Acupuncture is one of the most widely used and successful alternative therapies available in equine practice. It has been practiced in China for over 3000 years in both humans and animals and now has become an exciting tool for American practitioners since its introduction to the Western world. Many scientific studies have been performed that validate the efficacy of acupuncture therapy. It can be used for a variety of musculoskeletal and medical conditions such as back pain, arthritis, non-sweating, and heaves. Acupuncture can be a valuable addition to the management of the performance horse, helping to keep them at the top of their game.