Looking Into the Neck and Shoulders
What is really happening when a certain part of the body has a locomotor dysfunction? Does that body have an isolated problem or does the problem originate elsewhere? That is the dilemma often confronting horse owners and riders, and through chiropractic examination, one can get to the source of the problem.
We all know that the body is a whole, and what goes on in one part can affect another. When looking at the neck, for instance, there is a wide range of possible scenarios that may present themselves if there happens to be a slight misalignment in any of the cervical vertebrae. Because the central nervous system or spinal cord runs from head to tail, with nerves radiating out from it in all directions and affecting every miniscule area of the body, anything can happen. A subluxation here, a limp there.
Cause and effect
According to Rick Kauffman, DC of Clifton, Colorado, "Anything can be related to anything - the list of symptoms from a neck subluxation, or any subluxation, is huge. Any vertebra that misaligns anywhere in the spine can cause symptoms in other areas that don't seem to be related. Most commonly though, if it is in the neck you may see that the horse doesn't like to flex in one direction or both, or the horse may have a hard time picking up a lead. The horse may fight the bit, and depending on how low the misalignment is on the neck, the horse may not like to be saddled, or may resent a breast collar. Or the horse may carry his head cocked off to one side because he is avoiding pain or discomfort. You may see incoordination, because a subluxation changes the function of the nervous system," he says.
"Therefore, the way I do chiropractic is I don't assume anything," says Dr. Kauffman. "There are no 'cookbook' answers. When I work on a horse, I use a total approach. I look at the horse when he is standing in neutral, I watch him walk and sometimes trot and canter, I do static palpation and motion palpation of the spine and extremities, I feel along the spine for changes in temperature - some areas may feel cool, some hot - and I always get the horse's history from the owner," Dr. Kauffman explains. "With a neck subluxation, as with any subluxation, there can be any number or variety of problems so a complete, total approach to the animal is needed. Subluxations can occur in the spine - cervical, thoracic, lumbar, or pelvic - or the extremities."
Can subluxations be avoided? Most times, yes. What causes neck misalignments? Jim Ennis, DC, of Clinton, AR explains, "There are various causes but I find that most often, neck misalignments are due to horses pulling back when they are tied - to a post, cross ties, a trailer, or anything that doesn't give when they spook and pull back. If the rope or snap breaks, they can flip over, and they can flip over in cross ties, still tied. When a horse pulls back, the pressure is on the top portion of the halter across the first cervical vertebra so it can cause some problems up in that area, and it can cause some problems even further down in the neck. The vertebra can actually fracture anywhere, especially the upper neck area. Sometimes horses get their heads stuck in between two rails and pull back," says Dr. Ennis. "I find misalignments are usually a result of injury."
Shoulders have their problems too. Dr. Ennis says, "Shoulder problems are often a result of poorly fitting saddles and saddles put in the wrong place on the horse. Most of the time we put the saddle too far forward and the saddle is actually resting on the point of the shoulders instead of back behind the shoulders where it is supposed to be. That tends to pinch the point of the shoulders on both sides and that causes a variety of different problems there. I have also seen shoulder problems as a result of falling, both out in the pasture and while training. A fall on a shoulder can cause the shoulder blade to not move correctly if it starts to develop some adhesions in its musculature, limiting its normal range of motion," he explains. The shoulder extends from the point of the shoulder back toward the chest and all the way up to include the withers.
Dr. Ennis points out, "The withers area is often affected by an ill-fitting saddle. I see a lot of withers problems, mostly in heading horses used in team roping, because of the sudden jerk on the horn, which pulls the withers off to the right; this results in the horse not being able to perform like he should. Mounting on the same side and mounting incorrectly - using the saddle horn and the cantle and really pulling on the saddle and cranking it over - cause a lot of problems too," says Dr. Ennis.
Can shoulders subluxate? Dr. Ennis explains, "Regarding the shoulder blade itself, sometimes a buildup of adhesions or fibrous tissue related to an injury will not allow the shoulder blade to move through its total range of motion. Adjusting the shoulder blade can free up some of those adhesions. If you catch it early enough the outcome is obviously a lot better than if it has been there for years. If there are definite soft tissue changes in that area, they may or may not allow a complete correction of the problem. Adjustments will probably make it much better, but it may not be 100 percent again," says Dr. Ennis.
Neck and shoulder problems are not always easily differentiated. If these areas appear problematic, it could be difficult for a rider to determine where the problem originates. Shoulders are fed by the nervous system through the lower cervical and upper thoracic spine. Dr. Kauffman says, "Theoretically, a shoulder problem could be developing because of a subluxation in the spine that is altering the nerve flow to the area. Either the muscles or the joint can be affected by this alteration in nerve function; it can cause the muscles to contract too much or become too flaccid depending on the degree or type of the subluxation."
Dr. Ennis agrees. "A lower neck problem, where it ties into the shoulder area, sometimes can cause what would otherwise look like a shoulder or a front leg problem but can actually be the result of a problem in the lower cervical area. It's not cut and dried or cookbook by any means; we must look at the whole animal. I have even found where an upper cervical problem has actually been the cause of a rear end problem because of compensation. We can't always just look at the horse and say, 'It's definitely a withers problem' or 'a lower cervical problem'; it could be something totally different. Horses usually compensate on the diagonal so if he's got a right front problem it could be a secondary compensation for a rear left problem, in the pelvis. We have to consider the whole horse, not just one area or we may miss what the actual cause of the problem is," says Dr. Ennis.
How is a subluxation different from a dislocation? "A complete dislocation is a very serious, excruciatingly painful situation of a bone out of place in which veterinary intervention is necessary," says Dr. Kauffman. "It is not a chiropractic situation. It may require surgery, splinting, or casting. The word 'subluxation' comes from 2 words: 'luxation' means dislocation and 'sub' means 'less than', so a subluxation is less than a complete dislocation. But it is a definite alteration of joint biomechanics, which then results in neurologic manifestations or muscle manifestations (myology)." A subluxation, though less than a dislocation, has its consequences, and over time a series of events takes place if the subluxation goes uncorrected. Subluxations affect the entire body; when a vertebra subluxates it can also change the way the heart, lungs, kidneys, pancreas, digestive system, and immune system function because all are controlled by nerves, and the nerves get there via the spine.
Dr. Kauffman explains, "When a subluxation occurs, we see kinesiopathology, or altered biomechanics. Generally the next thing we see is neuropathophysiology - altered neurology. Then there's myopathophysiology, which is a change in muscle function; then histopathophysiology, which is cellular damage at the tissue level. Then there's altered physiology (physiopathology). This cascade of events can happen once a vertebra subluxates. It's a more serious and noticeable cascade with a subluxation in the spine than in an extremity because the spine houses the central nervous system."
Dr. Kauffman adds, "When we have a muscle spasm, which is a form of myopathophysiology, sometimes that is the body's way of putting on its own cast to prevent further damage to the joints. The muscle hurts, so we don't want to move it, and the muscle is very tight so the joint itself doesn't move. That's the body saying, 'I need help'. When we go in medically and take muscle relaxers, we take away that natural splint or cast and we may open things up for further damage. I'm not saying muscle relaxers are never needed, however; that is the veterinarian's area of expertise."
How does hoof care relate to biomechanics and chiropractic? "Hoof care affects everything," says Dr. Ennis. "Hooves have to be properly balanced. I have actually told clients to call the farrier in and then call me back. We must have the feet balanced first and then we can make a lot of changes. If I adjust a horse that's not balanced, then the adjustment is not going to hold nearly as well; the horse is not going to benefit as much from the adjustment if he's not set up correctly. So shoeing and farrier work have a lot to do with how well my job is going to last," says Dr. Ennis.
Treatment of subluxations
Dr. Kauffman explains, "To treat a subluxation chiropractically, we make an adjustment to the bones. Preferably it is a very specific line of correction for the particular joint that is subluxated, whether it be spine or extremity, and the adjustment is a high velocity/low amplitude specific thrust into that joint to reestablish normal joint function and integrity. At the AVCA [American Veterinarians and Chiropractors Association] we usually clear out the spine first then work outward to the extremities - ribs, shoulder blades, humerus, femur. Working from the spine toward the feet is the usual pattern that I use. For example, after not responding to neck adjustment/treatment, a horse was found to have a subluxation in the humerus and when that was adjusted all the problems cleared up in a few weeks. So any joint in the body, TMJ too, can subluxate."
Chronic cases usually require more prolonged treatment than acute cases. Dr. Kauffman explains, "If a subluxation has just happened, and if the horse can be seen fairly quickly, the chances of fixing it in just a very few adjustments is much greater because there has been less time for the healing process to get underway, or for scar tissue to form. Though the healing process starts right at the time of injury, it hasn't proceeded long enough that it has healed with the vertebra in a subluxated position," he explains.
"Any subluxation, whether a vertebra or extremity, can heal in a misaligned position and will be much harder to change. If it is a subluxation from 10 years ago, it is obviously chronic; the healing process is over, there may be lots of scar tissue or adhesions around the subluxated area, and there may have been chronic neurological problems that started from this. Those are the really difficult ones to fix. The adjustment can disrupt or free up some of that old scar tissue when we try to reestablish normal joint function, but it will take many more adjustments in a chronic case, generally speaking," says Dr. Kauffman. However nothing is 'always' - the acute cases are generally easier to fix than the chronic cases, but even the chronic conditions are changeable. Rarely do we reestablish "like new" joint function, but we can improve the joint function from slight to considerable. So sooner is better - the sooner we can get to them, the better the outcome generally is," says Dr. Kauffman.Adjunctive therapies
Can massage be beneficial to chiropractic? Dr. Ennis says, "Massage can be a great asset to what we do. Horses that are in extreme pain often have fairly severe muscle spasms as a result of that pain. And the massage really helps to loosen up those muscles after the adjustment has been done to allow that adjustment to hold better. We don't have the muscles working against the adjustment when followed up with massage, especially in these extreme cases where they are real tight and sore."
Dr. Kauffman agrees that it can. "Massage can be very supportive. There have been times when I was unable to make an adjustment on a patient unless he/she was relaxed prior to treatment. Massage therapy is a great adjunct to chiropractic. Sometimes I'll also recommend that the massage therapy follow the adjustment so that the patient will stay relaxed and the adjustment can hold longer. Massage therapy cannot change the subluxation, but it can make adjustments easier to deliver and help them to hold longer."
Dr. Kauffman adds, "Acupuncture is another helpful adjunctive therapy. I don't do it but I refer to a vet who does do acupuncture. Again, it does not correct the subluxation but it does change the energy fields around the body and helps the chiropractic become more effective."
Dr. Ennis agrees. "I do not perform acupuncture but I know acupuncture can be a definite help to horses and a lot of times used in conjunction with chiropractic care, acupuncture can make a huge difference."
Stretching is something a horse may do on his own to keep himself flexible and comfortable. It is also something that an informed owner can do for the horse. Dr. Kauffman says, "Generally, I think all horses should be stretched before they are ridden, and that general range of motion stretches should be done on all animals. To take each joint through its comfortable full range of motion - the neck in extension, the neck in flexion, left and right lateral flexion, the shoulders in flexion and extension, the hip joint in flexion and extension - is just a nice common courtesy before we use the animal. But each case is different. I may recommend that the client take a carrot and do left and right lateral flexion exercises for the neck, and I may have them do twice as many to the right as to the left. When I watch my horses and see them stretch, I think it's a good sign," he says.
Observe the horse
Subluxations can be glaringly obvious, or they can be very subtle. What can an owner watch for when observing his horse? Dr. Kauffman says, "If you watch horses move, when they're feeling good, they look pretty, smooth, and nice. When things are subluxated, motion changes. A horse may demonstrate a limp, and we typically check the feet, the shoeing, the sesamoid bones, the suspensories, the shoulders, the saddle fit, and the rider. If all that is clear, it is time to check the spine. I see lots of limps that are related to the spine - a limp could be neck, thoracic spine, lumbar spine, or pelvis. When the horse stands on one leg it hurts his back, and when he stands on the other it doesn't, so he's going to want to unload the one that hurts. Thus you see a limp. When a horse walks, as he loads and unloads legs, there is a twisting motion that is applied to the spine and it can go the full length of the spine. The spine also moves side to side in a wave. If that particular gait or motion causes pain, the horse is going to unload whichever leg is creating the stress on spine a little quicker to avoid that pain," says Dr. Kauffman.
"Most horses want to move in a fluid, symmetrical, smooth and easy motion," Dr. Kauffman points out. "If something looks off and you can't really put your finger on it, get the horse checked. We also can't dismiss the anomalously formed bones in the body. During gestation, different bones may not form correctly. In those cases there may be a permanent malformation or malfunction in vertebrae or bones of the extremities that cannot be changed chiropractically, yet these horses should be chiropractically examined at least once every month because the altered biomechanics may cause recurring subluxations. Any time you see a symptom developing, the horse should be checked. I recommend all my performance horses, whether they have symptoms or not, be checked at least once a month."
It never hurts to check, and rather than allowing a subluxation to become fixed, sooner is better.
Natural Horse Magazine thanks Dr. Rick Kauffman and Dr. Jim Ennis for their help in preparing this article.
This article is for informational purposes only and is not intended to replace veterinary or other professional care.
Dr. Rick Kauffman's chiropractic expertise extends to both humans and animals. As the class valedictorian, Suma Cum Laude, Dr. Rick Kauffman received the prestigious John Connelly Award for professional and scholastic excellence at Palmer College of Chiropractic in Iowa. He is a board eligible Chiropractic Orthopedist and operates Kauffman Chiropractic and Noah's Ark Animal Chiropractic. Dr. Kauffman is certified in animal chiropractic by the American Veterinarians and Chiropractors Association in Hillsdale, Illinois. He performs animal chiropractic on mainly horses and dogs but his experience also includes goats, cats, and cattle, including bulls. He is currently an instructor at Options For Animals, the educational division of the AVCA, and is a noted speaker.
Dr. Rick Kauffman, DC
3489 G Road
Clifton, CO 81520
Dr. James Ennis is a licensed chiropractor certified in animal chiropractic by the American Veterinarians and Chiropractors Association. He is also an instructor at Options For Animals of the AVCA, and is the chiropractic advisor for ClipClop.com. Dr. Ennis has had several articles published on equine chiropractic and has been a featured guest on the nationally syndicated radio program, The Horse Show with Rick Lamb. Dr. Ennis conducts clinics and demonstrations on equine chiropractic for horse clubs and organizations. He maintains a full-time equine chiropractic practice and provides chiropractic care to the equine athlete in several states throughout the southern U.S. Visit his web site at www.horsechiropractic.com
Dr. Jim Ennis, DC
Hwy. 65 South
Clinton, AR 72031
For more information:
American Veterinarians and Chiropractors Association (AVCA)
623 Main Street
Hillsdale, IL 61257