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CASE STUDY: EPM Rehabilitative Support

Equine Protozoal Myelitis, or EPM, is a neurological disease that is caused by a small single-celled protozoal parasite called Sarcocystis neurona. This organism does not spread from horse to horse. Horses are infected by eating feed or drinking water contaminated by infected opossum feces.

The organism attacks the horse’s brain or spinal cord, damages the central nervous system, and causes a wide variety of symptoms including: lameness, instability, scuffing or dragging of the toes, and loss of major muscle mass, especially in the croup area. The disease may develop slowly or suddenly, and it may progress to the point where the horse is unable to stand. Pregnant mares may abort, riding horses may become unsafe to ride, and breeding stallions may be unable to serve mares.

Whiskey is a 7-year old Hanoverian that contracted EPM at a horse show in July of 2008. He seemed fine, enjoying two weeks of rest after the show plus two more weeks of just trail riding. The trouble began in late August when Whiskey was put back to work in earnest. Lateral work would lead to refusals in a rather expressive manner – rearing, kicking out, and bouncing up and down to avoid the task at hand.

His owner tried chiropractic adjustments, thinking that his back had “gone out,” without success. At this point the veterinarian was called in and blood work taken. The diagnosis came back positive for EPM. Whiskey went though the prescribed aggressive treatment successfully and received the recommended 5-6 months off for his body to normalize and to avoid stressing the immune system.

Again, Whiskey was brought back into work, this time starting with four months of trail riding – hills, slow gradual inclines, and technical crossings to get him strengthening and balancing the areas of atrophy and over-development. He had to re-learn how to organize his body for the different gaits, activities and terrains. Where Whiskey struggled the most was in straightness – he remained wobbly behind and had a hard time getting “through his body” – opening his shoulders, neck and back showing strength and flexibility.

In May 2010, the Vet diagnosed a hind end lameness that denied Whiskey the ability to show. Either a residual effect of the stress the EPM put on him, or his misuse of his musculoskeletal system to compensate for weaknesses, Whiskey’s hock joints contained a thick, heavy, milky white fluid instead of the normal clear synovial fluid. The hock joints were completely stressed at that point, and Depomedrol injections were administered with the assumption they would last only three months before needing another round.

Facilitating a horse after EPM will depend on the extent of the damage from the infection versus the timeliness and effectiveness of the prescribed medical treatments. Luckily for Whiskey, the extent of infection was minimal, creating a general lack of connectivity and weakness behind through the lumbar-sacral joint that led to a stuck weak muscular system and, in turn, a lack of free-flowing Chi.

Point selection for Whiskey’s particular case focuses mainly on enhancing free flow of Chi throughout his entire body (Gall Bladder points), in particular the hind end, and supporting his hock joint health. In order to bring nourishing support to his body and strengthen this joint, acu-points also included those that assist synovial fluid movement (Kidney/Bladder points).

Whiskey undergoes two separate acupressure sessions, one for his connectivity and strength, and alternatively, one focusing mainly on hock health. To begin, apply light pressure on the specific acupressure point for up to 30 seconds or until you see a release from the horse (licking, chewing, yawning, shaking, passing gas, or moving away from your touch).

ACUPRESSURE PROTOCAL A: Focusing on hind end strength

Bai Hui (100 Meetings )is easily located in th lumbosacral space used primarily for lower back or hind quarter problems. It is a point where all Yang meridians merge, therefore you can affect many parts of the body with this one point. Bai Hui is also used to warm the hind end and raise energy within.

Bladder 24 (Sea of Chi’s Hollow) is located 3 cun off the dorsal midline, in the 4th intervertebral space and relieves lumbosacral pain and moves stagnant Chi.

Gall Bladder 34 (Yang Mound Hill) located at the interosseous space between the tibia and fibula between the long and lateral digital extensor, craniodistal to the head of the fibula and is the Influential Point for the muscles and tendons, as well as relieves musculo-skeletal pain.

Bladder 27 (Small Intestine’s Hollow) located 3 cun lateral to the dorsal midline, between the 5th and 6th lumbar vertebrae, at the cranial edge of the wings of the ilium, is the Small Intestine Association Point used for sciatica and lower back pain.

ACUPRESSURE PROTOCOL B: Focusing on Hock Joint

Gall Bladder 44 (Foot Yin’s Aperture) found on the craniolateral aspect of the hind hoof, proximal to the coronary band and is a Ting Point used to help relieve laminitis, arthritis, and hock problems.

Gall Bladder 38 (Yang Aid) located 1 cun proximal to GB 39, between the lateral digital extensor muscle and the deep digital flexor muscle and is commonly used for hock problems and is also a Sedation Point.

Kidney 3 (Greater Stream) located in the depression between the medial malleolus and the tibia and the tendocalcaneus, at the level of the tip of the medial malleolus is a Source Point and helps restore the immune system and for arthritic hocks.

Bladder 60 (Kunlun Mountain) found between the lateral malleolus of the tibia and the tuber calcus and is the Aspirin Point, commonly used for arthritis of the hock and soft tissue injuries.


Whiskey continues to improve, showing more and more strength and flexibility during his workouts. As of this article I am proud to report that Whiskey returned to the show ring twice this summer, performing superbly and even placing in very competitive hunter classes during 10-day showing schedules. The grueling schedule seemed to strengthen him further, returning home more flexible than when he left.

The hock joints went the desired three months. The second injections, done in August, are to this point, maintaining without the need for another round. This is the desired outcome as increasing the time between injections creates less stress on the body and less of a threat to the immune system. Through rather inventive biomechanical exercises, Whiskey’s muscle building and symmetry is returning to his body. This improvement also creates less of a need for him to protect weaker areas, releasing the sacro-iliac joint and lumbo-sacral area, thus opening the hind end. By working along with the Veterinarian, protocols continue to support Whiskey’s return to the showing world, something that lay questionable just 6 months ago.Return to the show ring!

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