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Diagnostic Acupuncture/Manual
Therapy Exam (DAPE)
CVMA Program
October, 2012
Tim Holt, DVM
Diagnostic Acupuncture/Manual
Therapy Exam (DAPE)
Derived from a Japanese approach to acupuncture
Emphasizes palpation of tissue to arrive at a diagnosis of organ, joint, or muscle imbalance
Assists to identify local tissue swelling, pain, changes in texture, heat, and lack of motion.
– Segmental Dysfunction (SDF)
Findings may indicate local or referred
The DAPE
No diagnosis off of one reactive point
Put the entire picture together with multiple reactive points and clinical presentation/complaint
Advantages include – Ease of exam
– Body palpation
– Evaluation of trigger points
– Identifying Segmental dysfunction (SDF)
– Guidance to biomechanical relevance to dysfunction elsewhere in the body
DAPEUtilizes pressure, palpation and touch of over 200 diagnostic acupuncture points for reactivity
An accumulation of input from many including but not limited to Dr. Peggy Fleming, Dr. Marvin Cain, Dr. Phillip Rogers, Dr. Pam Muhonen, Dr. Kevin Haussler, Dr. Allen Schoen, and me
This exam is only a guideline for further evaluation
To Perform the DAPE
Use any type of blunt object (needle case) to apply pressure along the body
Use about three pounds of pressure when doing the exam in a uniform manner
If sensitivity is found stop and apply direct pressure to that point to better evaluate
See Movie
Location of
Diagnostic Acupuncture Points
Schoen, A. Veterinary Acupuncture:
Ancient Art to Modern Medicine. Mosby, St. Louis, MO, 2001
Many references available with much variability
Chi Institute
www.tcvm.com
Myofascial Pain Syndrome
Trigger Points
MPS develops as a result of the activation of C afferent Nociceptors at trigger point sites in muscle
The pain may be abolished by means of stimulating cutaneous and subcutaneous A delta nerve fibers with dry needles
Flishie & White, Medical Acupuncture: A Western Scientific Approach. Churchill
Livingstone, London, 1998Robinson, Narda. Veterinary Acupuncture Course Notes, Colorado State University, 1999-2007.
Trigger Point
Hyperirritable point within a muscle
Can be locally painful or have a characteristic referred pain
Possibly caused by:– excess release of acetylcholine from
dysfunctional motor endplate
– abnormal contracting regions of the motor endplate or muscle tissue
– spontaneous electrical activity of muscle
Trigger Point Therapy
Palpate trigger points (TP)
TP’s are easy to treat and results are good
Look for TP’s away from primary site of pain,
Trigger point at SI-9, deltoid and triceps area
– Lumbo-sacral pain
– Sacroiliac pain
– Coxofemoral pain
– Pelvic/sacral pain
SI-9
Common Equine
Trigger Points
Triceps brachii, infra/supraspinatus, Deltoids,
Extensor carpi radialis, Trapezius,
Brachiocephalicus, Gluteus medius, Iliocostalis
lumborum, Longissimus, Multifidus, Quadriceps
femoris, Semitendinosus-membranosus, Psoas
major, Iliacus, Iliopsoas, and Biceps femoris
Treatment of trigger points
– Acupuncture, manual therapy techniques at point and
joint around point
Trigger Points
Doing the DAPE
To record an objective pressure sensitivity an algometer can be used
The algometer also allows non-bias evaluation following therapy, that day or later exam
Wagner pain test algometer
800-345-4188
http:www.paintest.com
Algometer use
Apply pressure with
algometer
monitoring pressure
Observe for pain reaction record reading
LI-18Ipsilateral forelimb, foot
BL-19, BL-20, BL-21Ipsilateral hock, stifle, lateral
hip, stomach (ulcers),
GI motility, local muscle
pain, saddle fit
DAPE sweeping motion
SI-9shoulder, pelvic pain
BL-39, BL-40hock, stifle
SI-9 Is often a region of intense
trigger points and can be very sensitive, use caution
Reactive Points
Identify regions of segmental dysfunction
Identify a sensitive or painful response to pressure– Muscle fasciculation's
– Tail swishing
– Biting, kicking, rearing, collapse
– Mild changes in posture
Use caution not to diagnose normal panniculus response for a sensitive reaction
Reactive Points
A true reactive point will be seen at the point of pressureMuscle fasciculation away from the pressure is not a responseA reactive point may be reactive for a number of reasons including– Local pain
– Trigger point
– Saddle fit issues
– Somatovisceral reflex response
– Referred pain
– Compensatory pain
DAPE
evaluation of
ST-7
ST-7- Local TMJ
- Unilateral positive
- Teeth
- Unilateral positive
- Pelvic pain- Unilateral negative- Bilateral positive
Right side Neg. Left side Neg.
Bilateral Pressure Positive Head Going Up
Evaluating Space Between
Caudal Ramus and Cranial Wing C-1
- Personality???
- Pathology??
Palpating for trigger
Point, Infraspinatus
muscle
Isolating point for treatment:
- Muscle spindle cell work
- Pressure
- Manual therapy
- Acupuncture
- Massage
- Heat
- Anti-inflammatories
Muscle Spindle Cell
Receptor that has the greatest influence on central nervous system integrity
Designed to register changes in muscle length and joint movement
The muscle groups that have the most fine motor control have the largest number of muscle spindle cells
Neck vs. gluteus
Muscle Spindle Cell
3-12 small intrafusal fibers anchored at the polar ends of the receptor
Large diameter 1a afferent nerve fibers that wrap around the central region of the intrafusal fibers
Gamma motor neurons that innervate the polar ends of the intrafusal fibers
Muscle Spindle Cell
Relaxing the muscle spindle cell
treating the tight muscle or trigger point
- Isolate trigger point or tight pathological muscle group
- Hard inwardpressure into muscle
Relaxing Muscle Spindle Cell
- Inward pressure
thumbs push together
- Contracts muscle
spindle cell
- Relaxes alpha motor
neuron
- Muscle relaxes
- Do opposite to tone up
muscle
Another means of treating
tight sore muscles or trigger points
Myofascial rolling
Specific Vertebral Regions of Pathology
and Common Presentations
L-1—L-4
– Chronic colic, renal disease, saddle pain
L-4—6
– Trigger points, soft tissue pain
Intertransverse Joints
– DDx SI pain, hunched back, loss of performance
L-S
– Loss of speed and performance, extreme pain non block-able, unable to drop in rear
Specific Vertebral Regions of Pathology
and Common Presentations
T-18—L-1– Chronic colic
T-15– Increase in symptoms associated with heart, lung,
pericardium, local pain, and rib issues
T-11,12,13– TMJ, cribbing, ulcers
T-3,4,5,6,7– Refusal to jump
– Tripping
– Non blockable lameness
Questions
References
1. Schoen, A. Veterinary Acupuncture: Ancient Art to Modern Medicine. Mosby, St. Louis, MO, 2001
2. Filshie and White. Medical Acupuncture: A Western Scientific Approach. Churchill Livingstone, London, 1998
3. Gatterman, Meridel. Foundations of Chiropractic Subluxation. Mosby, St. Louis MO. 1995
4. Kamen, Daniel. Animal Chiropractic, Learn the Methods Seminar. 1995
5. Veterinary Manual Therapy Course Notes, Colorado State University. 2001
6. Giniaux, Dominique. Advanced Equine Veterinary Manual Therapy, Colorado State University, 2001.
7. Robinson, Narda. Veterinary Acupuncture Course Notes, Colorado State University, 1999-2007.
8. Schwartz, Cheryl. Four Paws Five Directions, Celestial Arts Publishing, Berkeley, California, 1996.
9. Kendall, Donald. Dao of Chinese Medicine, Oxford University Press Inc., New York, 2002
References (Continued)
10. Maciocia, Giovanni. The Foundations of Chinese Medicine,Longman Singapore Publishers (Pte) Ltd, Singapore, 1989. 11. DeStefano, Carl and Martin, Dan. Course Notes: Applied Kinesiology I & II, May 2002.12. Denoix, Jean-Marie and Pailloux, Jean-Pierre. Physical Therapy and Massage for the Horse, second edition, Trafalgar Square Publishing, North Pomfret, Vermont, 2001.13. Giniaux, Dominique. What the Horses Have Told Me, Xenophon Press Cleveland Heights, Ohio, 1996.14. Haussler, Kevin, ed. The Veterinary Clinics of North America –Equine Practice – Back Problems, W.B. Saunders Company, Philadelphia, Pennsylvania, April 199915. Fleming, Peggy, Equine Atlas of Acupuncture Loci, Florida Equine Acupuncture Center, Dade City Florida.