Secondary Back Discomfort

At our practice, we regularly get together as veterinarians to share educational information.  Sometimes we have a wet-lab, where we can tryout new xray views or learn landmarks for unusual diagnostics etc (Don’t be concerned; no horses are harmed, just palpated!!)  Other times we discuss recent conference information and how we can apply the information to our patients.  At a recent vet meeting at MPES, we discussed applications and cases in which acupuncture has been useful.  Upon reflection, I have been very happy with my results with acupuncture for secondary back and neck discomfort this year.  As I learn more about acupuncture and improve my practice of acupuncture, I am interested and impressed by the results.

Many horses I see will experience some discomfort from arthritis or inflammation within the joints.  Secondarily, they experience compensatory back discomfort.  I liken this to having a sore knee or hip.  While avoiding moving the sore joint, we hold the back in tension, leading to a sore back at the end of a long day.  There is soreness within the back or neck, but no primary arthritis or issue.  Is this back pain the primary or root problem?  Of course not, but it sure hurts!

As all veterinarians do, I deal with primary problems first, perhaps treating a sore hock or fetlock.  For the most part, this should alleviate the discomfort and make our equine friend more happy and comfortable in his job.  However, I try not to ignore the secondary soreness areas, as they have been inflamed for almost as long as the primary issue (as long as the horse has been compensating!) so the pain from those areas can be profound.  When evaluating these secondary spots, I have to decide if they will alleviate themselves within a week or two or if they require some help.  If they need help, what kind of help do they need?  People do often ask, “Will this problem resolve with a joint injection?” From a mathematical perspective, a + b =c.  Unfortunately, as anyone with a sore back knows, the answer is “it depends, but I hope so!”  It depends on the horse’s lifestyle (job, turnout, nutrition), conformation, ability to withstand pain (!), workload etc.

At the vet meeting, I discussed the work I did in a barn where several horses had sore backs and one a sore neck.  On lameness evaluation, one had stifle inflammation, one had hock arthritis, and another sore feet with abnormal changes in the coffin joints.  The back and neck pain I palpated was pretty noticeable, and two of the horses were no longer enjoying being brushed anymore. Once inflammation and pain conduction gets started, the cycle can be hard to break, so sometimes we need to inject these sore areas with steroids, or perform mesotherapy, even though the “primary” pain is gone.  I am a big advocate of treating secondary issues when they need to be treated, so our athletes/companions can be as pain-free in their jobs as possible. I treated the affected joints/regions in all 3 horses (stifles, hocks and coffin joints) and added in electro-acupuncture of the secondary areas while the horse was sedated.  If the single acupuncture treatment and joint injections did not deal with the secondary discomfort adequately, we would come back and re-evaluate to see if other therapies would be needed. I have a good idea of how much improvement we should see after 1 treatment of acupuncture, so if there is still a terribly inflamed back a week later, I know that the secondary inflammation is really profound enough to warrant more treatments (of acupuncture, mesotherapy, injections etc).

Happily, all 3 of these horses were able to show the following week and almost immediately went back to enjoying their brushing, and on recheck, looked great!  Admittedly this is not a scientific study, but based on previous experiences where joints where injected and acupuncture was not performed, using acupuncture at the time of injection seemed to reduce secondary inflammation and allow the horse to continue on with his athletic life sooner than if we hadn’t elected to use acupuncture.

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