JOURNAL 
American Holistic Veterinary Medical Association 

January - March 2008, Volume 26, Number 4 

CASE REPORT: The Osteopathic Approach to Chronic 
Lameness and Behavior Changes 

Kimberly Parker, DVM, EDO and Janek Vluggen, DO, MRO, EDO 

Abstract 
A 7-year-old Quarter Horse mare used as a cutting horse was presented with the complaint 
of not holding her stops and not making her turns. Osteopathic evaluation revealed 
problems in the parietal, visceral, and craniosacral systems. The three systems were 
treated osteopathically, with immediate response. 6 weeks later on recheck, the mare 
had fully returned to top performance. 3 months after that time, she had a few restrictions, 
which were easily manipulated, and she is scheduled for checkups every 3 to 6 months 
to maintain her edge. 

History of Osteopathy 
Andrew Taylor Still, an American physician, 
founded osteopathy in 1874 during the rise of the 
vitalistic perspective in human medicine. The vitalistic 
physicians believe that the body contains the ability 
of directed self-repair. And therefore, knows what is 
best for it. They believe treatments should be aimed 
at strengthening the body's defense mechanisms, not 
suppressing them. 

Twenty years ago,3 osteopaths from Europe 
working independently began developing Equine 
Osteopathy. Dominique Giniaux, Pascal Evrard 
and Janek Vluggen. Tragically in the early years 
of development Dominique and Pascal both died, 
but fortunately Janek Vluggen carried on the torch. 
Born in the Netherlands, Janek currently resides in 
Germany where he has a thriving human practice 
as well. He holds a master's degree and a doctorate 
in osteopathy from the International Academic of 
Osteopathy in Gent, Belgium. Janek has founded two 
schools for Equine Osteopathy, World Wide Equine 
Education in the Netherlands and The Vluggen 
Institute for Equine Osteopathy & Education here 
in the US and he continues to advance the science of 
Equine Osteopathy all over the world through lectures 
and demonstrations. 

Introduction 
In July 2007 Janek Vluggen, a renowned osteopath, 
and myself were asked to look at a cutting mare that 
wasn't performing for the owner. She was a 7-year-old 
Quarter horse with the major complaint of not holding 
her stops and not making her turns especially to the 
left. 

Upon further inquiry with the owner it was 
discovered that she had been injected in her hocks 
and stifles 3 times in the past year and a half with 
hyaluronic acid but without lasting results. And the 
owner was concerned because in the last 6 months 
this mare had gone from being very cooperative and 
willing to work to being hypersensitive and grumpy 
all the time. 

Osteopathic Evaluation 

On initial observation we noted her anal button 
was pulled in, she had atrophy of her gluteal muscles 
and the medial part of the quadriceps, swayed back, 
and a prominent tail. Also present was atrophy of 
the splenius muscle with increased development of 
the hamstrings and she was standing with her left 
hind leg in outer rotation. She had a lowered neck and 
constantly held her head in extension. 

As an Equine Osteopath (EDO) I have been taught 
by Dr. Vluggen to see this mare a little differently than 
I did in vet school. The principles behind osteopathy 
are 3 fold. First you evaluate the parietal system, 
then the visceral and craniosacral systems. It is 
these 3 pillars that distinguish osteopathy from the 
other vitalistic modalities such as chiropractic and 
homeopathy. 

Evaluation of the Parietal System: 

Upon initial Osteopathic evaluation of the parietal 
system we found both sacroiliac joints in a bilateral 
ventral restriction, the left ilium unable to move 

38 ¥ Journal of the American Holistic Veterinary Medical Association January - March 2008 


dorsally and the left stifle in an exorotation. In the 
spine the 6th lumbar vertebra was unable to flex and 
move to the right side and the 3rd, 2nd and 1st lumbar 
vertebrae were unable to extend or move to the left 
side. Thoracic vertebrae 17 and 18 were following the 
same direction as lumbar 6. Another restriction was 
found in the left shoulder, as it was unable to move 
to abduction as well as the first rib was not able to 
follow the inspiration. As the first ribs prominently 
dominate the movement of the 7th cervical vertebrae 
it could not move to the right side. 

Evaluation of the Visceral System: 

The visceral findings included a uterus with the 
parametrium restricted on the left side at the level 
of the cervix. The body of the uterus was positioned 
to the left side with a restricted teres ligament 
(mesometrium). The left uterine horn would not move 
cranially but could easily be moved caudally. The 
mesovarium of the left ovary was restricted ventrally 
and the mesosalpinx which is peritoneal tissue 
attached to the inner side of the pelvis could not move 
ventral. The left ovary had a retained corpus luteum 
and according to the owner this had happened before 
and been treated conventionally. 

Evaluation of the CranioSacral System: 

Evaluation of the cranial sacral system showed 
the mare to have what we call a compression of the 
SSB (the sphenobasilar synchondrosis), which can be 
a cause of behavior disturbances. 

Osteopathic Interpretation 

Interpretation of Lumbar Spine and SI Joints: 

In the EDO program I learned that the mechanical 
visceral disorders like ptosis (ligamental disorder) 
a spasm (a muscular disorder) or a congestion (a 
vascular disorder) will cause a restriction of the spine 
and sacroiliac joints through their influence of the 
autonomic nervous system. Thus 80% of the time the 
organ is the primary cause of the immobility of the 
parietal system. The segments of the SI joints are the 
parasympathetic centers of the organs in the pelvic 
cavity. The segments of the 1st 2nd and 3rd lumbar 
vertebrae are the segments of the lumbar splanchnical 
nerves connected to the same organs. The segments of 
the SI joints are the same segments that innervate the 
exorotators of the hip. So now how many times have 
you seen a mare standing with her leg in an outer 
rotation? 

Interpretation of the Diaphragm and Thl7 and 
Thl8: 

The 17th and 18th thoracic vertebrae are the 
insertions for the diaphragm and the psoas muscle. 
The loss of tone of the perineum ">ill cause the 
diaphragm to move more caudal during inspiration, 

which puts more traction on the insertions of thoracic 
18 and 17 causing a hyperlordosis of the lumbar spine. 
A hyperlordosis of the lumbar spine will cause the 
psoas muscle to contract and move the femur towards 
the ilium or the ilium towards the femur: the ventral 
out flare. 

Interpretation of the Shoulder and First Rib: 

The innervation of the diaphragm is the phrenic 
nerve, which enters the spine at the level of the 4th, 

5th

 and 6th cervical vertebrae, which is where the 
brachial plexus exits. The phrenic nerve has a side 
branch innervating the subclavian muscle at the 
height of the shoulder. The irritation of the phrenic 
nerve will thus cause a contraction of the subclavian 
muscle restricting the motion of the shoulder. As the 
diaphragm is connected to the lungs and the lungs are 
connected to the seventh cervical vertebrae and first 
rib, a diaphragm restricted in caudal direction will 
cause a constant strain in this area. 

Interpretation of the Endocrine Disturbance: 

At the level of the first rib and C7 is located the 
stellate ganglion. One of the postganglionic branches 
of the stellate ganglion is the vascular branch. This 
vascular branch runs together with the internal 
carotid artery as the internal carotid nerve or plexus. 
This nerve after entering the skull through the jugular 
foramen gives off a pituitary branch, which innervates 
the vascularization of the pituitary gland. Disturbance 
of this innervation will disturb the complete endocrine 
system. 

Interpretation of the CranioSacral Relation: 

The sacrum is directly connected through the 
meningeal tissue (duramater) with the occipital bone. 
A sacrum in restriction bilateral ventral will cause an 
occipital bone to restrict in extension in relation to the 
SSB. 

Treatment 

According to the principles of osteopathy the 
visceral restrictions need to be treated first to release 
as many parietal restrictions as possible so the 
adjustments can be reduced to a minimum. 

In this particular case we first released the 
visceral restrictions of the uterus and ovaries through 
osteopathic mobilization techniques. And tested 
the parietal system again. The osteopathic visceral 
manipulation released the restriction of the ilium, the 
restriction of L3, 2,1 therefore parietal manipulation 
was not needed. The bilateral ventral sacrum still had 
to be adjusted in order to release the strain on Thl7, 
18 and the 1st rib and C7 the diaphragm had to be 
mobilized. Several osteopathic techniques were used to 
release the cervical spine. Finally I used craniosacral 
osteopathy to diminish the compression disorder of 
the SSB. " 

January.- March 2008 Journal of the American Holistic Veterinary Medical Association ¥ 39 


Qsteopathic Approach to Chronic Lameness 

Evaluation of Results 

Immediately after treatment we observed the 
mare being very relaxed, less strain on her lower 
cervical spine with a changed top line to almost 
normal position. Her respiration became deeper and 
effortless. When she walked off she seemed to be more 
comfortable in her whole body. 

Upon recheck 6 weeks later the owner reported 
the mare had changed her personality and behavior 
back to normal and she was holding her stops and 
could move her back, neck and shoulders free in the 
turns. We found the exorotation gone from her stifle 
and her spine still free from restrictions. We agreed 
to do a follow up evaluation in 3 months. 

At this evaluation in mid November, we saw the 
mare developing her gluteal and quadriceps muscles. 
She was filling out her loins and splenius area and 

Author Kimberly Parker DVM, EDO 
office@drkimberly-dvm.com 

Coauthor Janek Vluggen DO, MRO, EDO 
Founder, Vluggen Institute for Equine Osteopathy and Education 
equineosteopathyl 01 @comcast.net