Chiropractic and Mesotherapy: What’s
New!
Dr. Katie Crossan
Certified by the American Veterinary Chiropractic Association
Kirkton Veterinary Clinic
Equine Services
What is Chiropractic?
►Chiropractic is a technique that restores motion to joints in order to maximize nerve function
►The back and neck contain multiple joints- if any of these are not moving through their full range of motion secondary issues will arise
Chiropractic- How Does it Work?
►The brain and spinal cord are the body’s “command centres” and are responsible for the behaviour of every organ in the body.
►The bones, ligaments, and soft tissues that surround these command centres can negatively impact their function if they are not working properly.
So… What’s New?
►“old style” chiropractic- theory that bones are out of place and need to be “moved”
►NEW RESEARCH: manipulating the release of chemical neurotransmitters by stimulating receptors in the body can help to “reset” dysfunctioning pathways.
► Electron microscope image of neurons
► Messages pass from neuron to neuron through the chemicals released between them
► Manipulating the release of different chemicals can change the message sent
►Resending a message again and again builds “plasticity”, which means the message is sent quickly and the resulting action occurs smoothly.
►Recognizing how the brain controls the body allows us to manipulate the “messages” to improve function.
EVERY CELL IN YOUR BODY IS UNDER NERVOUS
CONTROL
This may be an explanation as to why chiropractic seems to have an effect on
internal organs as well as the musculoskeletal system
How Do You Adjust a Horse?
►You adjust only one “joint” or segment at a time with very specific movements
►Chiropractic moves the affected joint in the direction it naturally should move- this is important as random motion could cause injury
► Newer techniques may use known pathways of the nervous system to “reset” muscles and nerves.
► Consequently, more recent chiropractic techniques may not resemble the quick thrust you have seen in the past, and may consist of multiple small motions.
Why Do Horses Respond so Well to These Therapies?
►Light horses have mostly fast twitch muscle fibers (Type II a and b)
►This helps them react very quickly to stimuli- ie skin twitches when a fly lands
►The brain receives information regarding motion much more quickly than it receives pain impulses.
The Vicious Circle
►Pain will cause the body to stop moving
►While this can be beneficial (ie broken bones!) it can also lead to problems as previously discussed
►The decreased motion in turn results in more inflammation (painful!)
When To Use Chiropractic
►Barrel racing►Roping► Jumping►Dressage►Driving►Cutting or working cattle►Racehorses►Older horses►After an accident as part of a rehabilitation program
Specific Problems
► Shortened stride
► Poor Performance
► Inability to pick up canter leads
► Sore back to the touch
Other Benefits
►Great way to pick up on subtle lamenesses more quickly
►Assess problems with harness or saddle fit
►Enjoyable for most horses
How Often…
►Animals hold their adjustments far better than people
►An individual schedule will be decided on depending on your horse’s workload and severity of findings
Mesotherapy
►Involves injection
of small amounts of
medication into
the mesoderm using
tiny needles mounted
on a device
Mesotherapy- How It Works
►Used since 1950’s
►Originally thought to work only on muscle spasm, and to work through temporarily blocking a nerve reflex loop traveling from the skin to the spinal cord.
Mesotherapy- Multiple Modes of Action
► Pharmacological effect of medication given
►Blocking the reflex arc
► Stimulating “giant fibers” and changing the impulses sent from underlying tissue
►Very effective at breaking the cycle of muscle spasm
►Also provides long lasting (up to 6 months) pain relief from neck and back pain resulting from ligament strain, arthritis, etc.
Other Techniques to Treat Back and Neck Pain
►Shockwave therapy
►Ultrasound guided injection of the cervical facets/ bursa of the nuchal ligament
►Anti-inflammatories
►EXERCISE!!! It is crucial to maintain muscle mass in horses with sore backs, so every effort must be made to make them comfortable enough to work.
WHAT IS A JOINT?
� A joint is the location where
two bones make contact. They
are constructed to allow
movement and provide
mechanical support.
� Synovial joints are the most
common moveable joints in
mammals.
Synovial joints
� Synovial joints consist of a
synovial cavity, an articular
capsule and an articular
cartilage.
� They can also include
accessory ligaments, fat pads,
menisci, tendons, and bursae
Joint Diseases
� ARTHRITIS
� OSTEOARTHRITIS (DJD)
� SYNOVITIS
� OSTEOCHONDROSIS
� SOFT TISSUE INJURIES
� TRAUMA
� FRACTURES
� WOUNDS
Diagnosis
� HISTORY/ PRE PURCHASE EXAMINATION
� LAMENESS EXAMINATION
� RADIOGRAPHS
� ULTRASOUND
� BONE SCAN (NUCLEAR SCINTIGRAPHY)
� MRI
� ARTHROSCOPY
WHAT CAN YOU DO?
� Controlled growth
� Consistent regular exercise
� Good quality diet
� Good body condition
� Preventative Therapies
� Treatment
Non-Steroidal Anti-Inflammatory Drugs
(NSAIDs)
� PHENYLBUTAZONE (bute)
� FLUNIXIN (banamine)
� ASPIRIN
� MELOXICAM
� FIROCOXIB (equioxx)
� NAPROXEN
� CARPROFEN
NSAIDs
� IN GENERAL – INHIBIT ONE PART OF INFLAMMATORY CHAIN
� WANT TO USE RECOMMENDED DOSES AND NOT USE POLYPHARMACY
� TRY TO DECREASE DURATION OF USE
� GASTROPROTECTANTS FOR LONGER TERM USE OR SENSITIVE HORSES
� COX 1 AND COX 2
� COX 1 INHIBITORS ARE MORE LIKELY TO PRODUCE MUCOSAL DAMAGE AND ULCERATION IN THE GASTROINTESTINAL TRACT THAN COX 2 INHIBITORS.
INTRA-ARTICULAR CORTICOSTEROIDS
� METHYL-PREDNISOLONE ACETATE (depo-medrol)
� TRIAMCINOLONE
� BETAMETHASONE
THE GOOD, THE BAD AND THE UGLY!!!
Hyaluronic acid
� Integral component of both synovial fluid and articular cartilage. It is synthesized within the synovial membrane and chondrocytes.
� Important in elasticity of joint and lubrication of joint.
� Tons of beneficial effects after IA administration of HA have been reported in a number of equine studies.
� Anti-inflammatory
� Increased production of HA within the synovium
� Helps clear infected joints
� Potentially reduces cartilage degradation
SODIUM HYALURONATE IA
� SIGNIFIGANT STUDIES ON INCREASED JOINT HEATLH
� IA injections with steroid only versus HA and steroid together
resulted in HA/steroid having a better and longer lasting
improvement.
� Significant difference in studies compared to placebo!
IVHA (Hyonate/ Legend)
� Horses treated once a week for 3 weeks were found to have
lower lameness scores and significantly better synovial
membranes as well as significantly lower inflammatory
mediators within their joints compared to placebo treated
horses.
� Mechanism is uncertain
POLYSULFATED
GLYCOSAMINOGLYCANS
Thought to be chondroprotective (PROTECTS CARTILAGE FROM DAMAGE)
Repeated IA injections show significant improvement in synovial fluid protein concentration and improved viscosity.
Improves clinical signs of arthritis.
Can markedly decrease development of OA but no benefits for cartilage lesions already present in one study.
Potential complications of IA use is a greater potential for infection compared to other products.
Intramuscular use: positive side effects for IA difficult to show with IM use. Minimal objective data. May be useful at higher concentrations? Only therapy every 4 days seems to show anti-inflammatory levels with the joint.
IRAP
� INTERLEUKIN-1 RECEPTOR ANTAGONIST PROTEIN
� An anti-inflammatory protein that counteracts the destructive effects of inflammatory proteins such as Interleukin-1 (IL-1) within the inflamed joint.
� Harvest from the horses own blood and incubated with glass beads that enhance the production of anti-inflammatory proteins including IRAP. The serum is then filtered and frozen until use.
� We often recommend IRAP if a joint is non-responsive to corticosteroid injections or if frequent injections are required. Additionally recommend IRAP when there is a well defined synovitis/ capsulitis within a joint.
� In general the process produces 5-6 doses of the serum. We usually us 2-3 consecutive doses within the joint 8-14 days apart.
LONDON EQUINE
HOSPITAL
Tiludronate
� Inhibits osteoclasts
� Research shows improvement for navicular
disease, hock arthritis, back/neck arthritis…
� WANT TO USE BASED ON BONE LYSIS to
reduce resorption of bone.
Why would YOU call?
• Colic
• Open wound
• Eye injury
• Lameness
• Choke
• Foaling
• Fever
• Sickness
• Routine health care
• Export papers
#1 COLIC�• EMERGENCY!
• Some colics may be simple and can be resolved easily - others can be deadly, especially if untreated
• BEFORE YOU GIVE YOUR HORSE ANYTHING - call us! Even a phone call with your vet can help you decide the best course of action
• If colic signs do not improve after a half hour of handwalking (or worsen) it is better to have your horse examined and treated ASAP than to wait
COLIC�
– Take away all feed (water is ok)
– Handwalk if your horse is trying to roll
– If the horse will stand in the stall, make sure it is clean so you can monitor for new manure
– Do not administer any medication without consulting the vet
– If you administer medication, make sure you take the heart rate and temperature first and record time of administration
–Rolling, pawing
–Sweating
–Lifting upper lip
–Kicking at belly
–Off feed,
distress
What to do while you
wait�
Signs:
#2 OPEN WOUNDS�• Lacerations that go all the way
through the skin (full thickness)
should be sutured
• The newer a wound is when it is
sutured, the better the chance is that
it will heal well
• If you think that a wound can be
sutured, DON’T WAIT!
• Especially wounds on lower limbs -
these like to grow proud flesh if they
are not closed and can be a
nightmare to heal
OPEN WOUNDS�• What to do while you wait??
• If the wound can be rinsed clean (cold
hose, clean water) safely, do so
• If the vet is on their way, avoid applying
any topical medications (Blue/silver
spray, furacin, etc) as they can
complicate suturing
• If the wound is on a limb and/or
bleeding, apply a clean bandage if
possible. Applying pressure with a
clean towel will work for wounds that
can’t be bandaged
#3 EYE INJURIES�
• Eyes are ALWAYS an
emergency!!
• If you suspect your horse
has had an eye injury don’t
wait to call
• Treating eyes quickly can
mean the diffence between
keeping and losing vision,
as well as the eyeball!
EYE INJURIES�
– Squinting, tearing
– Ocular discharge (yellow
or greenish)
– Eyelid lacerations
– Visible scratches or
spots on the surface of
the eyeball (cornea)
• If you think your horse has
had an eye injury>
•Call the vet!
•Move the horse to a safe, dark
location
•Do not apply any eye ointments
without consulting your vet - some
can actually make they eye
worse!
•If you think the eye is very
painful, putting a well-fitting fly
mask on can help protect the eye
until the vet arrives
Signs to look for:
#4 LAMENESS�
Different people will call the vet for
lamenesses of differing severities..
– SEVERE LAMENESS IS AN
EMERGENCY!
– Mild lameness may not provoke an
emergency call> but even mild
lameness that persists for an extended
period of time should be diagnosed
– If the lameness seems to involve
BOTH FRONT FEET - call your vet
right away, as you may be seeing the
first signs of laminitis - TIME TO
TREATMENT IS CRITICAL
SEVERE LAMENESS�• What to do while waiting for the vet>
– If possible, move the horse to a safe location where they will not be bothered by other horses, inclement weather, etc. Soft bedding is usually ideal.
– Do not remove any foreign objects that may be causing the lameness (ie. Nail in the foot, penetrating sticks, etc)
– If there is an obvious injury to a lower limb, and a bandage can be applied safely it may be helpful in providing support and stability
– Before administering medication, consult with your veterinarian
#5 CHOKE�• Can be mistaken for other
things (ie colic)
• Generally seen after feeding
• Older horses more prone -esophageal motility not as good
• Signs of choke:
– Excessive salivation
– Coughing (cough up feed material - seen in/around nostrils
– Agitation, retching
CHOKE�• What to do??
– If a choke does not resolve on it’s own in 10-15 minutes, it will likely
need veterinary attention
– Remove all feed material (water is ok)
– Sometimes taking the horse out for a brief walk will help relieve their
distress and distract them (won’t fix a serious choke)
– If the choke is mild (and recent) a few syringes of water given orally
may help with swallowing
– If signs persist after 15 minutes THIS IS AN EMERGENCY!
– Untreated choke can lead to esophageal rupture, aspiration
pneumonia and other bad things!! Not to mention the horse feels
miserable :(
– Even mild chokes can have some aspiration - if you have any doubt it
is best to treat with antibiotics
#6 FOALING�• Generally, foaling is a quick and
easy event
• It is an EMERGENCY if the process stalls anywhere along the way!!
• From the time the mare’s water breaks, foaling should progress quickly - the foal should be born in 30-45 minutes
• If you are nervous, or inexperienced with foaling - call your vet as soon as the water breaks (this gives a few minutes to get on our way to your farm!!)
FOALING�
• Emergencies DURING foaling..
– Malpositioning of the foal
– Fetal-maternal disproportion
– Congenital deformities
– Umbilical cord abnormalities
– ‘Red-bag’ - premature
placental separation
– Failure of amniotic sac to
rupture (suffocation)
• Emergencies BEFORE foaling>
– Premature udder development
– Vaginal discharge
– Leaking colostrum
• If any of these are noted, it is best
to contact your vet ASAP - things
like abortion and immunodeficient
foals can hopefully be avoided with
early treatment
** ALL MARES AND FOALS SHOULD BE EXAMINED BY A VET
WITHIN 24 HOURS TO CHECK FOR CONGENITAL BIRTH
DEFECTS AND ENSURE PASSIVE TRANSFER OF ANTIBODIES
#7 FEVER�And
#8 SICKNESS• Fever generally
indicates an underlying illness
• It is often accompanied by other clinical signs such as dullness and being off-feed
• Febrile horses are often reported to “not be themselves”
• Febrile = Temp over 38.5º Celsius or 102.5° Fahrenheit
• Sickness - coughing,
nasal discharge, etc
• Can be mild, but may lead
to more serious illness (ie
pneumonia) if left
untreated
• Often viral causes (EHV,
influenza) but can be
complicated by secondary
bacterial infections
FEVER�and SICKNESS• Your vet can do bloodwork on the
most affected horse(s) to determine the best treatment course
• In addition to calling the vet>
– Avoid bringing new horses into/out of the barn
– Monitor rectal temperatures daily
– Wash hands between sick and healthy horses
#9 ROUTINE HEALTH
CARE�
– Rabies
– Tetanus
– EEE/WEE
– WNV
– EHV/Influenza
– Strangles
• Dentistry (annual
check-up)
• Deworming/Fecal
sampling (3-4 times
per year, depending
on environment)
Vaccinations:
COGGINS and EXPORTS�
• A Coggins test determines if a horse is affected with Equine Infectious Anemia (EIA)
• Not a common disease in this part of the world, but very serious
• Negative test required for some horse shows/events as well as for racing and importing/exporting horses
• Takes 5-10 days to get original paperwork back from the lab!!
• Export papers are a statement
verifying that a horse is healthy
and fit for travel
• They also list the most current
negative Coggins result
• Required to cross the border
between Canada and the US
• ‘Temporary’ papers are good
for 30 days to leave the country,
any longer requires a
“permanent’ set
• Must be signed by a CFIA vet to
be valid*Take home message: Paperwork takes time - plan ahead! :)
And finally�