A) TWO CLINICAL CASES FROM A SERIE
During a rather small period in September, were presented at my consultation various horses presenting simultaneously:
– A persisting pathology of the anterior right fetlock (tendonitis, peritendonitis, sprain) not healing satisfyingly by the means of common medicine.
– A stiffness of the hindquarter with a defect of engagement of the right posterior and some digestive disorders (gas, dry dung, or at the contrary rather soft).
Of these two problems, the first is the one that brings the owner to choose to consult; the second seems anodyne and could be neglected towards the gravity of the first. In fact, using these 2 representative cases of this very frequent observation in osteopathy practice, we will see that not only there is a link but that the connection must be made.
AZAD: is a young purebred Arab stallion of five years already used as an endurance competitor and presented for peritendonitis of the perforating tendon (deep phalangial flexor) of the right anterior, treated during three months by rest and non-steroidal anti-inflammatory drugs as well as various local cares. The problem aggravated again recently now compromising his sporting season.
– Clinical exam findings
Visually the concerned tendon is slightly bigger than its equivalent and the palpation reveals as previewed a swelling of the tendons sheath shown by the presence of oedema. Walking, a little dissymmetry in the bearings is observed, and is striking trotting.
– Osteopathic exam findings
The exam shows a dysfunction (disturbance of joint mobility) of the sacrum, the fifth lumbar (L5), the caecum, as well as D18, D4, C7, C0, right shoulder and of course, right anterior fetlock. These dysfunctions are revealed by various passive mobility osteopathic tests on each articulation.
NEPTUNE: French saddle gelded horse of ten years used as riding horse. Presented following a serious sprain of the right anterior fetlock treated by the pose of a resin during two months as well as non-steroidal anti-inflammatory drugs. Unfortunately three weeks after the withdrawal of the resin, he still does not use this limb for support, and a little detail: the smell in the pen is repulsive and the dung is dark and very offensive.
– Clinical exam findings:
The right anterior fetlock is painful at palpation, his volume is doubled, the X-ray done by a colleague does not show any visible radiological anomaly.
– Osteopathic exam findings:
We found the following dysfunctions: caudal-sacrum, L6, L5, caecum, L1, D10, C7, C2, frontal right, right shoulder, right elbow, and right anterior fetlock.
In both cases, the symptomatic approach has failed to resolve the whole problem. The accountings of osteopathic findings, in extenso a loss of mobility between tissues make us take in account what a common exam doesn’t: the various muscular tensions as well as a minor digestive disorder.
But what is the point of a global diagnostic and therapeutic for the comprehension and the follow up of these cases? An intellectual exercise or a real purpose? We will now, using the basic principles of osteopathy and Traditional Chinese Medicine show that there is a real interest. (1)
B) THE OSTEOPATHIC CONCEPTS TO KNOW
Using various tests, osteopathy is able to identify dysfunctions; tissue deterioration is outside the field of this medicine. These dysfunctions are loss of mobility of a tissue (generally bony) regarding another.
The concept of osteopathic dysfunction.
Commonly it is known as the displaced vertebra, which evidently is not, but in fact can not achieve all the movements that are required.
*Macro and micro adaptative movement.
Therefore a vertebra should be able of flexing downwards or to the contrary extending up, should be able to incline laterally to the right or to the left, and make a right or left rotation of the vertebral body.
A joint as the fetlock should be able to make a flexion/extension, but also an adaptative abduction or adduction; the metacarpal bone should also be able to do an intern or extern rotation on the phalanxes as well as a compression / decompression.
For the joint to function correctly, these small adaptative movements are considered essential to reestablish. The manual perception of such a dysfunction in a joint a tendon or a muscle is a sign of the disturbance of a proprioceptive or nociceptive receptor. It also shows a disturbance of the orthosympathic responsible for the muscular tone and in a whole for the quality of the movement and the vascularization which are essential for the tissue to repair.
An osteopathic manipulation will restore these adaptative movements and consequently regulate the functioning of the joint receptors and of the responsible neurones.
*Primary dysfunction and secondary dysfunction.
The osteopathic exam allows to classify the dysfunctions found and identify primary dysfunctions (more important or / and older) and secondary dysfunctions that are consequences of the primaries and on which it may not be important to work on. In all cases, to understand the lesional scheme, it is needed to search everywhere from the posterior hoofs to the head.
Corporal continuity : muscular chains, fascias..
Indeed, this last idea compels to the global concept: it is not a fetlock that is brought to the exam but a horse.The fascias form successive relays from one end of the body to the other; they are considered as a continuous package that gives shape and nutriments.
Therefore, because of this continuity, a dysfunction of the lower part can engender a dysfunction of a higher part. The classical example is the knee cap whish could be seen as a shroud attached to the tibial bone and to the iliac paddle and which behaviour largely depends on the position of these two bones.
We therefore arrive to the idea of muscular chain and of adaptative lesional chain. The observed symptom is at the end of a long sequence of dysfunctions and can only be treated efficiently and for a long lasting period if we resolve the dysfunction at the beginning of the chain.
The orthosympathic system : tone , visceral and vascular function.
The most adequate system to explain the result of osteopathy is the orthosympathic nervous system, globally metamerised under the backbone.
His study by Irvin Korr[2], shows clearly that the osteopathic dysfunction is followed by a lowering of the neuronal sensibility threshold and that this system called neuronal lentil becomes hypersensitive to all impulse from its own receptors or from other parts of the body. A triggered neuron lowers his threshold for all his functions. This explains that a vertebral dysfunction often goes along with an organic, vascular or cutaneous dysfunction (cf scheme). The counterpart is that an action on one of these functions will allow in return an action on all of these functions. And in the case which interests us, an action on L5 who sends a branch to the adjacent ganglion L3 which takes care of the Large Intestine, lets us regulate the caecum.
Osteopathy allows us to have a vision on all the dysfunctions of the patient, it gives us a tool to rebalance by a manipulation the entire body and therefore expect a better effect on the symptom observed. Here it allows us to understand the relationship between caecal pathology and stiffness of the back. It allows us to understand that we can neglect nothing as everything is linked. But it can not assert the relationship between CAECUM/FETLOCK as the link between the fascial chain grouping L5 and the fetlock hasn’t been found. Therefore we need to use the conceptualisation given by Traditionnal Chinese Medecine richer in concepts and giving many paths to assemble cause and effect.
C) THE CHINESE MEDECINE CONCEPTS QUESTIONNED LES CONCEPTS DE MEDECINE CHINOISE MIS EN CAUSE.
The Large Intestine meridian:
Chinese Medicine describes meridians or channels on which preferentially flows the energy (Qi) of the body. Here it is the Large Intestine (LI) meridian that interests us, (cf scheme). With some specific points:
*YU Points : Located between L5 and L6 according to shoen [3], it is an important command point of the LI meridian, it is located on the Bladder meridian.
It supports the osteopathic observation that a dysfunction of L5 is linked to a disorder of the reflex zone of the fetlock.
*Antic “SHU” points : entry points of the meridian for the coupled energies (water, wood, fire, earth, metal). Around the fetlock, we found the points GI2 (water point) and GI3 (wood point) on the medial face of the fetlock. Another important point will be the GI 11, point of tonification located on the lateral face of the elbow, between the radius and the ulna, just under the joint. Point that osteopathy often reveals as dysfunctionning in these cases.
We therefore notice that an osteopathic dysfunction can be located where an acupuncture point is disturbed; this shows that although using different conceptualisations, both medicines work on the same dysfunctions.
We now can see why we can group L5 with the fetlock. According to the acupuncture concepts, the fetlock is located on the path of the meridian that takes care of the caecum.
Notion of elements, laws of creation and control, Seasonal aspects.
We can go further in our reasoning (4) understanding why the fetlock is disturbed and not another point of the LI meridian.
The “LI” meridian is under the influence of the element metal. These elements interact following the laws of creation and control which maintains the balance between them all. The metal is in relation with the element water by the law of creation and of the element wood by the law of control. If you remember that the fetlock is surrounded by the water and wood points of the Large Intestine, you found an explanation for it’s weakness in case of disrespect of these laws.
We still need to explain why we meet pathologies of the right fetlock in September and of the left fetlock during springtime with a more extensive stiffness of the elbow at that time.
Here we can use the concepts around the flow of the « Qi ».
The energy annually goes through all the meridians: we have a maximum activity of the LI meridian in september and a minimal one, six months later. We expect YIN pathologies at the moment of maximum YANG, therefore on the right side (rather YIN) and YANG pathologies at the moment of maximum YIN, therefore on the left side (rather YANG) and we there see the worth of treating the point LI 11, which is the point of tonification of the LI meridian. Pushing the analysis to the limit we can easily explain many troubling coincidences even though if at first sight this way of thinking seems very unusual.
D) TREATMENT AND FOLLOW UP
– Osteopathic treatment. (5)
With various manipulations, we will have to restore the normal mobility’s to regulate the orthosympathic functions concerned withholding the lesional scheme. They will be structural, muscular, reflex or functional techniques. Specifically on those cases, it is important to insist on the treatment of:
– The vertebra L5
– The long term treatment of the reflex zone of the caecum by the owner (slow and deep massage of the zone with a horse that « fits » in the hand).
– The fetlock, moving all the structures in every direction of space to restore fluidity and tissue flexibility and also using the specific technique of the V spread, a fluid technique that helps to dissipate local inflammations.
– Every dysfunction that seems important.
– Treatment of the digestive dysfunction.
And we shall not forget to change the diet for a better digestion, generally lowering the intake of carbohydrates or proteins, and adding fibbers. And even more it is helpful to spread a new intestinal flora with some of today’s very good products that you can find in the local suppliers. This, in an attempt to bring a better coecal fermentation, this organ will therefore take less space in the pelvis, the impulses sent by the receptors will be lower and giving therefore a lower muscular tension of the pelvis and of the last lumbars. The horse then starts better on his right, jibs less to gallop and doesn’t ask to defecate minutes after he started the work, his dung also has a better aspect.
CONCLUSION:
The question withholds: is it interesting to take car of the hind to cure the front?
We intellectually understood why we can have a link between a symptom at the fetlock and on L5, but what can we do about it?
The answer for me is given by the result of both of these cases. Neptune put down his feet a week after, his fetlock reduced, a few more visits allowed to have an acceptable result: no lameness walking.
And for AZAD, he took back training a week after, with no reappearance of lameness or bulking.
And if we needed more to be convinced, a phone call from the owner of AZAD six month later (spring...YANG....) saying : “Last week the fetlock of AZAD was swollen again, i’ve given the probiotics and everything went well again...”.
It is sad that our academic medicine is reluctant to accept these conceptual tools that are osteopathy and Traditional Chinese Medicine, they are in our point of view a great help in the comprehension and the treatment of many disease.
BIBLIOGRAPHY:
1-les chevaux m’ont dit. Dr Dominique Giniaux Ed; cheval magazine.
2-bases physiologique de l’ostéopathie. Irvin Korr ED. frison roche
3-veterinary acupuncture schoen Ed.mosby
4-traité d’acupuncture vÈtÈrinaire Dr Frédéric Molinier
5-"une consultation d’ostéopathie.." K7 vidéo. Dr P. Chêne Ed vetosteo.com
