Vet Clin North Am Exot Anim Pract. 2018 (May); 21 (2): 511–528 ~ FULL TEXT
Jessica A. Marziani, DVM, CVA, CVC, CCRT
CARE Veterinary Services PLLC,
PO Box 132082,
Houston, TX 77219, USA
The nontraditional therapies of Traditional Chinese Veterinary Medicine and chiropractic care are adjunct treatments that can be used in conjunction with more conventional therapies to treat a variety of medical conditions. Nontraditional therapies do not need to be alternatives to Western medicine but, instead, can be used simultaneously. Exotic animal practitioners should have a basic understanding of nontraditional therapies for both client education and patient referral because they can enhance the quality of life, longevity, and positive outcomes for various cases across multiple taxa.
Keywords: Acupuncture; Alternative therapies; Chiropractic; Complementary therapies; Integrative therapies; Nontraditional therapies; Traditional Chinese Veterinary Medicine
From the FULL TEXT Article:
Nontraditional therapies can be used in conjunction with conventional Western
therapies to enhance patient outcome.
Nontraditional therapies are often sought out by exotic pet owners; therefore,
overall understanding is important for general practitioners.
Exotic animal species can benefit from the application of nontraditional therapies.
Traditional Chinese Veterinary Medicine is tailored to the individual patient
to optimize health.
Chiropractic care can be used as preventative form of treatment and for
In the broadest definition, nontraditional therapies are therapies that currently are not
conventionally used in Western practice. Other terms, such as alternative, integrative,
and complementary, are commonly used to categorize nontraditional therapies. However,
no matter what nomenclature is used, all are considered the practice of veterinary
According to the National Center for Complementary and Integrative Health, a division
of the National Institute of Health (NIH), approximately 38% of adults in 2007 were
using some sort of complementary therapy.  Those same adults may seek similar
complementary therapies for their pets. Therefore, even if complementary therapies
are not a core part of a veterinarian’s skill set, it is still prudent to be grounded in
general knowledge, treatment options, and how and when nontraditional therapies
can be used effectively.
This general working knowledge of the subject will help veterinarians better educate
clients in nontraditional therapies. Without a referral from their veterinarian, clients may
research nontraditional therapies on their own if they believe that the treatments will be
beneficial. A recent survey of competitive horse riders and trainers showed that of the
37% of the respondents that were seeking nontraditional therapies for their horses,
only 7% were doing so in collaboration with their veterinarian. 
Practitioners who integrate nontraditional therapies and Western medicine can take
advantage of the strengths of each. This integration of methodologies can deliver
overall better results than Western medicine or nontraditional therapies alone. A working
knowledge of nontraditional therapies and open dialogue can also enhance the
This article is intended to expose the general practitioner to the 2 most common and
sought out nontraditional therapies: Traditional Chinese Veterinary Medicine (TCVM)
and chiropractic treatments. The descriptions of each are intended to provide a basic
understanding of what additional therapies are available and how they can be effectively
utilized. The article is not intended to train the general practitioner on how to
perform these therapies. Attending a specialized training course is highly recommended.
These are listed in Table 1. Alternatively, practitioners who are trained in nontraditional
therapies but have not practiced on exotic animals will also find this article
useful as a reference for species comparisons and differences.
INTRODUCTION TO TRADITIONAL CHINESE VETERINARY MEDICINE
Traditional Chinese Medicine (TCM) used in Western culture is relatively new. TCM
was first introduced to the United States when an aide to President Nixon became
ill while Nixon was visiting China in the 1970s. This aide was treated successfully
with TCM and thus TCM was prominently introduced to Western culture. Because it
has been practiced in the United States only in the last 40 years, TCM is considered a
nontraditional or complementary therapy. However, it is among the oldest recorded
forms of medical practice.
Thousands of years ago, ancient farmers began identifying methods to treat their
sick livestock and horses. Without horses, they would lose battles, be limited in travel,
and unable to plow their fields. Without livestock, they would go hungry. Effective
methods of treatment were passed down from generation to generation and, in this
way, TCVM was born.
As TCVM was introduced to the Western world, modern advances were also added
to the implementation of TCVM. Western practitioners changed from multiple-use
needles to reusable sterile needles, and added electrical current and laser light stimulation
to acupoints.  Western society also expanded TCVM to fit other species
beyond livestock and horses.
TCM and TCVM are often difficult for the Western practitioner to understand
because both take an entirely different approach to health and treatment of disease.
The general overriding principle in Western medicine is control. If the spread of the
bacteria can be controlled, the infection can be treated. In TCVM, the prevailing principle
is balance. If the body is in balance, it is in good health. The diagnostics in
Western medicine range from an examination to advanced imaging. Diagnostics in
TCVM are limited to observation and examination of the tongue, pulse, and palpation
of points throughout the body. Western medicine treats a disease, whereas TCVM
treats an individual’s imbalance pattern. TCVM is so individualized that it is not effective
in herd-health medicine. For example, 2 Netherland dwarf rabbits with radiologically
similar spinal arthritis are treated with the same approach in Western medicine,
probably with nonsteroidal antiinflammatories and/or a centrally acting opiate
agonist.  In TCVM, those same 2 Netherland dwarf rabbits will be treated differently
based on their individual disease pattern, not solely based on the diagnosis of the
Explanation of Traditional Chinese Veterinary Medicine Pattern Diagnosis
An overarching tenant of TCVM is that the absence of disease means that the body is
in harmony and balanced. Illness occurs when the body is out of harmony and out of
balance. To establish balance, the practitioner must first ascertain what is out of balance.
Is the patient too hot or too cold? Is there too much (an excess) of something or
too little (a deficiency) of something? Are there multiple deficiencies and excesses?
TCVM treatments revolve around what is referred to as a pattern diagnosis. For a patient
with a complicated chronic disease condition, that pattern diagnosis may change
numerous times throughout treatment while working through each layer of the imbalance.
A TCVM practitioner must constantly be reassessing the patient’s pattern as the
treatment continues to achieve better results.
The essentials of balance start with Yin and Yang. The Yin and Yang are 2 supporting
opposites. Without the other to balance the scale, either can get out of control. Yin
characteristics are cold, rest, slowness, weakness, and night. Yang characteristics are
the opposite of Yin: warmth, activity, speed, strength, and day. If there is not enough
warmth to balance the cold, then cold wins out and the leading characteristic
exhibited is cold. In TCVM, this is considered Yang deficient because the body is deficient
of warmth. The opposite of Yang deficient is Yin deficient, which is described as
being too hot because there is not enough Yin, or cold, to counteract the warmth from
the Yang. There is species variability in how much Yin or Yang is possessed, especially
when it comes to exotics. For example, reptiles and amphibians are naturally more Yin
than most animals, whereas avians are more Yang than most animals. 
After identifying the Yin-Yang pattern, the practitioner must also identify the Zang-Fu
pattern to know which organ system is deficient or in excess. The Zang organ systems
are heart, kidney, liver, lung, pericardium, and spleen. The Fu organ systems are
bladder, gall bladder, large and small intestines, stomach, and triple heater (similar
to the Western circulatory system). The zang-fu organ systems are similar to the Western
organs they are named after; however, in TCVM principles, each has additional or
slightly different jobs than considered in a Western sense.
For instance, in TCVM principles, the kidney system not only functions as the kidney
organ but also regulates bone, controls energy, and stores the essence of the body.  If
a patient is diagnosed by an acupuncturist as kidney deficient, that does not necessarily
mean that they have abnormal renal values. The kidney deficiency may be diagnosed
based on the presence of arthritis, which suggests that the kidney system is not
controlling the growth of bone. It is a good idea to support the kidneys in these patients
with normal renal values but they are diagnosed as kidney deficient because
they may have renal insufficiency later in life. The zang-fu organ system is very detailed
and complicated beyond the scope of this introduction.
The basis of a TCVM examination is the evaluation of the tongue and pulse. A TCVM
practitioner uses the quality and symmetry of pulses, and the color, shape, and texture
of the tongue, to identify the disease pattern or come to a TCVM diagnosis. In most
species, the tongue has round edges and is relatively flat, pink, moist, and smooth.
For example, tongues that are coated in yellow and are dark red and swollen indicate
too much heat in the body, or a Yin deficiency. When tongues vary in shape, color, and
texture, using the tongue color for pattern diagnosis becomes more of a challenge.
Reptiles, amphibians, and avians, for example, are not suitable species for tongue
diagnosis. For birds, an alternative to tongue evaluation is to assess the color and
characteristics of the vent and cloaca. 
In most species the pulse is taken bilaterally, comparing the contralateral pulse. The
artery used depends on which is most assessable, usually the carotid or femoral artery.
For most avian species, the brachial artery on ventral surface of the wing as it
crosses the ventral surface of the humerus provides the most assessable palpable
Pattern diagnosis in certain exotic species poses unique problems. Reptiles are
particularly challenging because, typically, there is not a palpable pulse and their
tongues do not follow the general TCVM characteristics. Therefore, pattern diagnosis
is based more for general observations about their behavior; changes in quality, quantity,
or color of feces; discharges; skin lesions; body odor; and so forth.  The same observations
are used for pattern diagnosis in amphibians.
After the pattern is identified, treatment is focused on correction of the excess or
deficiency. The course of treatment is modified because the excess or deficiency
Explanation of Acupuncture
While TCVM encompasses many different types of treatments, the most common type
of treatment is acupuncture. Acupuncture works through acupoints, which are stimulated
to have an effect on the nervous and circulatory system. The acupoints are
located on meridians or channels that run throughout the body. Point selection is
based on the pattern diagnosis and correcting the identified imbalance. The location
of acupoints in exotic animals is not as well studied as it is in domestic animals. An
experienced acupuncturist uses anatomic correlation between species to identify
the possible locations of the acupoints. Careful palpation around those areas may
reveal active acupoints, which are perceived as vague depressed areas. When those
areas feel cool, it signifies a deficiency. When there is warmth, or areas that are raised
and swollen, it signifies excess. 
After the point is selected and located, it can be stimulated in a variety of ways. The
classic method is using an acupuncture needle. This type of stimulation is termed dry
needle acupuncture (Figure 1). These needles are malleable and range in thickness from
0.12 mm to 0.25 mm. Each needle requires a guide tube for placement because they
will bend during insertion. This flexibility is important because muscle contraction in
response to stimulation of the acupoint can bend and twist the needles. The needles
can be used alone or can be stimulated with electrical current at frequencies based on
the pattern being treated. This method is called electroacupuncture (Figure 2). Needles
can also be stimulated with heated herbs, a process called moxibustion, which is useful
in cases in which heat is needed in the body. In addition to dry needle acupuncture,
hypodermic needles can be used to inject a substance, usually vitamin B12, into an
acupoint. This method is termed aquapuncture. Injecting the patient’s own blood
into an acupoint is termed hemopuncture.
Acupoints do not need to be stimulated by needles, they can also be stimulated with
pressure, or acupressure. Laser can also be used to stimulate the acupoint [10, 11]
(Figure 3). Acupressure and laser acupuncture have advantages in exotic animal patients
that would not tolerate needle placement, cannot be touched, need to be handled in
protected contact, or are at risk of needle placement depth, such as over the air sacs
in birds. Laser acupuncture has an advantage over dry needle acupuncture because
there is no perception of the needle entering the skin, it can be used without contact
and even at a distance and also decreases acupoint stimulation time. [10, 12] Functional
MRI studies in humans are being completed with laser acupuncture verses dry needles
to eliminate any placebo effect from sensing needle placement.  Table 2 contains
some examples of acupoints that are easily stimulated at a distance with laser
Explanation of Traditional Chinese Veterinary Medicine Food Therapy
Another approach TCVM practitioners use to restore their patients to a balanced state
is food therapy. Sun Si Miao, a famous TCM practitioner from the Tang Dynasty (AD
618–907), said “dietary therapy should be the first step when one treats a disease.
Only when this is unsuccessful should one try medicines. Without the knowledge of
proper diet, it is hardly possible to enjoy good health.” 
Western nutritional principles rely on categorization into carbohydrates, fat, protein,
vitamins, minerals, and trace elements. For TCVM, food therapy considers the energy,
or thermal nature of the food, and uses the food as a form of treatment.  The most
practical principle of TCVM food therapy to apply to exotic practice is using the thermal
nature of the food to balance the Yin-Yang pattern. Feed cooling foods to patients
who are overheated (Yin deficient) and warming foods to patients that are too cold
(Yang deficient). Diet change in exotic medicine can be limited, but subtle application
of TCVM food therapy can be straightforward and just as effective as herbal medicine.
Tables 3–5 serve as general references for introducing TCVM food therapy into an
exotic animal practice.
Explanation of Traditional Chinese Veterinary Medicine Herbal Therapy
Herbs should be treated like medications and only be used when assured of the patient’s
pattern diagnosis. Herbs are not necessarily safe because they are natural.
When the correct herb is chosen, it can be of great benefit to the patient. Because
TCVM treats the individual patient and not a disease, it is not advisable to always use
herb A to treat arthritis in a bird. In TCVM, arthritis in that bird may be due to several
different TCVM pattern diagnoses. The bird could be Yin or Yang deficient. It could
also have a Qi deficiency, kidney deficiency, and so forth. Each of these circumstances
would call for a different herbal formula. Therefore, consultation with a
Chinese herbalist is highly encouraged. In exotic medicine, it is even more difficult
to give guidelines on herbs due to patient size, limited information on dosages, and
differences in absorption. This is an area in which more studies are needed in exotic
animals and domestic species. Herbal therapies also pose additional complications
because the product consistency varies with growth cycles, harvest, storage, and processing
practices, making them not as reliable as pharmaceuticals. It is also important
to be sure that products are coming from a reputable company with ethically sourced
Cases That Could Benefit from Traditional Chinese Veterinary Medicine
TCVM has a wide scope of potential uses. Because TCVM is a complementary therapy,
any TCVM treatment modalities can be used alongside Western treatments to
enhance the Western therapy; decrease side effects; or, in some cases, prolong the
need for Western therapy intervention.
TCVM can be used as preventative care in healthy patients. Patients that, based on
species or breed, may be predisposed to conditions later in life can benefit from
preventative TCVM therapies. Examples include supporting heart function in parrots
and hedgehogs that are predisposed to cardiovascular disease, boosting the endocrine
function of ferrets, and supporting renal and liver function across all species.
TCVM can also be used for acute and chronic diseases that are being treated with or
without Western medical therapies. In cases of acute emergencies, Western medicine
provides a faster response. When stable, TCVM can be added to help complement the
Western therapies. Additionally, there is an acupoint that can be stimulated to help
with resuscitation. However, the author recommends that cardiopulmonary resuscitation
be initiated first and the acupoint only be stimulated if there is an extra person who
can do so without interfering with the resuscitation efforts (see Table 2). TCVM is also
beneficial when there is no definitive diagnosis, cause, or course of treatment. A study
performed by Brady and colleagues  found a positive response to treatment of owl
monkey wasting disease (OMWD) using acupuncture with vitamin B12. Before this
study, there was no known treatment of OMWD.
Examples of cases involving exotic animals treated with acupuncture are in Box 1.
TCVM works to restore balance, which is a gradual process in the face of a chronic
condition. The author recommends that owners commit to at least 5 treatments before
making a decision on treatment effectiveness or assessing patient response. Treatments
are typically spaced 1 to 2 weeks apart for most cases. For severe cases, there
may be a need for 2 treatments a week. After the initial 3 to 5 treatments at 2 weeks
apart, if the patient is responding, then the treatment intervals are gradually spread out
to get to a maintenance treatment schedule of 3 to 4 times a year. If using TCVM to
treat an acute illness, then only a few treatments may be necessary.
Side Effects, Precautions, and Contraindications
TCVM generally is considered safe with relatively few side effects. Acupuncture
side effects include the release of endogenous endorphins that can cause patients
to be sleepy or tired. In some cases, acupuncture temporarily worsens symptoms
before gradual improvement. For exotic patients, there could be bruising around
needle placement in thinner-skinned species and possibly soreness in the muscle
from needle insertion. Side effects of using TCVM food therapy are gastrointestinal
related. Herbal therapy can have varying side effects, depending on the potency of
Precautions should be taken when using acupuncture, especially on a new species
in which the practitioner has no prior experience. A veterinarian experienced with the
species should work closely with the acupuncturist to ensure that species variables
are known, for the safety of both the patient and the acupuncturist. An acupuncturist
also needs to understand the diet of the species before suggesting any changes for
using TCVM food therapy.
Contraindications for TCVM food and herbal therapy include unknown source
of herb or food, unknown pattern diagnosis, and unfamiliarity with species digestion
and absorption. Considerations for acupuncture include avoiding certain points
during pregnancy, avoiding points around a tumor, and not using acupuncture
needles in open wounds. Electroacupuncture should be used with caution in
the weak or debilitated patient or patients with history of seizures. Additionally,
electrical leads should not cross the heart in a patient in poor cardiovascular
INTRODUCTION TO CHIROPRACTIC
Chiropractic-type therapies can be traced back to multiple ancient civilizations,
including Chinese, Roman, Greek, and Egyptian. Modern day chiropractic attributes
its founding to D.D. Palmer, with Palmer School of Chiropractic being the first official
training institution in the 1800s. Unlike TCVM, which seems to be more easily
accepted by Western practitioners, chiropractic typically has more difficulty gaining
broader acceptance. There is also frequently limited knowledge regarding the safety
and education level of a trained chiropractor. Only 15% of people can correctly
answer how much education is required to be a chiropractor. 
Chiropractic care in humans is widely requested. A Gallop poll from 2015 showed
that over 50% of adults had sought chiropractic care at some point in their life. 
Chiropractic care in animals may be sought out by those who have experienced chiropractic
for themselves. Although well-intentioned, a problem can arise when these
owners cannot find appropriate chiropractic care for their animals and seek treatment
by laypersons or other underqualified practitioners.
Dr Sharon Willoughby was a veterinarian who also became a doctor of chiropractic
in order to apply it to companion animals. Her endeavors lead to the formation of the
first animal chiropractic training courses in the late 1980s. Since that time, several
schools have been established that train both human chiropractors and veterinarians
in chiropractic care for animals. In most states, animal chiropractic must be performed
by a licensed veterinarian or a licensed chiropractor. A licensed chiropractor needs
written consent from the patient’s attending veterinarian before performing any animal
chiropractic. Despite this legal requirement, there are still many lay people who inaccurately
refer to themselves as animal chiropractors and who have caused injury to the
animals and problems for the image of the profession. Clients seeking chiropractic for
their animals, if not educated by their veterinarian about how to find a certified animal
chiropractor or, for that matter, why they should, will often find a lay or untrained
person to provide the treatment. Table 6 can be used to help seek certified animal
As with any new skill, a veterinarian should be properly trained in chiropractic techniques
before providing these services to patients. The purpose of this article is to
broadly educate the general practitioner regarding chiropractic, not necessarily to
teach specific chiropractic techniques.
Explanation of Chiropractic
Dating back to ancient civilizations, with energy and balance as principles of health,
chiropractic, like acupuncture, directly affects the circulatory and nervous systems.
Most Western thinkers consider chiropractic relevant for only musculoskeletal type issues
because that is the focus of most research and studies. This is a common
misconception. The musculoskeletal component and influence of chiropractic on
the body is profound. The impact on the nervous system is an overlooked benefit of
chiropractic care and modern research has shown the imprint chiropractic can have
on the body as a whole.
When describing chiropractic care, some of the confusion is due to terminology. The
term chiropractic subluxation typically raises the most uncertainty. In Western training,
a subluxation is a partial dislocation of a joint. A chiropractic subluxation refers to
2 adjacent joints that are lacking normal motion and/or alignment but are within the
normal joint space. It is this lack of normal motion or alignment that causes interference
with the nervous and circulatory system and, therefore, generates decreased
function and pain. This is referred to as the vertebral subluxation complex (VSC). Modern
advances in imaging have supported the VSC, which is now widely accepted and
taught in chiropractic university training programs. VSC encompasses a variety of issues
that can arise from a subluxation.
A trained chiropractic practitioner assesses a patient with the understanding of
normal joint motion. A normal or healthy joint has a springy end feel and subluxated
joints have a hard or restricted end feel when put through normal range of motion.
Within the normal joint space, there are varying degrees of motion. Joints move
through passive range of motion to active range of motion. At the end of the active
range of motion of a joint there is an elastic barrier that stops the joint from going all
the way to the end of its anatomic barrier. The chiropractic adjustment occurs in the
space between the elastic barrier and the physical barrier to restore both passive
and active range of motion.
To carry out the adjustment, the practitioner must know the directional plane in
which the joint normally moves. This correct directional plane is determined by
knowing the facet angle of the joint, which provides the practitioner the line of correction
(LOC). The LOC is the guideline for the correction of the subluxation or the adjustment.
Within a normal spine, the LOC changes with each segment and, in the case
of the thoracic spine, it changes with each vertebra. A chiropractic practitioner can
make adjustments in their LOC for each individual patient due to unique anatomic
Recognizing differences in LOC within the same species will allow a practitioner to
be more comfortable adapting to new species in which the practitioner has no prior
experience. Training courses for animal chiropractic focus on the dog and horse.
Extrapolating from those species, a skilled practitioner can move on to different species
but only after becoming well-practiced and proficient (Figure 4). The size of smaller
exotic species puts a premium on chiropractic finesse because the correction of the
VSC does not stop at finding the LOC. After the LOC of the joint that is lacking normal
motion is found, the adjustment is made by thrusting into the LOC. This thrust is a lowamplitude,
high-velocity motion that, if not well practiced, could be particularly
dangerous on a species in which the practitioner has no prior experience or training.
The thrust that makes the adjustment is usually performed manually; however, new
adjustment devices in the human field are slowly being introduced to animal chiropractic
Cases That Could Benefit from Chiropractic
The Journal of the American Medical Association published a study in 2017 that supports
the use of spinal manipulative therapy as a first-line treatment of acute low back
pain.  The American College of Physicians released new guidelines in 2017 that recommended
spinal manipulation among the first-line of treatments for acute and
chronic low back pain.  Acute and chronic low back pain cases have a high rate of
positive response to chiropractic care in humans and in animals. However, for animals,
chiropractic is not yet the first-line of treatment of back pain. Ettinger’s Textbook
of Veterinary Internal Medicine lists exercise restriction and pain medication as
treatments for back pain in animals.  More veterinary studies are needed to know
if chronic back pain, spinal osteoarthritis, intervertebral disc degeneration, and
advanced spondylosis could be prevented if chiropractic was introduced as an initial
defense. Many clients are not waiting for these studies and are pursuing veterinary
chiropractic on their own to potentially prevent these types of long-term issues.
Thirty-one percent of pet rabbits have vertebral column deformities and degenerative
back lesions.  Chiropractic care can be initiated early in life to help prevent these
issues by maintaining normal joint range of motion throughout the spine. Later in life,
chiropractic can still be used to restore motion, even with an arthritic spine. Any motion
that can be returned will help improve function. A series of animal experiments on
nerve root compression found that only 10 mm Hg (which is about the weight of a
dime) of compression on a nerve decreased the conduction of that nerve by 40% in
the first 15 minutes and by 50% at 30 minutes.  Other studies have suggested this
decrease in function to be 60% to 75%. After the compression is removed, recovery
to near normal function occurred in 15 to 30 minutes.
Torticollis or wryneck has been documented in several species. In the human literature,
there are many case reports of chiropractic improving or resolving torticollis. [24–29]
In the veterinary literature, there is a case of successful management of
acute-onset torticollis acquired during shipping in a 2-year-old giraffe (Giraffa camelopardalis
reticulate).  The author has also successfully treated wryneck in a Congo
peafowl (Afropavo congensis) and numerous canines (Fig. 4A). After fractures are
ruled out, any species with an abnormal neck position should be considered for chiropractic
Nutritional deficiencies are common in exotic practice and several nutritional deficiencies
can lead to joint inflammation. Examples include iguanas with metabolic
bone disease and Guinea pigs with scurvy.  An inflamed joint can easily become
fixated and lack normal motion. Once nutritional deficiencies have been treated, patients
should be evaluated by a professional chiropractor.
Chiropractic can also be used as part of a preventative health care plan because it
maintains a healthy nervous system and encourages normal gate patterns and weightbearing
to decrease the likelihood of extremity injury and maximize overall performance.  Many human athletes attest long careers in part to chiropractic care as a
key component of overall physical conditioning. National Football League players
often receive chiropractic adjustments before, during, and after a game. 
Examples of cases involving exotic animals treated with chiropractic are given in Box 2.
The recommended frequency of chiropractic adjustments depends on the condition, if
it is acute or chronic, and if the goals are preventative or maintenance of a chronic condition.
The recommended treatment frequency also varies between practitioners. For
most cases, the author sees patients every 1 to 2 weeks for 2 to 3 treatments, in total. If
the patient is responding well, then the time between treatments can gradually
disperse to assess efficacy. Each situation is unique. One patient with spinal arthritis
may walk better if adjusted every 4 weeks, whereas another may benefit with treatments
every 12 weeks. Because the spine is constantly in motion and subject to strain,
the author does not recommend longer than 4 to 6 months between adjustments. In
acute cases, several adjustments may completely resolve the issue and ongoing
chiropractic for that particular issue may no longer be needed. However, one must
keep in mind that spinal nerve root compression can be present without causing
the sensation of pain and, therefore, the absence of clinical signs. 
Side Effects, Precautions, and Contraindications
When used skillfully and appropriately, chiropractic therapy is safe and effective.35
The most common side effect to chiropractic is muscular soreness. Changing the
way that the joint moves also changes the muscles engagement. This muscle soreness
is similar to a new workout routine when muscles are stressed beyond typical
restful conditions. Some patients are noticeably sore 24 to 48 hours after their first
adjustment, whereas other patients do not show any signs of soreness. In the author’s
experience, patients that do exhibit soreness do so for only 24 to 48 hours and generally
do not require any medical intervention. Using damp or moist heat therapy over
sore, tight muscles will help a patient improve faster and provide relief (Figure 5). Damp
heat also prevents the drying effect on skin and muscles that can come from dry heat
therapy. To apply damp heat, a moist warm towel is used. To increase duration of
treatment a heating pad or hot rice bag maybe added.
Precautions should be made whenever undertaking treatment on a new species.
Having an understanding of species anatomy and normal motion is important. It is
difficult to assess abnormal motion without a baseline definition of normal motion. Chiropractors
(DC or DVMs) who are not familiar with particular exotic species should be
assisted by an experienced exotic veterinarian. This helps to ensure the safety of the
patient as well as the practitioner, who may not be aware of the dangers of working
with certain exotic species.
Chiropractic is contraindicated if there is a history of trauma or disease in which
bone integrity could be compromised. This case history could include fractures,
congenital anomalies, acute infections (eg, osteomyelitis and septic discs), spinal
tumors or malignancies, dislocation of vertebra, internal fixation or stabilization devices,
and other diseases causing instability of the spine.35 In cases of focal spine lesions,
a chiropractic adjustment may still be performed on other areas of the spine.
Studies on applying nontraditional therapies in exotic animal practice are very limited.
However, the research being done in the human and companion animal fields support
the safe application of nontraditional therapies into exotic animal practice.
Integrating nontraditional therapies into general practice requires advanced training
and skills. Attending an advanced training course or coordinating with a practitioner
who is already trained in nontraditional therapies will provide a practitioner additional
tools to complement Western therapies and work together toward the goal of prevention
and relief of animal suffering.
Model Veterinary Practice Act July 2017. Available at:
Accessed November 28,
Barnes PM, Bloom B, Nahin R.
CDC National Health Statistics Report #12.
Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007. 2008.
Accessed November 16, 2017.
Meredith K, Bolwell CF, Rogers CW, et al.
The use of allied health therapies on competition horses in the North Island of New Zealand.
N Z Vet J 2011;59(3): 123–7.
Xie H. Preface. In: Xie H, Preast V, editors.
Xie’s veterinary acupuncture.
Ames (IA): Blackwell Publishing; 2007. p. xi–xiii.
Conference Proceedings: Pacific Veterinary Conference:
PacVet 2015. Peter G. Fisher
“Exotic Mammal Geriatrics”.
Accessed November 16, 2017.
How to start traditional Chinese veterinary medicine in exotic animal practice.
In: Xie H, Trevisanello L, editors.
Application of traditional Chinese veterinary medicine in exotic animals.
Reddick(FL): Jing Tang Publishing; 2011. p. 3–28.
Xie H. Zang-Fu physiology.
Traditional Chinese veterinary medicine fundamental principles, vol. 1.
Reddick(FL): Chi Institute; 2007. p. 105–48.
TCVM for avian species: introduction, general overview, acupuncture point locations,
indications and techniques.
In: Xie H, Trevisanello L, editors.
Application of traditional Chinese veterinary medicine in exotic animals.
Reddick( FL): Jing Tang Publishing; 2011. p. 53–72.
Traditional Chinese veterinary medicine in reptiles.
In: Xie H, Trevisanello L, editors.
Application of traditional Chinese veterinary medicine in exotic animals.
Reddick(FL): Jing Tang Publishing; 2011. p. 159–92.
Law D, McDonough S, Bleakley C, et al.
Laser acupuncture for treating musculoskeletal pain: a systemic review with meta-analysis.
J Acupunct Meridian Stud 2015;8(1):2–16.
Quah-Smith I, Sachdev PS, Wen W, et al.
The brain effects of laser acupuncture in healthy individuals: an fMRI investigation.
PLoS One 2010;5(9):e12619.
The components of the pulse controlled laser acupuncture.
American Journal of TCVM 2012;7(1):57–67.
Kastner J. Theory.
Chinese Nutritional Therapy Dietetics in Traditional Chinese Medicine (TCM).
2nd edition. New York: Thieme; 2009.
Kindle edition Chapter 1, section 5, paragraph 10–11.
Kastner J. Theory.
Chinese Nutritional Therapy Dietetics in Traditional Chinese Medicine (TCM). 2nd edition.
New York: Thieme; 2009.
Kindle edition Chapter 1, section 7, paragraph 1–2.
Brady A, Wilkerson G, Williams L, et al.
Characterization and treatment of a new wasting disease of owl monkeys (Aotus sp.).
In: Joint AAZV/EAZWV/IZW Conference Proceedings, Atlanta (GA), July 16–22, 2016.
General rules of acupuncture therapy. In: Xie H, Preast V, editors.
Xie’s veterinary acupuncture.
Ames(IA): Blackwell Publishing; 2007. p. P245–6.
Gallup-Palmer College of Chiropractic Inaugural Report: American’s Perception of Chiropractic. 2015.
Accessed November 29, 2017.
Duarte FC, Kolberg C, Barros RR, et al.
Evaluation of peak force of a manually operated chiropractic adjusting instrument with an adapter for use in animals.
J Manipulative Physiol Ther 2014;37(4):236–41.
Paige NM, Miake-Lye IM, Booth MS, et al.
Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis.
Qaseem A, Wilt TJ, McLean RM, et al.
Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians.
Ann Intern Med 2017;166(7):514.
LeCouteur R, Grandy J.
Diseases of the spinal cord.
In: Ettinger S, Feldman E, editors.
Textbook of veterinary internal medicine. 6th edition.
St Louis (MO): Elsevier Sanders; 2005. p. 871.
Makitaipale J, Harcourt-Brown FM, Laitinen-Vapaavuori O.
Health survey of 167 pet rabbits (Oryctolagus cuniculus) in Finland.
Vet Rec 2015;177(16):418.
Susceptibility of spinal roots to compression block.
In: Goldstein M, editor.
The Research Status of Spinal Manipulative Therapy.
Bethesda (MD): HEW/NINCDS Monograph #15; 1975. p. 976–98.
Hobaek Siegnthaler M.
Unresolved congenital torticollis and its consequences: a report of 2 cases.
J Chiropr Med 2017;16(3):257–61.
Hobaek Siegnthaler M.
Chiropractic management of infantile torticollis with associated abnormal fixation of one eye: a case report.
J Chiropr Med 2015;14(1): 51–6.
Co-management and collaborative care of a 20-year-old female with acute viral torticollis.
J Manipulative Physiol Ther 2009;32(2):160–5.
McWilliams JE, Gloar CD.
Chiropractic care of a six-year-old child with congenital torticollis.
J Chiropr Med 2006;5(2):65–8.
Reduction of cervical dystonia after an extended course of chiropractic manipulation: a case report.
J Manipulative Physiol Ther 2004;27(6): 421–6.
Chiropractic correction of congenital muscular torticollis.
J Manipulative Physiol Ther 1993;16(8):556–9.
Dadone LI, Haussler KK, Brown G, et al.
Successful management of acute-onset torticollis in a giraffe (Giraffa camelopardalis reticulata).
J Zoo Wildl Med 2013; 44(1):181–5.
Chiropractic care for exotic pets.
Exotic DVM 2000;2(1):15–8.
Use of chiropractic for therapy and prevention of disease.
In: Western Veterinary Conference Proceedings. 2003. Available at:
Accessed December 11, 2017.
Chiropractic in the NFL.
In: Professional Football Chiropractic Society. Available at:
Accessed December 1, 2017.
Pain and the nerve root.
Guidelines on safety of Chiropractic.
In: WHO guidelines on basic training and safety in chiropractic. 2005. Available at:
Accessed December 1, 2017.
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