Narrowing Down Lameness
The ancient art of acupuncture has proven its worth in alleviating pain by helping to harmonize the energy flow through the body. It brings the negative Yin and positive Yang back into a state of homeostasis, or balance. Not only is it useful therapeutically, it has proven quite valuable in diagnostics as well.
Diagnostic acupuncture is a relatively simple procedure. It can be used to reveal the source of a problem by merely placing a finger against the horse. However, knowing where to put the finger, and what it indicates if there is a tender spot, is much more challenging, so consult your professional.
Martha Moses, DVM, CVA explains, "There are diagnostic points, known as Association or Shu points, and Alarm points found along the meridians, which are the energy pathways of the body. There are 12 paired and two unpaired meridians. The Shu points are located on the back along either side of the spine and are associated with, or related to, a meridian, points on another meridian, and an internal organ. The Alarm points are in various locations such as the chest and lumbar area. The Alarm points are used in association with the Shu points to determine the source of a problem or illness thus narrowing down the possibilities."
The Chinese word Shu means to transport or convey. The 12 Shu points located along the back on the urinary Bladder meridian, on the branch closer to the spine [see Figure 1], are also referred to as Beishuxue or Back Shu points, and are traditionally believed to transport the life force to the corresponding organs. Each Shu point is allocated to one of the organs and will become sensitive when the corresponding organ is diseased. The Shu points, alone or in conjunction with other points, are used to find an energy imbalance in the corresponding meridian or to confirm or rule out sources of pain or problems.
Dr. Moses points out, "Diagnosis is performed with fingertips, not needles; treatment is administered with needles, and other methods."
The causes of lameness may be obvious, but many are not. Most frustrating are the lamenesses that occur as a secondary problem, as a result of something else going unnoticed, such as muscular strain from overcompensation in a limb caused by an ill-fitting saddle or even an unbalanced shoe. In other instances, a lameness may be accompanied by a seemingly unrelated disorder; for instance, problems such as headshyness or girthiness may appear if the association points located in these areas (on the atlas and behind the girth, respectively) are sensitive due to a problem elsewhere. The body is a whole entity, and seemingly unrelated parts are most certainly related, as acupuncture can verify.
James O'Krepki, DVM, from Berkshire, New York, uses both acupuncture and conventional modalities to determine the source of lameness. He explains his diagnostic process: "Before checking acupuncture points, I observe the horse's demeanor. I ask the owner when the problem was first noticed and if there was any change associated with the lameness, for example different tack, farrier, or exercise regime. I determine if it is a rider problem, saddle fit or horse problem. If it is a horse problem, I first look at the hoof for anything obvious. Then I check the lower leg and perform necessary diagnostics such as flexion tests, nerve blocks, or radiographs. I do chiropractic evaluation as well, so I check for range of motion in the pelvis, low back, withers, and neck, and how the skull moves on the atlas."
He continues, "When secondary problems are involved, things are even harder to sort out. Acupuncture can really help because it can be diagnostic as well as therapeutic.
For example, a point just behind the angle of the jaw may be tender, indicating a problem in the hoof, such as navicular disease, pedal osteitis, or laminitis. Using this knowledge in conjunction with sensitive Shu points can enable one to better localize the problem," he says.
"Pain indicates that there is a disruption of energy flow," explains Dr. O'Krepki. "According to Traditional Chinese Medicine, of which acupuncture is a branch, the life force, called Chi, flows continuously throughout the 12 paired and 2 unpaired meridians. If it is not flowing freely, there is a problem, whether it be lameness, respiratory or other organ system problems. Needling is used therapeutically to help regain proper flow of Chi much like a rheostat regulates electrical current making a light dimmer or brighter." If an association point is tender, it indicates an interruption of energy flow somewhere - either in that meridian or its associated organ. Pain relief is a sign of a rebalance or reestablishment of energy flow.
The use of these points [see Figure 2] is a guide, and when used with alarm points, one can further pinpoint problems. Says Dr. Moses, "For instance, BL 13 is the association point for the Lung meridian. If the point is sore, it could mean a lameness or a respiratory problem. But if LU 1, the alarm point for the Lung meridian, is also sore, the problem is more likely respiratory and not a lameness problem. Likewise, if there is tenderness at BL18, the association point for the Liver meridian, it can indicate a hind limb problem or a liver problem. If there is sensitivity also at LI 14, then it is most likely liver trouble." Concurrent sensitivity among points can help narrow down the possible sources of a lameness. It can also confirm a source; concurrent sensitivity in BL 21, 36, and 37 can confirm soreness in the stifle.
When diagnosing, light and heavy pressure may be used to determine if the pain is chronic or acute. Response to light pressure on the point indicates an acute or superficial condition; response to deeper pressure indicates a more chronic condition. "If a horse leans into the person touching a point, the heavy pressure feels good; it's like a deep palpation, and it indicates chronic pain," says Dr. Moses.
She adds, "The points used to diagnose may or may not be the same points used to treat; it depends on the situation. Sometimes the points are so sensitive that they need to be treated proximally (close) or even distally (farther away) to relax the area and get the energy somewhat moving again before treating the actual point."
Dr. O'Krepki explains, "There are many techniques. One may recheck the sensitive diagnostic point after a treatment elsewhere to see if there is a reduction in sensitivity. One might not get to the root of the problem by treating the sensitive diagnostic point; like giving aspirin, it might relieve the symptom but not get to the cause. An acupuncturist may steer clear of a tender diagnostic point to find where there may be other involvement, treat that, then recheck the tender point to see if there is an improvement."
Getting to the source: some important points
There are four important points that are not considered association points yet they can be useful for diagnosis. These points are often checked for sensitivity first when starting a diagnosis:
Bladder 10, located on the wings of the atlas (behind poll); sensitivity suggests a problem in the hind leg on the opposite side.
Small Intestine 16, on the side of the neck (where the second and third vertebrae meet); sensitivity indicates a possible subluxation of a neck vertebra or atlas, hind leg lameness, tendon problems, sacral injuries, shoulder problems.
Triple Heater 15, located on the scapula at the front edge near the apex; sensitivity indicates a possible suspensory ligament problem.
Large Intestine 16, located on the front edge of the scapula midway between the apex and the point of the shoulder; sensitivity indicates a shoulder, elbow, knee, shin, ankle, or pastern problem, or a problem on the opposite hind leg (stimulating this point produces endorphin-like effects).
The association points and their diagnostic indications
These points lie along the Bladder meridian which has the unique capability of helping to balance the entire meridian system.
Bladder 13 is the association point for the Lung meridian. Tenderness here suggests soreness on the inside of the foreleg at the knee, splint, or sesamoid. Interestingly, this point is often tender in cribbers and during acute respiratory trouble. CV12 is often tender in cribbers also.
Bladder 14 is the association point for the Pericardium meridian. Sensitivity on this point suggests heart or chest trouble. It is also sensitive during anxiety, nervousness or behavioral episodes; stimulating this point has a calming effect.
Bladder 15 is the association point for the Heart meridian. This is usually tender in problems concerning the back of the foreleg such as tendons and sesamoids, circulatory trouble, and from anxiety.
Bladder 16 is the association point for the Governing Vessel meridian (not an organ). Tenderness here may indicate stiffness and pain somewhere in the spinal column; it may be tender in horses who are unable to adequately stretch their neck and back muscles and ligaments due to being stalled.
Bladder 17 is the association point for the diaphragm and not for a specific meridian. Tenderness may indicate altered blood composition due to dehydration, anemia, infection, or toxicity, all of which could affect any of the muscles.
Bladder 18 is the association point for the Liver meridian. Sensitivity here may indicate an excess of liver enzymes due to muscle damage from tying up, overexertion, or disease. If this point is sensitive due to a muscular problem, usually the opposite side is the affected side.
Bladder 19 is the association point for the Gall Bladder meridian (Note: horses don't actually have a gall bladder, but this meridian has very important functions in the horse.) Tenderness at this point also indicates a possible increase in liver enzymes and muscle problems including tying up, stressed tendons and ligaments, splints, problems at the outside of the stifle and/or hock, and hip problems.
Bladder 20 is the association point for the Spleen meridian. Tenderness may indicate problems with circulation (this point is commonly tender in bleeders), digestive disturbances, a problem with the inside of the hock and stifle, and back injury.
Bladder 21 is the association point for the Stomach meridian. Tenderness suggests dental problems, digestive disturbances, frontal and outside hind leg and stifle problems, back injury, and more specifically, sacrosciatic ligament pain.
Bladder 22 is the association point for the Triple Heater meridian. Though this point largely indicates ovarian pain in mares and testicular pain in stallions, the point being tender can cause muscle spasms in the neck inducing a choppy forward stride in the foreleg. Tenderness can also suggest disorders of body heat regulation, pain in the neck vertebrae, problems on the outside of the foreleg, and back problems.
Bladder 23 is the association point for the Kidney meridian. Tenderness here may indicate back pain, problems on the inside of the hind leg, and hock pain when BL 39 is also tender.
Bladder 25 is the association point for the Large Intestine meridian. Tenderness here suggests a problem in the opposite forelimb if LI 16 on the opposite forelimb is also tender.
Bladder 27 is the association point for the Small Intestine meridian. Tenderness suggests a problem down the back of the foreleg in the tendons, ligaments or sesamoids, possible back injury, and pain in the upper hind limb.
Bladder 28 is the association point for the Bladder meridian. This is tender in spinal column disorders from the atlas to the sacrum and problems on the outside of the hind limb.
Other useful points
Pericardium 1 - tender in founder, navicular and other hoof conditions
Spleen 20 - indicates pain in the knee
Stomach 10 - relates to a stifle problem on the same side
Acupuncture diagnosis is not meant to be used as a substitute for a conventional veterinary diagnosis, but as an adjunct or accessory diagnosis. Getting to the source of a problem can be complicated and challenging, but the use of the diagnostic points can make things easier and assist in the accuracy of diagnosis.