therapeutic options in equine practice

EQUINE P O R TS MEDICINE

THERAPEUTIC OPTIONS IN EQUINE PRACTICE

Joyce Harman, DVM

I N T R O D U C T I O N

The last several years have brought an increase in the interest and availability of many therapeutic options not generally taught in veterinary college. These include, but are not limited to, acupuncture, chiropractic, massage, physical therapy, and homeopathy. Most equine practitioners have heard of one or more of these therapies. However, very few practitioners are educated in the scientific basis and actual practice of these therapies. Interested practitioners may even have difficulties accessing detailed information on therapeutic options. This paper will present a brief introduction to acupuncture, chiropractic, homeopathy, massage and physical therapy.

The equine, as an athlete, can benefit from many of the same considerations given the human athlete. Many human athletic trainers are realizing they can improve the soundness and longevity of their athletes through the use of the treatments described here. The basic physiology of the muscles and bones is similar in the human and equine athlete, with the equine having the added stress of carrying a rider or pulling a carriage. Some of these therapies such as acupuncture and homeopathy work well on internal disease conditions also, as they do in people. Veterinarians and horse owners are realizing that these therapeutic options work extremely well on the equine athlete. For maximum benefit, therapeutic options are often used as a complement to conventional veterinary medical techniques. The end result is improved health and performance for the horse.

Acupuncture Acupuncture originated in China about 4000 years ago

and is currently the primary medicine for over one-quarter of Author's address: P.O. Box 193, Odean, VA 22128

the world's population. Some veterinarians feel that acupuncture is still experimental, but with a track record that long compared to about 150 years for our western medicine and surgery and about 50 years for antibiotics, it is the most proven of all medical techniques available today. Acupuncture has only been practiced routinely in the United States since the early 1970's. Being relatively new to this country, many people do not understand it yet.

There are three main scientific theories that attempt to explain how acupuncture works. Most likely the correct way is a co mbination of all three. More research will lead to a better understanding of the scientific basis for acupuncture.

The neural-opiate theory is perhaps the one many people recognize. In this theory the stimulation of an acupuncture point produces a release of endogenous opiates, endorphins and encephalins. These chemicals act on the central nervous system to inhibit pain perception and pain transmission.

The hormonal opiate theory states that there is a release of humoral factors from the pituitary gland. These then cause an increase in the endorphin level which decreases pain. The neural-non opiate theory describes how there are pain inhib- iting impulses arising from the extra lumniscal system which includes the reticular formation. This is in the centramedian nucleus of the thalamus. These theories are discussed in detail in Ulett 1982.16

There are several other explanations that bear a brief presentation. There appears to be a relationship between the cutaneous-visceral and visceral cutaneous reflexes. 1 There is also a bioelectric theory involving the bioelectrical current of EKG's and EEG's. The current becomes inhibited in pathologic areas and the stimulation of the acupuncture points has changed EKG's. And then, of course, the Chinese approach that believes that the flow of life energy force or "Qi" is disturbed in pathologic areas. By doing acupuncture the flow of this Qi or life energy is restored evenly throughout the body and homeostasis is restored.

A very complete bibliography can be found in Shoen 1992.14 , Parts of the acupuncture system are easily quantifiable.

Acupuncture points occur along the meridians all over the body and can be measured in concrete terms. A device that is essentially a modified ohm meter can measure a decrease in electrical resistance at each acupuncture point. These points are found electricially where the Chinese have mapped them our for 4000 years. Acupuncture points can also be differen- tiated from the rest of the body histologically. There are more fine lymphatics, venules, arterioles, capillaries and mast cells at each point than in the surrounding tissue. There are also

368 JOURNAL OF EQUINE VETERINARY SCIENCE

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Table 1.

Acupuncture treatments are commonly used for: neck pain and stiffness arthritis muscle atrophy navicular back pain tying-up nerve damage wobbler syndrome muscle soreness laminitis colic: acute allergies performance/training problems skin problems colic: chronic, recurrent COPD

more sympathetic nerves supplying the vessels, more nerve bundles, nerve plexuses and free nerve endings. This electrical and histological proof should go a long way to help define acupuncture as having a physiologic basis.

Acupuncture in the horse can be used to treat many conditions (Table 1), although in this country it is used primarily to treat musculoskeletal conditions. Arthritis is very common in horses and responds very well to treatment with acupuncture, especially in the hock, stifle and hip. Navicular disease frequently responds well, although the longer (in terms of years) that the horse has been lame, the lower the response rate. Back pain is commonly treated with acupuncture and is extremely responsive to therapy as is neck pain and stiffness. Some horses diagnosed as wobblers can be helped, although horses with significant lesions and vertebral instabil- ity that shows up on x-rays are much less responsive than those with minor lesions. Some horses that are ataxic, but show no vertebral lesions, respond very well while others do not respond at all. Being able to offer acupuncture to these cases gives the client one more avenue to choose from, in what is often a frustrating situation.

Some chronic obstructive pulmonary disease (COPD) horses can be helped significantly with acupuncture, however allergies are often harder to treat than many of the other conditions. Often a combination of therapies works best. Colic is very responsive to treatment, both in acute and chronic recurrent cases. However, acupuncture treatment is no more of a substitute for surgery than is traditional drug treatment.

Acupuncture is also used to treat many internal disease conditions (Table 2) and can be very effective. However, these particular conditions are much less common in horses and, as a consequence, equine veterinarians have less experience treating these than do the small animal veterinarians. In small animals and people, internal diseases are frequently treated.

To learn more about veterinary acupuncture, an excellent course is given by the International Veterinary Acupuncture Society 21 that leads to a certification in veterinary acupuncture. Lectures are also given at several of the larger veterinary meetings, such as Eastern States aad Western States, as well as the Ohio Veterinary Medical Association meeting. There are only a few books on the subject.

Table 2.

Acupuncture can also be used for internal medical problems: liver disease kidney disease heart disease digestive disease seizures

Chiropractic Chiropractic care for humans is almost accepted in the

medical profession and by many insurance companies. In the equine world, chiropractic is now being recognized to greatly benefit horses, but has not gained much acceptance by the veterinary profession. In many cases this is justified, as there are too many stories of adjustments being done to horses' spines with brute force and often with the aid of rubber mallets, boards and other hard objects. Horses have been injured by this brutal form of chiropractic and, unfortunately, this gives chiropractic a bad name.Anumber of chiropractors are doing very high quality work however, so it is important to evaluate each practitioner individually according to certification, education, techniques and results.

Chiropractic as a profession began in 1910 as a method for correcting spinal subluxations which cause interruptions in the flow of nervous energy to the rest of the body. By correcting these subluxations, the nerve supply to the body flows uninterrupted and cellular health can be improved, since all the cells need a good nerve supply just as much as they need a good blood supply.

A significant amount of research has been done about human chiropractic care. The physiology has been worked out in detail, and is covered in numerous textbooks and journal articles. Some very interesting data shows an enormous reduction in medical costs experienced by chiropractic pa- tients indicating that the health benefits are far reaching, is Bones are bones and they function in similar ways between species, so there is every reason to believe that horses have subluxations similar to humans and can benefit from chiropractic care.

There are several scientifically-related theories about chiropractic and how it works. 9,1s, Lack of movement between the bones of the spine decreases the normal pumping action of the intervertebral discs. This prevents or slows the exchange of nutrients to the disc which allows it to age or degenerate abnormally. The ligaments and muscles around the vertebrae are also affected. They may become scarred and thickened or may end up in a painful spasm. When there is a lack of movement, due to a subluxation between vertebrae, the spinal nerves at the intervertebral foramina become irri- tated and result in aberrant neural activity. These nerves appear to be extremely sensitive to small amounts of pressure and conduction of nerve impulses is easily affected. The effects of impaired nerve conduction frequently show up in

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the body as subtle malfunctions, but when there is significant impairment, muscle atrophy is frequently the result. Atrophy is commonly seen in horses, especially when there are cervical or sacroiliac subluxations.

Contrary to popular belief, it is possible to move a horse's spine and to correct subluxation. 17 Most good chiropractors use a variety of hand techniques designed to release the vertebrae and the tight muscles that surround it. As with humans it often takes several sessions, however horses are often more easily adjusted than humans. They will need some maintenance treatments because the causes of subluxations are impossible to remove from a horse's career, although they can be minimized.

Horses are natural athletes and actually can be very supple their entire life if cared for properly. However, most horses begin to accumulate subluxations at a young age. These are not generally treated. As the horse ages and becomes stiffer, veterinarians and riders alike attribute the stiffness to age. In truth, many horses can regain their flexibil- ity through chiropractic care. However, a few horses will have been so severely injured that chiropractic care cannot realign the vertebrae completely.

Horses' spines can be out of alignment of subluxated for many reasons. 17 The most common causes are traumatic in origin, i.e. a horse becoming cast in its stall, slipping out in the field, or falling over a cross-country fence. The end result of many equine falls is comparable to a person being in an automobile accident and sustaining whiplash. Following a traumatic incident, performance either instantly or gradually declines as the effects of the subluxations take place, depend- ing on the severity of the problem.

Other causes of subluxations include holding a race horse's head tightly to the pony horse while the race horse bucks, canters and pulls with his head turned sideways; tension or force applied to longe lines; pulling back on cross- ties or tie chains; and acting-up on hot walkers. Jerking horses around, as well as unbalanced riding, can cause subluxations. Horses that slip at the takeoff at a jump or coming out of a starting gate, or even going across a paddock can acquire a sacroiliac subluxation, commonly known as an uneven "hunter's or jumper's bump." Such subluxations are generally correctable with chiropractic care.

Young horses can obtain subluxation through the birth process, especially if the birth is assisted by a person. Young horses can also slip and fall while playing in the fields. Halter breaking and teaching horses to stand tied are other causes of major subluxations, as is any situation where a horse flips over backwards. Some horses that appear to be wobblers may have subluxations, some of which can be corrected with chiropractic care. " Confinement to stalls and small paddocks can contribute to malalignment problems since the horses do not get to roll, buck and play freely as they would in nature. These normal activities of horses correct many subluxations before they

Table 3.

Chiropractic can treat: subluxations stiffness back pain performance/training problems neck pain muscle tightness/spasms

become a problem. Horses that swat at flies with their heads often correct cervical subluxations, while horses standing in stalls with intermittent fly repellent sprayers do not. Feeding horses in hay racks, where they need to reach up to eat, can cause subluxations and also contributes to the tightening of the horse's back making it difficult for minor subluxations to correct themselves. In nature, the horse stretches its topline to eat and drink.

Chiropractic care is aimed at correcting subluxations, however signs of subluxations are varied. Stiffness is a common indication that there is a chiropractic problem. An easy diagnostic tool to identify this is to hold a carrot at each hip and stifle and between the horse's front legs and have the horse reach for it. A normal horse can reach in all these directions easily, but a horse with subluxations will often have difficulty, especially if there are cervical subluxations. How- ever, some types of subluxations will allow a horse to turn the head and neck but can still affect performance. (Table 3.)

Some back pain and most neck pain can be directly attributed to subluxation.ll Many performance-related problems, especially where no obvious lameness exists, can be attributed to back and neck pain and stiffness. Muscle tight- hess and muscle spasms often occur secondary to subluxations. However, if an injury causes a muscle to become tight or go into a spasm, a subluxation can be a secondary problem.

Veterinarians are being trained in chiropractic care through a course given by the American Veterinary Chiropractic Association, 2° a group which trains human chiropractors in animal chiropractic at the same time. This course is providing a pool of qualified practitioners. The human chiropractors are instructed to work on a referral basis from veterinarians. Since state laws vary widely, the degree of referral varies widely, also. In a few states, such as California, no laws exist for the practice of chiropractic. There is a disturbing increase in unqualified people claiming to be chiropractors. This is a serious situation, present in all states no matter what the laws are. It is best to check the credentials of practitioners and educate clients to seek qualified practitioners. Numerous books on human chiropractic care and physiology are available and a couple of veterinary books.

Homeopathy Homeopathy is a system of natural healing that involves

the use ofmicrodoses of many natural compounds. Homeopa- thy originated in Europe and is presently much more accepted over there than it is here in the United States. For people trained in western medicine, homeopathy is perhaps the most


complex form of natural healing to understand, but is really just another different system of healing. Once a veterinarian understands the terminology and the principles, homeopathy becomes just as workable as any other form of medicine.

Homeopathy is based on a verifiable law of pharmacol- ogy which is termed the Law of Similars. This means that a pharmacologically active substance administered to a person in good health triggers a series of symptoms. These can be cured by the same substance when it is given in mierodoses to a patient having those symptoms. For example, a person suffering from a red, itching rash from poison ivy or poison oak, who noticed the itch felt better when placed in hot water, would be treated by several doses of dilute homeopathically- prepared poison ivy. For those people who do not understand, think of it as similar to a vaceine--a minute dose of a vaccine stimulates a response in an animal. Homeopathy is not a vaccine, but it is easier for the analytical left side of our brain to think of it this way.

Homeopathy was founded in the late 1700's in Germany by Samuel Hahnemann, using principles from ancient Greek times. Many medical techniques have come and gone since then, but homeopathy has remained virtually unchanged in its principles. This is indicative of a system of healing that has withstood the test of time and it has grown steadily more popular.

The remedies, as they are frequently called, are made from plants, primarily, and also from animal and mineral extracts. The name of the remedy is taken from the Latin name of the source together with a number indication of strength or "potency" as it is called. The remedies are made by making an extract of the original substance called a Mother Tincture. Serial dilutions are performed either by tenths (one part mother tincture to nine parts alcohol) or by hundredths (1 part mother tincture to ninety parts water). The dilutions are then shaken up or succussed. This increases the strength of the medicine. Dilutions up to 10,000 times or more can be performed and the higher dilutions are the most potent. The dilutions are done under extremely clean conditions, by modern manufacturers, to be certain that no contaminants are present. The diluted material is then used as a liquid, or applied to lactose pellets of various sizes.

The scientific community has a difficult time with these infinitesimal doses where there is virtually no possibility of a molecule of the original substance left after multiple dilutions, yet the medical results from homeopathic treatments are frequently spectacular. There have been a number of very good scientific studies done over the years, not yet proving exactly how homeopathy works, but proving that these infinitesimal doses do affect the organism, be it a single cell, person or animal.

One paper was a double-blind study involving people with allergies. 12 A homeopathic preparation of some common grass allergens was prepared and identical control pellets were used. The results were a statistically-significant im-

provement in the subjects allergies, when they received the treated pellets and no improvement when they received the control pellets. Another study showed that there was an increase in the synthesis ofpaf-acether (a well-known marker of macrophage stimulation), a An extensive review of the literature was done by Jos Kieljnen et a17 He turned up some studies of questionable scientific accuracy, but showed plenty of evidence that homeopathy does work and does stand up to clinical trials. Studies have not generally been done on animals, but there is also no placebo effect with animals so the results need to be considered as significant.

Homeopathy has a wide application in the equine world, for treating many conditions ranging from simple wounds to complex mental conditions, a Many horse owners are explor- ing the uses of homeopathic medicines on themselves and are eager to try it with their horses. Homeopathy is quite safe and can be used by lay people in the lower potencies. The 6 to 30 X or C potencies (diluted 6 to 30 times) can be bought at many health food stores. Higher potencies require more experience to use and are only available to health care professionals.

Homeopathic treatment of acute cases covers a broad variety of conditions (Table 4). Though it is most desirable to use it alone, it is possible to use western treatments at the same time and may be desirable in some cases, such as those requiring surgery. However, sometimes apparently surgical cases can be treated with homeopathy alone and surgery can be avoided, such as a case where there is a foreign body imbedded in the muscle.

Homeopathy also offers the practitioner choices in treating some conditions that western medicine has minimal ability to treat. The most notable are behavior problems. Many fears and nervous conditions that horses have can be over- come by using the correct homeopathic remedy. Scar tissue can be reduced in size on the body and in the eyes, sometimes restoring normal vision to a badly scarred eye. Homeopathy covers such a broad base that there is not room here to discuss it further.

To learn more about homeopathy there are several veterinary seminars around the country on a regular basis. There is also an extensive course being taught by Dr. Richard Pitcarin. Information about upcoming events can be obtained through the American Holistie Veterinary Medical Association. Nu- merous books are also available.

Massage and physical therapy Massage therapy, in various forms, has been used for

centuries around the world, but in the United States it has often been associated with sleazy, back-alley operations. Physical therapy has been recognized for many years as a valuable rehabilitative therapy and is now being looked at more and more in terms of prevention of muscle injuries. In recent years there has been a growing interest in therapeutic massage, both for humans and for horses. Athletes are realizing that massage and physical therapy is extremely beneficial to their peffor-


Table 4.

Homeopathy can treat: wounds - all types osteomyelitis tendon injuries musculoskeletal conditions laminitis skin disease scar tissue foreign bodies allergies colic tying-up internal medicine mental conditions navicu.lar arthritis sprains

mance and few major athletic teams are without a therapist of some type. In the equine world, people performing various forms of massage and physical therapy are appearing every- where. Most of these therapists learned the techniques in courses designed for humans and then applied the techniques to horses.

Massage and physical therapy can be considered together for the purpose of this paper, since they are related in many ways. Massage is almost always done with the practitioner's hands while physical therapy can be done with the hands or a large variety of equipment such as lasers, ultrasound units, electrical stimulators and magnets.

Massage has been shown to have effects on the flow or lymph and blood in both normal and edematous tissues, actually removing edema in many instances. The increase in lymph flow is mainly due to the mechanical kneading effect on the muscle. The increase in blood flow is partly due to the mechanical effects of kneading and partly due to the release of local vasodilators and the activation of the autonomic nervous system as a refex response from the stimulation of the muscle tissue, is Magnets, lasers and therapeutic ultrasound units an all increase blood flow to an area and help release muscle spasms? 1 Different types of equipment work best in different conditions. 2,11

Muscle spasms impair blood flow. 1° Areas that are in spasm can actually be cooler than surrounding tissues as shown in a study that measured skin temperatures with an infrared scanner pre- and post-massage. 9 Muscle spasms and cramps involve part or all of muscle and result from over activity of the muscle spindles and their gamma efferents. The contractile activity of skeletal muscle is controlled by the nervous system and resting muscle tone is maintained by muscle spindle activity on the alpha motor neurons. Muscle spindle activity is governed by the f'mng of gamma efferent fibers under the control of the extrapyramidal system and specific spinal tracts originating in the brain stem reticular formation. Muscle tone becomes reset to be more relaxed and normal by the reticular formation during a massage, because of the enormous increase in sensory input to it. 18

Various forms of massage, especially the cross-fiber friction type, will break up scar tissue and adhesions within muscle. Fibrous and scar tissue from trauma, and inflamma-

Table 5.

Massage and physical therapy uses are: improve athletic performance improve athletic recovery prevent and/or treat post-exercise muscle soreness relax muscle spasms and cramps relieve myofacial pain increase blood and lymph flow prevent stiffness and stocking-up while confined decrease post-traumatic and operative edema help prevent decubitus ulcers aid healing of muscle strain aid healing of ligament/tendon strain/sprain remove or reduce scar tissue

tion results in cross-linking between muscle fibers and tendons and their tendon sheaths. Massage and physical therapy can prevent or break these down as was demonstrated in an early study on traumatized animal muscle, described inYates, 1990.1a Some of the muscles were examined microscopically after rest and some were examined after massage therapy. The muscle tissue after rest and healing had fibrotic connective tissue, while the massaged muscle was normal. Personally, I have seen some dramatic changes in range-of-motion and reduction of scar tissue resulting from the use of massage and physical therapy techniques.

Massage and physical therapy can be used for many conditions that affect performance horses (Table 5). Horses that receive massage show an improvement in athletic performance and in recovery from athletic endeavors. A study done in humans 5 showed a significant increase in post-exercise strength in massaged subjects over rested subjects. Muscle spasms, cramps and myofacial pain are extremely common in the athletic horse, if one looks for these problems. The horses response to massage and physical therapy is excellent. Fre- quently, however, myofacial back pain needs more than just massage and can benefit from acupuncture, laser or ultrasound therapy.

In the injured or laid-up horse, massage and physical therapy can have excellent beneficial results. Through in- creasing blood and lymph, edema can be decreased or pre- vented in post-traumatic cases as well as post-surgical cases. Many human athletes are sent straight to the physical therapist or massage therapist within a few days after an accident or surgery. Muscles and tendons that have been pulled or severely injured will heal faster with improved blood flow. Adhesions and scar tissue can be broken down, both during the healing process and also years after the initial injury occurred. All horses seen by this author that were confined to their stalls for any reason for a long period of time have benefited enormously by massage and stretching. This is shown by a faster return to performance and a lack of stiffness when first being allowed out of confinement.

Most physical therapists have college level educations,


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while excellent massage schools train massage therapists. All of those techniques can be applied to horses, if the practitioner has some guidance and practice. At the present time there are no courses designed for teaching equine massage or physical therapy techniques. There are a few very short courses that claim to teach these techniques but do not train people to be qualified practitioners, even though they claim to. The best way to find a qualified practitioner is to check for education in human massage or physical therapy. Then check for re- suits--there are many practitioners who do not help horses but also do not hurt them---they just take the clients money. There are a few books available on massage and physical therapy. For information contact qualified therapists in your area and develop a working relationship with them.

This paper is presented to introduce the topic of therapeutic options veterinary medicine and to, hopefully, spark some interest and discussion on the topics.

REFERENCES

1. AItman S: Acupuncture, taking a closer look. MVP 71:3,1006.

2. Bromiley M: Equine Injury and Therapy. Howell Book House, Inc:New York, 1987.

3. Davenas E, Poitevin B, Benveniste J: Effect on mouse peritoneal macrophages of orally administered very high dilution of silicea. Eur J Pharm 135:1313-1319,1987.

4. Holland R: Tracking energy change during massage using IR photography. Massage Therapy J 27(2):54-56,1988.

5. Jorden KD, Jessup D: The recuperative effects of sports massage as compared to passive rest. Massage TherapyJ 29(1):59- 61,1990.

6. Kirkaldy-Willis WH: The relationship of structural pathol- ogyto the nerve root. Spine 9,1984.

7. Kleijnen J, Knipschild P, terRiet G: Clinical trials of homeopathy. Brit Med J 302:316-323,1991.

8. McLeod G: Treatment of horses by homeopathy. Hillman Printers Ltd:Somerset, England, 1977.

9. Meade TW, Dyer S, Browne W, Townsend J, Frank AO: Low back pain of mechanical origin: Randomized comparison of chiropractic and hospital out-patient treatment. BritMedJ 300:1431- 1437,1990.

10. Meagher J: Beating muscle injuries for homes. Hamilton, MA, Hamilton Horse Association, 1985.

11. Porter M: Equine Sports Therapy, Veterinary Data:Wildomar, CA, 1990.

12. Reilly D, Taylor M, McSharry C. Aitchison T: Is homeopathy a placebo response? Controlled trial of homeopathic potency with pollen in hay fever as model. The Lancet 8512, 18 Oct, p881,1986.

13. Shingler D, Davis I: Critical new developments in the treatment of low back pain: The chiropractic option is giving respect among health care practitioners. Amer Chiropractic Assoc News, July, pl-3,1991.

14. Shoen A: Prob/ems in Veterinary Practice, Veterinary Acupuncture, Lea and Febiger:New York, 1992.

15. Suh CH: Sharpless SK, MacGregor RJ, Luttges MW: Researching the fundamentals of chiropractic: Summary of Re- search 1971-1973, the University of Colorado, Boulder, CO, pp11- 26,1974.

16. Ulett G: Principles of Practice and PhysiologicAcupunc- ture, Warren Green Inc: St. Louis, MO, 1982.

17. Willoughby S: Equine Chiropractic Care. P.O. Box 249, Port Byron, IL 61275, 1992

18. Yates J: A physicians guide to therapeutic massage: Its physiological effects and their application to treatment. Massage Therapists Assoc of British Columbia, 1990.

19. American Holistic Veterinary Association, 2214 Old Emmorta Rd, Bel Air, MD 21014, (410) 568-0795.

20. American Veterinary Chiropractic Association, PO Box 249, Port Byron, IL 61275, (309) 523-3995.

21. International Veterinary Acupuncture Society, Box 142, The Mall Station, 1750-1 30th St, Boulder, CO 80301, (303) 449- 7131.

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