof testers, flexion tests, etc. all rely on pain and inflammation. Conventional treatments therefore most often center on anti-inflammatory medication, either locally and/or systemically, shoeing changes and rest, and pay too little attention to the biomechanics and efficiency of movement. Positive results are seen when the patient appears to be moving without pain or apparent lameness, at which point he is released from care.
THE INTEGRATIVE SPORTS MEDICINE EXAMINATION
An integrative sports medicine exam is multifaceted and includes the following:
- Detailed history: emphasis on duration of clinical problem, previous treatments, diet, dental care, shoeing, type/ intensity/change of work, warm-up/cool-down, access to turnout, social behavior.
- Static exam: emphasis on stance, foot balance, muscle symmetry, careful palpation of topline and all limbs, passive range of motion of all limbs, passive range of motion of TMJ, cervical flexions, hoof testers on all four feet.
- DAPE: Diagnostic acupuncture palpation exam.
- Dynamic exam: careful evaluation of walk, trot, canter in straight line and circle, on soft and hard ground (no canter on hard ground), followed by an evaluation of the horse ridden by a regular rider/trainer if performance problem is subtle.
- Stress tests: Lower and upper limb flexions.
- Chiropractic exam of entire axial skeleton.
- Evaluation of saddle.
The integrative approach (incorporating acupuncture and chiropractic) to diagnosis and treatment focuses on the functionality and biomechanics of the whole horse and how this can change over time. This approach focuses on the entire horse and can potentially detect and address preclinical problems before actual structural damage has occurred. Due to the increased strain placed on equine athletes, it is important to examine sport horses on a regular basis every six to 12 weeks, depending on the intensity of work and the presence of clinical problems.
Saddle fit checklist
- Balance: The center of the seat should be parallel to the ground.
- Withers clearance: Two or three fingers should fi t between normal withers and the saddle. (Low “mutton” withers may allow a little more; very high withers, a little less.) Clearance should be all around, not just at the top. It is important to check that there is sufficient wither clearance even with the weight of the rider.
- Gullet width: The gullet should be three or four fingers wide, so it won’t interfere with the spinal processes or the muscles of the horse’s back.
- Panel contact: Panels should rest evenly on the horse’s back from front to back, without overstuffing in the middle (the saddle will rock) or bridging (with a gap in the middle).
- Billet alignment: Billets should hang perpendicular to the ground so the girth is not angled. This way, the girth will always find its correct position at the sternal groove, the narrowest point behind the elbow.
- Shoulder ﬁt: Panels at the front should be parallel to shoulder. Tree points (the front tips of the saddle frame) should be behind both shoulder blades.
- Straightness: The saddle should not tilt to one side when viewed from the back.
- Saddle length: The saddle should not be so long that it puts weight on the shoulder or loin area. The rider’s weight should be carried on the support area over the rib cage.
1le Jeune SS, Jones JH. “Prospective Study on the Correlation of Positive Acupuncture Scans and Lameness in 102 Performance Horses”. American Journal of Traditional Chinese Veterinary Medicine, 2014.
2Lynn B: Cutaneous nociceptors. In: Winlow W, Holden AV. The neurobiology of pain: symposium of the Northern Neurobiology Group, held at Leeds on 18 April 1983, Manchester University Press, 1984, ISBN 0-7190-0996-0. p. 106.
3Raj PP: Taxonomy and classiﬁ cation of pain. In: Niv D, Kreitler S, Diego B, Lamberto A. The Handbook of Chronic Pain. Nova Biomedical Books; 2007. ISBN 1-60021-044-9.
4Vernon H, Aker P, et al. “Pressure pain threshold evaluation of the eff ect of spinal manipulation in the treatment of chronic neck pain: a pilot study”. J Manip Physiol Ther 1990; 13:13-16.
5Kandel, Eric R, et al. Principles of Neuroscience, McGraw-Hill, 1991.
6Xie H, Colahan P, Ott EA. “Evaluation of electroacupuncture treatment of horses with signs of chronic thoracolumbar pain”. J Am Vet Med Assoc. 2005 Jul 15;227(2):281-6.
7P Kulchaiwat, H Xie. “Eff ect of EA on chronic back pain in Sporthorses”. AJTCVM, Vol 4(1) 200