The intent behind an acupressure treatment for tying-up is to restore the balance of chi energy throughout the body.


Tying-Up: A Scary Predicament
By Amy Snow and Nancy Zidonis

The weekend athlete is very familiar with the sensation of muscle contractions when every step is absolutely painful. Over-exertion during a workout may be painful for us; for a horse-athlete it can be disastrous. Tying-up is the most familiar name for the syndrome, but it has earned many a name in many a culture over hundreds of years: Monday Morning Disease, Black Water Disease, Set-fast, and more technical names – Azoturia, Myoglobinuria, Rhabdomyolysis, Acute Exertional Rhabdomyolysis. No matter what it is called, tying-up is dangerous and all horse guardians do their best to avoid having their animals suffer from even the mildest form.

The indicators of tying-up can be as simple as a decrease in performance and as frightening as the horse passing dark red-brown colored urine, lying down in shock, or thrashing in pain. In mild and sporadic cases of tying-up the horse usually exhibits some stiffness, shortened gait, possibly cramping and pain especially in the hindquarter muscles. Unfortunately, even in mild cases there can be a breakdown in muscle cells causing muscle dysfunction and permanent damage.

Severe cases of tying-up can be life threatening. A horse with a severe case may pass dark red-brown urine, and along with this there can be kidney and muscle damage. Other indicators of severe tying-up are: heightened heart and respiration rates; dehydration from excessive sweating; hard, stiff, painful muscles; inability to move; extreme thrashing in pain; shock and ultimately death.

There are horses that suffer from recurrent tying-up, or Recurrent Exertional Rhabdomyolysis (RER). Some of these horses often exhibit problems even with light exercise starting at a young age. Other horses with RER have frequent severe bouts of tying-up.

Every horse has his own constitution and may exhibit different indications of tying-up. Your veterinarian can test blood and urine samples and provide more conclusive information if you suspect any level of tying-up.

The most common incidence of tying-up is in young, nervous fillies, but it can happen to any horse. Since it is a syndrome, or a collection of physical reactions, there are many causes. The most consistently identified cause is when a horse’s exercise level has exceeded his level of conditioning. Other noted causes include: diet (especially feeding oats and/or grains covered with molasses during periods of rest); dehydration causing loss of electrolytes; muscle metabolic imbalances; hormonal imbalances; deficiencies of vitamin E, calcium, phosphorus, and selenium; emotional stress; physical trauma; temperament; and, respiratory diseases such as equine herpes virus 1 and influenza. Additionally, some breeds, such as Arabians, Standardbreds, and Thoroughbreds, are said to be more prone to tying-up.

From a Traditional Chinese Medicine (TCM) perspective, tying-up may be caused by an imbalance of the Liver organ system, which is responsible for the harmonious flow of chi (life force energy) and dominates the muscles in the body. Additionally, the Liver Meridian (the energy pathway or channel of the Liver organ system) belongs to the Wood Element and it is associated with spring. Tying-up frequently occurs in the springtime, though it can occur in any season.

There are different approaches to treating tying-up depending on the severity of the horse’s condition. If your horse is obviously in extreme pain or exhibiting any of the signs of severe tying-up or RER, please contact your veterinary professional immediately.

In mild cases the common protocol, with the addition of acupressure, is to initially stop all exercise and allow the horse to cool down slowly by walking without a rider for 3-4 minutes. If the horse is not able to walk, it is probably a relatively severe case, so do not force him to walk. If the horse will walk, alternate walking, massaging the affected muscles, and performing acupressure every 3-4 minutes until the horse seems to be able to move more freely and comfortably. If the weather is cold, blanket the horse after the horse has cooled down. Some sources say, for the next few days, only feed hay (no grain), restrict exercise, offer electrolytes and other mineral supplements, continue the acupressure treatments, and have plenty of clean water available. After three or four days, the horse can usually be slowly reintroduced to his regular conditioning program.

In more severe cases of tying-up or RER, stop all exercise and contact a veterinarian. Do not force the horse to walk since that can cause further, permanent muscle damage. While waiting for medical help to arrive, balance the horse’s body temperature: if he is hot, try to cool him; if he is cold, blanket him. You can perform the acupressure Tying-up Treatment provided in this article, but select only six of the acupressure points given in the chart; too many acupoints might overwhelm the horse’s system. Keep the horse as comfortable as possible until the medical professional can assess his condition and recommend a course of treatment.

The intent behind an acupressure treatment for tying-up is to restore the balance of chi energy throughout the body using acupressure points that will affect the organ systems associated with Wood, Earth, and Water Elements of the 5-Element theory.

By balancing meridians associated with the Wood Element, Liver and Gall Bladder, we are beginning the process of restoring the harmonious flow of chi and balancing the meridian that dominates muscles. The Stomach and Spleen Meridians belong to the Earth Element. By stimulating acupressure points affecting these meridians, we are addressing issues concerning diet and the metabolizing of nutrients. When we use acupressure points affecting the Water Element meridians, Kidney and Bladder, we are dealing with the pain and fear that accompany tying-up.

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The treatment provided in this article can be used from the moment you realize that your horse is showing signs of tying-up and can be continued during his recovery period every third day. The acupressure points selected for this treatment are based on Meridian Therapy and are chosen specifically to clear the entire energy channel. The Bladder Meridian acupoints are known as Back Shu points (or Back Transporting Points) and relate to the internal organ system. The acupoints along the coronet band are called Ting Points and function to clear the entire meridian while also helping to alleviate pain and contend with trauma. This Tying-up Treatment can be part of your 'First Aid' strategy. Additionally, it can be used in conjunction with other medical professionals' suggested courses of action.

Hopefully, you will not have any reason to use the acupressure treatment provided or any other medical treatment, but even when you take all possible precautions to avoid tying-up, it can happen. It is good to be aware of the best way to deal with it if your horse needs your help.

About the authors:
Nancy Zidonis and Amy Snow are the authors of "Equine Acupressure: A Working Manual", "The Well-Connected Dog: A Guide To Canine Acupressure", and "Acu-Cat: A Guide to Feline Acupressure". They own Tallgrass Publishers, which offers Meridian Charts for horses, dogs, and cats, plus "Introducing Equine Acupressure", a 50-minute training video. Tallgrass Animal Acupressure provides training courses worldwide. To contact them: phone: 888-841-7211; web:; email:

A Guide To A Short Acupressure Treatment Session

Start by finding a comfortable location for you and your horse where it is calm and you both can relax. Slowly, take three even breaths in and out. Think about how you want to help your horse feel better; taking a moment to formulate the intent of your treatment is very important. Begin by resting one hand near your horse’s shoulder. Using the heel of your other hand, place it at the poll and gently stroke down his neck, just off the midline. Continue stroking down to the hindquarters staying to the side of the midline. To finish, stroke down the outside of his leg to the coronary band. Your opposite hand can trail along the same path touching the horse lightly. Repeat this stroking procedure three times on each side of your horse.
Now you are ready for Point Work in the chart for tying-up. Rest one hand on your horse wherever it is comfortable. You are going to perform the actual Point Work with the other hand. Use either the thumb or two-finger technique depending on what is most comfortable for you.

Thumb technique: Place the tip of your thumb directly on the acupressure point, also called “acupoint,” and hold the point gently, but with intent, for about three to eight seconds.

Two-finger technique: Put your middle finger on top of your index finger and then place your index finger gently, but with intentional firmness, directly on the acupressure point for approximately three to eight seconds.

Use six to eight acupoints per acupressure session. Watch your horse’s reaction to the point work. Healthy energy releases are: yawning, deep breathing, muscle twitches, release of air, and softening of the eye. If your horse is overly reactive to a particular point or exhibits a pain reaction, work the acupoint in front of the reactive point or behind it. Try that point again at a later session.

To complete your treatment session, rest your hand comfortably on his shoulder. Place the heel of your other hand just off his poll and stroke down his neck, over his back to his hindquarters, keeping your hand to the side of his spine and down the outside of his leg in exactly the same way you did to start the session. Your opposite hand can lightly trail along the same path as the working hand. Repeat this procedure three times on each side of your horse. It can take 24 hours for the effects of an acupressure treatment to be experienced. Occasionally, the initial issue can seem to be worse during that time before it resolves.