A study carried out by a team at the Royal Veterinary College (RVC) found the technique had “good success” in treating equine trigeminal nerve-mediated headshaking.

TMHS causes uncontrollable, involuntary flicking and shaking of the head; it can be very painful and distressing for horses and mean sufferers are unrideable; in some of the most extreme cases, it can mean euthanasia.

“Although the exact cause has not yet been identified, it is presumed that the trigeminal nerve in affected horses reacts excessively to external stimulation,” an RVC spokesperson said. “Currently, there is no cure for the condition. However, electroacupuncture, which is the use of needles and an electric current to change the pain perception in the nerve, has been successful in treating TMHS in a small number of cases, but results from a more substantial number of cases have not yet been assessed.”

The RVC team, led by Bettina Dunkel, head of equine and professor of equine internal medicine, emergency and critical care, and with four external collaborators, retrospectively assessed electroacupuncture’s effectiveness in 42 horses treated with the technique between 2015 and 2024.

Data assessed included the horses’ history, duration and severity of TMHS, diagnostic tests, number of electroacupuncture treatments and the effect of treatment as perceived by the owner or main vet.

“The findings showed that the procedure was well tolerated by all horses and achieved a significant improvement in headshaking, with the median grade before treatment at three and after treatment at one,” the spokesperson said.

“Overall, 64% of cases showed an improvement in TMHS after their final treatment, with complete resolution of signs seen in 33% of horses. No improvement was seen in 31% of cases and two horses (4.8%) experienced worsening of clinical signs post-treatment.”

The team concluded that electroacupuncture was well tolerated with minimal complications and improvement in most horses. The advantages of the treatment include the fact it has a low complication rate and can be carried out in the yard.

Professor Dunkel said: “Electroacupuncture is a viable treatment option for horses suffering from this devastating disease. We are very pleased with the results of the study and hope that it will encourage veterinarians and horse owners to pursue this treatment option.”

Refining the technique

The team suggested that refinement of the technique over time, such as changing the duration of the treatment or electrical frequencies, could help increase the success rate and create longer remission periods.

Equine vet Sue Devereux, the author of the first study in this area in 2017 (vet clinic, 2 June 2022), told H&H the treatment is a major step forward as apart from the use of nose nets and masks, “which I wholeheartedly recommend”, the condition is so hard to manage.

“The results of this study with a larger number of horses are very encouraging as they are consistent with the earlier findings and confirm that electroacupuncture is a worthwhile treatment option for TMHS,” she said. “It is important that other possible causes of head shaking are always ruled out first.”

Ms Devereux said she was inspired to use the treatment on more horses by a dressage mare called Izzy who had been “tormented” by TMHS and had been unrideable in spring and summer for three years.

“She responded remarkably well, remaining free of signs for longer than we had dared hope and was able to compete all year round,” she said. “This encouraged me to treat other cases.”

She added that although factors such as pollen, sunlight, wind and rain can trigger headshaking, it is still not known what causes the effect on the nerve.

“If only we could establish the causes of this painful condition, then we would be closer to finding a cure,” she said.

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“I was trying to tell people that it’s not just a case of sticking a few needles in,” explains Sue, who was one of the first UK vets to establish an equine acupuncture referral practice around 15 years ago. “Gradually, clients wanted it for their horses — and vets slowly started to get used to it. The past three years have seen a massive acceptance within veterinary practices.”

Sue’s interest was ignited when acupuncture achieved what conventional medical treatment couldn’t: relieving the severe neck pain she was suffering due to a long-standing riding injury. Yet, while 2.3m acupuncture treatments are carried out on humans in the UK each year, according to the British Acupuncture Council, we’re still behind when it comes to horses.

“Acupuncture is an established part of sports horse medicine in the USA and many European countries,” points out Sue, whose patients include Olympic athletes alongside general riding horses and racehorses. “I believe it will become a fully integrated part of veterinary medicine here, too, instead of being viewed as a complementary therapy.”

So what can acupuncture do — and how is it developing from a last-resort consideration to a first line of defence in treating and managing a whole host of equine conditions?

Getting the needle

The use of acupuncture within traditional Chinese medicine can appear somewhat mystical. It’s easier to grasp an understanding of its adaptation for Western medicine, to alter nerve and muscle function and promote natural self-healing.

“Inserting acupuncture needles stimulates tiny nerve endings that carry impulses to the spinal cord 
and brain,” says Sue. “Responses within the nervous and endocrine systems lead to the release of neurotransmitters and hormones, which influence the function of body tissues and organ systems.

“Natural painkillers, such 
as endorphins, enkephalins 
and serotonin, can then act on 
pain pathways — effectively modulating the transmission 
of incoming pain signals.”

According to Sue, acupuncture is effective for musculo-skeletal and medical conditions including digestive, respiratory and reproductive problems.

“It can stimulate the immune system, perhaps if the horse is lethargic or post-viral, and offers a pain-relieving alternative if a horse cannot have bute or other non-steroidal anti-inflammatories [NSAIDs],” says Sue. “There are just three things it cannot be used for: irreparable fracture, terminal organ failure and malignant tumours.”

While often used as a stand-alone treatment, acupuncture is particularly effective in combination with conventional veterinary medicine. “It can speed up recovery and reduce the amount of medication needed, which is important for horses competing under FEI or racing rules,” says Sue. “Horses receiving acupuncture before or during competitions must be properly examined. Acupuncture should never be used to mask pain, 
in case serious injury occurs.”

Acupuncture using needles can only be practised by qualified vets who have had specialised training.

“The horse has the same clinical work-up,” says Sue. “I consider the horse’s history before carrying out 
a full clinical exam. This includes palpation to feel for swelling, heat, pain or tension, and interpreting sometimes very subtle responses such as a pause in his chewing or a change in his eye. I like to see him lunged, turned in tight circles and ridden, if appropriate, as well 
as inspecting his teeth and his tack.

“Ideally, this examination takes place in his home environment,” she adds. “I can then check the things you’d miss at a clinic, such as his demeanour and posture at rest and 
at home, his management and even the fit of his rugs and the quality of 
his hay. It’s a holistic, whole-horse assessment, not just ‘What’s wrong?’, but ‘How did it get like that?’”

Hitting the target

Based on these findings and her knowledge of veterinary anatomy and physiology, Sue selects acupuncture points.

“The needle locations are close to bundles of nerves and blood vessels that act as ‘doorways’ to the nervous system,” she says. “For a hindlimb problem, for example, I might place a needle close to the area of the spine where the nerves that supply that area originate.

“Needles are generally left in for around 15-20 minutes, shorter for an acute injury and longer for a chronic problem. In some cases the horse displays good relaxation in seconds, especially with tight, tense back muscles. A chronic injury may need several sessions before you see improvement, although there is usually a response after one or two.”

Sue starts with “dry needling”, using sterile, stainless steel needles. If the response could be better, she may use “electroacupuncture” — where a pulsating electrical current passes through the needles.

“Electroacupuncture produces greater activation of descending nerve pathways, from the brain to the injury, to block pain,” she says.

Some horses are notoriously needle-shy, so how do they cope?

“Acupuncture should not be stressful for horse, owner or vet,” says Sue. “Generally the horse is calm and relaxed after gentle palpation. Some acupuncturists don’t like to put a needle into a very sore area, but this can be really effective. In this situation I insert 
one needle at a time.”

Sue briefs the owner about safety and prefers working in an empty stable with rubber flooring, to avoid the needle-in-a-haystack search should one go missing.

“In experienced hands, acupuncture is very safe,” she adds. “Side effects are far less common than with many conventional forms of medication.

“There is risk of infection at the needle site, but this is incredibly rare. Nevertheless, I would never insert a needle into a joint or a tendon sheath. If there are any safety doubts I use laser acupuncture, which does not penetrate the skin.”

Where’s the evidence?

Sceptics may highlight the lack 
of scientific proof behind equine acupuncture, yet Sue points to growing evidence in human research.

“With horses, response to treatment is the measure of success,” she says, explaining that randomised trials with animals are tricky for reasons of funding, logistics and welfare.

“Our understanding of the brain and nervous system is increasing all the time, but is far from complete,” adds Sue, who recently submitted 
a paper to a scientific journal regarding electroacupuncture in the management of trigeminal mediated headshaking, a small study returning “really encouraging results”.

“If a horse is stiff or sore, and hasn’t been helped by vet treatment or rest, acupuncture is well worth considering.”

Ref: Horse & Hound; 2 February 2017

Other types of acupuncture include:

• Electroacupuncture — effective for chronic pain. The points are electrically stimulated by attaching leads from a battery operated electroacupuncture unit to the inserted needles
• Laser acupuncture — a low intensity laser is used on the points
• Moxibustion — cigar-like sticks of the herb Artemesia vulgaris are lit at one end and used to heat the needles or moved slowly in a circular fashion over the point to be treated. This is particularly good for chronic arthritic conditions in the cold winter months
• Aquapuncture — substances such as vitamin B12, local anaesthetic or homeopathic medicines may injected into a point
• Gold beads can be implanted to provide long-term stimulation of a point
• Trigger point acupuncture — the needles are inserted into trigger points, which are small circumscribed exquisitely tender knots that may be found within taut bands in a muscle. Trigger points are very common in horses and may form in response to a direct injury, chilling, chronic overuse of a muscle or repeated microtrauma (repetitive strain injury). Trigger points can lead to chronic pain and muscle shortening, causing the horse to change its action to a short, choppy gait. Affected animals are often grumpy and dislike being rugged and groomed.

What is acupuncture used for?

It can be used to treat almost any medical condition with the exception of malignant tumours, irreparable fractures and end-stage organ failure. It is often used with conventional veterinary treatment, so the horse experiences the benefit of their combined effects. It works well with complementary therapies, including physiotherapy, chiropractic, osteopathy, healing and homeopathy.

In equine practice, acupuncture is commonly used for:

• Muscle soreness, particularly of the neck, shoulders, back and hindquarters. Clinical signs that may be alleviated by acupuncture include “cold backs” — resentment of saddling and girthing, dipping on mounting; general stiffness or inability to bend on one or both reins; head tilt or inability to flex from the poll; shortness of stride and not going forward from the leg; disunited or bunny-hopping at canter; “hopping” on the transition from walk to trot; bucking on the transition from trot to canter; irritability and soreness during grooming.
• Arthritis
• Digestive problems, including poor appetite, diarrhoea, some types of colic
• Respiratory problems
• Reproductive problems
• Poor immunity and post-viral lethargy

Who can do acupuncture?

By law, acupuncture can only be performed by a vet. This is because it is an invasive procedure that requires a thorough knowledge of veterinary anatomy and physiology.

How does acupuncture work?

Inserting the acupuncture needles stimulates tiny nerve endings that carry impulses to the brain and spinal cord. This results in responses within the nervous and endocrine systems, leading to the release of neurotransmitters and hormones influencing the body tissues and organs. The effect of an individual needle depends on where it is placed in the body and which nerves are stimulated.

Acupuncture is particularly good for pain relief, as it increases the release of natural painkillers such as endorphins and enkephalins. These act on the pain pathways in the brain and spinal cord and can block the transmission of incoming pain signals.

An acupuncture needle has a direct effect on trigger points in tense, shortened muscles. As a needle penetrates a trigger point, the muscle will often contract and then lengthen almost immediately. Sometimes the needle is “grasped” by the muscle and relaxation takes place over 20-30min. This process can often be hastened by twirling the needle. As soon as the trigger point relaxes, the pain and tenderness disappear and the blood supply to the muscle improves.

Acupuncture also helps restore a patient to a state of balance, or homeostasis. By influencing part of the brain called the hypothalamus, acupuncture can affect homeostatic regulatory mechanisms such as the control of pulse, respiration, hormone secretion, intestinal motility and white blood cell production.

How do I find a veterinary acupuncturist?

A list of vets who perform acupuncture in each county can be found on the Association of British Veterinary Acupuncturists website: www.abva.co.uk

• This veterinary feature was first published in Horse & Hound (19 October, ’06)

Nick Thompson MRCVS replies: Acupuncture(AP) can be used to treat virtually any condition you can think of! Believe it or not, it is useful in colic, some skin conditions, behavioural problems and small problems like conjunctivitis or sinusitis.

In Britain, it is mainly used for back and lameness problems, but in China it is used, along with herbs, to treat everything in every species!

The limiting factor, I am afraid to say, is the experience of the practitioner. There are only a few vets in the UK who have the knowledge and experience to use AP in medical as well as structural (musculoskeletal) problems.

There are many more, myself included, who use AP regularly to treat mainly musculoskeletal problems.

I will also use AP for some cases of infertility or behavioural problems in mares in season. Here, I’ll use homoeopathy too. So far the results are promising.

Acupunture can help treat the following:

• Musculoskeletal lameness of unknown origin (after diagnostics, not before)
• Navicular disease
• Laminitis in some cases
• Cold Back Syndrome etc.
• Back pain of unknown origin
• Respiratory problems
• COPD/hay dust cough/hay allergy
• Chronic nasal discharges
• Chronic cough
• Some forms of headshaking, but not idiopathic headshaking
• Urinary infections
• Incontinence
• Kidney disease
• Alimentary problems
• Recurrent colic
• Poor appetite
• Diarrhoea and constipation
• Infertility and other reproductive system problems
• Cystic ovaries
• Mares not coming into season
• Excessive behaviour when in season.

Veterinary surgeons are the only people in the UK who are legally allowed to perform acupuncture on animals.

To find your nearest AP vet, send an SAE to Gill Hewson MRCVS, Secretary of the Association of British Veterinary Acupuncturists (ABVA), East Park Cottage, London Road, Hand Cross, West Sussex RH17 6BD.

I have read about herbal therapies and homoeopathy but I can’t find any information about acupuncture. Could you please explain exactly what acupuncture is and how it works?

Nick Thompson MRCVS replies: Acupuncture is a treatment method developed by the Chinese over the last 2,000 years. They discovered they could initiate healing by stimulating special points, which they call acupoints, with needles.

They believe that energy, or Qi (pronounced Chi) circulates around the body and maintains the health of tissue. When this Qi flow is blocked, disease flourishes. These blockages can occur through trauma, scars or through exposure to wind, damp and cold. Acupuncture is one of an array of treatments used in traditional Chinese medicine.

Choosing the right treatment

Modern western medicine has come to similar conclusions throughthe scientific route, eg: poor blood circulation can lead to fibrositis in the muscles, angina in the heart and strokes in the brain. Western medicine uses drugs where the Chinese would use needles and herbs.

Needling acupoints has been scientifically proven to release morphine-like substances called endorphins, as well as “re-educating” the way the brain and nervous system recognises disease. Chinese medicine can sometimes work better than the scientific approach, especially when dealing with long-standing disease or illness.

If you have a lame horse, however, an initial assessment by a veterinary surgeon is essential. It would be poor medicine to wade in with acupuncture (or any other alternative treatment) until broken bones or severedtendons have been eliminated.

The Royal College of Veterinary Surgeons, in their Guide to Professional Conduct (www.rcvs. org.uk), states that only a veterinary surgeon trained in acupuncture can treat animals with needles.

The benefitsof acupuncture

Modern equine acupuncture, after an initial veterinary assessment, is useful in musculoskeletal conditions. Where the conventional veterinary approach to lameness is to use box rest and bute (phenylbutazone) to allow healing totake place, acupuncture may enhance and speed up the healing process.

Tendon and ligament sprains and other soft tissue healing can be be helped by using acupuncture. Degenerative joint disease, arthritis or rheumatic problems have also responded positively.

I would always use acupuncture in conjunction with manipulation, such as osteopathy or chiropractic, carried out by a trained practitioner. Remember that horses were not designed to carry people around on their backs, any more than humans were meant to wear high heels or sit at their computer terminal all day long.

First introduced to Europe in the late 17th century, the treatment has grown in popularity for humans and, more recently, animals during the past 50 years.

The Chinese believe that energy (or Qi, pronounced “Chi”) circulates around the body and helps maintainhealth and vitality. When the energy becomes blocked, there is an imbalance which in turn leads to illness and disease.

Acupuncture can be useful either on its own, or used in conjunction with Western medicine in the treatment of most gait abnormalities, such as stiffness, going disunited and bucking, and is frequently used for temperament problems.

A good practitioner will be fluent in both traditional Chinese medicine and the Western medical approach to acupuncture. The object is to re-establish normal energy flow – balancing “yin” and “yang” is the main concept.

This treatment has been used successfully to relieve pain, as well as for COPD, colic, laminitis and skin disorders, and does not leave residue or contravene FEI rules.

How does it work?

Fine, flexible needles, usually made of stainless steel, are inserted at specific acupuncture points along traditional meridian lines (channels connecting related nerves). When stimulated, each point has a specific action, which can relate to the internal organ.

Stimulating acupuncture points will release certain neurotransmitters, including endorphins (natural hormones) which help to suppress pain. It also has an effect on spinal pathways and reflexes.

Chinese medicine works on the principal that a healthy body which is working in harmony can go a long way towards healing itself. It is only when the body’s energy flow is worn down or blocked that those normal defence mechanisms are weakened and illness can set in. Acupuncture works simply by correcting the flow of the body’s natural energy.

The Royal College of Veterinary Surgeons guidelines state that only a vet trained in acupuncture can treat animals with needles.

• To find out more contact the Association of British Veterinary Acupuncturists, East Park Cottage, Handcross, Haywards Heath, West Sussex RH1 6BD
  (tel: 01444 400213 or 020 7937 8215).

Acupuncture is one of the waysto re-address these imbalances.

The acupuncture points lie in 361 traditional meridians (channels connecting related nerves). When stimulated, each point has specific actions, relating to the internal organ with which it is associated.

Acupuncture tends to be used mainly on competition horses. Most of the complaints are back and neck problems, which lead to restrictions in movements such as shoulder-in, as well as the failure to bend and flex correctly.Racehorses also benefit from acupuncture, and are frequently treated for temperament problems.

Acupuncture can be useful, either alone or in conjunction with western medicine, in the treatment of most gait abnormalities, such as the inability to turn, stiffness on one rein, changing legs at canter, bucking and dragging hind limbs and changes in temperament.

Diseases that may respond to acupuncture include chronic catarrh, conjunctivitis, colitis, diarrhoea and liver and lung problems.

Practitioners often find themselves called in for non-specific conditions where an injury cannot be located.

Vets will start by treating the spine, which is well supplied with nerves. Acupuncture releases endorphins, which promote well-being and has a calming, uplifting effect so, even on a horse with no specific injury, the treatment can make it happier and more relaxed.

In these cases, there is a theory that the problem is caused by a memory cell left in the brain from an old injury. The horse feels pain, even though the medical problem has been healed, and a course of acupuncture may wipe the memory clean. Results depend on the extent and severity of the condition and the animal¡s individual response to acupuncture.

The treatments can make a difference after a few sessions, but vets often treat horses weekly at first – at least three sessions are needed to see if there is any positive response.

If the condition has improved by then, the practitioner will treat the horse less regularly until it shows improvement, and then return for treatments when necessary. The process of acupuncture is painless. However, mild sedatives are often given to make the horse stand still, which avoids the problem of broken or twisted needles.

There are different approaches to acupuncture, the traditional way being the insertion of needles at certain pressure points using the theories of yin and yang, Chi (vital energy) and the meridian network.

Trigger point acupuncture is based on identifying tender spots by palpation and other criteria, such as the horse flinching when the trigger point is pressed or a muscle twitching when pressure is applied to it.

Other methods include the application of a thermal stimulus using Moxa, a dried plant fibre and, in the west, injection techniques are sometimes used to treat musculo-skeletal disease.

Laser therapy has received much attention in recent years. There are obvious attractions in using lasers in that it is painless and there is no risk of infection. However, equipment is expensive, and clinical trials have produced mixed results.

The laser light used in this kind of therapy stimulates the cells in a specific area to divide, thus helping a wound to heal faster.

Electro-acupuncture is used more frequently for chronic pain and appears to have benefits that outlast the temporary analgesic effect. The stimulators used in this kind of treatment tell the practitioner the intensity of the endorphins being produced, which means that they can stimulate the area to maximum effect without hurting the horse. Electro-acupuncture is generally used on more specific, serious tissue damage.