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New Insights: Acupuncture and Chiropractic
William E. Jones, DVM
The veterinary profession is made up of individuals with a wide variety of opinions, experience, skills, and prejudices. Some are content to live in a University ivory tower all their lives, others take their university education to the countryside and let it flower into a rich understanding of the animals they treat. Some never get their noses out of the books they studied in school, while others develop a specialized set of skills and quietly settle down in their corner of the world and perform minor miracles on a daily basis.
These realities are reaffirmed each December at the convention of the American Association of Equine Practitioners (AAEP). This is an organization of all types of veterinarians. While they are the cream of those who practice equine medicine and surgery, they vary greatly in abilities, experience, and knowledge. The program is usually a reflection of the current state of veterinary practice, but varies in its scope depending on the program director, who is the incoming president. This past year, Dr. Gary Norwood, a racetrack practitioner from Louisiana was in charge, and he brought a wide variety of very practical information to the meeting.
One session, billed as "Therapeutic Options," focused on the techniques of chiropractic and acupuncture for diagnosis and treatment of a variety of problems in the racehorse. Not so many years ago all leaders in the AAEP considered acupuncture and especially chiropractic to be of no value in equine practice. What's more, they considered anyone who practiced these techniques on horses to be a charlatan. Over time, the value of acupuncture for horses has been proven, but the value of chiropractic for horses has been slow to surface.
Over the years it has become evident that these techniques are not learned
in a short period of time, and that understanding and expertise in them
is built on a strong base of knowledge of equine anatomy, physiology and
pathology. Acupuncture and chiropractic techniques for horses are similar,
but not the same as those for humans. While formal training in human acupuncture
and human chiropractic is helpful to those who attempt it on horses, the
differences in anatomy make special equine training a necessity for success.
Chiropractic
Speaking at the AAEP meeting, Dr. Kevin K. Haussler said that because veterinarians have not been formally educated in chiropractic principles or techniques in their traditional education, many practitioners do not understand the basic premise behind chiropractic or its indications or contraindications. Dr. Haussler holds both a chiropractic degree (DC) and a veterinary degree (DVM). He explained that owners of horses who believe in chiropractic value for themselves, want to believe that it also holds value for their horses. If these owners do not get equine chiropractic help from their veterinarian, they often turn to someone who is not professionally trained in the techniques on horses. The result is not the best thing for the horse.
Dr. Haussler's appeal to the equine practitioners was to become familiar with the value of chiropractic for horses. He explained and demonstrated with videos how joints of the horse can be manipulated. It is not done with giant mallets or mechanical hammers. Firm pressure with the heal of the hand in the appropriate area of the horse is usually all that is required for proper adjustment of a joint.
He described the concept of a spectrum of wellness, with ideal wellness on one end and death on the other. Often there develops a "dis-ease" condition which is difficult to define because it is not yet a disease state. The horse is not acting right, but it is hard to say why. In many cases this is because joint dysfunction has affected the normal neurological balance.
It is just as important for the veterinarian to know when chiropractic
manipulation is not needed as it is to know when it is and how to do it.
In general more value is obtained when there has been an acute injury than
when a condition is chronic. Dr. Haussler emphasized that chiropractic
is not a cure-all for all neck or back problems and is not appropriate
for the treatment of fractures, infections, neoplasia, metabolic disorders,
or non mechanically related joint disorders. The most important contribution
the veterinarian makes is accurate diagnosis of the underlying problem,
and application of the proper treatment modality, which often is not chiropractic
manipulation.
Acupuncture
The president of the International Veterinary Acupuncture Society (IVAS) described his use of acupuncture for treatment of various disorders of racehorses. Dr. Cletus M. Vonderwell lives in Delphos, Ohio, which is not close to any racetrack, but there is a steady trail of racehorses being hauled to his clinic for evaluation and treatment. Acupuncture is his primary diagnostic approach.
Dr. Vonderwell said that he seldom asks the owner to tell him what the problem is with the horse, and he does not usually ask to see the horse move before his examination. He palpates the acupuncture points and the soreness of some of them provide enough information for him to tell the owner what the problem is with the horse.
"The newcomers are always amazed that I can tell them what the problem is without hearing the history or seeing the horse move out. He said, "In practice, acupuncture recognizes syndromes; this means that if a group of body points are sore on palpation, a predictable anatomical area is involved and is the source of soreness."
He described the acupuncture points which are sore when the horse has a stifle problem. He described those sore with the hock syndrome, and those with several other syndromes. One point on the rear leg, which he described in detail, is diagnostic for equine protozoal myeloencephalitis (EPM)- at least in his hands.
"It is important to remember that individual horses will often show signs of more than one problem," he said. "Acupuncture diagnosis will help determine which problems are present."
Stimulation of the sore points by various means is the basic means of treatment with acupuncture. The traditional method of stimulation is by inserting a needle in the point. Today lasers and electrical stimulation are sometimes used. Some veterinarians inject Vitamin B12 in the points. Dr. Vonderwell prefers to inject the points in most cases, because the effects last longer, he claimed.
"My personal choice is to inject the points because many times I see the patient only one time before he races again, and I feel I get better longer-lasting results," he said.
Many of the veterinarians were astonished to hear Dr. Vonderwell declare such unwavering belief in his ability to diagnose EPM by detecting soreness in the gall bladder 32 point (GB32). He said that 92 out of 93 horses he diagnosed as positive, had later been confirmed positive by traditional laboratory testing.
It was hard for many to imagine the effectiveness of acupuncture diagnosis for this disease. After all EPM is a disease in which a parasite, Sarcocystis neurona, invades and damages the spinal cord. The traditional diagnosis is the detection of antibodies from the parasite in a cerebrospinal fluid (CSF) sample. As the disease develops, the horse becomes ataxic. The affected nerves cause a syndrome which continues to get worse unless the horse is treated with medication designed to kill the invading parasites.
A nationally known expert in EPM diagnosis, Dr. Clara K. Fenger, reported at the meeting her study which compared acupuncture diagnosis to the CSF test (Western blot test). She concluded that acupuncture diagnosis was not accurate, but in the face of Dr. Vonderwell's claimed results, many veterinarians realized that perhaps experience in acupuncture was a key factor in obtaining good results.
Another veterinarian, Dr. Earl C. Sutherland, described how he uses both acupuncture and chiropractic manipulation in his standard lameness examination and treatment of various lameness conditions. He said acupuncture therapy primarily works through the neurohumoral systems of the body.
"Diagnostically, acupuncture is useful to map out where in the body the problem is located," he said. "Most abnormal situations of the body, such as pain, inflammation, decrease or increase in circulation, decrease or increase in myofacial tone, etc., are already mapped out by the central nervous system. The central nervous system reflects this map onto the surface of the body by way of the acupuncture meridians and points. By palpation of the meridians and points, noticing increased or decreased reflexes and differences in tissue quality (firm, soft, yielding to pressure, tightening up under pressure, warm, cold, etc.), the acurpuncturist can figuratively read the reflected map. This not only helps in locating the problem areas but also helps in differentiating between primary and secondary lameness."
He explained how joint abnormalities can cause lameness in horses. "A joint with all its associated structures is called a motor unit," he said. "These motor units can be hypomobile or hypermobile. Hypomobile or fixated motor units result in a decreased range of motion. This causes stiffness, pain, and contracture of the associated soft tissue. Short term this causes some muscle spasms because of the local damage or stress on the nervous system. Long term this causes some muscle atrophy because of constant damage to the nerves or because of disuse that is due to pain."
Dr. Sutherland went on to describe how he uses both acupuncture and chiropractic manipulation to correct many lameness problems. He emphasized that he uses all the traditional methods in lameness diagnosis such as imaging techniques. This helps him to not only do a better job of assessing the entire horse in relation to movement, but helps him to perform or offer treatment options that in combination gives him the best of all three approaches- acupuncture, manipulation, and standard veterinary techniques.
"The result,' he claimed, "is a horse that can quickly achieve its optimum movement with respect to its conformation and training, and usually extremely satisfied clients."
Dr. Kevin K. Haussler, Veterinary Orthopedic Research Laboratory, Dept. of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California, Davis, California.
