Photo: Kevin Thompson/The Horse
Veterinary care takes many forms these days, with practitioners relying on both traditional Western approaches as well as complementary and alternative medicine (CAM) strategies to alleviate patients’ pain and illness. When the former does not afford all the answers or allow veterinarians to achieve full treatment success, it is not uncommon that they or their clients seek the latter additional approaches.
A variety of nonconventional treatments are in use in the horse industry—the foremost among them being acupuncture and chiropractic. Others include herbal remedies, homeopathy, massage therapy, physiotherapy, and rehabilitation therapy.
“Complementary and alternative medicine is becoming more integrated with Western treatment,” says Ed Boldt, DVM, owner of Performance Horse Complementary Medicine Services, in Ft. Collins, Colo. “More veterinarians are seeing the benefit in combining both modalities to help the horse. While some veterinarians don’t support CAM, that attitude is diminishing; in fact, there are now more veterinarians who practice strictly CAM than ever -before.”
Since 1993, the 800 certified members of the International Veterinary Acupuncture Society (IVAS) have grown to the current roster of 1,800. This number doesn’t factor in the certified acupuncture practitioners who do not pay dues or remain listed members of IVAS, and it doesn’t include members (and certifeid nonmembers) of other CAM organizations. The actual number practicing is yet unknown; nonetheless, Boldt says he’s seeing a clear and significant upward trend in the number of veterinarians offering these services.
Although strictly a CAM practitioner, Boldt recognizes and believes in the value of traditional medical practices. “Complementary medicine should never be used as a substitute for thorough and complete medical care,” he stresses. “As its name implies, it is an additional treatment modality that can be used in both diagnosis and treatment. In most emergency situations or cases of infectious diseases, Western conventional veterinary medicine should be the first line of treatment. That said, CAM can be valuable in certain (situations) such as acute laminitis, breathing difficulties, and shock, as well as aiding recovery.”
Boldt explains how complementary therapies fit into the scheme of veterinary care: “The concept of CAM encourages examination of the whole horse, not just targeting one area. An issue in one part of the body can cause reactivity in another part.”
Kevin May, DVM, an equine -practitioner offering complementary medicine at El Cajon Valley Veterinary Hospital, in Southern California, adds, “If a horse with inflamed hocks has his hocks injected with anti--inflammatory medications, this does not directly address the upper body (hip, -pelvis, spine, and gluteal and lumbar areas) that may be experiencing secondary pain and restrictions due to gait compensations created by hock pain. Incorporation of acupuncture and chiropractics is useful to help relieve the entire package of spasm and constriction in the upper torso.”
“Complementary medicine should never be used as a substitute for thorough and complete medical care.”
Dr. Ed Boldt
Treatment results, however, are only as good as the diagnosis, and when considering any problem with any horse, it is important to track down the source of the problem. “It is important for the complementary practitioner to refer the horse back to the routine vet when there is a need for further diagnostics or conventional therapy,” Boldt says. “By the same token, I hope that the routine vet recognizes when acupuncture and/or chiropractic may benefit a horse’s recovery and then refers the horse to a complementary practitioner for treatment.”
“If a conventional veterinarian is trying something that improves the horse but not all the way,” advises May, “or the treated horse needs re-treatment sooner than expected, then some key point may be missed that perhaps a CAM practitioner might find and address. A different approach of diagnosis could uncover other problem areas.”
Veterinarians use acupuncture to help manage horses’ pain and alleviate tension in muscles and fascia (connective tissues surrounding muscle) by stimulating specific tissue points via needles. Many practitioners have incorporated acupuncture into their treatment of reproductive issues, nerve problems, weakness, and atrophy. They select acupuncture points in horses based on a system of meridians that connect each point, as has been mapped out in the human body.
Typically, practitioners perform acupuncture using solid acupuncture needles, but other approaches might include -pulsing a mild electrical current through needles inserted in specific pairs of acupuncture points (electroacupuncture), injecting vitamin B solution through hypodermic needles (aquapuncture), or applying firm manual pressure over selected acupuncture points (acupressure). On occasion, veterinarians apply heat (by burning a specific type of herb) either directly over the acupuncture point or to solid needles (moxibustion) to amplify point stimulation. They can modify their approach according to how horses respond and/or the need to extend the effects.
“Acupuncture is very effective in eliciting pain control and particularly in cases of nonspecific pain, such as caudal heel pain, back pain, and in areas where we can’t fully point to the cause of the pain,” Boldt says, based on his observations and experiences. “Where it is not useful is in pain alleviation from something like a chip fracture in a joint.
“However,” he emphasizes, “For a horse in pain, everything should be done to relieve the pain, including the use of both acupuncture and pharmaceuticals.”
But Does it Work?
Complementary and alternative medicine (CAM) is a topic of much discussion and controversy among equine veterinarians. Does it work or not? If so, how does it work? And how should we be using it in practice? While there are many questions yet to be answered, researchers are working hard to put science behind CAM. Here are some recent study results:
- Canadian researchers determined that acupuncture does not impact or induce ovulation in healthy, cycling mares. TheHorse.com/31532
- An Italian practitioner found that electroacupuncture-treated horses exhibited a significantly deeper depth of anesthesia than controls. This therapy could help decrease horses’ general anesthetic requirements, reducing the amount of medication their bodies must metabolize. TheHorse.com/28683
- University of Florida researchers studied the use of electroacupuncture to treat laryngeal hemiplegia in “roarers.” They concluded that the grade of laryngeal disease improved in all the electroacupuncture-treated horses, with no adverse side effects. TheHorse.com/24615
- Colorado State University researchers found that both spinal manipulation and mobilization therapies increased spinal mobility in 24 actively ridden horses. TheHorse.com/26687
- A Michigan State University researcher and colleagues determined that performing dynamic mobilization exercises regularly over a three-month period can activate and strengthen the muscles that support and stabilize the horse’s back. TheHorse.com/26188
Chiropractic and Manual Therapies
The objective of chiropractic or manual adjustment is to return motion to restricted joints or motion units—the joint and its surrounding soft tissues. Some areas, such as dorsal spinous processes, can move or rotate, even if it’s just a millimeter or two, either as a cause of or secondary to muscle spasm or contraction. But bear in mind that manual adjustments are not intended to correct something “out of place.” Rather, practitioners use them to help reduce muscle splinting (tightening in an area to avoid pain associated with muscle movement) and spasms that restrict normal movement of a painful joint. “Improved movement of affected areas is instrumental to healing and also helps override muscle memory that otherwise restrains movement of a painful body part,” Boldt explains.
Manual procedures that serve similar noninvasive comfort and soundness purposes include massage therapy and Rolfing (a deeper form of massage-type therapy).
Additional Complementary Modalities
Owners might pursue other complementary therapy avenues for their horses, although most are not supported by peer-reviewed research. “In my own experience, Chinese herbal therapy can be beneficial in treating horses for a variety of problems, such as stomach ulcers, tendon/ligament problems, EIPH (exercise--induced pulmonary hemorrhage), COPD (chronic obstructive pulmonary disease), muscle problems, or arthritic conditions,” Boldt observes. However, “herbal remedies must be used properly and under the guidance of a complementary medicine veterinarian.”
Risks involved with using herbal remedies include diarrhea or other complications when combining herbs with certain pharmaceuticals, as well as potential adverse effects on pregnancy.
As for other approaches, Boldt and May have had good results using laser therapy for treating acupuncture points and myofascial pain (chronic pain due to muscle tension).
Effects and Side Effects
Owners frequently do not notice the effects of a complementary treatment, such as acupuncture or chiropractics, until four to five days after the procedure, says Boldt. The objective, however, is to see improvements in a horse’s performance, appetite, and/or attitude lasting for extended periods rather than just the short term. Longevity of effect depends on the complexity of a horse’s problem, the level of performance demanded of the horse, and the quality of the horse’s overall management, he notes.
There is always a concern about adverse effects associated with any treatment, whether conventional or complementary. “Typically, acupuncture performed by a (certified) veterinarian is safe, with few side effects,” Boldt says. “Occasionally, there may be local swelling at the site or a horse becomes a bit sleepy following treatment.” Following chiropractic treatment, one practitioner might suggest one to two days of rest while another recommends light exercise to help the body stretch out and use its newfound range of motion. Essentially, suggestions vary depending on the individual horse and its specific -problems.
“Most states recognize laypersons offering acupuncture and chiropractics as acting illegally.”
Dr. Ed Boldt
Boldt does note that there is significant danger in using chiropractic following a major trauma (e.g., running into a fence, flipping over, being kicked) without an accurate diagnosis. “I won’t do any chiropractic adjustment on a horse with a history of neck or spinal trauma until the horse has had an exam by their routine vet and radiographs where indicated,” he says. “Doing a chiropractic adjustment into a vertebral or pelvic fracture can be disastrous.”
Which Therapist to Choose?
“Horse owners should look to their veterinarian for complementary medicine services,” stresses Boldt. “If their veterinarian does not provide those services, they often can refer the client to a colleague who does.” Also, many websites list qualified veterinarians that implement complementary medical procedures. Some state organizations also provide lists of such practitioners.
By selecting a practitioner who has earned specific CAM therapy credentials, he says an owner can expect the best results for the horse. The IVAS, the Medical Acupuncture for Veterinarians course at Colorado State University, and The Chi Institute (tcvm.com) provide education and “certification” to veterinarians in veterinary acupuncture, while Options for Animals (animalchiro.com), Healing Oasis Wellness Center, and Parker University (parker.edu/animal-chiropractic-program.aspx) provide certification for animal chiropractic. Boldt says the American Veterinary Medical Association (AVMA) does not recognize these certifications because they only specify that the veterinarian has met all requirements needed for that certificate: completion of the course, written and practical exams, and internship with a certified member, along with approval of case report submissions. Some organizations that provide certification also require annual continuing education credits to keep that certification.
Boldt reminds us that complementary medicine is still “medicine” and should not be practiced by the layperson. “Laypersons don’t have the proper training to treat a horse, much less offer a diagnosis,” he explains. “Most states recognize laypersons offering acupuncture or chiropractics as acting illegally; however, some states allow human practitioners licensed in these modalities (for humans) to work on horses under the direct supervision of a veterinarian.”
Furthermore, in many states needle insertion is considered a surgical procedure that only a licensed veterinarian can perform. “I have seen some serious problems caused by CAM administered by nonveterinarians,” Boldt says. “In addition, most horse owners may not realize that if their horse is insured, anyone other than a licensed veterinarian treating their horse may negate insurance coverage should something bad happen.”
“At the end of the day,” May says, “The only ones with any rights are our equine patients, and they have the right to the best care. Veterinarians are the most capable to address equine issues—this is based on comprehensive education, training, and experience of the equine practitioner. That said, everyone involved in a horse’s care is there to give a full complement of care and therapy that addresses all issues, not just some. Nonvets who are certified in a specific modality should be involved but only under supervision and working alongside a veterinarian. All therapists need to collaborate with each other rather than working independently, thus providing the best health care possible for the horse.”
The use of complementary medicine is growing, Boldt says. “As more people utilize it for their own health, they naturally look to implement it for their horses. More veterinarians are recognizing the benefits. It is critical, though, for horse owners to know that they should look to a certified veterinarian to provide these services to benefit their horse’s health.”
He suggests that the best way for conventional and CAM veterinarians to collaborate is for both to be -active -participants in the horse’s treatment. “They must understand the benefits of both modalities and communicate their treatment plans,” he says. “This allows the horse to gain from the best in both medical formats.”
About the Author
Nancy S. Loving, DVM, owns Loving Equine Clinic in Boulder, Colorado, and has a special interest in managing the care of sport horses. Her book, All Horse Systems Go, is a comprehensive veterinary care and conditioning resource in full color that covers all facets of horse care. She has also authored the books Go the Distance as a resource for endurance horse owners, Conformation and Performance, and First Aid for Horse and Rider in addition to many veterinary articles for both horse owner and professional audiences.