Diagnosis and Treatment of Chronic Back Painin Horses

Benson B. Martin, VMD and Alan Klide, VMD

The diagnosis of chronic back pain in horses can often be difficult. It is often a diagnosis of ex-clusion. Horses may have concurrent problems. Several methods of treatment have been successfulin treating chronic back pain. The emphasis in this paper is to present the use of acupuncture in thetreatment of chronic back pain. In the majority of horses, horses were treated in nine differentacupuncture points once weekly for 8 weeks. Of 350 horses treated with acupuncture, 263 horses(75%) were able to perform at an acceptable level after treatment. We feel that acupuncture may be auseful form of treatment for chronic back pain in horses. Authors’ addresses: Dept. of ClinicalStudies, New Bolton Center, University of Pennsylvania, 382 West Street Rd., Kennett Square, PA19348-1692 (Martin) and University of Pennsylvania, School of Veterinary Medicine, Philadelphia, PA19104 (Klide). r 1997 AAEP.

1. Introduction

Poor performance caused by chronic back pain iscommon in many breeds of horses performing manytypes of work.1,2 Determining primary back painand localizing the pain are not difficult; however, it isdifficult to know the exact cause of pain.1–6 Inhorses, most treatments for chronic back pain areineffective or only effective for a few weeks.3–6

Acupuncture is a useful treatment for chronic backpain in horses.3–6 The purpose of the study reportedhere was to determine the responses of a largenumber of horses with chronic back pain to variousmethods of acupuncture treatment.

2. Materials and Methods

A. Horses

Three hundred and fifty horses were referred aspotential candidates for acupuncture treatment.These horses could not train or perform acceptably.

The presumed cause for their poor performance wasprimary back pain. Horses were randomly as-signed by the authors to one of four treatmentgroups: (1) laser stimulation of acupuncturepoints, (2) traditional needling of acupuncture points,(3) injection of saline solution alone, or (4) injectionof saline solution and methylprednisolone acetate.All treatments were near or in acupuncture points.These assignments were based on when the horseswere referred to our hospital.

B. Diagnosis

Diagnosis of back pain was based on history, physicalfindings, performance or change in performance, orradiographic interpretation. The first three crite-ria were most important and were always used.Radiography alone was the least effective method ofdiagnosis of primary back pain. Signs of back paininclude sinking away from the saddle when the ridermounted; sinking when a saddle was placed on the

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horse’s back, or when a girth was tightened; reluc-tance to canter or trot; reluctance to take andmaintain one lead of the canter; reluctance to changeleads; or reluctance to back. Other clinical signs ofback pain include hindlimb lameness without otherobvious causes for hindlimb lameness, refusal tojump, changing the style of jumping, refusing tobreak acceptably from the starting gate, vigoroustail movements, grinding of the teeth, dragging oneor more hindfeet, and perhaps most importantly, ahistory of poor or decreased performance.

C. Acupuncture Treatments

Horses were treated by using one of the four afore-mentioned treatment methods. Most horses weretreated once weekly for 8 weeks. The acupuncturepoints used were T10, TLR, T2, T4, and HL10.These points have been previously described.6 T10is equivalent to bladder 48, TLR is equivalent tobladder 23, T2 is equivalent to bai hui, T4 is equiva-lent to bladder 27, and HL10 is equivalent to bladder30. The bladder points have also been described.7

D. Evaluation

Horses were evaluated before, during, and aftertreatment. An evaluation was independently per-formed by the investigators, the rider, the trainer,and the referring veterinarian. Treatment resultswere classified as improvement of clinical back painor as no change. We determined the horse to havean alleviation of clinical signs of back pain if threecriteria were filled: (a) if the examination did notreveal improvement in clinical signs associated withback pain, (b) if the horse was able to performnormally for its intended use, and (c) if the ownerthought the performance of the horse was acceptableor normal. The horse was determined to have hadno change in its condition if at least one of the threepeople evaluating the horse believed that it had notimproved enough to fulfill the criteria for the classifi-cation of improvement of clinical signs of back painand performance. Of 13 group 1 horses that hadimprovement in back pain, nine were still alive 8years after their last treatment. Of these nine,seven were still performing their sport, one wasbeing used as a breeding animal, and one could notbe evaluated. One year after the last treatment,nine of the 11 group 2 horses had no back pain andwere still performing. Of 289 group 3 horses thathad improvement of clinical signs of back pain, 20died during competition and 269 were still alive 6months after their last treatment. Of these 269horses, 237 horses were still performing their sport.Of these 237 horses, 60 (25%) needed to be retreatedwithin 3 months. Of the eight group 4 horses thathad alleviation of back pain, all are alive and threeare still performing their sport. In summary, of 350horses treated with acupuncture, 263 horses (75%)were able to perform at an acceptable level aftertreatment.

3. Discussion

Traditional needling, laser stimulation of acupunc-ture points, and the injection of saline solution nearacupuncture points were equally effective in thetreatment of horses with chronic back pain. Acombination of methylprednisolone acetate and ster-ile saline was less effective because these horseswere treated just once. A further evaluation ofthis method may be beneficial. The finding thatsome horses had increased pain the day after treat-ment is consistent with our observations. Approxi-mately 20% of our equine patients with chronic painthat were treated with acupuncture experienced theeffect after each of the first few treatments. Horsesthat had increased pain after the first few treat-ments ultimately had improvement or alleviation ofpain after treatment. Similar results in horsesgiven previous treatments and those not given previ-ous treatments indicate that acupuncture was usefulnot only in horses not given previous treatments butalso in horses given previous treatments that wereonly effective for a short duration.

It is important to understand that acupuncturetherapy is not a panacea. It must be used in con-junction with a careful physical examination andlameness examination. In all the above horses,these examinations were performed. Any lame-ness problem was addressed in conjunction withother concurrent problems including back pain.Acupuncture therapy is a useful adjunct to thepracticing veterinarian’s armamentum.

4. Conclusion

We recommend that horses receive weekly treat-ments for 8 weeks, that they stay in their normaltraining regime, and that they be exercised on theday of treatment. Some horses improved after onetreatment, some horses improved after the second tofourth treatment, and 75% of the horses improvedafter five to eight treatments. Various methods ofacupuncture treatment appear to be clinically usefulfor treating chronic back pain in horses.

References1. Jeffcott LB. Diagnosis of back problems in the horse. Cont

Educ Pract Vet 1981;3:S134–S143.2. Jeffcott LB. Back problems in the horse—a look at past,

present, and future progress. Equine Vet J 1979;11:129–136.3. Klide AM. Acupuncture for treatment of chronic back pain in

the horse. Acu Electother Res Int J 1984;9:57–70.4. Martin BB Jr, Klide AM. Treatment of chronic back pain in

horses; stimulation of acupuncture points with a low-poweredlaser. Vet Surg 1987;16:106–110.

5. Martin BB Jr, Klide AM. Use of acupuncture for the treat-ment of chronic back pain in horses: stimulation of acupunc-ture points with saline solution injections. J Am Vet MedAssoc 1987;190:1177–1180.

6. Martin BB Jr, Klide AM. Treatment of chronic back pain in200 horses, in Proceedings. 37th Annu Conv Am Assoc EquinePractnr 1991;593– 601.

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