Acupuncture has potential in managing axial stiffness in steeplechase racehorses: a blinded prospective randomized preliminary study

Antoinette Terlinden CIRALE, BPLC, INRAE, Ecole nationale vétérinaire d’Alfort, Maisons-Alfort, France

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Manon Szymkowiak FAMILYVETS Herbignac, Herbignac, France

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Eva Jonville La Trinité de Réville, France

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Chloé Hatrisse University of Lyon, Lyon, France
Gustave Eiffel University, Lyon, France
Claude Bernard University Lyon 1, Lyon, France
CWD-VetLab, Ecole nationale vétérinaire d’Alfort, Maisons-Alfort, France
Laboratoire de recherche en imagerie et orthopédie, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada

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Emeline De Azevedo CIRALE, BPLC, INRAE, Ecole nationale vétérinaire d’Alfort, Maisons-Alfort, France

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Virginie Coudry CIRALE, BPLC, INRAE, Ecole nationale vétérinaire d’Alfort, Maisons-Alfort, France

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Jean-Marie Denoix CIRALE, BPLC, INRAE, Ecole nationale vétérinaire d’Alfort, Maisons-Alfort, France

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Fanny Pilot-Storck Ecole nationale vétérinaire d’Alfort, Maisons-Alfort, France
Paris-East Créteil University, Créteil, France

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Loïc Desquilbet Ecole nationale vétérinaire d’Alfort, Maisons-Alfort, France
Paris-East Créteil University, Créteil, France

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Lélia Bertoni CIRALE, BPLC, INRAE, Ecole nationale vétérinaire d’Alfort, Maisons-Alfort, France

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Abstract

OBJECTIVE

Evaluate the short-term effects of acupuncture on the dynamic manifestations of axial stiffness in steeplechase racehorses.

ANIMALS

12 steeplechase racehorses presenting signs of axial stiffness during training.

METHODS

Horses were randomly assigned to either an acupuncture treatment by an experienced certified acupuncturist (n = 6) or no treatment as negative controls (6). The horses’ locomotion was evaluated during training before treatment (D0) and 7 (D7) and 14 (D14) days after by their rider and trainer through a questionnaire. Additionally, the improvement of their dorsal flexibility 2 days after treatment was evaluated subjectively at the trot, free jumping at the canter was evaluated by expert clinicians, and free jumping at the trot was evaluated objectively via inertial measurement units.

RESULTS

Significantly more horses were improved on D7 and D14 in the acupuncture group (6/6) compared with the control group (1/5; P =.01) according to the scores set by the trainer and riders. Subjective evaluation of the dorsal flexibility also revealed a significant improvement (P = .04) for horses receiving the acupuncture treatment (median improvement score, 0.50 [reference range, 0.5 to 0.9]) compared with control horses (–0.25 [reference range, –0.5 to 0]).

CLINICAL RELEVANCE

Acupuncture may be an interesting nondoping strategy to improve clinical signs of axial stiffness and performance on steeplechase racehorses.

Abstract

OBJECTIVE

Evaluate the short-term effects of acupuncture on the dynamic manifestations of axial stiffness in steeplechase racehorses.

ANIMALS

12 steeplechase racehorses presenting signs of axial stiffness during training.

METHODS

Horses were randomly assigned to either an acupuncture treatment by an experienced certified acupuncturist (n = 6) or no treatment as negative controls (6). The horses’ locomotion was evaluated during training before treatment (D0) and 7 (D7) and 14 (D14) days after by their rider and trainer through a questionnaire. Additionally, the improvement of their dorsal flexibility 2 days after treatment was evaluated subjectively at the trot, free jumping at the canter was evaluated by expert clinicians, and free jumping at the trot was evaluated objectively via inertial measurement units.

RESULTS

Significantly more horses were improved on D7 and D14 in the acupuncture group (6/6) compared with the control group (1/5; P =.01) according to the scores set by the trainer and riders. Subjective evaluation of the dorsal flexibility also revealed a significant improvement (P = .04) for horses receiving the acupuncture treatment (median improvement score, 0.50 [reference range, 0.5 to 0.9]) compared with control horses (–0.25 [reference range, –0.5 to 0]).

CLINICAL RELEVANCE

Acupuncture may be an interesting nondoping strategy to improve clinical signs of axial stiffness and performance on steeplechase racehorses.

Introduction

The musculoskeletal system is a primary cause of poor performance in athletic horses, and its management is at the heart of equine medicine.1,2 Within this system, the axial skeleton and more specifically the back are important contributors to poor performance and financial loss in racehorses. Back pain and axial stiffness have been frequently overlooked in the race industry, as the poor specificity of clinical signs and imaging challenges make diagnosis of back conditions difficult.35 However, over the past decade, veterinarians have gained awareness regarding this condition, and various treating modalities have been developed. These include many scientifically validated medical and surgical treatments.69 Unfortunately, all these treatments are invasive or considered doping by racing authorities in France and other European countries, and most of them cannot be applied within 2 weeks of a race. Training management is also an essential part of the management of back problems but is not always applicable in racehorses.5

Considering these constraints, a growing interest for alternative therapies has developed. Some alternative therapies, such as chiropractics and osteopathy, rely on mobilization and tension relief.1015 Others, such as extracorporeal shockwave therapy or laser, aim for pain relief.1623 However, the use of some of these techniques prior to racing has also been restricted due to their short- or long-term consequences. Acupuncture has been a part of traditional Chinese medicine for centuries and has evolved over time. It is commonly used in modern veterinary medicine to treat pain and many other specific painful conditions. Acupuncture points are located close to major nerves, blood vessels, or lymphatic vessels at sites of muscle or fascia penetration, bone foramina, or neurovascular bundles.24,25 Stimulation of a point results in tissue damage, activation of the inflammatory cascade, and neural excitation, causing the release of various neurotransmitters that can have local or peripheral effects such as increased local microcirculation or muscle spasm relief.2428

Studies2933 have been performed on various types of acupuncture techniques used in treatment of axial stiffness in horses, with positive clinical results. However, few of them were randomized and controlled, and none involved racehorses. The objective of this study was to evaluate the short-term effects of acupuncture on the clinical signs of axial stiffness in steeplechase racehorses. We hypothesized (1) that the trainer and rider would find the signs of axial stiffness from horses treated with acupuncture improved for up to 2 weeks, compared with signs in untreated horses, and (2) that back mobility would be improved for treated horses compared with back mobility in control horses 2 days after treatment.

Methods

Horses

Twelve healthy steeplechase racehorses that were 2 to 5 years old, were free of lameness on visual evaluation, and presented clinical signs of axial stiffness, including back stiffness, shortened strides at the canter, or poor hind limb propulsion, were included in this exploratory study out of 43 horses at training at the facility. Horses that had received any medical or physical treatment < 3 weeks prior to the study or that had raced < 4 days prior to the study were not included. The study took place at a single facility where all horses were housed and trained. Written informed consent was obtained from the owner and trainer of the horses. This protocol was approved by the ComERC/ENVA Ethical Committee (Permit No. 2019-07-19).

Study design

The horses were randomly assigned to either the acupuncture treatment group (n = 6) or to the control group (6) using an Android app (Randomizer; Giannis Macheras). Each horse was ridden 3 days prior to treatment and a questionnaire was submitted to the trainer and rider, blinded to the treatment groups (Supplementary Table S1). On day 0 (D0; baseline) before treatment and day 2 (D2) after treatment, the back mobility of all horses was evaluated and graded on dynamic examination at the trot and then free jumping at the canter. On day 1, all horses were turned out in the walker. From days 3 to 6 and from days 8 to 13, all horses underwent an identical training program including walker, routine paddock turnout, and ridden exercise at the canter. All horses were ridden by the same rider with identical equipment during each exercise session. On days 7 (D7) and 14 (D14), the horses underwent their regular training, and a questionnaire was submitted to the trainer and rider still blinded to the treatment groups. A summarized timeline of the study is presented (Figure 1).

Figure 1
Figure 1

Summarized timeline of the study. Locomotor examination included 2 round trips of 30 m at the trot and 5 laps of approximately 120 m long at the canter with free jumping of 3 jumps of 90 cm high/lap. Routine training program consisted of ridden exercise at the canter at increasing speed over 5 laps of 1,500 m and free jumping over fences.

Citation: Journal of the American Veterinary Medical Association 261, 12; 10.2460/javma.23.04.0197

Primary outcome

As the trainer and rider’s opinion is the criterion used in equine practice to evaluate the response to back treatments, it was selected as the primary outcome. The axial mobility was evaluated by the trainer and the rider based on the horses’ flexibility and mobility at the canter and above the jumps, both from a visual and ridden perspective, and a consensual grade was attributed following an exercise session. This was divided into different categories to assess response to treatment in the most global way possible. Therefore, behavior was included to evaluate the willingness of the horse to perform the expected exercise, balance and rectitude to assess any potential compensatory patterns manifested by crookedness, head and neck pendulum to evaluate the fluidity of the pendular motion of the head or lack thereof that could be considered as stiffness, back and pelvic mobility, and overall amplitude and relaxation over the jumps as an evaluation of flexibility and ability to jump adequately. The horse behavior, balance and rectitude, head and neck pendulum, back and pelvic movement, stride length, and mobility during the jump were graded separately from 0 to 4, then summed to obtain a first combined score out of 20. The horses’ overall performance was also spontaneously subjectively graded out of 20 to obtain a second score. A total combined score out of 40 for D0, D7, and D14 was then obtained by addition of both scores (Supplementary Table S1).

Secondary outcomes

Visual evaluation—Previously described criteria, which took into account the thoracic and lumbosacral flexibility, hind limb propulsion, and stride length, were used to evaluate dorsal flexibility during in-hand examination of the horses in a straight line at the trot (3 to 4 m/s) and then free jumping at the canter in both directions on soft ground.8 All examinations were videotaped to allow final review after completion of the study by specialists in equine locomotion (JMD, VC, LB) who were blinded to the treatment groups. The video recordings from D0 and D2 of each horse were successively reviewed, and a subjective improvement grade of the dorsal flexibility was independently established by each observer for each condition of the examination as follows: –1, severe degradation; –0.5, mild to moderate degradation; 0, no change; 0.5, mild to moderate improvement; and 1, marked improvement. Grades were then fixed by consensus agreement, during which horses with different grades assigned by the observers were reviewed and discussed (Supplementary Table S2). A final dorsal flexibility improvement score was established by adding the trot and free jumping at canter grades together.

Quantification of the thoracolumbar mobility using inertial measurement units—Horses were equipped with 6 wireless inertial measurement units (IMUs; ProMove-mini wireless IMUs; Inertia Technology BV; triaxial accelerometer ± 16 X g, triaxial gyroscope ± 2,000°/s) placed on the head, withers (at the midlevel), thoracolumbar junction (at the level of the last rib), pelvis (at the level of the tuber sacrale), and 2 distal metacarpal areas (Supplementary Figure S1). They recorded at 200 Hz during 2 round trips on a straight line of 30 m on regular hard ground at the trot. The handler was the same person for the duration of the experiment for all horses.

Data were analyzed using custom-written Matlab2020a (The MathWorks) scripts. The dorsoventral acceleration signal was integrated twice to obtain displacement values and was high-pass filtered using a fourth-order Butterworth filter with a cutoff frequency set to 1 Hz chosen after checking that the filter suppresses the slow drift without distorting the shape of the signal.34 From the vertical displacement of the withers (W), thoracolumbar junction (TL), and pelvis (P), 2 variables were extracted for each inertial sensor: UP was the mean upward displacement (in cm) during the propulsion phase from the lowest point reached by the sensor at the end of the absorption phase to the highest point reached at the end of the propulsion phase, and DOWN was the mean downward displacement during the absorption phase from the highest to the lowest point (Figure 2).

Figure 2
Figure 2

Example of dorsoventral acceleration signal obtained for the 3 sensors of interest at the trot in a straight line (withers [W], thoracolumbar junction [TL], and pelvis [P]) illustrating the 2 variables measured: UP (propulsion phase) and DOWN (absorption phase), represented by the blue and green dashed arrows, respectively. Time points A and B correspond to A and B in Figure 3, where A is the highest point reached by the sensor at the end of the propulsion phase and B is the lowest point reached at the end of the damping phase. The red dashed arrow represents the duration of a stride.

Citation: Journal of the American Veterinary Medical Association 261, 12; 10.2460/javma.23.04.0197

Thoracolumbar mobility was assessed at the trot using a biomechanical beam model loaded in flexion by the weight of the abdominal mass (Figure 3). The displacements of the W and P sensors reflecting the displacement of the trunk were considered as fixed points to isolate the relative displacements of the TL sensor. The relative thoracolumbar mobility was then obtained by subtracting the average of the W and P displacement values to each TL value of UP and DOWN (Supplementary Table S3) such as presented in the following equation:

article image
Figure 3
Figure 3

Simplified beam model of the back submitted to extension by the weight of the abdominal mass (W) at the trot during the stance phase. Z-axis represents vertical displacement. A and B correspond to time points A and B in Figure 2.

Citation: Journal of the American Veterinary Medical Association 261, 12; 10.2460/javma.23.04.0197

Acupuncture treatment

Treatment was tailored to each horse and performed by a certified acupuncturist (EJ) after systematic diagnostic palpation consisting in detailed digital pressure along the 6 neck meridians and along the thoracolumbar muscular groove where the bladder meridian runs, ending with specific points of the croup and gluteofemoral region. This systematic palpation highlighted hyperalgesic points associated with mobility restrictions along the spine itself, or referred pain from a limb or internal imbalances. Clinical signs and treatment for each horse are summarized (Supplementary Table S4). Puncture was performed via acupuncture needles or 21-gauge hypodermal needles that were left in place for around 10 minutes. The treatment was well tolerated by all horses. Immediate response to treatment was evaluated by palpation, and the treatment was adjusted if any residual sensitivity remained. No treatment of any kind was performed on the control group. Owners, trainer, and rider were absent from the barn during selection of the horses and treatment.

Statistical analysis

A binary classification of the primary outcome was performed, and the Fisher exact test was used. The 2 following categories were selected: (1) improvement, when the differences of the D7 – D0 and the D14 – D0 values were > 8; and (2) no improvement, when the D7 – D0 and/or the D14 – D0 values were ≤ 8. The threshold of 8 (20% of the highest score [40]) was chosen to consider the improvement as clinically relevant, to take into account a possible placebo effect, and to avoid a transient random effect.

For the secondary outcomes, the Mann-Whitney test was used due to sample size. The relative improvement of the thoracolumbar mobility measured with IMUs between D0 and D2 in each treatment group was evaluated by calculation of the difference in values between D2 and D0 relative to D0, such as presented in the following equation:

article image

Data collected were centralized via Microsoft Excel, version 16.0 (Microsoft Corp). All statistical analyses were performed using R software, version 3.4.3 (R Foundation for Statistical Computing). Results are expressed in means and SDs or median with IQR, depending on the normal distribution of the data assessed visually.

Results

Population

Horses from both groups were similar in breed, age, exercise level, race earnings, and median values of baseline trainer and rider score, as well as propulsion UP and absorption DOWN (Table 1). Gender distribution was not similar in both groups, with 4 of 6 of the control group being female versus 5 of 6 in the treated group. One of the horses from the control group was excluded from follow-up after day 6 due to wound injury.

Table 1

Characteristics of the population.

Criteria Control group (n = 6) Treated group (n = 6)
Breed (% [n])
 Thoroughbred 83 (5) 17 (1)
 French Chaser 83 (5) 17 (1)
Age (y [mean, SD]) 3 ± 0 3 ± 0
Sex (% [n])
 Gelding 33 (2) 67 (4)
 Female 17 (1) 83 (5)
Earnings
 Absent 100 (6) 0 (0)
 Present 100 (6) 0 (0)
Trainer and rider score D0 (median, IQR)/40 15.2 (9.5–17.6) 11 (10.2–11.7)
Propulsion (UP) D0 (mean, SD) –1.3 (–0.1) –1.5 (0.03)
Absorption (DOWN) D0 (mean, SD) 1.3 (–0.2) 1.5 (0.04)
Passive mobilization amplitude (median, IQR) 1.5 (1, 20) 2.5 (2, 3)
Passive mobilization sensitivity 1 (1, 1) 0.5 (0, 1)

D0 = Baseline before treatment. UP/DOWN = Relative dorsal flexibility obtained with inertial measurement units (IMUs) by subtracting the average of the withers and pelvis upward/backward mean vertical displacement values (cm) during the propulsion/absorption phase to each thoracolumbar value collected in Supplementary Table S2.

Evaluation of the locomotion

All the results are presented (Table 2). No adverse event occurred during the study period that could have impaired the general movement symmetry of the horses, and no subjective gait change was noticed over the study period. According to the primary outcome (rider and trainer’s evaluation of the locomotion), there were significantly more horses improved on D7 and D14 in the treated group (6/6) compared to the control group (1/6; P = .01).

Table 2

Compiled results from data analysis of the primary criterium (trainer and rider score) and subjective (dorsal flexibility improvement score) and objective (UP and DOWN IMU measurements) secondary criteria.

Horse ACUPUNCTURE Horse CONTROL
Trainer and rider score (/40) Dorsal flexibility subjective improvement score (trot/canter) UP improvement relative to D0 DOWN improvement relative to D0 Trainer and rider score (/40) Dorsal flexibility subjective improvement score (trot/canter) UP improvement relative to D0 DOWN improvement relative to D0
D0 D7 D14 D0 D7 D14
1 12 22 26.5 1 (0.5/0.5) 0 0 7 16.5 17.5 20 –1 (0/–1) –0.1 0.1
2 15 26 26 0.5 (0.5/0) 0 –0.1 8 7 32 32 0 (0/0) –0.1 0
3 11 39 39 0.5 (0/0.5) –0.2 0.2 9 14 Excluded 0.5 (0.5/0) 0 0.1
4 7 37 40 1 (1/0) –0.6 0.7 10 22 22 22 –0.5 (–0.5/0) –0.4 0.4
5 11 23 23 –0.5 (0/–0.5) –01 0.1 11 18 18 18 0 (0/0) –0.5 0.4
6 10 39 39 0.5 (0.25/0.25) 0.1 –0.1 12 8 11 20 –0.5 (0/–0.5) –0.2 0.1
Median [IQR] or mean (SD) Horses > 20% improved (D7 and D14): 6 (100%)* 0.50 [0.5 to 0.88] * –0.1 (0.2) 0.1 (0.3) Median [IQR] or mean (SD) Horses > 20% improved (D7 and D14): 1 (20%)* –0.25 [–0.5 to 0.0] * –0.2 (0.2) 0.2 (0.1)

*Significant differences between groups (P < .05).

See Table 1 for remainder of key.

Among the secondary outcomes, horses receiving the acupuncture treatment showed a significant improvement between D0 and D2 in their dorsal flexibility at the trot and free jumping at the canter compared to control horses (P = .04). There were no statistically significant differences between treatment groups in the improvement of the mean relative thoracolumbar mobility measured with IMUs during the propulsion (UP) and absorption (DOWN) phases between D0 and D2 (Table 2).

Discussion

The purpose of this study was to evaluate whether a single acupuncture treatment improved clinical signs of axial stiffness in steeplechase racehorses from 2 days after treatment and up to 2 weeks. Our results were divided into primary and secondary outcomes to avoid multiple statistical testing. In previous studies,8,22 response to treatment as assessed by riders or trainers has already been considered relevant as an efficacy clinical variable in several controlled trials evaluating axial stiffness treatments and was selected as the primary outcome to reflect field practice. According to the results of those studies, acupuncture treatment significantly improved the horses’ locomotion and behavior when the horse was ridden at training compared to the control group 7 and 14 days after treatment.

Among the secondary outcomes comparing the improvement of both groups 2 days after treatment, only the subjective visual assessment of back mobility by expert clinicians demonstrated a significant improvement both at the trot and free jumping at the canter for the acupuncture group compared to the control group. No significant difference occurred considering the relative mobility of the thoracolumbar region with IMU objective measurements. This may be due to the fact that acupuncture treatment altered the horse’s overall locomotion pattern and made its movements more flexible, without specifically affecting the thoracolumbar segment. Indeed, the subjective visual assessment took into account the thoracic and lumbosacral mobility as well as hind limb propulsion or stride length.8 On the other hand, the present study used IMUs to measure the amplitude of the vertical displacements of the back over a whole stride, while several studies with motion capture have shown half-stride asymmetry of back movement, which were not captured in our model.35 Even if horses were judged nonlame by experts during the study period, mild gait asymmetry might have been missed by human perception.36 It would then be interesting in a future study to highlight such asymmetry within strides, all the more so since in a previous blinded crossover pilot study37 of 8 pasture horses that were sound or mildly lame on inclusion, acupuncture appeared to change horses’ gait symmetry, measured with a quantitative sensor-based gait analysis system. However, in that study and others38 aiming to calculate movements of the back using IMUs, the methodology of quantification differed from the present study in a number of ways. First, the number and general positioning of the sensors were different. Second, data analysis was based on symmetry indexes highlighting the asymmetry of back movements between the two halves of each stride (differences between the values obtained from each half-stride), while the present study analyzed the general amplitude of the thoracolumbar sensor displacement during a whole stride (average of all upward or downward vertical displacements). Finally, the vertical displacements from the TL sensor isolated from the displacement of the trunk by subtraction were analyzed here, whereas other studies focused on minimal and maximal height reached by the thoracic and pelvic sensors for the whole horse. Our results are therefore not comparable in their current state, but a dedicated analysis of similarly placed sensors with an extraction of symmetry data from the horses of the present study would be interesting as a future study.

Objective systems of quantitative measurement of back mobility at the trot to evaluate the effectiveness of back treatment have already been reported with kinematic systems, but to our knowledge, this study is the first one to use an IMU-based system.39 Accuracy of dorsoventral displacement from IMUs similar to those used in this protocol, placed along the spine of horses trotting over ground, was verified with a good correlation to the gold standard motion capture in a previous study.38 In that study, sensor data were also found to be reproductible between trials and between strides, thus allowing for data pooling. Quantification of flexion-extension angles might bring more accuracy than measures of vertical displacements to assess back movements, and the future development of algorithms for quantifying thoraco-lumbo-sacral flexion-extension angles from IMUs will bring additional information that might further improve the evaluation of back mobility. IMU systems demonstrated good reliability for quantification of flexion-extension movements in horses’ backs compared to motion capture systems.40 In this study, more sensors were placed over the back, with 2 flexion-extension angles calculated between 3 IMUs. The suitability of the method used in the present study for assessing changes in back mobility and discriminating sound horses from stiff horses needs to be validated on a large number of horses before drawing conclusions on the results. It would also be interesting in such a study to compare subjective visual assessment of back mobility to IMU-based systems. The growing number of studies using IMUs to assess back movements and the new sensor generations with improved ease of use suggest that IMUs will be more consistently used in the future in the field to assess back mobility and complete the diagnostic approach used to characterize axial stiffness. In our study, no diagnostic imaging techniques were used, to reflect the situation in racehorse stables. In France, these horses are rarely ensured, and the use of expensive imaging techniques is limited, therapeutic strategies being usually preferred as a first step. In addition, it is not uncommon for axial pain or stiffness to be poorly correlated to lesions on conventional imaging.4,41

Several studies report beneficial effects of acupuncture for the treatment of chronic axial stiffness. These studies26,3032 have been performed using various types of acupuncture techniques. Among them, dry-needle stimulation, aquapuncture, and electro-acupuncture are the most commonly used in the West. Electro-acupuncture has been used successfully for treating axial stiffness in performance horses, and research suggests that it is more efficient than dry-needling or aquapuncture.26 However, many of these studies lack control groups, blinded evaluation, and randomization, which are essential elements to ensure an objective interpretation of the results. Nevertheless, a limited number of recent and rigorous studies32,33 have demonstrated the effectiveness of acupuncture, especially electroacupuncture, in the treatment of axial stiffness in horses. Xie et al,33 in a study of electroacupuncture versus phenylbutazone or saline, demonstrated a higher effectiveness of electroacupuncture to improve thoracolumbar pain scores after 3 sessions, with effects that lasted at least 2 weeks. In that study, however, the discipline, level of activity, and performance of horses were unknown. Because this technique is easier to perform in the field and therefore reflects routine practice, only 1 dry-needling acupuncture treatment was performed in our study.

Our study did have limitations, such as the evaluation of short-term effects of acupuncture only whereas axial stiffness is a chronic and recurring problem. It would be interesting in the future to study more precisely the duration of the effect of acupuncture and to evaluate the interest of repeating the treatments at regular intervals and with a crossover study design. Additionally, our sample size was limited to 12 horses, which may have influenced the impact of confusion bias despite the random attribution of each horse to either group. For example, both groups were not comparable regarding sex, while other studies42 have reported that the analgesic effect of acupuncture may be different in males and females. Other factors that could potentially influence axial stiffness, such as saddle fit, were not explored in this study, as its purpose was to evaluate the effect of acupuncture alone.43 Additionally, the saddles used were identical for all horses throughout the duration of the study. Further studies on a greater number of horses would be necessary to confirm our results.

Subjective evaluations from all reviewers blinded to treatment groups concur and are in favor of a positive effect on locomotion of a single acupuncture treatment on performing steeplechase racehorses showing clinical signs of axial stiffness. These results suggested that this nonconventional therapy could be used as a nondoping treatment option. The results should, however, be considered with caution given the limitations of the study.

Supplementary Materials

Supplementary materials are posted online at the journal website: avmajournals.avma.org

Acknowledgments

This work was supported by Boehringer Ingelheim Animal Health (France, Europe) through the “Bourses aux idées” organized by the Ecole Nationale Vétérinaire d’Alfort (ENVA) on April 4, 2019.

The authors declare that they had no conflicts of interest.

The authors thank M. Guillaume Lassaussaye and his team for their participation in this study.

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    Haussler KK. Chiropractic evaluation and management of musculoskeletal disorders. In: Diagnosis and Management of Lameness in the Horse. 2nd ed. Elsevier Saunders; 2011:892-901.

    • Search Google Scholar
    • Export Citation
  • 14.

    Sullivan KA, Hill AE, Haussler KK. The effects of chiropractic, massage and phenylbutazone on spinal mechanical nociceptive thresholds in horses without clinical signs. Equine Vet J. 2008;40(1):14-20. doi:10.2746/042516407X240456

    • Search Google Scholar
    • Export Citation
  • 15.

    Wakeling JM, Barnett K, Price S, Nankervis K. Effects of manipulative therapy on the longissimus dorsi in the equine back. Equine Comp Exerc Physiol. 2008;3(3):153-160. doi:10.1017/ECP200693

    • Search Google Scholar
    • Export Citation
  • 16.

    McClure SR, VanSickle D, Evans R, Reinertson EL, Moran L. The effects of extracorporeal shock-wave therapy on the ultrasonographic and histologic appearance of collagenase-induced equine forelimb suspensory ligament desmitis. Ultrasound Med Biol. 2004;30(4):461-467. doi:10.1016/j.ultrasmedbio.2003.12.005

    • Search Google Scholar
    • Export Citation
  • 17.

    McClure SR. Shock wave therapy. In: Diagnosis and Management of Lameness in the Horse. 2nd ed. Elsevier Saunders; 2011:914-919.

  • 18.

    Bolt DM, Burba DJ, Hubert JD, et al. Determination of functional and morphologic changes in palmar digital nerves after nonfocused extracorporeal shock wave treatment in horses. Am J Vet Res. 2004;65(12):1714-1718. doi:10.2460/ajvr.2004.65.1714

    • Search Google Scholar
    • Export Citation
  • 19.

    Sutton A, Watson T. Electrophysical agents in physiotherapy. In: Diagnosis and Management of Lameness in the Horse. 2nd ed. Elsevier Saunders; 2011:901-907.

    • Search Google Scholar
    • Export Citation
  • 20.

    Harman J, Porter M. Integrative and physical therapies. In: Equine Neck and Back Pathology: Diagnosis and Treatment. 2nd ed. Wiley Blackwell; 2018:265-282.

    • Search Google Scholar
    • Export Citation
  • 21.

    Trager LR, Funk RA, Clapp KS, et al. Extracorporeal shockwave therapy raises mechanical nociceptive threshold in horses with thoracolumbar pain. Equine Vet J. 2020;52(2):250-257. doi:10.1111/evj.13159

    • Search Google Scholar
    • Export Citation
  • 22.

    Haussler KK, Frisbie DD. Effects of low-level laser therapy and chiropractic care on back pain in Quarter Horses. J Equine Vet Sci. 2020;86: 102891. doi:10.1016/j.jevs.2019.102891

    • Search Google Scholar
    • Export Citation
  • 23.

    Johnson SA, Richards RB, Frisbie D, et al. Equine shock wave therapy—where are we now? Equine Vet J. 2023;55(4):593-606. doi:10.1111/evj.13890

    • Search Google Scholar
    • Export Citation
  • 24.

    Cantwell S. Mechanisms of acupuncture analgesia. In: Pain Management in Veterinary Practice. John Wiley & Sons Ltd; 2013:177-182.

  • 25.

    Clemmons RM. Functional neuroanatomical physiology of acupuncture. In: Xie’s Veterinary Acupuncture. John Wiley & Sons, Ltd; 2007:341-347.

    • Search Google Scholar
    • Export Citation
  • 26.

    Dewey CW, Xie H. The scientific basis of acupuncture for veterinary pain management: a review based on relevant literature from the last two decades. Open Vet J. 2021;11(2):203-209. doi:10.5455/OVJ.2021.v11.i2.3

    • Search Google Scholar
    • Export Citation
  • 27.

    Leung L. Neurophysiological basis of acupuncture-induced analgesia—an updated review. J Acupunct Meridian Stud. 2012;5(6):261-270. doi:10.1016/j.jams.2012.07.017

    • Search Google Scholar
    • Export Citation
  • 28.

    Schoen AM. Acupuncture. In: Diagnosis and Management of Lameness in the Horse. 2nd ed. Elsevier Saunders; 2011:881-892.

  • 29.

    Martin BB Jr, Klide AM. Treatment of chronic back pain in horses: stimulation of acupuncture points with a low powered infrared laser. Vet Surg. 1987;16(1):106-110. doi:10.1111/j.1532-950X.1987.tb00919.x

    • Search Google Scholar
    • Export Citation
  • 30.

    Phutthachalee S, Wattanachai S, Tangkawattana P, Saihoo P. The use of electro-acupuncture to reduce stiffness of longissimus dorsi in Thoroughbred racehorse having clinical back pain. K K U Vet J. 2015;25(1):16-31.

    • Search Google Scholar
    • Export Citation
  • 31.

    Rungsri P, Trinarong C, Rojanasthien S, et al. The effectiveness of electro-acupuncture on pain threshold in sport horses with back pain. Am J Tradit Chin Vet Med. 2009;4(1):22-26.

    • Search Google Scholar
    • Export Citation
  • 32.

    Xie H, Ott EA, Harkins J. Influence of electro-acupuncture on pain threshold in horses and its mode of action. J Equine Vet Sci. 2001;21(12):591-600. doi:10.1016/S0737-0806(01)80020-4

    • Search Google Scholar
    • Export Citation
  • 33.

    Xie H, Colahan P, Ott EA. Evaluation of electroacupuncture treatment of horses with signs of chronic thoracolumbar pain. J Am Vet Med Assoc. 2005;227(2):281-286. doi:10.2460/javma.2005.227.281

    • Search Google Scholar
    • Export Citation
  • 34.

    Bragança FS, Roepstorff C, Rhodin M, Pfau T, van Weeren PR, Roepstorff L. Quantitative lameness assessment in the horse based on upper body movement symmetry: the effect of different filtering techniques on the quantification of motion symmetry. Biomed Signal Process Control. 2020;57:101674. doi:10.1016/j.bspc.2019.101674

    • Search Google Scholar
    • Export Citation
  • 35.

    Gómez Alvarez CB, Wennerstrand J, Bobbert MF, et al. The effect of induced forelimb lameness on thoracolumbar kinematics during treadmill locomotion. Equine Vet J. 2007;39(3):197-201. doi:10.2746/042516407x173668

    • Search Google Scholar
    • Export Citation
  • 36.

    Gómez Álvarez CB, Oosterlinck M. The ongoing quest for a validated, universally accepted visual lameness grading scale. Equine Vet J. 2023;55(1):5-8. doi:10.1111/evj.13896

    • Search Google Scholar
    • Export Citation
  • 37.

    Dunkel B, Pfau T, Fiske-Jackson A, et al. A pilot study of the effects of acupuncture treatment on objective and subjective gait parameters in horses. Vet Anaesth Analg. 2017;44(1):154-162. doi:10.1111/vaa.12373

    • Search Google Scholar
    • Export Citation
  • 38.

    Warner SM, Koch TO, Pfau T. Inertial sensors for assessment of back movement in horses during locomotion over ground. Equine Vet J Suppl. 2010;38:417-424. doi:10.1111/j.2042-3306.2010.00200.x

    • Search Google Scholar
    • Export Citation
  • 39.

    Gomez Alvarez CB, L’ami JJ, Moffat D, Back W, van Weeren PR. Effect of chiropractic manipulations on the kinematics of back and limbs in horses with clinically diagnosed back problems. Equine Vet J. 2008;40(2):153-159. doi:10.2746/042516408X250292

    • Search Google Scholar
    • Export Citation
  • 40.

    Martin P, Chateau H, Pourcelot P, Duray L, Cheze L. Comparison between inertial sensors and motion capture system to quantify flexion-extension motion in the back of a horse. Equine Vet J. 2014;46:43. doi:10.1111/evj.12267_131

    • Search Google Scholar
    • Export Citation
  • 41.

    Weaver MP, Jeffcott LB, Nowak M. Back problems: radiology and scintigraphy. Vet Clin North Am Equine Pract. 1999;15(1):113-129, vii-viii. doi:10.1016/S0749-0739(17)30168-2

    • Search Google Scholar
    • Export Citation
  • 42.

    Bossut DF, Page EH, Stromberg MW. Production of cutaneous analgesia by electroacupuncture in horses: variations dependent on sex of subject and locus of stimulation. Am J Vet Res. 1984;45(4):620-625.

    • Search Google Scholar
    • Export Citation
  • 43.

    Murray R, Mackechnie-Guire R, Fisher M, Fairfax V. Could pressure distribution under race-exercise saddles affect limb kinematics and lumbosacral flexion in the galloping racehorse? J Equine Vet Sci. 2019;81(81):102795. doi:10.1016/j.jevs.2019.102795

    • Search Google Scholar
    • Export Citation
  • Figure 1

    Summarized timeline of the study. Locomotor examination included 2 round trips of 30 m at the trot and 5 laps of approximately 120 m long at the canter with free jumping of 3 jumps of 90 cm high/lap. Routine training program consisted of ridden exercise at the canter at increasing speed over 5 laps of 1,500 m and free jumping over fences.

  • Figure 2

    Example of dorsoventral acceleration signal obtained for the 3 sensors of interest at the trot in a straight line (withers [W], thoracolumbar junction [TL], and pelvis [P]) illustrating the 2 variables measured: UP (propulsion phase) and DOWN (absorption phase), represented by the blue and green dashed arrows, respectively. Time points A and B correspond to A and B in Figure 3, where A is the highest point reached by the sensor at the end of the propulsion phase and B is the lowest point reached at the end of the damping phase. The red dashed arrow represents the duration of a stride.

  • Figure 3

    Simplified beam model of the back submitted to extension by the weight of the abdominal mass (W) at the trot during the stance phase. Z-axis represents vertical displacement. A and B correspond to time points A and B in Figure 2.

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    Denoix J-M. Spinal biomechanics and functional anatomy. Vet Clin North Am Equine Pract. 1999;15(1):27-60. doi:10.1016/S0749-0739(17)30162-1

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    Mayaki AM, Intan-Shameha AR, Noraniza MA, Mazlina M, Adamu L, Abdullah R. Clinical investigation of back disorders in horses: a retrospective study (2002-2017). Vet World. 2019;12(3):377-381. doi:10.14202/vetworld.2019.377-381

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    Jeffcott LB. Disorders of the thoracolumbar spine of the horse—a survey of 443 cases. Equine Vet J. 1980;12(4):197-210. doi:10.1111/j.2042-3306.1980.tb03427.x

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    Denoix J-M, Dyson SJ. The thoracolumbar spine. In: Diagnosis and Management of Lameness in the Horse. 2nd ed. Elsevier Saunders; 2011:592-605.

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    Haussler KK. Managing back pain. In: Robinson’s Current Therapy in Equine Medicine. 7th ed. WB Saunders; 2014:92-96.

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    Haussler KK, Jeffcott LB. Back and pelvis. In: Equine Sports Medicine and Surgery. 2nd ed. Elsevier Saunders; 2014:419-456.

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    Coudry V, Thibaud D, Riccio B, Audigié F, Didierlaurent D, Denoix JM. Efficacy of tiludronate in the treatment of horses with signs of pain associated with osteoarthritic lesions of the thoracolumbar vertebral column. Am J Vet Res. 2007;68(3):329-337. doi:10.2460/ajvr.68.3.329

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    Coomer RPC, McKane SA, Smith N, Vandeweerd JM. A controlled study evaluating a novel surgical treatment for kissing spines in standing sedated horses. Vet Surg. 2012;41(7):890-897. doi:10.1111/j.1532-950X.2012.01013.x

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    Colles C, Brooks J. Osteopathic treatment of the axial skeleton of the horse. In: Diagnosis and Management of Lameness in the Horse. 2nd ed. Elsevier Saunders; 2011:907-914.

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    Colles CM, Brooks J. The osteopathic treatment of somatic dysfunction causing gait abnormality in 51 horses. Equine Vet Educ. 2014;26(3):148-155. doi:10.1111/eve.12122

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    Haussler KK, Hill AE, Puttlitz CM, McIlwraith CW. Effects of vertebral mobilization and manipulation on kinematics of the thoracolumbar region. Am J Vet Res. 2007;68(5):508-516. doi:10.2460/ajvr.68.5.508

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  • 13.

    Haussler KK. Chiropractic evaluation and management of musculoskeletal disorders. In: Diagnosis and Management of Lameness in the Horse. 2nd ed. Elsevier Saunders; 2011:892-901.

    • Search Google Scholar
    • Export Citation
  • 14.

    Sullivan KA, Hill AE, Haussler KK. The effects of chiropractic, massage and phenylbutazone on spinal mechanical nociceptive thresholds in horses without clinical signs. Equine Vet J. 2008;40(1):14-20. doi:10.2746/042516407X240456

    • Search Google Scholar
    • Export Citation
  • 15.

    Wakeling JM, Barnett K, Price S, Nankervis K. Effects of manipulative therapy on the longissimus dorsi in the equine back. Equine Comp Exerc Physiol. 2008;3(3):153-160. doi:10.1017/ECP200693

    • Search Google Scholar
    • Export Citation
  • 16.

    McClure SR, VanSickle D, Evans R, Reinertson EL, Moran L. The effects of extracorporeal shock-wave therapy on the ultrasonographic and histologic appearance of collagenase-induced equine forelimb suspensory ligament desmitis. Ultrasound Med Biol. 2004;30(4):461-467. doi:10.1016/j.ultrasmedbio.2003.12.005

    • Search Google Scholar
    • Export Citation
  • 17.

    McClure SR. Shock wave therapy. In: Diagnosis and Management of Lameness in the Horse. 2nd ed. Elsevier Saunders; 2011:914-919.

  • 18.

    Bolt DM, Burba DJ, Hubert JD, et al. Determination of functional and morphologic changes in palmar digital nerves after nonfocused extracorporeal shock wave treatment in horses. Am J Vet Res. 2004;65(12):1714-1718. doi:10.2460/ajvr.2004.65.1714

    • Search Google Scholar
    • Export Citation
  • 19.

    Sutton A, Watson T. Electrophysical agents in physiotherapy. In: Diagnosis and Management of Lameness in the Horse. 2nd ed. Elsevier Saunders; 2011:901-907.

    • Search Google Scholar
    • Export Citation
  • 20.

    Harman J, Porter M. Integrative and physical therapies. In: Equine Neck and Back Pathology: Diagnosis and Treatment. 2nd ed. Wiley Blackwell; 2018:265-282.

    • Search Google Scholar
    • Export Citation
  • 21.

    Trager LR, Funk RA, Clapp KS, et al. Extracorporeal shockwave therapy raises mechanical nociceptive threshold in horses with thoracolumbar pain. Equine Vet J. 2020;52(2):250-257. doi:10.1111/evj.13159

    • Search Google Scholar
    • Export Citation
  • 22.

    Haussler KK, Frisbie DD. Effects of low-level laser therapy and chiropractic care on back pain in Quarter Horses. J Equine Vet Sci. 2020;86: 102891. doi:10.1016/j.jevs.2019.102891

    • Search Google Scholar
    • Export Citation
  • 23.

    Johnson SA, Richards RB, Frisbie D, et al. Equine shock wave therapy—where are we now? Equine Vet J. 2023;55(4):593-606. doi:10.1111/evj.13890

    • Search Google Scholar
    • Export Citation
  • 24.

    Cantwell S. Mechanisms of acupuncture analgesia. In: Pain Management in Veterinary Practice. John Wiley & Sons Ltd; 2013:177-182.

  • 25.

    Clemmons RM. Functional neuroanatomical physiology of acupuncture. In: Xie’s Veterinary Acupuncture. John Wiley & Sons, Ltd; 2007:341-347.

    • Search Google Scholar
    • Export Citation
  • 26.

    Dewey CW, Xie H. The scientific basis of acupuncture for veterinary pain management: a review based on relevant literature from the last two decades. Open Vet J. 2021;11(2):203-209. doi:10.5455/OVJ.2021.v11.i2.3

    • Search Google Scholar
    • Export Citation
  • 27.

    Leung L. Neurophysiological basis of acupuncture-induced analgesia—an updated review. J Acupunct Meridian Stud. 2012;5(6):261-270. doi:10.1016/j.jams.2012.07.017

    • Search Google Scholar
    • Export Citation
  • 28.

    Schoen AM. Acupuncture. In: Diagnosis and Management of Lameness in the Horse. 2nd ed. Elsevier Saunders; 2011:881-892.

  • 29.

    Martin BB Jr, Klide AM. Treatment of chronic back pain in horses: stimulation of acupuncture points with a low powered infrared laser. Vet Surg. 1987;16(1):106-110. doi:10.1111/j.1532-950X.1987.tb00919.x

    • Search Google Scholar
    • Export Citation
  • 30.

    Phutthachalee S, Wattanachai S, Tangkawattana P, Saihoo P. The use of electro-acupuncture to reduce stiffness of longissimus dorsi in Thoroughbred racehorse having clinical back pain. K K U Vet J. 2015;25(1):16-31.

    • Search Google Scholar
    • Export Citation
  • 31.

    Rungsri P, Trinarong C, Rojanasthien S, et al. The effectiveness of electro-acupuncture on pain threshold in sport horses with back pain. Am J Tradit Chin Vet Med. 2009;4(1):22-26.

    • Search Google Scholar
    • Export Citation
  • 32.

    Xie H, Ott EA, Harkins J. Influence of electro-acupuncture on pain threshold in horses and its mode of action. J Equine Vet Sci. 2001;21(12):591-600. doi:10.1016/S0737-0806(01)80020-4

    • Search Google Scholar
    • Export Citation
  • 33.

    Xie H, Colahan P, Ott EA. Evaluation of electroacupuncture treatment of horses with signs of chronic thoracolumbar pain. J Am Vet Med Assoc. 2005;227(2):281-286. doi:10.2460/javma.2005.227.281

    • Search Google Scholar
    • Export Citation
  • 34.

    Bragança FS, Roepstorff C, Rhodin M, Pfau T, van Weeren PR, Roepstorff L. Quantitative lameness assessment in the horse based on upper body movement symmetry: the effect of different filtering techniques on the quantification of motion symmetry. Biomed Signal Process Control. 2020;57:101674. doi:10.1016/j.bspc.2019.101674

    • Search Google Scholar
    • Export Citation
  • 35.

    Gómez Alvarez CB, Wennerstrand J, Bobbert MF, et al. The effect of induced forelimb lameness on thoracolumbar kinematics during treadmill locomotion. Equine Vet J. 2007;39(3):197-201. doi:10.2746/042516407x173668

    • Search Google Scholar
    • Export Citation
  • 36.

    Gómez Álvarez CB, Oosterlinck M. The ongoing quest for a validated, universally accepted visual lameness grading scale. Equine Vet J. 2023;55(1):5-8. doi:10.1111/evj.13896

    • Search Google Scholar
    • Export Citation
  • 37.

    Dunkel B, Pfau T, Fiske-Jackson A, et al. A pilot study of the effects of acupuncture treatment on objective and subjective gait parameters in horses. Vet Anaesth Analg. 2017;44(1):154-162. doi:10.1111/vaa.12373

    • Search Google Scholar
    • Export Citation
  • 38.

    Warner SM, Koch TO, Pfau T. Inertial sensors for assessment of back movement in horses during locomotion over ground. Equine Vet J Suppl. 2010;38:417-424. doi:10.1111/j.2042-3306.2010.00200.x

    • Search Google Scholar
    • Export Citation
  • 39.

    Gomez Alvarez CB, L’ami JJ, Moffat D, Back W, van Weeren PR. Effect of chiropractic manipulations on the kinematics of back and limbs in horses with clinically diagnosed back problems. Equine Vet J. 2008;40(2):153-159. doi:10.2746/042516408X250292

    • Search Google Scholar
    • Export Citation
  • 40.

    Martin P, Chateau H, Pourcelot P, Duray L, Cheze L. Comparison between inertial sensors and motion capture system to quantify flexion-extension motion in the back of a horse. Equine Vet J. 2014;46:43. doi:10.1111/evj.12267_131

    • Search Google Scholar
    • Export Citation
  • 41.

    Weaver MP, Jeffcott LB, Nowak M. Back problems: radiology and scintigraphy. Vet Clin North Am Equine Pract. 1999;15(1):113-129, vii-viii. doi:10.1016/S0749-0739(17)30168-2

    • Search Google Scholar
    • Export Citation
  • 42.

    Bossut DF, Page EH, Stromberg MW. Production of cutaneous analgesia by electroacupuncture in horses: variations dependent on sex of subject and locus of stimulation. Am J Vet Res. 1984;45(4):620-625.

    • Search Google Scholar
    • Export Citation
  • 43.

    Murray R, Mackechnie-Guire R, Fisher M, Fairfax V. Could pressure distribution under race-exercise saddles affect limb kinematics and lumbosacral flexion in the galloping racehorse? J Equine Vet Sci. 2019;81(81):102795. doi:10.1016/j.jevs.2019.102795

    • Search Google Scholar
    • Export Citation

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