The horse, an accident victim, was barely able to stand in his paddock, and when we asked him to move, he'd bear no weight on the leg at all. He was sweating, with a heart rate of 100, meaning his pain was severe and unrelenting. Even worse, the accident had happened seven days ago, and instead of calling a veterinarian, the owners had opted to call a local "chiropractor" who'd performed an adjustment and recommended four grams of bute a day for the following week until the horse could be seen again. The adjuster owned a gas station in town, and had learned to "crack backs" from his next-door neighbor.
Sadly, the adjustment did nothing for the fractured tibia seen on radiographs, and even if it could've been repaired, it was too late by the time the owners finally decided to call their vet. The horse was also in severe kidney failure, most likely due to toxic doses of bute.
This is a frightening example of an alternative-therapy choice gone bad, and similar episodes happen way too frequently. Yet acupuncture, chiropractic, and equine massage therapy can be valuable parts of your horse's management plan when used appropriately by a qualified practitioner. In our practice, we work closely with a variety of therapists who help us manage chronic back pain in hard-working performance horses, keep our older horses comfortable in their retirement, or provide relief from compensatory pain following a severe injury.
The key is knowing when to use these modalities, and who to call for help.
I'll outline seven key steps to follow that'll help you make the most of alternative therapies in your horse's management plan. I'll also explain basic information on acupuncture, chiropractic, and massage, outlining what they are, when to use them, and how to choose a qualified practitioner who'll help your horse and do no harm.
7 Steps for Success
Step 1: Diagnose
First and foremost, if your horse has a musculoskeletal problem, you'll be most successful getting him back to work if you know what's wrong?and more often than not this should begin with your veterinarian, who can do a lameness work-up in pursuit of a specific diagnosis.
Why is this so important? Because an injury like a torn suspensory ligament or broken bone is generally best identified and managed using conventional medical treatments. And in some cases, such as a neck or pelvic fracture, it's downright dangerous for a horse to have certain manipulations performed.
Does that mean alternative therapies should be avoided altogether in these cases? Absolutely not. They can be extremely valuable for pain management and to address compensatory issues. In some cases, they can even contribute to the healing process. It just means they should be applied with care-which requires an accurate diagnosis from the start.
Step 2: Choose Wisely
A key element to success is to choose your practitioner carefully. A properly trained chiropractor, acupuncturist, or body worker will refer you to your veterinarian when it's appropriate, and won't apply therapy until an underlying problem is diagnosed and treated. Begin by seeking a practitioner who's certified, ideally through one of the organizations listed later in this article.
These organizations all boast rigorous education and testing procedures, meaning a practitioner with one of these certifications is guaranteed to have received a certain amount of training and to have demonstrated a level of knowledge and competence with which you can feel comfortable. If your therapist claims to be "certified" but not through one of the organizations listed, ask questions before you allow him or her to work on your horse.
A wide variety of training programs exist, and some programs are better than others. Many issue their own "certificates" when the course is completed, but a piece of paper doesn't necessarily equal valid certification.
If this is what you discover, ask some specific questions about the amount of training your chosen therapist has really had. Be aware of a non-veterinarian therapist who recommends prescription medications without consulting with your vet. This can often be a red flag that the therapist is unclear about where the boundary between him or her and the veterinarian should lie?which could not only mean trouble if medications are misused, but also raises a concern about whether he or she will appropriately involve the veterinarian for other aspects of your horse's care.
Step 3: Involve Your Vet
Your veterinarian should remain an important part of your horse's management plan?even when you turn to alternative therapies that are outside his or her direct expertise. In fact, your vet usually will be familiar with most or all of the individuals offering alternative therapies in your area, and can probably direct you to the most competent person who's most likely to help your horse.
In our practice, we have close working relationships with a number of alter- native therapists in our area. We chose to develop these relationships because the individuals are well trained, know when it's not safe or appropriate to work on a horse with a specific problem, and maintain open channels of communication regarding horses in our care.
The result? When we all work as a team rather than as solo artists, your horse is more likely to get better.
Step 4: Be Prepared
Once you've decided on a therapy and selected a qualified practitioner, it's important to be prepared for your appointment. The therapist is likely to request a full medical history, including information from your veterinarian about chronic conditions or recent treatments. He or she generally will perform some kind of exam on your horse, and decide on a treatment plan according to his condition.
If the therapist detects any type of lameness, heat, or swelling on the body, or sign of a systemic illness, chances are he or she will recommend your horse be seen by your regular veterinarian prior to administering treatment. Don't be frustrated if this happens. Instead, see it as a good sign that the person you've selected is conscientious and well trained.
As with any visit for medical care, make sure your horse is in the barn, clean and dry, and ready for your appointment. Also have any medication information or other medical history at your fingertips.
Step 5: Tell the Truth
Have you ever paused when filling out that medical history form, wondering whether that nighttime glass of wine really qualifies as "drinks alcohol"? Yes?it does. And if you don't answer truthfully, it could have a significant impact on your health care.
The same holds true for your horse. If your acupuncturist, chiropractor, or massage therapist asks you about the type and intensity of work your horse does, about previous lameness or medical problems, or even whether you were able to follow suggestions for after-care, it's important to be accurate with your answers. Not only will it help your therapist devise the best treatment plan, it'll also let him or her know whether treatments are being effective.
After all, if your massage therapist recommends a specific stretching exercise for your horse and you don't do it... it's hard to know whether the treatment plan is working.
Step 6: Follow Recommendations
As with any form of treatment, if you want the best results you should follow the recommendations of the doctor or therapist who's helping you. If the acupuncturist tells you to give your horse a day off following treatment, give him a day off. And if the body worker suggests a follow-up exam and treatment in two weeks, make the appointment before he or she leaves your farm.
Just as you can't expect your horse to recover from a disease if you don't administer medications recommended by your veterinarian, it's unlikely you'll see the benefits of treatment if you don't follow the protocol outlined by your acupuncturist, chiropractor, or massage therapist.
Step 7: Be Realistic
If you want a miracle from alternative therapies, you're likely to be disappointed. Medications can't completely cure every instance of every disease, and likewise, alternative therapies won't fix every problem. If your horse has severe chronic laminitis and Cushing's disease, for example, acupuncture may help relieve his pain, but it's not likely to cure his disease. And if your horse has hock arthritis, your massage therapist may help relieve muscle spasms in his back and hindquarters to increase his comfort, but the horse is still likely to experience some amount of chronic lameness.
But if you follow all of the steps outlined above and have realistic expectations, the following alternative therapies can make a valuable contribution to your horse's overall good health.
What it is: Acupuncture is a procedure in which tiny needles are inserted at specific locations of the body for therapeutic purposes. This procedure was originally developed by the ancient Chinese, who believed that these anatomic locations were portals in the skin. Through these portals, the ancient acupuncturist could access meridians, or energy channels, that communicated with internal organs.
Experiment-based research has since shown us that these points are actually anatomic locations particularly rich in nerve endings and/or blood vessels. When needles are placed in these locations, neurotransmitters and other local factors are released, starting cascades that ultimately lead to body-wide therapeutic effects. An acupuncture treatment involves placement of needles into the points appropriate for your horse's specific problems.
When to use it: Acupuncture is a very effective treatment option to help minimize performance-related muscular soreness or to manage compensatory soreness secondary to other injuries. It's especially likely to be recommended as a first line of treatment for your horse if he suffers from back pain.
Many people don't realize that acupuncture can also be a useful therapy for problems beyond the musculoskeletal system. For example, a mare with decreased fertility may be having difficulty clearing fluid from her uterus. Acupuncture can help lead to smooth muscle contractions of the uterus, thereby helping the mare clean herself out.
Or, if your horse has allergy problems (hives, skin rashes, or a chronic cough), acupuncture, in combination with medical therapy, can help control symptoms and improve his response to other medications. Acupuncture may even be used to relieve jaw pain following a dental procedure, or to help quiet intestinal spasms that occur during an acute colic.
Who does it? Three primary programs are recognized for acupuncture training, and each has a slightly different emphasis. All three require that students be licensed veterinarians, with the exception that third-and fourth-year veterinary students and veterinary technicians can participate in some courses. The practitioner you select should be able to provide credentials from one of the three.
The Chi Institute (tcvm.com) focuses on traditional Chinese medicine with the underlying belief that needles are a way to unblock energy channels within the body. To become a certified veterinary acupuncturist with the Chi Institute, a veterinarian must complete approximately 130 hours of course work (four sessions of approximately three and a half days each); pass a written and practical exam; submit a case report; and log an additional 30 hours of internship, either by shadowing a CVA practitioner in the field or enrolling in advanced courses.
The Colorado-based Medical Acupuncture for Veterinarians course (colovma.org) is at the other end of the spectrum. This course emphasizes Western medical acupuncture based on neuroanatomy and physiology?a more scientific-based approach. Similar to the Chi Institute's requirements, certification through this program requires veterinarians to complete 140 hours of course work (four sessions of 35 hours each), and pass both a clinical and practical exam.
Finally, the philosophy of the International Veterinary Acupuncture Society (ivas.org) lies somewhere in the middle. One stated goal of this organization is to integrate traditional Chinese medicine and Western veterinary science. For certification, the IVAS program requires approximately 160 hours of course work, a written and practical exam, a case report, and a 40-hour internship with an IVAS-certified practitioner.
What it is: Chiropractic involves manipulation of the bones to restore proper alignment of the vertebrae or other joints when they've been disrupted. The bones of the spine and joints should be maintained in a specific alignment, and any change in that alignment is called a subluxation. Subluxation can impact nerves, muscles, and joints in the surrounding area, which can cause pain and discomfort. A subluxation may even have an effect on other organs in the body due to the disruption of nerve supply and blood flow.
When to use it: Chiropractic adjustment can be particularly useful for horses with back pain, especially when the condition is accompanied by visible asymmetry such as a horse that travels crooked, carries its tail to one side, or has a consistent headtilt. Stiffness and training issues unassociated with apparent lameness often will respond well to chiropractic therapy. The well-trained chiropractor will examine your horse carefully to identify any subluxations, and then will make necessary adjustments.
Who does it? The American Veterinary Chiropractic Association (refer to animalchiropractic.org or avcadoctors.com) is the most widely recognized group that certifies chiropractic practitioners in the U.S. To be AVCA-certified, a practitioner must be a licensed veterinarian or chiropractor. He or she is required to attend a program from one of five approved schools. The training involves approximately 220 hours of course work covering a range of topics from basic anatomy and physiology to specific adjustment techniques.
Veterinarians are required to take special courses covering chiropractic theory and techniques, while chiropractors are required to take additional coursework on basic veterinary medicine. Following this training, candidates must pass both a written and clinical examination. Re-certification is required every three years, and requires 30 credit hours of continuing education.
What it is: Massage therapy or body work involves hands-on manipulation of muscles to help improve circulation, relieve muscle spasms, and increase range of motion. Practicing therapists use not only massage techniques, but also stretches or other exercises in their work.
When to use it: Massage therapy can be beneficial for your horse in a wide variety of situations. Like acupuncture, it'll help minimize performance-related muscular soreness, and can be especially useful for managing compensatory soreness secondary to other illnesses or injuries. If your horse has back pain, massage therapy is likely to be a valuable part of his management plan. Massage therapists often use acupuncture points as trigger points in their work.
Who does it? Consumer beware: Unlike acupuncture and chiropractic, massage-therapy training programs don't require participants to be veterinarians. In addition, a large number of programs offer "certificates" for coursework completion, making it more difficult to determine which therapists are truly qualified to work on your horse. Training offered ranges from weekend courses to extensive programs that educate students in anatomy, physiology, and biomechanics, as well as basic and advanced massage techniques.
Although there's no single certification shared by most massage therapists, the International Equine Body Workers Association (iebwa.com) is one to look for. To become an IEBWA member, a practitioner must complete at least 150 hours of coursework from a recognized school, submit case studies, and complete an externship as well as pass a practical hands-on test. To maintain this certification, members are required to have 16 hours of continuing education each year and carry professional liability insurance.