Acupuncture Was Used To Treat Neck Pain In A Malinois | BEVAS Courses

Acupuncture Was Used To Treat Neck Pain In A Malinois

By:

                                                                      Andrea Blaser

                                                                       Switzerland

                                                                andrea.i.blaser@gmail.com

 

ABSTRACT

Acupuncture was used successfully to treat neck pain due to a myalgia in a Malinois. Two dry needling sessions in a weekly interval, in addition with Laser acupuncture, were performed. The neck pain, the inability to turn the head to the right side and the muscle spasm improved directly after the first treatment and returned to normal after the second treatment.

HISTORY

Lasco, a eleven years old, male castrated Malinois, 30kg, was presented for an acupuncture consultation in May 2017 because of neck pain. Prior to this Lasco was consulted by an orthopaedic specialist directly after the symptoms started one month earlier. The orthopaedic specialist diagnosed neck pain due to myalgia with an inability to turn the head to the right side and a slight discomfort to flex and extend the neck. Carprofen 150mg q12 PO and Gabapentin 200mg q12 PO were prescribed for 10 days. The pain improved slightly but the effect was insufficient and Lasco could still not move his neck. The orthopaedic specialist recommended a X-Ray of the neck in sedation and a Magnetic Resonance Imaging (MRI) in general anaesthesia in case the X-Ray would not be diagnostic. The owner decided to first try acupuncture treatment before performing continuative diagnostic.

CLINICAL SIGNS/ DIAGNOSTICS/ DIAGNOSIS - CONVENTIONAL (WESTERN)

The owner has presented Lasco because of his neck pain. The problems started sudden one month earlier when Lasco played with a ball. There seems to be no constant pain, but specific movements are painful. This leads to careful movements. Some movements, as lying on the back, are avoided. During the treatment with painkillers (Carprofen 150mg q12 PO and Gabapentin 200mg q12 PO for 10 days) the symptoms improved. But Lasco can still not move his neck, moves carefully and does not lie on his back. The treatment was stopped 2 weeks ago. There was no significant worsening of the symptoms when the treatment was stopped.

Lasco loves to control and moves around unsettled in the exam room during the first few minutes to check everything. He demands to be petted but does not like to be examined by strangers. An exact clinical exam can only be performed with an muzzle because he tries to bite in painful situations.

Lasco moves carefully but no lameness is present. He cannot turn his head to the right side. The passive bending to the right side is very painful. Lasco can flex end extend his neck but does it very carefully. Scalenus dorsalis muscle on the right side is tense and painful. A hyperirritable locus in the same muscle (Trigger point) in the region of the 6th and 7th cervical vertebra is present. The neurological examination is without any abnormalities.

For an exact diagnosis continuative diagnostic as X-Ray and MRI or Computer Tomography (CT) are necessary. The owner wants to first try acupuncture treatment before performing diagnostics. She is afraid of the anaesthesia because of Lascos’ age. Besides, knowing Lascos’ temper, she wishes to reduce the stress to a minimum for him.

There are no other past medical problems noted in the history and the owner just complains the neck pain. There was no indication to perform any blood test at this moment.

A presumptive diagnosis of myalgia due to trauma or sudden overload was made based on history and clinical symptoms, and by ruling out other conditions. Differential diagnoses of canine intervertebral disc disease and nerve root compression were made. To rule out both of the differential diagnoses, continuative diagnostics are necessary.                                                                  

CLINICAL SIGNS/ DIAGNOSIS – TCM (EASTERN)

The first 7 years of his life Lasco spent first with two different families and in the end for a long time in a dog shelter. The first owner had to give him away because he divorced. With the second owner he started to be aggressive against other dogs. That was the reason why he came to the dog shelter. His aggressions did not improve during his stay in the dog shelter. Now, since 4 years, Lasco lives with the current owner. It took a long time to normalise the psychological condition. He still shows aggression against black dogs and loves to control. But otherwise he seems to be back to normal.

The neck pain started sudden in April when Lasco played with a ball. The owner does not notice a constant pain, but specific movements seems to be very painful and Lasco moans. This leads to careful movements. Some movements, as lying on the back, are avoided. The pain always occurs during daytime, never during night time. It is not worse after rest or after exercise. The neck pain does not get worse with specific weather conditions or weather changes.

Lasco does not drink a lot, but when he is drinking, he drinks big amounts. Lasco is fed with commercial high quality dry food. He loves to eat and eats very fast. Lasco sleeps well and does not change his sleeping places during the night. He has no preference for hot or cold places. His stool and his urine are of a normal appearance and odour.

Lasco loves to control and moves around unsettled in the exam room during the first few minutes to check everything. Then he calms and demands to be petted. But even if he loves to be petted he does not like to be examined. An exact exam can only be performed with an muzzle because he tries to bite in painful situations.

Lasco has a muscular shape. His fur is bright and he has strong nails. Scalenus dorsalis muscle on the right side is tense and painful. But there is no change in temperature of this muscle. The pain gets worse with pressure. A hyperirritable locus (Ah-Shi point) in the same muscle is present in the region of GB 21. His pulse is wiry. The tongue is long but normal in colour and coating. No sensitivity in any Shu or Mu point can be found.

Because of his breed, his behaviour (easily stressed or irritated, aggressive) and his appearance (robust, muscular, strong nails) Lasco has a Wood Constitution.

A diagnosis of Qi Stagnation in the Gallbladder Tendinomuscular Channel with Excess pain due to a trauma was made, based on the history of neck pain during daytime, tension of scalenus dorsalis muscle (belongs to Gallbladder Tendinomuscular Channel) on the right side, the Ah-Shi point on the Gallbladder Meridian pathway, the absence of any sensitivity in Shu or Mu points and the absence of any symptom related to a Zang Fu pathology.

CONVENTIONAL (WESTERN) TREATMENT

Carprofen (Rimadyl®) 150mg q12 PO and Gabapentin (Neurontin®) 200mg q12 PO were prescribed for 10 days. The treatment was over 2 weeks prior to acupuncture treatment. The pain improved slightly with this treatment but the effect was insufficient and Lasco could still not move his neck. No deterioration was obvious when the treatment was stopped.

TCM (EASTERN) TREATMENT

The treatment principle was to disperse Qi Stagnation, to move Qi, to open and invigorate the Gallbladder Meridian and to alleviate neck pain.

0.2 x 15mm needles were used for LIV 3, PC 6, LI 4 and GB 39. 0.25 x 25mm needles were used for GB 20 and TH 10. 0.25 x 40mm needles were used in GV 14. An even needle technique was used in all points for 10 to 15 minutes. The same needle technique was used in the second treatment.

During the first treatment BL 21 was an Ah-Shi point and it was too painful to treat with dry needle. A soft laser class IIIa (Qi Pulse; 635nm, 5mw) was used. The treatment time was 25 seconds.

May 5, 2017: GB 21 was used as a local point to direct the flow of Qi and Blood to the affected area. It was also used to regulate Qi, activate the Channel and relieve pain (esp. neck). Because a dry needle treatment was too painful, GB 21 was treated with a soft laser class IIIa (Qi Pulse; 635nm, 5mw). GB 20 was also used as a local point and to treat neck pain. GB 39 was used as a distal point to disperse the Stagnation and to treat pain and stiffness in the neck. PC 6 was used to regulate Qi, to suppress pain and to calm the mind. TH 10 was used to remove the Qi Stagnation, to regulate Defensive Qi and to treat pain in the neck. LIV 3 was used to treat muscle spasm and to promote the smooth flow of Liver Qi. GV 14 was used to treat cervical problems, to strengthen Wei Qi and to calm the mind.

The pulse changed to moderate during and after the treatment. Scalenus dorsalis muscle on the right side was only tensed slightly and the neck could be bent to the right side without pain after the treatment.

May 17, 2017: Since the first acupuncture treatment Lasco never moaned or showed any other pain reaction. He regained his normal movement and lies on his back again. Scalenus dorsalis muscle on the right side was only tensed very slightly and the neck could be bent in every direction without pain. The Ah-Shi point was no longer present. There was still no sensitivity in any Shu or Mu point. The treatment principle stays the same: disperse Qi Stagnation, move Qi, open and invigorate the Gallbladder Meridian and alleviate neck pain. Because treatment of the Four Gates is a good strategy to treat Stagnation and pain I included this points in the second treatment. Because I did not wanted to use too many needles I chose only one local point (GB20) and did not treat TH10 and PC6 anymore.

GB 21 was used as a local point to help to open the Meridian and to treat neck problems.GB 39 was used as a distal point to disperse the Stagnation and to treat stiffness in the neck. LIV 3 was used to treat muscle spasm and to promote the smooth flow of Liver Qi. LI 4 was used to regulate the Wei Qi, to alleviate spasms in the neck and to activate Qi and Blood. Together with LIV 3 it ensures the passage of Qi and Blood throughout the body (Four Gates). The pulse returned to moderate during and after the treatment. The scalenus dorsalis m. was not tensed anymore.

DISCUSSION

Even if Lasco was consulted by an orthopaedic specialist, the western diagnostic was very limited and the diagnosis of myalgia due to a trauma or sudden overload only based on history and clinical abnormalities found with the clinical examination. Further diagnostics as X-Ray and MRI or CT were not performed. The owner was afraid of the anaesthesia because of Lascos’ age. Besides, knowing Lascos’ temper and his aversion to examinations and manipulations, she wished to reduce the stress for him to a minimum. If there would not have been a sufficient improvement of the symptoms with acupuncture a X-Ray and eventually also a MRI or CT would have been necessary anyway to confirm the presumptive diagnosis of myalgia and to rule out the differential diagnoses.

The owners’ main complaint was Lascos’ neck pain. From a Traditional Chinese Medicine (TCM) perspective, pain is Stagnation. It may be a Stagnation of Qi, Blood or a combination of them.4 Lasco was painful only in daytime. The pain was not worse after rest but could be triggered with specific movements. His tongue was of a normal colour. This are all signs of a Qi Stagnation.5 Furthermore muscle spasms tend to be Qi Stagnations.6 Stagnation can be the result of a trauma or an underlying imbalance in Yin and Yang.4 Lasco had no sensitivity in any Shu or Mu point. Clinically, except for his neck pain, he showed no abnormalities. The neck pain started sudden, when he played with a ball. For me this Qi Stagnation was the result of a trauma which affects only the external part of the body, means only the Meridians- in this case the Tendinomuscular Meridians- and not the Zang Fu organs.

From the TCM perspective, pain can also be subdivided in Excess or Deficiency. This differentiation bases on the relative strength of the Wei Qi and the amount of the Pathogenic Factors.7 The onset of Lascos’ neck pain was acute. The pain was fixed and severe, his pulse was excessive. Lasco disliked pressure or massage on the tensed muscle. Even if Lasco seemed just painful with specific movements, the muscle stayed tensed and painful all the time. These are all signs of an Excess pain.

As determined before, a trauma was the cause of the neck pain. From a TCM perspective, trauma is an Excess condition which leads to acute injuries. The excess trauma creates a local Stagnation of Qi or Qi and Blood.8 This confirms the further conclusion that Lasco suffers from a Qi Stagnation in the Gallbladder Tendinomuscular Meridian with excess pain due to a trauma. There was no sign of a Blood Stagnation. In TCM Stagnation will give rise to Heat. Heat will injure the Yin.8 In Lasco no signs of Heat and Yin Deficiency were visible.

The tensed muscle belly of scalenus dorsalis m. was obvious to palpate. Scaleni mm. form a muscle triangle between the transvers processes of the lower cervical vertebra (C3 to C7) and the first rip. In dogs scaleni mm. are subdivided in scalenus medius m. and scalenus dorsalis m. Scalenus ventralis m. is missing in dogs. The function of scaleni mm. is the rotation of the neck downwards and laterally.9 Scalenus dorsalis m. belongs to the Gallbladder Tendinomuscular Channel.10 Shao Yang Channels allow the ability to rotate, to look around and it is also where power is generated to initiate a turn.11 All of this functions were missing or reduced in Lasco.

The domain of Tendinomuscular Channels is the musculoskeletal movement. They travel superficially trough tendons and muscles along the adjacent Main Channels trajectory. Tendinomuscular Channels can reflect disturbances of the Primary Channels or can be injured themselves mainly by traumatic injury or attack by Exterior Pathogens.12  Lasco showed no sensitivity in BL 19 (Gallbladder Shu point) or GB 24 (Gallbladder Mu point). His tongue was long, which is a hit to an Excess situation, but normal in colour and coating. His pulse was wiry. He suffered from an inability to turn his head to the right side. Scalenus dorsalis m. on the right side was tensed and painful. An Ah-Shi point was found in the region of GB 21 on the right side. All this signs together lead to the diagnose of Qi Stagnation in the Gallbladder Tendinomuscular Channel. For me Lascos’ behaviour (aggression, easily stressed, loves to control) was still in the normal range what I can expect from a dog with Wood Constitution.13 But Wood Constitution animals tend to suffer from muscle lesions if the Wood element is not balanced any more. And with the history of changing owners several time and his long stay in a dog shelter, Lasco has some predilection to develop Wood imbalances. Emotions as frustration, depression and repressed anger can lead to a Liver Qi Stagnation. And as Liver governs the smooth flow of Qi in general a Liver Qi Stagnation can provoke a Qi Stagnation anywhere in the body. In reverse this means that every Stagnation originating from an External Pathogenic Factor can be treated with the Liver.14  Lasco showed no Liver imbalances at the moment of the acupuncture treatments. But in spring Liver has his maximum energy level. Some pathologies can disappear or heal themselves. With the history of Lasco a previous Liver Qi Stagnation is very likely. In acupuncture you should only treat what you see. That is why I did not include more points to support the Liver in my treatment. Anyway I just tried to support the Liver to govern the smooth flow of Qi by needling LIV 3.

I suspected to find an underlying Liver pathology in the second acupuncture treatment after the Qi Stagnation was solved. But even in the second acupuncture treatment I could not find any sensitive Shu or Mu point and there were still no symptoms of a Zang Fu pathology.

As discussed above Lasco suffers from a Qi Stagnation (Excess) in the Gallbladder Tendinomuscular Channel with Excess pain due to an trauma (Excess). For the treatment of Excess pain it is recommended to disperse the Stagnation, to invigorate the Channels, to eliminate the External Pathogenic Factor and to treat any Liver Qi Stagnation.15 For the treatment of Qi Stagnation it is recommended to clear the Excess, to move Qi and Blood, to resolve pain and to treat any underlying Deficiency. To move Qi and Blood helps in resolving Stagnation. It is important to pick first points above and below the lesion as local points. Then to pick points further away on the affected Channel to help move the Stagnation.16 From this two recommendations I generated the goals for Lasco. The treatment principles for Lasco were to disperse Qi Stagnation, to move Qi, to open and invigorate the Gallbladder Tendinomuscular Meridian and to alleviate neck pain. I started the first treatment with GB 21 and GB 20 as local points. Because GB 21 was an Ah-Shi point and because Lasco was not that tolerant to painful stimuli I decided to treat GB 21 with the Qi Pulse laser (635nm, 5mw). According to TCM, a De Qi sensation is necessary for an effective acupuncture treatment. In traditional acupuncture, metal needles are inserted and stimulated until a De Qi sensation is evoked. The De Qi sensations may also be achieved with laser light of sufficient intensity. The stronger the laser energy, the greater are the effects.17 In laser only red light with a wave length of 600-1200nm is capable to effective tissue penetration.18 Qi Pulse laser is a class IIIa laser and belongs to the category of soft lasers. His wave length is 635nm which provides an effective tissue penetration. But it stays a soft laser and his effect is clearly less strong than the effect I could have reached with a dry needle. But for Lasco, who suffered from a Qi Stagnation in the Gallbladder Tendinomuscular Channel (superficial problem), the laser acupuncture treatment of GB 21 was sufficient in combination with the dry needle acupuncture treatment of the other points. Another option instead of treating GB 21 on the right side with the laser would have been to treat GB 21 on the left side with dry needle. However, treating the affected region directly is clinically more effective in animals.8

As said before, GB 21 was used as a local point to direct the flow of Qi and Blood to the affected area. It was also used to regulate Qi, to activate the Channel and to relieve pain (esp. neck). GB 20 was also used as a local point and to treat neck pain. GB 39 was used as a distal point to disperse the Stagnation and to treat pain and stiffness in the neck. PC 6 was used to regulate Qi, to suppress pain and to calm the mind. Lasco is a nervous dog that is why I had the feeling that it could help to calm his mind a bit. TH 10 was used to remove the Qi Stagnation, to regulate Defensive Qi and to treat pain in the neck. LIV 3 was used to treat muscle spasm and to promote the smooth flow of Liver Qi as discussed above. GV 14 was used to treat cervical problems, to strengthen Wei Qi and to calm the mind. The pulse returned to moderate during and after the treatment. Scalenus dorsalis muscle on the right side was only tensed slightly and the neck could be bent to the right side without pain. All this signs together confirmed me the effectiveness of my treatment. After this first treatment Lasco did not moan or show any other pain reaction anymore. He regained his normal movement and lies on his back again. Nevertheless I treated Lasco a second time because the scalenus dorsalis muscle on the right side was still slightly tensed which indicates still a slight Qi Stagnation in the Gallbladder Tendinomuscular Channel. There was still no sensitivity in any Shu or Mu point. The goal of the second treatment was again to disperse Qi Stagnation, to move Qi, as to open and invigorate the Gallbladder Meridian. Because treatment of the Four Gates is a good strategy to treat Stagnation and pain I included this points in the second treatment. Because I did not wanted to use too many needles I chose only one local point (GB20) and did not treat TH10 and PC6 anymore. GB 20 was used as a local point to help to open the Meridian and to treat neck problems. GB 39 was used as a distal point to disperse the stagnation and to treat stiffness in the neck. LIV 3 was used to treat muscle spasm and to promote the smooth flow of Liver Qi. LI 4 was used to regulate the Wei Qi, to alleviate spasms in the neck and to activate Qi and Blood. Together with LIV 3 it ensures the passage of Qi and Blood throughout the body (Four Gates). The pulse returned to moderate during and after the treatment. The scalenus dorsalis m. was not tensed anymore.

Acupuncture represents a form of nerve stimulation. The needle insertion leads to micro-trauma of the tissues. The acupuncture mechanisms in regards to the nervous system can be subdivided in local (peripheral), segmental (spinal) and suprasegmental (supraspinal) mechanisms.19  Local effects lead to vasodilatation and increase in blood flow which may help with pain removal and to support healing mechanisms. It also leads to relaxation of the muscles and tissues in the treated area.20 In the segmental and suprasegmental mechanisms acupuncture stimulates nerve endings which in turn alters segmental and suprasegmental spinal pathways. This leads to changes within the brainstem and the cortical regions and eventually affects the entire neural axis. The most impressive suprasegmental mechanism is the release of endogenous opioids.21 The local points I used for the treatment (GB 20, GB 21) led to a segmental pain ascending inhibitory response through the Gate Control Mechanism. This type of analgesia is produced primarily only locally and is more intense than distal non-segmental needling. It uses the local reactions of acupuncture. With the distal point I used in my treatment (GB 39) I activated a strong supraspinal pain-descending inhibitory response trough stimulation of Aẟ fibres and subsequent endogenous opioids release by stimulation of the midbrain and hypothalamus-pituitary.22

With the laser acupuncture treatment of GB 21 with a Qi Pulse laser I stimulated intercellular photoreceptors. This leads locally to an increase of blood and lymphatic circulation, anti-inflammatory and analgesic effects, as well as eutrophic effects. This eutrophic effects stimulate the production of Adenosine triphosphate (ATP). ATP acts as a secondary messenger who controls all kind of processes for example muscle contractions.23

Acupuncture is a great option to treat myalgia as well as many other musculoskeletal problems. Lasco responded very well to the treatment of acupuncture. For a Wood constitution animal this is not taken to be granted. They tend to exhibit such muscles that it can be difficult to insert the needles properly. After the first treatment Lasco was not painful anymore and the scalenus dorsalis m. was only slightly tensed. After the second treatment Lasco returned to normal, scalenus dorsalis m. was not tensed anymore and Lasco did not have to come back for further acupuncture treatments.

REFERENCES

 

1.      IVAS. IVAS Canine Acupuncture Points. 2015.

2.      IVAS. IVAS Canine Acupuncture Points. 2017.

3.      Eul-Matern, C. Taschenatlas Akupunktur bei Hund und Katze. Stuttgart: Sonntag, 2014

4.      Todd G F. Acupuncture For Musculosceletal Diseases. IVAS Course Notes: Session 3 (2015): 471.

5.      Craig D. Bi Syndrome Or Bi Zheng. IVAS Course Notes: Session 2 (2015): 390.

6.      Todd G F. Acupuncture For Musculosceletal Diseases. IVAS Course Notes: Session 3 (2015): 472.

7.      Craig D. Bi Syndrome Or Bi Zheng. IVAS Course Notes: Session 2 (2015): 391.

8.      Todd G F. Acupuncture For Musculosceletal Diseases. IVAS Course Notes: Session 3 (2015): 473.

9.      Friess A E und Stoffel M H. Topographie von Rücken, Nacken, Brust- und Bauchwand.Arbeitsunterlagen für Studierende der Veterinärmedizin. Bern, Universität Bern, 2004.

13.   Snijders A. The 5 Constitutions. IVAS Course Notes: Session 1 (2015): 1-2.

14.   Puertas Navarro D. Wood Element. IVAS Course Notes: Session 1 (2015): 3-4.

15.   Craig D. Bi Syndrome Or Bi Zheng. IVAS Course Notes: Session 2 (2015): 392.

16.   Todd G F. Acupuncture For Musculosceletal Diseases. IVAS Course Notes: Session 3 (2015): 471-472.

17.   Litscher G, et al. Acupuncture using laser needles modulates brain function: first evidence

from functional transcranial Doppler sonography and functional magnetic resonance imaging.Laser Med Sci. 2004; 19(1):6-11.

18.   Snijders A. Laser Acupuncture. IVAS Course Notes. Session 5 (2016): 2.

19.   Gutiérrez Cepepda L. Neurophysiology And Acupuncture. Pain And Neurophysiology. IVAS Course Notes. Session 5 (2016): 30-31.

20.   Gutiérrez Cepepda L. Neurophysiology And Acupuncture. Pain And Neurophysiology. IVAS Course Notes. Session 5 (2016): 36.

21.   Gutiérrez Cepepda L. Neurophysiology And Acupuncture. Pain And Neurophysiology. IVAS Course Notes. Session 5 (2016): 30-32.

22.   Gutiérrez Cepepda L. Neurophysiology And Acupuncture. Pain And Neurophysiology. IVAS Course Notes. Session 5 (2016): 40-41.

23.   Snijders A. Laser Acupuncture. IVAS Course Notes. Session 5 (2016): 3-4.

 

 

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