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Scooped by
Dr. Alex Jimenez
November 5, 8:58 PM
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For individuals going through post surgery, injury rehabilitation, illness and/or chronic condition management, can physical therapy isometric exercises help? Isometric Exercise Isometric exercises are used in physical therapy to help build muscle endurance, improve range of motion, relieve pain, and reduce blood pressure more effectively than other types of exercise. Because they don't involve joint movement, they are a solid starting point for rehabilitation and are suitable for individuals with a limited range of motion. They can be performed by pushing against an immovable object, like a wall, or by having a therapist provide resistance. Examples of isometric exercises include: - Planks
- Glute bridges
- Adductor isometrics
A physical therapist/PT may have a patient perform isometric exercises after injury or illness. During an isometric contraction, the muscle does not change in length, and there is no motion around the joint surrounding the muscle/s. (Rhyu H. S. et al., 2015) When To Use Isometric muscular contractions can be used at any time during physical rehabilitation and strengthening or a home exercise program and are regularly used with the following (Rhyu H. S. et al., 2015) - Post-surgery
- When muscles cannot contract forcefully enough to move the joint it surrounds.
- To help increase neuromuscular input to a specific muscle/s.
- When injury or condition frailty makes other forms of exercise dangerous and not beneficial.
A healthcare provider or physical therapist should be consulted first if isometrics are used in a rehabilitation program. Benefits The benefits of using isometric exercise after injury or surgery may include the following: - No special equipment is necessary to perform isometric exercises.
- The ability to safely contract a muscle while protecting a surgical incision or scar tissue.
- The muscles can be strengthened in a specific range of motion around a joint. (NikolaidouO. et al., 2017)
A physical therapist can help determine whether isometric exercise benefits the specific condition. Effectiveness Isometric exercise is very effective after injury or surgery. However, when a muscle is contracted isometrically, it gains strength in a very small area and with a short range of motion. For example, an isometric shoulder external rotation performed with the arm at the side will only strengthen the rotator cuff muscles in the specific position that the arm is in. (NikolaidouO. et al., 2017). - Strength gains are specific to the joint's position during the exercise.
- Individuals who want to strengthen their gluteal muscles in their hip using isometrics would have to contract their glute muscles in one specific position for several reps.
- Once several reps of the exercise in one position have been performed, the individual moves their hip joint into a new position and repeats the gluteal contractions in the new position.
- This makes the exercise time-consuming, but it is perfect for injury rehabilitation, preventing and avoiding worsening or further injuries.
How to Perform To perform isometric exercises, all that is needed is something stable to push against. (Rhyu H. S. et al., 2015) For example, to strengthen the shoulder muscles: - Stand next to a wall and try to lift an arm out to the side.
- Allow the hand to press against the wall so no motion occurs at the shoulder joint.
- Once pressed against the wall, hold the contraction for 5 to 6 seconds and slowly release it.
- Perform 6 to 10 repetitions of the exercise.
- This could be one set of completed isometric exercises for the shoulder muscles.
Elastic resistance bands or tubing can also be used to perform isometric exercises. Hold the tubing in a specific position and then move the body away from the anchor point instead of moving the joint. The muscles will contract against the increased resistance of the elastic tubing, and no motion will occur at the joint. A physical therapist can show and train on how to perform isometric exercises with the bands. Neuromuscular Stimulation Isometric exercise can strengthen muscles and help improve the neuromuscular recruitment of the muscles being trained. This enhances muscle contraction and expedites gains in muscle recruitment while protecting the joint. Isometric exercise can also be used during physical therapy using neuromuscular electrical stimulation (NMES). (Fouré A. et al., 2014) For example, a PT may use NMES to improve muscular function for individuals who have difficulty contracting their quadriceps after knee surgery and may be instructed to perform isometric quad-setting exercises during the session. Injury Medical Chiropractic and Functional Medicine Clinic A physical therapist can use isometric exercises to help individuals injured or have had surgery and are experiencing difficulty with normal functional mobility by improving their strength during recovery. The exercises can safely enhance the function and stability of the muscles and return individuals to the previous level of activity and function. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues. General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies that are available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to contact Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References Rhyu, H. S., Park, H. K., Park, J. S., & Park, H. S. (2015). The effects of isometric exercise types on pain and muscle activity in patients with low back pain. Journal of Exercise Rehabilitation, 11(4), 211–214. https://doi.org/10.12965/jer.150224 Nikolaidou, O., Migkou, S., & Karampalis, C. (2017). Rehabilitation after Rotator Cuff Repair. The Open Orthopaedics Journal, 11, 154–162. https://doi.org/10.2174/1874325001711010154 Fouré, A., Nosaka, K., Wegrzyk, J., Duhamel, G., Le Troter, A., Boudinet, H., Mattei, J. P., Vilmen, C., Jubeau, M., Bendahan, D., & Gondin, J. (2014). Time course of central and peripheral alterations after isometric neuromuscular electrical stimulation-induced muscle damage. PloS one, 9(9), e107298. https://doi.org/10.1371/journal.pone.0107298
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Scooped by
Dr. Alex Jimenez
September 26, 8:42 PM
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Can physical therapies help individuals with a Colles' or wrist fracture? Colles' Fracture A broken wrist or Colles fracture can be a painful and stressful experience. Individuals may be unable to perform their jobs or engage in recreational activities. A Colles fracture is a break in the radius bone of the forearm that occurs near the wrist, usually about an inch from the end of the bone. It's a common type of broken wrist often caused by falling on an outstretched hand. (American Academy of Orthopaedic Surgeons, 2022) As the individual lands on their hand, the end of the radius bone breaks off and gets pushed toward the inner wrist. If the wrist is flexed when falling on the hand, the radius may break and move toward the front of the wrist. This is called a Smith's fracture. (Matsuura, Y. et al., 2017) A physical therapy team can help improve functional mobility to quickly and safely return to normal activity. Symptoms Individuals who have suffered trauma to their wrist or have fallen onto their hand or wrist may have a Colles fracture. Common signs and symptoms of a wrist or Colles fracture include: (American Academy of Orthopaedic Surgeons, 2022) - Bruising
- Loss of mobility in the wrist.
- Swelling in the arm, wrist, or hand.
- Pain
- Visible deformity or a lump on the backside of the forearm near the wrist.
Initial Treatment Individuals who have fallen and injured their wrist and hand and suspect a Colles fracture should seek immediate medical attention. Call a healthcare provider or report to a local emergency clinic. Left untreated, a Colles fracture can result in complications and permanent loss of arm and hand function (American Academy of Orthopaedic Surgeons, 2022). An X-ray will show a wrist fracture. Because of the pain and swelling, it is recommended that individuals put an ice pack on their wrists and hands until they can get to a healthcare provider or emergency room. The R.I.C.E. principle can help control swelling and lessen pain until a medical professional can provide treatment. The initial treatment is to reduce the fracture. This is where a healthcare provider situates the broken bone or bones back into the correct position to ensure proper healing. This is done manually if the fractured bone is not too far out. If the fracture is severe, a surgical procedure known as an open reduction internal fixation or ORIF may be required to reduce the fracture. (American Academy of Orthopaedic Surgeons, 2022) Once the fracture has been reduced, it must be immobilized. This is done with a cast or a brace. Individuals may also be required to wear a sling. They may need to visit a physical therapist to learn how to wear the sling properly. It is essential to keep the bones immobilized for proper healing. Consult a healthcare provider for questions about cast, sling, or brace. Physical Therapy After four to six weeks of immobilization, a healthcare provider may remove the cast and refer a physical therapist or team. (American Academy of Orthopaedic Surgeons, 2022) A physical therapist may measure and evaluate pain, swelling, range of motion, and strengthening. The physical therapist may assess the surgical scar tissue and analyze the hand, wrist, and arm function of individuals who underwent an ORIF procedure to reduce the fracture. After the initial evaluation, a physical therapist will work with the patient to develop an appropriate plan of care to help improve the impairments and functional limitations. The therapist may prescribe a specific exercise program as well. Pain and Swelling - Individuals may experience pain and swelling around their wrists and hands.
- A physical therapist can provide individuals with various treatments and modalities to help decrease swelling and pain.
Range of Motion - After a Colles' fracture, individuals may lose hand, wrist, and elbow mobility.
- The shoulder may also be tight, especially after wearing a sling.
- Range of motion exercises for the hand, wrist, and elbow can be prescribed.
Strength - Loss of strength is common after a Colles' fracture.
- Exercises focusing on hand, wrist, and elbow strength may be prescribed.
- At-home exercises and stretches will get the best results from physical therapy.
Scar Tissue - Individuals who have had an ORIF procedure will likely have scar tissue that has developed around the surgical site.
- A physical therapist may perform scar tissue massage and mobilization to help improve mobility and can train patients how to self-massage.
Injury Medical Chiropractic and Functional Medicine Clinic After a few weeks of physical therapy, individuals should notice their mobility and strength improve while pain and swelling decrease. Individuals will find it easier to use their arms and hands to perform functional activities. While the fracture should be fully healed six to eight weeks after injury, individuals may still be limited for potentially 12 to 16 weeks. At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for every patient to restore function. If other treatment is needed, individuals will be referred to a clinic or physician best suited to their injury, condition, or ailment. General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies that are available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References American Academy of Orthopaedic Surgeons. (2022). Distal radius fractures (broken wrist). https://orthoinfo.aaos.org/en/diseases--conditions/distal-radius-fractures-broken-wrist/ Matsuura, Y., Rokkaku, T., Kuniyoshi, K., Takahashi, K., Suzuki, T., Kanazuka, A., Akasaka, T., Hirosawa, N., Iwase, M., Yamazaki, A., Orita, S., & Ohtori, S. (2017). Smith's fracture generally occurs after falling on the palm of the hand. Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 35(11), 2435–2441. https://doi.org/10.1002/jor.23556
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Scooped by
Dr. Alex Jimenez
August 13, 8:57 PM
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Can the Oswestry Low Back Pain Disability Questionnaire help assess how low back pain impacts individuals' ability to perform everyday tasks and activities and help physical therapists incorporate the outcome measure into an effective treatment plan? Oswestry Disability Questionnaire The Oswestry Disability Questionnaire, also known as the Oswestry Disability Index, provides objective data about an individual's lower back pain. It determines the severity of the pain and how much it limits their daily activities. The questionnaire is a validated measure backed by research that can be used to justify the need for medical treatment. It includes questions regarding the symptoms and severity of low back pain and how these symptoms interfere with regular activities. Lower back pain can result from various causes (National Institute of Neurological Disorders and Stroke, 2020) - Poor posture
- Pregnancy
- Low back muscle strain
- Muscle imbalances
- Bulging discs
- Herniated discs
- Nerve root compression
- Sacroiliac joint dysfunction
- Arthritis, including inflammatory types of arthritis like psoriatic arthritis and ankylosing spondylitis.
- Lumbar vertebrae compression fractures - usually from trauma or osteoporosis.
- Low back surgery - including spinal fusions, discectomies, and laminectomies.
- Spinal stenosis
- Spondylolisthesis
- Scoliosis
How The Questionnaire Works The Oswestry Disability Questionnaire consists of 10 questions about the impact of lower back pain on daily life. The questions are divided into the following categories: (American Academy of Orthopedic Surgeons, N.D.) Pain Intensity - How intense is the pain?
- If painkillers are used, how much symptom relief do they provide?
Personal Care - Can the patient perform self-care activities like bathing and dressing when experiencing significant pain or limitations?
- Whether physical assistance from another person is needed?
Lifting - Can the patient lift objects like weights with or without pain?
- Can lifting be performed from the floor or a higher surface like a table if the objects are light, moderate, or heavy?
Walking - If and to what extent does the pain limit the patient's walking distance and independence?
- If an assistive device like a cane or crutches are needed?
Sitting - If so, how much pain limits the patient's sitting tolerance?
Standing - If so, how much pain limits the patient's standing tolerance?
Sleeping - If so, how much pain limits a patient's sleeping duration?
- Whether pain medication is needed to help the patient sleep comfortably?
Social Life - If and to what extent a patient’s social activities are limited because of pain symptoms?
Traveling - If so, to what extent does pain limit a patient’s ability to travel?
Employment and/or Homemaking Duties - Does pain limit a patient’s ability to perform job-related and/or household activities, including physically demanding and light duties?
- Patients self-report the information and complete it on their own based on their understanding of the extent of their lower back pain and disability.
- Each question can be scored between 0 and 5, with 0 indicating no limitations and 5 indicating complete disability.
- The scores from all the questions are added together for a cumulative total score of 50 points.
Scores The Oswestry Disability Questionnaire assesses how much a patient’s lower back pain limits daily activities. This information is used in clinical documentation for medical services. A higher score indicates a greater level of disability, according to the following scoring criteria: - 0–4: No disability
- 5–14: Mild disability
- 15–24: Moderate disability
- 25–34: Severe disability
- 35–50: Completely disabled
Physical therapists must create individualized goals for each patient to develop a treatment plan and receive authorization from insurance companies. One of the most important aspects of a physical therapy goal is that it must be measurable. The Oswestry Disability Questionnaire provides a numerical score to track functional limitations and monitor the range of motion and strength testing. A baseline measurement is taken at the beginning of treatment, and progress is tracked in follow-up visits. A new score is used as a treatment goal. According to a study, the minimal clinically important difference (MCID) for the Oswestry Disability Questionnaire is 12.88. The MCID is the minimum score healthcare providers need to confirm a patient's progress in function due to treatment. (Johnsen, L. G. et al., 2013) By tracking changes in the total score before, during, and after treatment, healthcare providers can better assess whether treatment improves symptoms. A decrease in total score by 13 points or more would indicate that treatment is helping to improve a patient’s lower back pain and level of disability. Along with physical examination results, the patient’s score and the severity of symptoms can help healthcare providers determine an appropriate treatment plan. No Disability - Treatment is unnecessary other than providing advice for lifting mechanics and general physical activity to maintain health.
Mild Disability - Conservative measures, such as physical therapy, exercise, hot or cold therapy, pain medication, and rest, are needed to help alleviate symptoms.
Moderate Disability - More aggressive intervention is needed, which can include extensive physical therapy services and pain management.
Severe Disability - Significant medical intervention is needed, including surgery, pain management, equipment like wheelchairs, and help from a caretaker.
Completely Disabled - Patients are either bedbound or have worsening symptoms, and a caretaker is needed to complete daily activities and self-care tasks.
Injury Medical Chiropractic and Functional Medicine Clinic Improvements in range of motion, strength, and quality of movement and a decrease in total score can help show the treatment's positive impact in managing lower back pain. A thorough medical exam and diagnostic tests, such as X-ray, MRI, or EMG, can help determine the underlying causes, discover the cause of the problem, and develop an effective treatment plan. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. Using an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility and help individuals return to normal activities. Our providers use Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers. General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies that are available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, don't hesitate to contact Dr. Alex Jimenez or us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References National Institute of Neurological Disorders and Stroke. (2020). Low Back Pain Fact Sheet. Retrieved from https://www.ninds.nih.gov/sites/default/files/migrate-documents/low_back_pain_20-ns-5161_march_2020_508c.pdf American Academy of Orthopedic Surgeons. (N.D.). Oswestry Low Back Pain Disability Questionnaire. https://www.aaos.org/globalassets/quality-and-practice-resources/patient-reported-outcome-measures/spine/oswestry-2.pdf Johnsen, L. G., Hellum, C., Nygaard, O. P., Storheim, K., Brox, J. I., Rossvoll, I., Leivseth, G., & Grotle, M. (2013). Comparison of the SF6D, the EQ5D, and the Oswestry disability index in patients with chronic low back pain and degenerative disc disease. BMC musculoskeletal disorders, 14, 148. https://doi.org/10.1186/1471-2474-14-148
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Scooped by
Dr. Alex Jimenez
July 1, 8:58 PM
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Can incorporating stretches and exercises help relieve pain and provide more support for individuals with knee pain? Knee Strengthening The knee is the largest joint connecting the shin and thigh bones. Its cartilage, muscles, ligaments, and nerves all play a role in maintaining the joint's health and movement. Individuals of all ages can experience knee pain, but it is more common in those with labor-intensive jobs, arthritis, and athletes. A healthcare provider will prescribe targeted stretches and exercises for individuals with pain, inflammation, or a health disorder that affects the strength of their knees to relieve knee pain while strengthening the muscles around the joint. Knee stretches and exercises are great for those with sore knees and knee pain or stiffness, but they can also be used as preventative medicine. Exercise Benefits Doing knee-strengthening exercises can significantly improve joint health. The benefits associated with exercises include (Zeng C. Y. et al., 2021) - Reduced pain, stiffness, and joint dysfunction.
- Reduced inflammation.
- Improved mobility.
- Improved strength.
- Cartilage degeneration prevention.
- Bone loss prevention.
Leg Lifts Leg lifts are done by lying on the back with one leg bent and the other fully extended. To perform the exercise: (American Academy of Orthopaedic Surgeons, 2009) - Raise the extended leg, keeping it straight.
- Hold for three to five seconds once the leg is elevated roughly one foot off the floor.
- Lay it back down to rest.
- Repeat the exercise 20 times for each leg.
What To Avoid When performing the single-leg lift, there are certain things to avoid as they can lead to other issues or injuries. This includes: (American Academy of Orthopaedic Surgeons, 2009) - Arching the back
- Flexing the neck
- Moving too quickly through the motion.
- Using momentum instead of the muscles.
To know the exercise is being performed correctly, individuals should feel it in the front of their thighs. Hamstring Stretch on a Bench If a weight bench is available, doing hamstring stretches can help strengthen the knee. To perform this stretch: - Sit straight on the bench, with one leg straight out and the other planted on the floor.
- With the knee straight, hinge over from the hips, keeping a straight, neutral spine.
- Slowly push the chest towards the leg straight out on the bench. Hold for 15 to 30 seconds.
This exercise helps with overall strength, stamina, and balance. (Kothawale S. Rao K. 2018) (Wang H. et al., 2016) What To Avoid Avoid curving the spine to get closer to the thigh during the stretch. The key is not how far you can bend down but getting a deep stretch. Individuals not yet flexible enough to go all the way down should bend until comfortable but can still feel the stretch in their hamstrings. With practice and time, flexibility will improve. This stretch should be felt in the hamstrings. Step Exercises Step exercises, or step-ups, involve using a platform at least 6 inches high. To perform the exercise: - Put one foot onto the platform and use that leg to lift the other foot off the floor.
- Hold the position with the foot hanging loosely for 3 to 5 seconds, then place the foot back on the floor.
- Repeat each motion 20 times on each leg. (American Academy of Orthopaedic Surgeons, 2009)
What To Avoid Avoid locking the knees when stepping up on the platform. Locking the knees switches off the muscles that need strengthening (American Academy of Orthopaedic Surgeons, 2009). Step exercises work out various areas of the leg. Individuals should feel this exercise in the thigh, hip, and buttocks. Post-Exercise Stretching Post-exercise stretching is vital in physical rehabilitation and strengthening. Stretching after exercise, individuals can (Afonso J. Clemente. et al., 2021) - Relieve and reduce soreness.
- Expedite recovery times.
- Increase range of motion.
- Strengthen the knees more quickly and effectively.
Post-exercise stretches for knee pain and weakness can include: Quadricep Stretch This stretch targets the quad muscles located in the thighs. To perform this stretch: - Stand with the feet planted flat on the floor, spaced the same width as the shoulders.
- Bending the left knee, grab the foot with the left hand and pull the heel toward the buttocks.
- Hold for 5 to 10 seconds.
- Repeat on both sides.
What to Avoid There is no need to pull the heel too far into the buttocks. The goal is to feel a deep stretch. Pushing it too far can lead to injury. (Lee J. H. et al., 2021) Toe Touches Toe touches will help stretch calve muscles and hamstrings. To perform this stretch: - Sit on the floor with the legs straight out in front.
- Bend the body over the legs at the hips, reaching for the toes in front while maintaining a straight back.
- Relax the shoulders and keep them away from the ears.
- Once touching the toes, hold the stretch for 15 seconds.
What To Avoid Individuals who cannot yet touch their toes should perform the same steps and reach only as far as is comfortably possible. Over time, flexibility will improve. (Lee J. H. et al., 2021) Injury Medical Chiropractic Clinic These are examples of exercises and stretches that a physical therapy and chiropractic team may prescribe. Each case is different and requires reviewing individual medical history and physical examination to determine the proper treatment program. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment program through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility to relieve pain and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments. General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please get in touch with Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References Zeng, C. Y., Zhang, Z. R., Tang, Z. M., & Hua, F. Z. (2021). Benefits and Mechanisms of Exercise Training for Knee Osteoarthritis. Frontiers in physiology, 12, 794062. https://doi.org/10.3389/fphys.2021.794062 American Academy of Orthopaedic Surgeons. OrthoInfo. (2009). Knee exercises. https://orthoinfo.aaos.org/en/staying-healthy/knee-exercises/ Kothawale S. and Rao K. (2018). Effectiveness of positional release technique versus active release technique on hamstring tightness. Int J Physiother Res., 6(1), 2619-2622. https://doi.org/https://dx.doi.org/10.16965/ijpr.2017.265 Wang, H., Ji, Z., Jiang, G., Liu, W., & Jiao, X. (2016). Correlation among proprioception, muscle strength, and balance. Journal of Physical Therapy Science, 28(12), 3468–3472. https://doi.org/10.1589/jpts.28.3468 Afonso, J., Clemente, F. M., Nakamura, F. Y., Morouço, P., Sarmento, H., Inman, R. A., & Ramirez-Campillo, R. (2021). The Effectiveness of Post-exercise Stretching in Short-Term and Delayed Recovery of Strength, Range of Motion and Delayed Onset Muscle Soreness: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Frontiers in physiology, 12, 677581. https://doi.org/10.3389/fphys.2021.677581 Lee, J. H., Jang, K. M., Kim, E., Rhim, H. C., & Kim, H. D. (2021). Effects of Static and Dynamic Stretching With Strengthening Exercises in Patients With Patellofemoral Pain Who Have Inflexible Hamstrings: A Randomized Controlled Trial. Sports Health, 13(1), 49–56. https://doi.org/10.1177/1941738120932911
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Scooped by
Dr. Alex Jimenez
May 21, 9:27 PM
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Can physical therapies help relieve muscle contractures in individuals who have endured prolonged bed rest, inactivity, or lack of use of certain muscle groups? Muscle Contracture A muscle contracture, or contracture deformity, is caused when a muscle loses elasticity. This causes permanent shortening and tightening of muscle fibers, which reduces flexibility and makes movement difficult. Muscles that cannot move and stretch cause the surrounding joints to lose mobility and develop pain symptoms. When trying to stretch the contracted muscle, the individual will feel the muscle become very rigid, which can increase pain. (Lieber, R. L., and Fridén, J. 2019) Delaying treatment can potentially cause irreversible and chronic symptoms. Commonly Affected Muscles Flexor muscles bend the joints and are those most affected by contractures. The stiffening and tightening prevent the body parts from moving out and away. The most common include: Wrist and Finger Flexors - Muscle groups that bend the wrist and fingers.
Biceps - The primary elbow flexor that bends the arm.
Gastrocnemius and Soleus - The calf muscles which allow the ankle to point the foot/plantarflexion.
Hamstrings - A group of three muscles behind the thigh that bend the knee.
Causes The permanent shortening of muscle fibers and changes in muscle structure cause muscle contractures or stiffer-than-normal tissue that is difficult to stretch. Sarcomeres are structural units of muscles that cause fibers to contract. With contractures, the sarcomeres overly lengthen when the muscle fibers tighten. This increase in sarcomere length prevents the muscle from contracting normally, resulting in weakness. Muscle fibers are encased in an extracellular matrix, a mesh composed of collagen and other proteins that help transmit force and provide muscle contraction. Muscle contractures cause the amount of collagen within the extracellular matrix to increase, causing a stiffening of fibers that restricts movement. (Lieber, R. L., and Fridén, J. 2019) Muscle contractures also form from decreased satellite cells. Satellite cells are specialized stem cells that can rebuild muscle and are necessary for muscle regeneration and repair. Without the proper amount of satellite cells, other cells like fibroblasts significantly increase in the muscle tissue, causing the fibers to become stiff and fibrotic or more fibrous. These changes to the sarcomeres, collagen within the extracellular matrix, and decreased satellite cells all result from conditions in which neurological input to the brain and spinal cord muscles becomes reduced. This is caused by lack of use, injury, or neurological and neuromuscular conditions. (Lieber, R. L., and Fridén, J. 2019) Cerebral Palsy Contractures often occur from upper motor neuron lesions, which prevent signals from the brain and spinal cord from reaching the motor neurons that control muscle contraction. When these signals are weakened or blocked, muscles become stiff and weak from lack of stimulation. (Lieber, R. L., and Fridén, J. 2019) Cerebral palsy is a group of disorders affecting mobility caused by an upper motor neuron lesion that is present at birth and is the most common motor disability in children. It causes: - Cognitive impairment
- Decreased muscle strength
- Problems with movement, coordination, and functional motions.
Because cerebral palsy prevents the muscles of the legs from being sufficiently stimulated, contractures commonly develop in the hips, knees, and ankles. Individuals can have a 75% decrease in satellite cells to repair muscle tissue and prevent muscle fibrosis or stiffening. Specific genes linked to collagen production are also altered, causing irregular changes to the extracellular matrix of muscles. (Lieber, R. L., and Fridén, J. 2019) Muscular Dystrophy Muscular dystrophy is a group of inherited neuromuscular disorders characterized by muscle weakness and wasting. Deficient nerve supply to muscles causes them to become stiff and tight, inhibiting the functional range of motion needed to move joints and activate muscles to move. Clinical research suggests that individuals with muscular dystrophy have decreased levels of satellite cells to repair, increasing the risk of developing muscle contracture. (Lieber, R. L., and Fridén, J. 2019) Disuse-induced Muscle Wasting or Disuse Atrophy When muscles are not used for some time because of hospitalization, prolonged bed rest, or immobilization from wearing braces, splints, or casts after injuries, the blood circulation and electrical signaling from nerves to muscles decreases. This results in weakness, increased muscle tightness and stiffness, and muscle wasting/atrophy. Over time, stiff and tight muscles can progress to contractures that become extremely difficult to stretch. Trauma or Injury Muscle or tendon injuries can cause contractures as scar tissue develops, joining muscle fibers and joints together. This can significantly restrict movement. Large burns can also cause skin, muscles, and joint contractures. The range of motion can become significantly limited, and the changes can become irreversible if not aggressively treated. Other Causes Other forms of upper motor neuron lesions that can cause contractures because of weak or blocked electrical input to muscles as a result of brain or spinal cord damage include: - Stroke
- Traumatic brain injuries
- Spinal cord injuries (Lieber, R. L., and Fridén, J. 2019)
- Neuromuscular disorders like spinal muscular atrophy - SMA.
- Conditions that cause inflammation and joint stiffening, like juvenile rheumatoid arthritis.
- A history of diabetes also increases the risk of developing contractures affecting finger flexors, like Dupuytren’s contractures and stenosing tenosynovitis
or trigger finger. (Lieber, R. L., and Fridén, J. 2019) Symptoms Symptoms include: - Extremely stiff and tight muscles resistant to stretching.
- Pain from the inability to stretch.
- Loss of range of motion.
- Impaired joint mobility.
- Severe contractures can interfere with the functional range of motion needed to move joints to complete normal tasks and movements, such as standing up from a chair and walking.
Treatment Physical Therapy Exercise Regular exercise can: - Reduce joint stiffening and muscle tightening.
- Help maintain joint mobility and range of motion.
- Improve blood circulation and muscle activation. (Lieber, R. L., and Fridén, J. 2019)
Braces and Splints - Specialized braces or splints can be custom-made to fit different body parts.
- These provide a prolonged low-intensity stretch over a period of time to increase muscle length.
- Once the muscle has stretched, a new brace or splint may be needed to adjust to the increased range of motion. (Lieber, R. L., and Fridén, J. 2019)
Surgery In severe cases where muscle contractures limit the functional range of motion needed for activities of daily living or ADLs, surgical release of the contracted tissue may be recommended. This surgery can improve functional movements like walking, getting in and out of bed, and standing up from chairs. The tight muscles can be surgically cut, and the tendons can be lengthened to allow more mobility. (Lieber, R. L., and Fridén, J. 2019) The causes of muscle contracture are not always avoidable, but various treatment options are available to help loosen up tight muscles and preserve or restore the range of motion. It’s important to move daily and stretch common areas like the fingers, arms, and legs to reduce the risk of muscle tightness and prevent contractures from developing. It is imperative to seek medical treatment for severe contractures resulting from neuromuscular disorders, including physical and occupational therapy, to prevent contractures from worsening and regaining as much functional range as possible. Injury Medical Chiropractic and Functional Medicine Clinic uses an integrated approach personalized to the individual that focuses on what works for them and treats injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers use an integrated approach to create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Our goal is to relieve pain naturally by restoring health and function to the body. If another treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments. General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please get in touch with Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References Lieber, R. L., & Fridén, J. (2019). Muscle contracture and passive mechanics in cerebral palsy. Journal of applied physiology (Bethesda, Md. : 1985), 126(5), 1492–1501. https://doi.org/10.1152/japplphysiol.00278.2018
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Scooped by
Dr. Alex Jimenez
April 11, 9:20 PM
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Can knowing treatment options for a dislocated hip help individuals expedite rehabilitation and recovery? Dislocated Hip A dislocated hip is an uncommon injury but can happen due to trauma or following hip replacement surgery. It usually occurs after severe trauma, including motor vehicle collisions, falls, and sometimes sports injuries. (Caylyne Arnold et al., 2017) A dislocated hip can also occur after hip replacement surgery. Other injuries like ligament tears, cartilage damage, and bone fractures can occur alongside the dislocation. Most hip dislocations are treated with a joint reduction procedure that resets the ball into the socket. It is usually done with sedation or general anesthesia. Rehabilitation takes time and could be a few months before full recovery. Physical therapy can help restore motion and strength in the hip. What Is It? If the hip is only partially dislocated, it's called a hip subluxation. When this happens, the hip joint head only partially emerges from the socket. A dislocated hip is when the head or ball of the joint shifts or pops out of the socket. Because an artificial hip differs from a normal hip joint, the risk of dislocation increases after joint replacement. A study found that around 2% of individuals who undergo total hip replacement will experience hip dislocation within a year, with the cumulative risk increasing by approximately 1% over five years. (Jens Dargel et al., 2014) However, new technological prosthetics and surgical techniques are making this less common. Hip Anatomy - The hip ball-and-socket joint is called the femoroacetabular joint.
- The socket is called the acetabulum.
- The ball is called the femoral head.
The bony anatomy and strong ligaments, muscles, and tendons help to create a stable joint. Significant force must be applied to the joint for a hip dislocation to occur. Some individuals report feeling a snapping sensation of the hip. This usually is not a hip dislocation but indicates a different disorder known as snapping hip syndrome. (Paul Walker et al., 2021) Posterior Hip Dislocation - Around 90% of hip dislocations are posterior.
- In this type, the ball is pushed backward from the socket.
- Posterior dislocations can result in injuries or irritation to the sciatic nerve. (R Cornwall, T E Radomisli 2000)
Anterior Hip Dislocation - Anterior dislocations are less common.
- In this type of injury, the ball is pushed out of the socket.
Hip Subluxation - A hip subluxation occurs when the hip joint ball starts to come out of the socket partially.
- Also known as a partial dislocation, it can turn into a fully dislocated hip joint if not allowed to heal properly.
Symptoms Symptoms can include: - The leg is in an abnormal position.
- Difficulty moving.
- Severe hip pain.
- Inability to bear weight.
- Mechanical lower back pain can create confusion when making a proper diagnosis.
- With a posterior dislocation, the knee and foot will be rotated towards the body's midline.
- An anterior dislocation will rotate the knee and foot away from the midline. (American Academy of Orthopaedic Surgeons. 2021)
Causes A dislocation can cause damage to the structures that hold the ball in the socket and can include: - Cartilage damage to the joint -
- Tears in the labrum and ligaments.
- Fractures of the bone at the joint.
- Injury to the vessels that supply blood can later lead to avascular necrosis or osteonecrosis of the hip. (Patrick Kellam, Robert F. Ostrum 2016)
- A hip dislocation increases the risk of developing joint arthritis following the injury and can raise the risk of needing a hip replacement later in life. (Hsuan-Hsiao Ma et al., 2020)
Developmental Dislocation of the Hip - Some children are born with developmental dislocation of the hip or DDH.
- Children with DDH have hip joints that did not form correctly during development.
- This causes a loose fit in the socket.
- In some cases, the hip joint is completely dislocated.
- In others, it's prone to becoming dislocated.
- In milder cases, the joint is loose but not prone to becoming dislocated. (American Academy of Orthopaedic Surgeons. 2022)
Treatment Joint reduction is the most common way to treat a dislocated hip. The procedure repositions the ball back into the socket and is usually done with sedation or under general anesthesia. Repositioning a hip requires significant force. A hip dislocation is considered an emergency, and reduction should be performed immediately after the dislocation to prevent permanent complications and invasive treatment. (Caylyne Arnold et al., 2017) - Once the ball is back in the socket, the healthcare provider will look for bone, cartilage, and ligament injuries.
- Depending on what the healthcare provider finds, further treatment may be necessary.
- Fractured or broken bones may need to be repaired to keep the ball within the socket.
- Damaged cartilage may have to be removed.
Surgery Surgery could be necessary to return the joint to its normal position. Hip arthroscopy can minimize the invasiveness of certain procedures. A surgeon inserts a microscopic camera into the hip joint to help the surgeon repair the injury using instruments inserted through other small incisions. Hip replacement surgery replaces the ball and socket, a common and successful orthopedic surgical procedure. This surgery may be performed for various reasons, including trauma or arthritis, as it is common to develop early arthritis of the hip after this type of trauma. This is why many who have a dislocation ultimately need hip replacement surgery. As a major surgical procedure, it is not without risks. Possible complications include: - Infection
- Aseptic loosening (the loosening of the joint without infection)
- Hip dislocation
Recovery Recovering from a hip dislocation is a long process. Individuals will need to walk with crutches or other devices early in recovery. Physical therapy will improve the range of motion and strengthen the muscles around the hip. Recovery time will depend on whether other injuries, such as fractures or tears, are present. If the hip joint was reduced and there were no other injuries, it may take six to ten weeks to recover to the point where weight can be placed on the leg. It could be between two and three months for a full recovery. Keeping weight off the leg is important until the surgeon or physical therapist gives the all-clear. Injury Medical Chiropractic and Functional Medicine Clinic will work with an individual's primary healthcare provider and other surgeons or specialists to develop an optimal personalized treatment plan. General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to contact Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References Arnold, C., Fayos, Z., Bruner, D., Arnold, D., Gupta, N., & Nusbaum, J. (2017). Managing dislocations of the hip, knee, and ankle in the emergency department [digest]. Emergency medicine practice, 19(12 Suppl Points & Pearls), 1–2. Dargel, J., Oppermann, J., Brüggemann, G. P., & Eysel, P. (2014). Dislocation following total hip replacement. Deutsches Arzteblatt international, 111(51-52), 884–890. https://doi.org/10.3238/arztebl.2014.0884 Walker, P., Ellis, E., Scofield, J., Kongchum, T., Sherman, W. F., & Kaye, A. D. (2021). Snapping Hip Syndrome: A Comprehensive Update. Orthopedic reviews, 13(2), 25088. https://doi.org/10.52965/001c.25088 Cornwall, R., & Radomisli, T. E. (2000). Nerve injury in traumatic dislocation of the hip. Clinical orthopaedics and related research, (377), 84–91. https://doi.org/10.1097/00003086-200008000-00012 American Academy of Orthopaedic Surgeons. (2021). Hip dislocation. https://orthoinfo.aaos.org/en/diseases--conditions/hip-dislocation Kellam, P., & Ostrum, R. F. (2016). Systematic Review and Meta-Analysis of Avascular Necrosis and Posttraumatic Arthritis After Traumatic Hip Dislocation. Journal of orthopaedic trauma, 30(1), 10–16. https://doi.org/10.1097/BOT.0000000000000419 Ma, H. H., Huang, C. C., Pai, F. Y., Chang, M. C., Chen, W. M., & Huang, T. F. (2020). Long-term results in the patients with traumatic hip fracture-dislocation: Important prognostic factors. Journal of the Chinese Medical Association : JCMA, 83(7), 686–689. https://doi.org/10.1097/JCMA.0000000000000366 American Academy of Orthopaedic Surgeons. (2022). Developmental dislocation (dysplasia) of the hip (DDH). https://orthoinfo.aaos.org/en/diseases--conditions/developmental-dislocation-dysplasia-of-the-hip-ddh/
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Scooped by
Dr. Alex Jimenez
March 5, 9:11 PM
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Can physical therapy with instrument-assisted soft tissue mobilization or IASTM improve mobility, flexibility, and health for individuals with musculoskeletal injuries or illnesses? Instrument Assisted Soft Tissue Mobilization Instrument-assisted soft tissue mobilization or IASTM is also known as the Graston technique. It is a myofascial release and massage technique used in physical therapy where the therapist uses metal or plastic tools to improve soft tissue mobility in the body. The ergonomically shaped tool is gently or vigorously scraped and rubbed across the injured or painful area. The rubbing is used to locate and release tightness in the fascia/collagen covering the muscles and the tendons. This helps reduce pain and improve movement. Massage and Myofascial Release Instrument-assisted soft tissue mobilization rehabilitation helps: - Improve soft tissue mobility.
- Release of restrictions in tight fascia.
- Decrease muscle spasms.
- Improve flexibility.
- Increased circulation to the tissues.
- Relieve pain. (Fahimeh Kamali et al., 2014)
Individuals often develop tissue tightness or restrictions in the muscles and fascia after an injury. These soft tissue restrictions can limit the range of motion - ROM and can trigger pain symptoms. (Kim J, Sung DJ, Lee J. 2017) History The Graston technique of instrument-assisted soft tissue mobilization was developed by an athlete who created their instruments to treat soft tissue injuries. The practice has grown with input from medical experts, trainers, researchers, and clinicians. - Physical therapists use different types of tools to perform IASTM.
- These massage instruments comprise various types for specific massage and release.
- The Graston company designs some of the tools.
- Other companies have their version of metal or plastic scraping and rubbing tools.
- The objective is to help release soft tissue and myofascial restrictions to improve body movement. (Kim J, Sung DJ, Lee J. 2017)
How It Works - The theory is that scraping the tissues causes microtrauma to the affected area, activating the body's natural inflammatory response. (Kim J, Sung DJ, Lee J. 2017)
- The body activates to reabsorb the tightened or scar tissue, causing the restriction.
- The therapist can then stretch the adhesions to alleviate pain and improve mobility.
Treatment Certain conditions respond well to instrument-assisted soft tissue mobilization, including (Kim J, Sung DJ, Lee J. 2017) - Limited mobility
- Decreased muscle recruitment
- Loss of range of motion - ROM
- Pain with movement
- Excessive scar tissue formation
Augmented soft tissue mobilization or ASTM techniques can treat certain injuries and medical conditions that include: - Musculoskeletal imbalance/s
- Ligament sprains
- Plantar fasciitis
- Myofascial pain
- Tendonitis and tendinopathy
- Scar tissue from surgery or trauma (Morad Chughtai et al., 2019)
Benefits and Side Effects Benefits include: (Kim J, Sung DJ, Lee J. 2017) - Improved range of motion
- Increased tissue flexibility
- Improved cell activity at the site of injury
- Reduced pain
- Reduced scar tissue formation
Side effects may include: Research - A review compared hands-on myofascial release to instrument myofascial release for chronic low back pain. (Williams M. 2017)
- Little difference was found between the two techniques for pain relief.
- Another review compared IASTM to other methods for treating pain and function loss. (Matthew Lambert et al., 2017)
- The researchers concluded that IASTM could positively affect blood circulation and tissue flexibility and reduce pain.
- Another study examined the use of IASTM, pseudo-fake ultrasound therapy, and spinal manipulation for patients with thoracic/upper back pain. (Amy L. Crothers et al., 2016)
- All groups improved over time with no significant negative events.
- The researchers concluded that instrument-assisted soft tissue mobilization is no more or less effective than spinal manipulation or pseudo-ultrasound therapy for thoracic back pain.
Every case is different, and musculoskeletal conditions respond differently to various treatments. For any questions or concerns, contact your primary healthcare provider to determine if IASTM is an appropriate treatment that can help. General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to contact Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References Kamali, F., Panahi, F., Ebrahimi, S., & Abbasi, L. (2014). Comparison between massage and routine physical therapy in women with sub acute and chronic nonspecific low back pain. Journal of back and musculoskeletal rehabilitation, 27(4), 475–480. https://doi.org/10.3233/BMR-140468 Kim, J., Sung, D. J., & Lee, J. (2017). Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application. Journal of exercise rehabilitation, 13(1), 12–22. https://doi.org/10.12965/jer.1732824.412 Chughtai, M., Newman, J. M., Sultan, A. A., Samuel, L. T., Rabin, J., Khlopas, A., Bhave, A., & Mont, M. A. (2019). Astym® therapy: a systematic review. Annals of translational medicine, 7(4), 70. https://doi.org/10.21037/atm.2018.11.49 Williams M. (2017). Comparing pain and disability outcomes of instrumental versus hands-on myofascial release in individuals with chronic low back pain: a meta-analysis. Doctoral dissertation, California State University, Fresno. https://repository.library.fresnostate.edu/bitstream/handle/10211.3/192491/Williams_csu_6050D_10390.pdf?sequence=1 Matthew Lambert, Rebecca Hitchcock, Kelly Lavallee, Eric Hayford, Russ Morazzini, Amber Wallace, Dakota Conroy & Josh Cleland (2017) The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review, Physical Therapy Reviews, 22:1-2, 76-85, DOI: 10.1080/10833196.2017.1304184 Crothers, A. L., French, S. D., Hebert, J. J., & Walker, B. F. (2016). Spinal manipulative therapy, Graston technique® and placebo for non-specific thoracic spine pain: a randomised controlled trial. Chiropractic & manual therapies, 24, 16. https://doi.org/10.1186/s12998-016-0096-9
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Scooped by
Dr. Alex Jimenez
February 14, 9:10 PM
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For individuals experiencing lower back pain can understanding the anatomy and function of the multifidus muscle help in injury prevention and in the development of a highly effective treatment plan? Multifidus Muscle The multifidus muscles are long and narrow on either side of the spinal column, which helps stabilize the lower region of the spine or lumbar spine. (Maryse Fortin, Luciana Gazzi Macedo 2013) Sitting too much, practicing unhealthy postures, and lack of movement can progress to the multifidus muscle weakening or atrophy, which can lead to spinal instability, vertebral compression, and back pain. (Paul W. Hodges, Lieven Danneels 2019) Anatomy Known as the deep layer, it is the innermost layer of the three muscle layers of the back and controls the movement of the spine. The other two layers, known as the intrinsic and superficial, are responsible for the thoracic cage/rib cage and shoulder movement. (Anouk Agten et al., 2020) The multifidus has attachment points at: - The thoracic spine of the middle back.
- The lumbar spine of the lower back.
- The iliac spine - the base of the wing-shaped iliac bone of the pelvis.
- Sacrum - series of bones at the base of the spine connected to the tailbone.
- When standing or moving, the multifidus muscle works with the transversus abdominus and pelvic floor muscles to stabilize the lumbar spine. (Christine Lynders 2019)
Muscle Function The main function is to stabilize the lower back, but it also helps extend the lower spine whenever reaching or stretching. (Jennifer Padwal et al., 2020) Because the muscle has numerous attachment points and is serviced by a specific branch of nerves known as the posterior rami, it allows each vertebra to work individually and more efficiently. - This protects against spinal deterioration and the development of arthritis. (Jeffrey J Hebert et al., 2015)
- The multifidus muscle works with two other deep muscle groups to stabilize and move the spine. (Jeffrey J Hebert et al., 2015)
- The rotatores muscle enables unilateral rotation, turning from side to side, and bilateral extension or bending backward and forward.
- The semispinalis muscle above the multifidus allows extension and rotation of the head, neck, and upper back.
- The multifidus muscle ensures spinal strength because it has more attachment points to the spine than the other layers, which reduces spinal flexibility and rotation but increases strength and stability. (Anouk Agten et al., 2020)
Lower Back Pain A weak multifidus muscle destabilizes the spine and provides less support to the vertebra. This adds pressure on muscles and connective tissues between and adjacent to the spinal column, increasing the risk of lower back pain symptoms. (Paul W. Hodges, Lieven Danneels 2019) The loss of muscle strength and stability can cause atrophy or wasting away. This can cause compression and other back problems. (Paul W. Hodges et al., 2015) Back problems associated with multifidus muscle deterioration include (Paul W. Hodges, Lieven Danneels 2019) - Herniated discs - also bulging or slipped discs.
- Nerve entrapment or compression pinched nerve.
- Sciatica
- Referred pain - nerve pain originating from the spine felt in other areas.
- Osteoarthritis - wear-and-tear arthritis
- Spinal osteophytes - bone spurs
- Weak abdominal or pelvic floor muscles can compromise the core, increasing the risk of chronic lower back pain and injury.
Individuals are recommended to consult a physical therapist and chiropractor who can help develop the appropriate treatment, rehabilitation, and strengthening plan based on age, injury, underlying conditions, and physical abilities. General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References Fortin, M., & Macedo, L. G. (2013). Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: a systematic review with a focus on blinding. Physical therapy, 93(7), 873–888. https://doi.org/10.2522/ptj.20120457 Hodges, P. W., & Danneels, L. (2019). Changes in Structure and Function of the Back Muscles in Low Back Pain: Different Time Points, Observations, and Mechanisms. The Journal of orthopedic and sports physical therapy, 49(6), 464–476. https://doi.org/10.2519/jospt.2019.8827 Agten, A., Stevens, S., Verbrugghe, J., Eijnde, B. O., Timmermans, A., & Vandenabeele, F. (2020). The lumbar multifidus is characterized by larger type I muscle fibers compared to the erector spinae. Anatomy & cell biology, 53(2), 143–150. https://doi.org/10.5115/acb.20.009 Lynders C. (2019). The Critical Role of Development of the Transversus Abdominis in Preventing and Treatment Low Back Pain. HSS journal: The Musculoskeletal Journal of Hospital for Special Surgery, 15(3), 214–220. https://doi.org/10.1007/s11420-019-09717-8 Padwal, J., Berry, D. B., Hubbard, J. C., Zlomislic, V., Allen, R. T., Garfin, S. R., Ward, S. R., & Shahidi, B. (2020). Regional differences between superficial and deep lumbar multifidus in patients with chronic lumbar spine pathology. BMC musculoskeletal disorders, 21(1), 764. https://doi.org/10.1186/s12891-020-03791-4 Hebert, J. J., Koppenhaver, S. L., Teyhen, D. S., Walker, B. F., & Fritz, J. M. (2015). The evaluation of lumbar multifidus muscle function via palpation: reliability and validity of a new clinical test. The Spine Journal: official North American Spine Society journal, 15(6), 1196–1202. https://doi.org/10.1016/j.spinee.2013.08.05 Hodges, P. W., James, G., Blomster, L., Hall, L., Schmid, A., Shu, C., Little, C., & Melrose, J. (2015). Multifidus Muscle Changes After Back Injury Are Characterized by Structural Remodeling of Muscle, Adipose and Connective Tissue, but Not Muscle Atrophy: Molecular and Morphological Evidence. Spine, 40(14), 1057–1071. https://doi.org/10.1097/BRS.0000000000000972
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Scooped by
Dr. Alex Jimenez
January 8, 9:02 PM
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Individuals may not realize they have a cracked rib until symptoms like pain when taking in a deep breath begin to present. Can knowing the symptoms and causes of cracked or broken ribs help in diagnosis and treatment? Cracked Rib A broken/fractured rib describes any break in the bone. A cracked rib is a type of rib fracture and is more a description than a medical diagnosis of a rib that has been partially fractured. Any blunt impact to the chest or back can cause a cracked rib, including: - Falling
- Vehicle collision
- Sports injury
- Violent coughing
- The main symptom is pain when inhaling.
- The injury typically heals within six weeks.
Symptoms Cracked ribs are usually caused by a fall, trauma to the chest, or intense violent coughing. Symptoms include: - Swelling or tenderness around the injured area.
- Chest pain when breathing/inhaling, sneezing, laughing, or coughing.
- Chest pain with movement or when lying down in certain positions.
- Possible bruising.
- Although rare, a cracked rib can cause complications like pneumonia.
- See a healthcare provider immediately if experiencing difficulty breathing, severe chest pain, or a persistent cough with mucus, high fever, and/or chills.
Types In most cases, a rib usually gets broken in one area, causing an incomplete fracture, which means a crack or break that does not go through the bone. Other types of rib fractures include: Displaced and Nondisplaced Fractures - Completely broken ribs may or may not shift out of place.
- If the rib does move, this is known as a displaced rib fracture and is more likely to puncture lungs or damage other tissues and organs. (Yale Medicine. 2024)
- A rib that stays in place usually means the rib is not completely broken in half and is known as a nondisplaced rib fracture.
Flail Chest - A section of the ribcage can break away from the surrounding bone and muscle, although this is rare.
- If this happens, the ribcage will lose stability, and the bone will move freely as the individual inhales or exhales.
- This broken ribcage section is called a flail segment.
- This is dangerous as it can puncture the lungs and cause other serious complications, like pneumonia.
Causes Common causes of cracked ribs include: - Vehicle collisions
- Pedestrian accidents
- Falls
- Impact injuries from sports
- Overuse/Repetitive stress brought on by work or sports
- Severe coughing
- Older individuals can experience a fracture from a minor injury due to the progressive loss of bone minerals. (Christian Liebsch et al., 2019)
The Commonality of Rib Fractures - Rib fractures are the most common type of bone fracture.
- They account for 10% to 20% of all blunt trauma injuries seen in emergency rooms.
- In cases where an individual seeks care for a blunt injury to the chest, 60% to 80% involve a broken rib. (Christian Liebsch et al., 2019)
Diagnosis A cracked rib is diagnosed with a physical exam and imaging tests. During the examination, a healthcare provider will listen to the lungs, press gently on the ribs, and watch as the rib cage moves. The imaging test options include: (Sarah Majercik, Fredric M. Pieracci 2017) - X-rays - These are for detecting recently cracked or broken ribs.
- CT Scan - This imaging test comprises multiple X-rays and can detect smaller cracks.
- MRI - This imaging test is for soft tissues and can often detect smaller breaks or cartilage damage.
- Bone Scan - This imaging test uses a radioactive tracer to visualize the structure of bones and can show smaller stress fractures.
Treatment In the past, treatment used to involve wrapping the chest with a band known as a rib belt. These are rarely used today as they can restrict breathing, increasing the risk of pneumonia or even a partial lung collapse. (L. May, C. Hillermann, S. Patil 2016). A cracked rib is a simple fracture that requires the following: - Rest
- Over-the-counter or prescription medications can help manage pain symptoms.
- Nonsteroidal anti-inflammatory drugs - NSAIDs like ibuprofen or naproxen are recommended.
- If the break is extensive, individuals may be prescribed stronger pain medication depending on the severity and underlying conditions.
- Physical therapy can expedite the healing process and help maintain the range of motion of the chest wall.
- For patients who are frail and elderly individuals, physical therapy can help the patient walk and normalize certain functions.
- A physical therapist can train the individual to transfer between bed and chairs safely while maintaining awareness of any movements or positioning that make the pain worse.
- A physical therapist will prescribe exercises to keep the body as strong and limber as possible.
- For example, lateral twists can help improve the range of motion in the thoracic spine.
- During the early stages of recovery, it is recommended to sleep in an upright position.
- Lying down can add pressure, causing pain and possibly worsen the injury.
- Use pillows and bolsters to help support sitting up in bed.
- An alternative is to sleep in a reclining chair.
- Healing takes at least six weeks. (L. May, C. Hillermann, S. Patil 2016)
Other Conditions What may feel like a cracked rib may be a similar condition, which is why it's important to get checked out. Other possible symptom causes can include: Emergency The most common complication is being unable to take a deep breath because of the pain. When the lungs cannot breathe deeply enough, mucous and moisture can build up and lead to an infection like pneumonia. (L. May, C. Hillermann, S. Patil 2016). Displaced rib fractures can also damage other tissues or organs, increasing the risk of a collapsed lung/pneumothorax or internal bleeding. It is recommended to seek immediate medical attention if symptoms develop like: - Shortness of breath
- Difficulty breathing
- A bluish color of the skin caused by lack of oxygen
- A persistent cough with mucus
- Chest pain when breathing in and out
- Fever, sweating, and chills
- Rapid heart rate
General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, please contact Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References Yale Medicine. (2024). Rib fracture (broken rib). Liebsch, C., Seiffert, T., Vlcek, M., Beer, M., Huber-Lang, M., & Wilke, H. J. (2019). Patterns of serial rib fractures after blunt chest trauma: An analysis of 380 cases. PloS one, 14(12), e0224105. https://doi.org/10.1371/journal.pone.0224105 May L, Hillermann C, Patil S. (2016). Rib fracture management. BJA Education. Volume 16, Issue 1. Pages 26-32, ISSN 2058-5349. doi:10.1093/bjaceaccp/mkv011 Majercik, S., & Pieracci, F. M. (2017). Chest Wall Trauma. Thoracic surgery clinics, 27(2), 113–121. https://doi.org/10.1016/j.thorsurg.2017.01.004
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Scooped by
Dr. Alex Jimenez
November 13, 2023 8:57 PM
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When a groin strain injury happens, can knowing the symptoms help in the diagnosis, treatment, and recovery times? Groin Strain Injury A groin strain is an injury to an inner thigh muscle. A groin pull is a type of muscle strain affecting the adductor muscle group (the muscles help pull the legs apart). (Parisa Sedaghati, et al., 2013) The injury is caused when the muscle is stretched beyond its normal range of motion, creating superficial tears. Severe strains can tear the muscle in two. (Parisa Sedaghati, et al., 2013) - A groin muscle pull causes pain and tenderness that worsens when squeezing the legs together.
- There may also be swelling or bruising in the groin or inner thigh.
- An uncomplicated groin pull takes four to six weeks to heal with proper treatment. (Andreas Serner, et al., 2020)
Symptoms A groin pull can be painful, interfering with walking, navigating stairs, and/or driving a car. In addition to pain, other symptoms around the injured area include: (Parisa Sedaghati et al., 2013) - A popping sound or snapping sensation when the injury occurs.
- Increased pain when pulling the legs together.
- Redness
- Swelling
- Bruising of the groin or inner thigh.
Groin pulls are graded by severity and how much they impact mobility: Grade 1 - Mild discomfort but not enough to limit activities.
Grade 2 - Moderate discomfort with swelling or bruising that limits running and/or jumping.
Grade 3 - Severe injury with significant swelling and bruising can cause pain while walking and muscle spasms.
Signs of a severe groin strain - Difficulty walking
- Groin pain while sitting or resting
- Groin pain at night
- A healthcare provider should see severe groin pulls because the muscle may have ruptured or be on the verge of rupturing.
- In severe cases, surgery is necessary to reattach the torn ends.
Groin pulls are sometimes accompanied by a stress fracture of the pubis/forward-facing pelvic bones, which can significantly extend healing and recovery time. (Parisa Sedaghati et al., 2013) Causes Groin pulls are often experienced by athletes and individuals who play sports where they must stop and change directions quickly, placing excessive strain on the adductor muscles. (Parisa Sedaghati et al., 2013) The risk is increased in individuals who: (T. Sean Lynch et al., 2017) - Have weak hip abductor muscles.
- Are not in adequate physical condition.
- Have a previous groin or hip injury.
- Pulls can also occur from falls or extreme activities without the proper conditioning.
Diagnosis A healthcare provider will perform a thorough investigation to confirm the diagnosis and characterize the severity. This involves: (Juan C. Suarez et al., 2013) Medical History Review - This includes any previous injuries and specifics about where and when the symptoms started.
Physical Examination - This involves palpating - lightly touching and pressing the groin region and manipulating the leg to understand better where and how extensive the injury is.
Imaging Studies - Ultrasound or X-rays.
- If a muscle rupture or fracture is suspected, an MRI scan may be ordered to visualize soft tissue injuries and stress fractures better.
Differential Diagnosis Certain conditions can mimic a groin pull and require different treatments. These include: (Juan C. Suarez, et al., 2013) Sports Hernia - This type of inguinal hernia occurs with sports and work injuries.
- It causes a portion of the intestine to pop through a weakened muscle in the groin.
Hip Labral Tear - This is a tear in the cartilage ring of the labrum outside the rim of the hip joint socket.
Hip Osteoarthritis - This is the wear-and-tear form of arthritis that can present with groin pain symptoms.
Osteitis Pubis - This is inflammation of the pubic joint and surrounding structures, usually caused by the overuse of the hip and leg muscles.
Referred Groin Pain - This nerve pain originates in the lower back, often due to a pinched nerve, but is felt in the groin.
Treatment Beginning treatment is conservative and includes rest, ice application, physical therapy, and prescribed gentle stretching and exercises. - Individuals may need crutches or a walking device to reduce pain and prevent further injury if the pain is significant. (Andreas Serner, et al., 2020)
- Physical therapy will be a part of the treatment plan.
- Over-the-counter pain medications like Tylenol/acetaminophen or Advil/ibuprofen can help with pain relief short term.
- If there is severe pain from a grade 3 injury, prescription medications may be used for a short period to help minimize pain. (Andreas Serner, et al., 2020)
- Surgery is not usually necessary. (Andreas Serner, et al., 2020)
Recovery Recovery times can vary based on the injury's severity and physical condition before the injury. - Most injuries will heal within four to six weeks with rest and proper treatment.
- Severe groin strains can take up to 12 weeks or longer if surgery is involved. (Andreas Serner, et al., 2020)
General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to contact Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References Sedaghati, P., Alizadeh, M. H., Shirzad, E., & Ardjmand, A. (2013). Review of sport-induced groin injuries. Trauma monthly, 18(3), 107–112. https://doi.org/10.5812/traumamon.12666 Serner, A., Weir, A., Tol, J. L., Thorborg, K., Lanzinger, S., Otten, R., & Hölmich, P. (2020). Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthopaedic journal of sports medicine, 8(1), 2325967119897247. https://doi.org/10.1177/2325967119897247 Lynch, T. S., Bedi, A., & Larson, C. M. (2017). Athletic Hip Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 25(4), 269–279. https://doi.org/10.5435/JAAOS-D-16-00171 Suarez, J. C., Ely, E. E., Mutnal, A. B., Figueroa, N. M., Klika, A. K., Patel, P. D., & Barsoum, W. K. (2013). Comprehensive approach to the evaluation of groin pain. The Journal of the American Academy of Orthopaedic Surgeons, 21(9), 558–570. https://doi.org/10.5435/JAAOS-21-09-558
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Scooped by
Dr. Alex Jimenez
October 10, 2023 8:55 PM
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Individuals dealing with back pain problems could be suffering from a bulging disc. Could knowing the difference between slipped and herniated disc symptoms help with treatments and finding relief? Bulging Disc Pain Back pain can become debilitating if not treated properly. A bulging disc is a common cause of cervical, thoracic, and lower back pain symptoms. It happens when one of the fluid-filled cushions between the vertebrae begins to shift out of place. Instead of being aligned with the edges, the disc bulges over. This begins to generate pressure on the nerves causing pain and inflammation. - Bulging discs are often caused by age, but repetitive movements and/or lifting heavy objects can contribute to the condition.
- Symptoms can resolve on their own, but individuals are recommended to consult with a physical therapist and/or chiropractor to make sure the disc healed properly, otherwise, it can lead to worsening and/or further injuries.
Bulging Disc vs. Herniated Disc Bulging and herniated discs cause pain symptoms. - Bulging - the intervertebral disc moves out of place but stays intact.
- Herniated - the thick outer layer of the disc ruptures, causing the cushioning gel inside to leak onto the spinal nerves.
Location of Symptoms - A bulging disc can happen anywhere along the spine.
- However, most occur between the last five vertebrae in the lower back.
- This is the lumbar spine. (American Academy of Orthopaedic Surgeons. 2022)
- This is because the lower back is subject to all kinds of pressure and movement with daily activities, increasing the chances of pain and injuries.
- The next most common place is the neck/cervical spine where there are constant movements making it prone to injury and pain symptoms.
Causes Bulging discs are most often caused by body aging and normal wear and tear. As time goes on the intervertebral discs naturally degenerate, known as degenerative disc disease. This can cause the discs to pull downward, causing them to bulge from their placement. (Penn Medicine. 2018) Factors that can cause or worsen the condition include: - Practicing unhealthy postures.
- Repetitive motions.
- Lifting heavy objects
- Spinal injuries.
- Medical history of spinal or disc disease in the family.
Treatment Treating a bulging disc takes time and patience. (American Academy of Neurological Surgeons. 2023) Examination Individuals with back pain that interferes with daily functions or has lasted longer than six weeks, should see a healthcare provider for diagnosis. They will order a magnetic resonance imaging scan/MRI, which can show where a disc is protruding. (American Academy of Neurological Surgeons. 2023) Rest - For bulging disc pain, resting the back is necessary. However,
- Many patients benefit from a day or two of bed rest. (American Academy of Orthopaedic Surgeons. 2022)
- After that, start light activities like walking. Avoid any movements that make your pain worse.
NSAIDs - NSAID pain medications like Advil, Motrin, or Aleve can keep pain symptoms and inflammation reduced.
- However, this is for short-term use, as the underlying cause still needs to be addressed.
- A healthcare provider will recommend safe dosage and how long these medications should be taken. (American Academy of Orthopaedic Surgeons. 2022)
Physical Therapy - Individuals may be recommended by their healthcare provider for a referral to a physical therapist.
- A physical therapist will address the injury for rehabilitation and introduce strengthening exercises. (American Academy of Orthopaedic Surgeons. 2022)
- Chiropractic Adjustments (NIH. 2022)
- Non-surgical spinal decompression
- Traction therapy
- Therapeutic massage
- Muscle Energy Technique
Steroid Injection - An epidural steroid injection can provide relief for individuals still experiencing symptoms after six weeks.
- A healthcare provider will inject cortisone into the spine to reduce inflammation and pain. (American Academy of Orthopaedic Surgeons. 2022)
Surgery - If conservative treatments don't work, a healthcare provider may recommend surgery, like a microdiscectomy.
- This procedure uses small incisions to remove all or part of a bulging disc.
- Most individuals with a bulging disc will not require surgery. (American Academy of Neurological Surgeons. 2023)
General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References Penn Medicine. (2018) Bulging disc vs. herniated disc: What’s the difference? American Academy of Orthopaedic Surgeons. (2022) Herniated disk in the lower back. American Academy of Neurological Surgeons. (2023) Herniated disc. National Institutes of Health. (2022) Spinal Manipulation: What You Need To Know.
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Scooped by
Dr. Alex Jimenez
August 30, 2023 8:55 PM
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Individuals who have suffered cervical acceleration-deceleration/CAD more commonly known as whiplash, can experience headaches, and other symptoms like neck stiffness, pain, fatigue, and shoulder/neck/back discomfort. Can non-surgical and conservative treatments help alleviate the symptoms? Cervical Acceleration - Deceleration or CAD Cervical acceleration-deceleration is the mechanism of a neck injury caused by a forceful back-and-forth neck motion. It happens most commonly in rear-end vehicle collisions when the head and neck whip forward and backward with intense acceleration and/or deceleration causing the neck to flex and/or extend rapidly, more than normally, straining and possibly tearing muscle tissues and nerves, ligaments, dislocation of spinal discs and herniations, and cervical bone fractures. - For symptoms that do not improve or worsen after 2 to 3 weeks, see a healthcare provider or chiropractor for further evaluation and treatment.
- Whiplash injuries strain or sprain the neck muscles and/or ligaments, but can also affect the vertebrae/bones, disc cushions between the vertebrae, and/or the nerves.
- For individuals who experience a headache that starts at the base of the skull following a motor vehicle accident is more than likely a whiplash headache. (National Institute of Neurological Disorders and Stroke. 2023)
Symptoms Whiplash symptoms can present right away, or after several hours to a few days after the incident, and tend to worsen in the days after the injury. Symptoms can last a few weeks to a few months, and can severely limit activity and range of motion. Symptoms can include: (National Institute of Neurological Disorders and Stroke. 2023) - Pain that extends into the shoulders and back.
- Neck stiffness
- Limited neck motion
- Muscle spasms
- Numbness and tingling sensations - paresthesias or pins and needles in the fingers, hands, or arms.
- Sleep problems
- Fatigue
- Irritability
- Cognitive impairment - memory and/or concentrating difficulties.
- Ringing in the ears - tinnitus
- Dizziness
- Blurred vision
- Depression
- Headaches - A whiplash headache usually starts at the base of the skull and can vary in intensity. Most individuals experience pain on one side of the head and toward the back, though some can experience symptoms all over their head, and a small number experience headaches on the forehead or behind the eyes. (Monica Drottning. 2003)
- The headaches can become aggravated by moving the neck around, especially when looking up.
- Headaches are often associated with shoulder pain along with sensitive neck and shoulder muscles that when touched can increase pain levels.
- Whiplash headaches can lead to chronic neck-related headaches known as cervicogenic headaches. (Phil Page. 2011)
Causes The most common cause of whiplash is rear-end automobile accidents and collisions. (National Institute of Neurological Disorders and Stroke. 2023) However, cervical acceleration-deceleration injuries can also occur from: - Playing sports - hockey, martial arts, boxing, tackle football, gymnastics, basketball, volleyball, soccer, and baseball.
- A slip and fall that causes the head to suddenly jolt forward and back.
- Physical assault - getting punched or shaken.
- Being struck on the head by a heavy or solid object.
Treatment - Symptoms usually resolve within 2 to 3 weeks.
- Icing the neck for 10 minutes several times a day can help reduce pain and inflammation. (National Institute of Neurological Disorders and Stroke. 2023)
- It is also important to rest your neck area following the injury.
- A cervical collar can be utilized temporarily to stabilize the neck, but for long-term recovery, it is recommended to keep the area mobile.
- Physical activity reduction until the individual can look over both shoulders, and tilt their head all the way forward, all the way back, and from side to side without pain or stiffness.
Additional Treatments - Traction and decompression therapies.
- Chiropractic adjustments
- Therapeutic various massage techniques.
- Electronic nerve stimulation
- Posture retraining
- Stretching
- Sleep position adjustments.
- Non-steroidal anti-inflammatories - NSAIDs - Ibuprofen or Naproxen.
- Muscle relaxers
If symptoms do not improve, a healthcare provider may recommend physical therapy and/or stronger pain medications. For whiplash headaches that last for several months, acupuncture, or spinal injections may be recommended. General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References National Institute of Neurological Disorders and Stroke. Whiplash Information Page. Drottning M. (2003). Cervicogenic headache after a whiplash injury. Current pain and headache reports, 7(5), 384–386. https://doi.org/10.1007/s11916-003-0038-9 Page P. (2011). Cervicogenic headaches: an evidence-led approach to clinical management. International journal of sports physical therapy, 6(3), 254–266.
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Scooped by
Dr. Alex Jimenez
July 24, 2023 8:59 PM
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Stiffness and pain developing in the shoulder could be adhesive capsulitis, (frozen shoulder), a condition in the shoulder's ball-and-socket joint/glenohumeral joint. It usually develops over time and limits the functional use of the arm. The pain and tightness restrict arm movement, and the duration of symptoms can persist for 12-18 months. The cause is often unknown, but it is more common in individuals over 40, individuals with diabetes, thyroid disease, and cardiac conditions have an increased risk of developing the condition, and women tend to develop the condition more than men. Chiropractic treatment can be effective at relieving pain and expediting recovery. Stiffness and Pain The shoulder joint allows more movement than any other joint in the body. A frozen shoulder causes the capsule surrounding the shoulder joint to contract and form scar tissue. The capsule contraction and the formation of adhesions cause the shoulder to become stiff, restrict movement, and cause pain and discomfort symptoms. Stages The progression is marked by three stages: Freezing - Stiffness and pain begin to restrict motion.
Frozen - Movement and motion are severely restricted.
Thawing - The shoulder starts to loosen up.
- It can take years to fully resolve symptoms.
- In mild cases, a frozen shoulder can go away on its own but that does not mean that it is truly healed and correctly aligned.
- Even in mild cases seeking treatment is recommended, rather than just waiting for it to go away.
Symptoms - Limited range of motion.
- Stiffness and tightness.
- Dull or aching pain throughout the shoulder.
- Pain can radiate into the upper arm.
- Pain can be triggered by the smallest movements.
- The symptoms are not always due to weakness or injury, but actual joint stiffness.
Causes Most frozen shoulders occur with no injury or discernible cause but the condition is often linked to a systemic condition or one that affects the entire body. Age and Gender - Frozen shoulder most commonly affects individuals between the ages of 40 to 60, and is more common in women than in men.
Endocrine Disorders - Individuals with diabetes have an increased risk of developing a frozen shoulder.
- Other endocrine abnormalities like thyroid problems can also lead to the development of this condition.
Shoulder Trauma and/or Surgery - Individuals who sustain a shoulder injury, or undergo surgery on the shoulder can develop a stiff and painful joint.
- When injury or surgery is followed by prolonged immobilization/resting the arm, the risk of developing a frozen shoulder increases.
Other Systemic Conditions Several systemic conditions such as heart disease have also been associated with an increased risk of developing the condition and can include: - High cholesterol
- Adrenal disease
- Heart and lung disease
- Parkinson's disease
Stiffness and pain can also be associated with damage to the joint from injuries or other shoulder problems that include: - Muscle or connective tissue injury
- Rotator cuff tendinopathy
- Calcific tendinitis
- Dislocation
- Fracture
- Osteoarthritis
- A frozen shoulder associated with any of these causes is considered secondary.
Treatment A diagnosis is made by observing the range of motion in the shoulder, considering the two types: Active Range - This is how far an individual can move a body part on their own.
Passive Range - This is how far another person like a therapist or doctor can move the body part.
Therapies - Chiropractic, massage, and physical therapy involve stretches, realignment, and exercises to relieve pain symptoms and restore mobility and function.
- Usually, strength is not affected by a frozen shoulder but a chiropractor may want to strengthen the surrounding muscles to better support the shoulder and prevent worsening the injury or causing a new injury.
- Anti-inflammatory medications and corticosteroid injections may help manage pain symptoms.
- Getting a diagnosis and treatment during the freezing stage can keep the condition from progressing and expedite recovery time.
General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References Brun, Shane. “Idiopathic frozen shoulder.” Australian Journal of general practice vol. 48,11 (2019): 757-761. doi:10.31128/AJGP-07-19-4992 Chan, Hui Bin Yvonne, et al. “Physical therapy in the management of frozen shoulder.” Singapore medical journal vol. 58,12 (2017): 685-689. doi:10.11622/smedj.2017107 Cho, Chul-Hyun, et al. “Treatment Strategy for Frozen Shoulder.” Clinics in orthopedic surgery vol. 11,3 (2019): 249-257. doi:10.4055/cios.2019.11.3.249 Duzgun, Irem, et al. “Which method for frozen shoulder mobilization: manual posterior capsule stretching or scapular mobilization?.” Journal of Musculoskeletal & neuronal interactions vol. 19,3 (2019): 311-316. Jain, Tarang K, and Neena K Sharma. “The effectiveness of physiotherapeutic interventions in the treatment of frozen shoulder/adhesive capsulitis: a systematic review.” Journal of back and musculoskeletal rehabilitation vol. 27,3 (2014): 247-73. doi:10.3233/BMR-130443 Kim, Min-Su, et al. “Diagnosis and treatment of calcific tendinitis of the shoulder.” Clinics in shoulder and elbow vol. 23,4 210-216. 27 Nov. 2020, doi:10.5397/cise.2020.00318 Millar, Neal L et al. “Frozen shoulder.” Nature reviews. Disease primers vol. 8,1 59. 8 Sep. 2022, doi:10.1038/s41572-022-00386-2
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Scooped by
Dr. Alex Jimenez
October 18, 8:53 PM
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Incorrect manual handling and lifting is a leading cause of workplace injuries. Can health and safety training help reduce injuries and lost workdays? Correct Manual Lifting Technique Manually lifting objects using incorrect techniques can lead to acute back injuries, herniated discs, sciatica, and long-term issues like increased risk of reinjury, body misalignment, and chronic back pain. Individuals can prevent spinal disc compression and/or lower back muscle strain by learning to use correct manual lifting techniques. (CDC. The National Institute for Occupational Safety and Health (NIOSH). 2007) Lifting Guide Individuals can protect their backs and prevent injury by following simple steps when lifting objects. Support Base - Ensure there is a healthy support base from which to lift.
- Keep feet shoulder-width apart with one foot slightly in front of the other.
Ask For Help - If coworkers or colleagues are available, ask for assistance.
- If the load is too heavy, ask for help lifting and moving the object/s.
Use Mechanical Assistant Devices - Use hand trucks, dollies, or pushcarts whenever possible for uneven and heavy loads.
Squat To Lift Object - Bend at the hips and knees only, not the back.
- Put one knee on the ground to ensure stability before lifting.
Check Posture - Looking straight ahead, maintain posture upright with the chest out, shoulders back, and lower back slightly arched.
Lift Slowly - Lift with the knees and hips only, gradually straightening the lower back.
Load Positioning - Once upright, hold the load close to the body around the stomach.
Move and Maintain Alertness - Always take small steps.
- Maintain alertness as to where you are going.
- Keep the shoulders square with the hips when changing directions to avoid twisting and losing or shifting balance.
Rest - If you are fatigued, set the load/object down and rest for a few minutes until you can fully engage in the task.
Squat To Set Object Down - Squat with the knees and hips and set the load down slowly.
- Avoid quickly rising and jerking movements, and allow the legs, hips, and back muscles to reset.
Planning and Tips Lifting anything heavy takes planning to prevent muscle spasms, back strain, and other musculoskeletal injuries. Considerations to keep in mind: Make a Plan Before Lifting - Knowing what object/s are being lifted and where they are going will prevent individuals from making awkward movements while holding and carrying something heavy.
- Set and clear a path.
- If lifting something with another person, ensure both agree and understand the plan.
Lift Close to The Body - Individuals are stronger and more stable lifters if the object is held close to their body rather than at the end of their reach.
- Make sure there is a firm hold on the object.
- It is easier to maintain balance close to the body.
Maintain Feet Shoulder-Width Apart - Keep the feet about shoulder-width apart.
- Having a solid base of support is important while lifting.
- Placing the feet too close together will cause instability while placing them too far apart will hinder movement.
- Take short steps.
Visualize The Motions Involved and Practice The Motions Before Lifting - Think about the motion before lifting.
- Practice the lifting motion before lifting the object.
- Focus on keeping the spine straight.
- Raise and lower to the ground by bending the knees.
- Avoid bending at the waist or hips.
Tighten the Stomach Muscles - Tightening the abdominal muscles will hold the back in a healthy lifting position and help prevent excessive force on the spine.
Lift With the Legs - The legs are stronger than the back muscles, so let the leg strength do the work.
- Lower yourself to the ground by bending the knees, not the back.
Keep Eyes Up - Looking slightly upwards will help maintain a better spine position and help keep the back straight.
Avoid Twisting or Bending - Face in the direction you are walking.
- Stop, take small steps, and continue walking if turning is required.
Back Belts It has become common for many who work in jobs requiring manual lifting to wear back belts or support. However, research does not show that they decrease the risk of a lifting injury. (CDC and The National Institute for Occupational Safety and Health, 2023) Instead, it is recommended that the belt be thought of as a reminder of where the back muscles are positioned to keep the individual aligned, combined with the correct lifting techniques. Injury Medical Chiropractic and Functional Medicine Clinic Training the body and maintaining its optimal health for correct manual lifting techniques requires daily efforts through practice, conscious position corrections, and ergonomics. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues. General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to contact Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References CDC. The National Institute for Occupational Safety and Health (NIOSH). (2007). Ergonomic Guidelines for Manual Material Handling. (No. 2007-131). Retrieved from https://www.cdc.gov/niosh/docs/2007-131/pdfs/2007-131.pdf CDC. The National Institute for Occupational Safety and Health (NIOSH) (2023). Back Belts - Do They Prevent Injury? (No. 94-127). Retrieved from https://www.cdc.gov/niosh/docs/94-127/
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Scooped by
Dr. Alex Jimenez
September 6, 8:55 PM
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Are there blood tests for individuals with chronic and severe back pain symptoms that can help healthcare providers diagnose? Blood Tests To Help Diagnose Back Pain If a healthcare provider suspects an infection or inflammatory arthritis is the cause of back pain, blood tests may be used to diagnose. When trying to find the cause of back pain, a healthcare provider will examine the patient's medical history, perform a physical examination, and, if necessary, order diagnostic tests. (Dansie E. J. and Turk D. C. 2013) For example, the National Institute of Arthritis and Musculoskeletal and Skin Diseases says that MRIs can reveal abnormalities in the spine. Still, a person may not feel pain or experience any other symptoms. The NIAMS also says healthy, pain-free individuals can have elevated SED levels. A high sedimentation rate or sed rate, also known as an erythrocyte sedimentation rate (ESR) test, can indicate inflammation in the body. (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023) Commonly Used Tests Blood tests that can help diagnose back pain include: Complete Blood Count - CBC - This test can indicate inflammation or infections.
Sed Rate or Erythrocyte Sedimentation Rate - This test measures inflammation by analyzing how red blood cells settle through plasma.
- Inflammation could point to an infection. (Harrison M. 2015)
- If the SED rate indicates that inflammation is present, the possibility of an underlying cause may be some form of arthritis or a tumor, which is rare.
CRP or C-reactive Protein HLA-B27 - A genetic marker in the blood that is more common in individuals with ankylosing spondylitis and reactive arthritis. (McMichael A. and Bowness P. 2002)
- This marker may be tested if the healthcare provider suspects either disease.
- Ankylosing spondylitis is an inflammatory arthritis affecting the sacroiliac joints, hips, and spine. (Sieper J. et al., 2002)
- Reactive arthritis is a type that occurs after an infection in a different body system or area. (Hamdulay S. S., Glynne S. J., and Keat A. 2006)
Injury Medical Chiropractic and Functional Medicine Clinic At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for you to relieve pain and restore function. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. Our areas of practice include Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, severe sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Wellness and nutrition, Functional Medicine Treatments, and in-scope care protocols. They can also work with other associated medical professionals to develop a personalized treatment plan to help relieve muscle pain, improve the body’s flexibility and mobility, resolve musculoskeletal issues, and prevent future pain symptoms from reoccurring. General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies that are available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, don't hesitate to contact Dr. Alex Jimenez or us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References Dansie, E. J., & Turk, D. C. (2013). Assessment of patients with chronic pain. British journal of anaesthesia, 111(1), 19–25. https://doi.org/10.1093/bja/aet124 National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2023). Back Pain. Retrieved from https://www.niams.nih.gov/health-topics/back-pain Harrison M. (2015). Erythrocyte sedimentation rate and C-reactive protein. Australian prescriber, 38(3), 93–94. https://doi.org/10.18773/austprescr.2015.034 Sproston, N. R., & Ashworth, J. J. (2018). Role of C-Reactive Protein at Sites of Inflammation and Infection. Frontiers in immunology, 9, 754. https://doi.org/10.3389/fimmu.2018.00754 McMichael, A., & Bowness, P. (2002). HLA-B27: natural function and pathogenic role in spondyloarthritis. Arthritis research, 4 Suppl 3(Suppl 3), S153–S158. https://doi.org/10.1186/ar571 Sieper, J., Braun, J., Rudwaleit, M., Boonen, A., & Zink, A. (2002). Ankylosing spondylitis: an overview. Annals of the rheumatic diseases, 61 Suppl 3(Suppl 3), iii8–iii18. https://doi.org/10.1136/ard.61.suppl_3.iii8 Hamdulay, S. S., Glynne, S. J., & Keat, A. (2006). When is arthritis reactive?. Postgraduate medical journal, 82(969), 446–453. https://doi.org/10.1136/pgmj.2005.044057
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Scooped by
Dr. Alex Jimenez
July 23, 9:04 PM
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Individuals who have sustained trauma to the knee area from work, physical activity, or a motor vehicle collision can experience significant pain and mobility impairment. Can physical therapy help heal and strengthen the PLC? Posterolateral Corner Knee Injury The posterolateral corner, or PLC, comprises muscles, tendons, and ligaments in the back of the knee that help support and stabilize the outside region. The primary role of the PLC is to prevent the knee from excessive amounts of rotation or bowing/turning outward. (Chahla J. et al., 2016) Posterolateral corner injuries can cause significant pain and can dramatically impact an individual's ability to walk, work, or maintain independence. Treatment options will depend on the severity of the injury. The Posterolateral Corner The posterolateral corner comprises multiple structures that support and stabilize the outside of the knee. The structures are subdivided into primary and secondary stabilizers. The primary group includes: - Lateral collateral ligament- LCL
- Popliteofibular ligament - PFL
- Popliteus tendon
The secondary stabilizers include: - The lateral capsule of the knee.
- Coronary ligament.
- Fabellofibular ligament.
- Lateral gastrocneumius tendon.
- The long head of the biceps femoris.
- Iliotibial/IT band (Chahla J. et al., 2016)
The primary role is to prevent the knee from excessively turning outward, so the grouping provides secondary assistance in preventing the lower leg bone/tibia from shifting forward or backward on the thighbone/femur. Occasionally, one or several posterolateral corner structures can be sprained, strained, or torn. How Injury Occurs An injury occurs when a direct blow to the inner portion of the front of the knee causes the leg to bow outward. A posterolateral corner injury may also be sustained without contact, for example, if the knee hyperextends or buckles away from the other leg into a varus/bow leg position. Because the knee usually moves during a PLC, concurrent sprains or tears to the anterior cruciate ligament/ACL or posterior cruciate ligament/PCL are also common. (Chahla J. et al., 2016) Other situations that can also cause PLC injuries include automobile crashes and falls from elevated surfaces. (Shon O. J. et al., 2017) When this type of trauma causes a posterolateral corner injury, bone fractures are also common. Symptoms Depending on the severity of the injury, multiple symptoms may be present, including: - Difficulty walking or climbing stairs due to instability. (Shon O. J. et al., 2017)
- Numbness or tingling in the lower leg.
- Pain, swelling, bruising, and hardening in the knee and surrounding area.
- Outward bowing position of the affected knee when standing.
- Foot drop presents on the injured side. (Chahla J. et al., 2016)
For individuals who suspect that they have sustained a PLC injury or have any of the symptoms listed, it is critical to be seen by an orthopedic specialist or emergency room physician. A healthcare provider will properly evaluate the leg and develop the appropriate treatment. Diagnosis Diagnosis begins with a comprehensive examination. In addition to looking for the symptoms noted, a healthcare provider will move the legs in different directions to assess for any instability. The dial test may be performed, which involves having the patient lie on their stomach while the healthcare professional assesses the side-to-side rotation in the leg to check for excessive motion. (Shon O. J. et al., 2017) Imaging is frequently ordered to determine which anatomical structures are affected more accurately. X-rays can help rule out concurrent fractures and check for excessive laxity in the knee area. MRIs are also useful for visualizing the various tendons and ligaments, helping the healthcare provider look closely at any sprains or tears that may have occurred. However, MRIs may be less accurate in diagnosing PLC injuries after 12 weeks, so they should be obtained as soon as possible. Based on this evaluation, the injury may be classified using the following system (Shon O. J. et al., 2017) Grade 1 - 0 to 5 degrees of rotational or varus/bowing instability.
- Incompletely torn posterolateral corner.
Grade 2 - 6 to 10 degrees of rotational or varus/bowing instability.
- Incompletely torn posterolateral corner.
Grade 3 - Eleven or more degrees of rotational or varus/bowing instability.
- Completely torn posterolateral corner.
Treatment The care received after a posterolateral corner injury can vary depending on the structures involved and the overall severity. Nonsurgical Nonsurgical treatment is typically reserved for isolated grade 1 or 2 PLC injuries. (Shon O. J. et al., 2017) Depending on which structures are affected, a stabilizing brace may be worn, and crutches are often needed to decrease the strain on the knee. Physical therapy is also commonly prescribed and focuses on the following goals: - Gradually reducing crutch use.
- Improving balance and stability.
- Improving walking patterns.
- Regaining the range of motion in the knee.
- Strengthening the leg muscles.
- Gradually reintroducing specific movements like running and jumping.
Surgery Non-surgical treatment tends not to work with grade 3 injuries. If surgery is not performed, individuals may also suffer from chronic knee instability or develop long-term osteoarthritis. (Chahla J. et al., 2019) Surgical treatment is often recommended for grade 3 injuries. The damaged primary stabilizers are surgically reconstructed using a graft from another body region. Surgical repairs may also be performed on any secondary stabilizers to improve stability. (Chahla J. et al., 2019) Any other ligament injuries, such as ACL, PCL, or concurrent fractures, will also be addressed. Following the procedure, individuals immobilize their knee with a brace and do not place weight on the affected leg to protect the surgical area. Depending on the surgeon's recommendations, this can last six weeks or more. Physical therapy is also initiated after a surgical procedure. Though rehabilitation progresses slowly, the goals are often the same as when treating milder PLC injuries. Returning to work, sports, and/or physical activity after surgery may take six months of therapy or more. (Shon O. J. et al., 2017) Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment program through an integrated approach to treat injuries and chronic pain syndromes, improve flexibility, mobility, and agility, relieve pain, and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments. General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies that are available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, don't hesitate to contact Dr. Alex Jimenez or us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References Chahla, J., Moatshe, G., Dean, C. S., & LaPrade, R. F. (2016). Posterolateral Corner of the Knee: Current Concepts. The archives of bone and joint surgery, 4(2), 97–103. Shon, O. J., Park, J. W., & Kim, B. J. (2017). Current Concepts of Posterolateral Corner Injuries of the Knee. Knee surgery & related research, 29(4), 256–268. https://doi.org/10.5792/ksrr.16.029 Chahla, J., Murray, I. R., Robinson, J., Lagae, K., Margheritini, F., Fritsch, B., Leyes, M., Barenius, B., Pujol, N., Engebretsen, L., Lind, M., Cohen, M., Maestu, R., Getgood, A., Ferrer, G., Villascusa, S., Uchida, S., Levy, B. A., Von Bormann, R., Brown, C., … Gelber, P. E. (2019). Posterolateral corner of the knee: an expert consensus statement on diagnosis, classification, treatment, and rehabilitation. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA, 27(8), 2520–2529. https://doi.org/10.1007/s00167-018-5260-4
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Scooped by
Dr. Alex Jimenez
June 6, 9:04 PM
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Can learning about comminuted fracture symptoms and repair help individuals and healthcare providers develop effective treatment and rehabilitation programs? Comminuted Fractures A comminuted fracture is a severe break in which the bone splits into at least three pieces. Comminuted fractures typically happen in the long bones like those in the arms and legs. But they can also happen in other places, including the ribs. (Corinne Tarantino, 2022) They are usually caused by intense impact, like an automobile collision/accident or a severe fall. Depending on the location of the fracture, recovery from a comminuted fracture can take months and often involves: - Surgery - A surgeon will place screws and rods to hold the pieces of the bone in position. Sometimes, the hardware is left in permanently. (American Academy of Orthopaedic Surgeons, 2021)
- Wearing a cast for several months.
- Physical therapy.
Types In these types of fractures, the bone is completely broken, not just cracked. The break is a highly comminuted fracture if the bone is broken into four or more pieces. (Corinne Tarantino, 2022) Symptoms The symptoms are the same as those of other broken bones, but they can be more intense because the bone is broken in multiple areas, which means there may also be more soft tissue injuries than with a simple fracture. Broken bone symptoms include: (MedlinePlus, 2024) - Persistent pain
- Swelling
- Bruising
- Deformity - the bone looks out of place or is at an odd angle.
- Tingling
- Numbness
- Difficulty moving the limb.
Causes An intense force causes a comminuted fracture, often a car accident or a hard fall, but it can also result from sports injuries. (Corinne Tarantino, 2022) Diagnosis A comminuted fracture is diagnosed by X-ray, which shows where the bone has broken and how many pieces it has split into (MedlinePlus, 2024). Healthcare providers will diagnose any broken bones but also look for other injuries. Treatment Typically, broken bones can be treated with casts, braces, or a boot to keep them immobilized. (MedlinePlus, 2024) Because comminuted fractures are more severe, they often need other treatments, including surgery. Sometimes, the bone can be reset instead of surgery using a closed reduction technique, where the healthcare provider resets the bone manually. Surgery may be recommended if that’s not possible or doesn't work. Types of Surgery Surgery allows the healthcare provider to correctly position all the pieces of the bone to heal in a strong, stable formation. The two types commonly used to treat comminuted fractures are: (American Academy of Orthopaedic Surgeons, 2021) External Fixation - This surgery uses rods and screws outside the body to stabilize the bone.
- This external frame is placed during surgery and later removed.
Open Reduction Internal Fixation - ORIF - During this surgery, the bone is stabilized with metal plates, screws, rods, and/or wires placed inside your body.
- Sometimes, these are permanent, but in other cases, they are removed later.
- An orthopedic surgeon performs these surgeries.
Casting After surgery, a cast is usually needed to prevent the bone from moving and allow healing. Typically, the cast is worn for six to eight weeks, but it may need to be worn longer with comminuted fractures. Some need a cast for several months (American Academy of Orthopaedic Surgeons, 2021). Sometimes, those with an external fixation must continue wearing a cast after removing the pins and rods, giving the bone more time to stabilize. The healthcare provider will inform the patient how long the cast will need to be worn and which sports activities should be avoided even after the cast comes off. Physical Therapy The healthcare provider may recommend physical therapy to help treat the fracture. Usually, when the cast is removed, physical therapy is activated to help rebuild strength and range of motion. (Corinne Tarantino, 2022) Prognosis Although these fractures are severe, they are treatable. The prognosis is good for individuals who follow their healthcare provider’s treatment plan. Most don’t have lingering pain after the initial injury and can eventually return to regular activities. (American Academy of Orthopaedic Surgeons, 2021) Recovery Healing a comminuted fracture can take months. During that time, it's helpful to focus on tasks that can be accomplished, like new hobbies that don’t involve physical injury. Talk to the healthcare provider about any problems with the cast or ongoing pain and what to expect during recovery. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help individuals return to normal. Our providers create personalized care plans for each patient. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments. General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please get in touch with Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References Corinne Tarantino, MPH. Osmosis. (2022). Comminuted Fracture: What is it, Examples and More. https://www.osmosis.org/answers/comminuted-fracture Throckmorton T.W. American Academy of Orthopaedic Surgeons. (2021). Fractures (broken bones). https://orthoinfo.aaos.org/en/diseases--conditions/fractures-broken-bones/ MedlinePlus. National Library of Medicine. (2024). Fractures Also called: Broken bone. Retrieved from https://medlineplus.gov/fractures.html
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Scooped by
Dr. Alex Jimenez
May 3, 8:23 PM
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Individuals suffering from a jammed finger: Can knowing the signs and symptoms of a finger that is not broken or dislocated allow for at-home treatment and when to see a healthcare provider? Jammed Finger Injury A jammed finger, also known as a sprained finger, is a common injury when the tip of a finger is forcefully pushed toward the hand, causing the joint to become compressed. This can cause pain and swelling in one or more fingers or finger joints and cause ligaments to stretch, sprain, or tear. (American Society for Surgery of the Hand. 2015) A jammed finger can often heal with icing, resting, and taping. This is often enough to allow it to heal in a week or two if no fractures or dislocations are present. (Carruthers, K. H. et al., 2016) While painful, it should be able to move. However, if the finger cannot wiggle, it may be broken or dislocated and require X-rays, as a broken finger or joint dislocation can take months to heal. Treatment Treatment consists of icing, testing, taping, resting, seeing a chiropractor or osteopath, and progressive regular use to regain strength and ability. Ice - The first step is icing the injury and keeping it elevated.
- Use an ice pack or a bag of frozen vegetables wrapped in a towel.
- Ice the finger in 15-minute intervals.
- Take the ice off and wait until the finger returns to its normal temperature before re-icing.
- Do not ice a jammed finger for over three 15-minute intervals in one hour.
Try To Move The Affected Finger - If the jammed finger does not move easily or the pain gets worse when trying to move it, you need to see a healthcare provider and have an X-ray to check for a bone fracture or dislocation. (American Society for Surgery of the Hand. 2015)
- Try to move the finger slightly after swelling, and the pain subsides.
- If the injury is mild, the finger should move with little discomfort for a short time.
Tape and Rest - If the jammed finger is not broken or dislocated, it can be taped to the finger next to it to keep it from moving, known as buddy taping. (Won S. H. et al., 2014)
- Medical-grade tape and gauze between the fingers should be used to prevent blisters and moisture while healing.
- A healthcare provider may suggest a finger splint to keep the jammed finger lined up with the other fingers.
- A splint can also help prevent a jammed finger from re-injury.
Resting and Healing - A jammed finger must be kept still to heal at first, but eventually, it needs to move and flex to build strength and flexibility.
- Targeted physical therapy exercises can be helpful for recovery.
- A primary care provider might be able to refer a physical therapist to ensure the finger has a healthy range of motion and circulation as it heals.
- A chiropractor or osteopath can also provide recommendations for helping rehabilitate the finger, hand, and arm to normal function.
Easing The Finger Back to Normal - Depending on the extent of the injury, the finger and hand can be sore and swollen for a few days or weeks.
- It can take some time to start feeling normal.
- Once the healing process begins, individuals will want to return to using it normally.
- Avoiding using a jammed finger will cause it to lose strength, which can, over time, further weaken it and increase the risk of re-injury.
If the pain and swelling persist, see a healthcare provider to get it checked for a possible fracture, dislocation, or other complication as soon as possible, as these injuries are harder to treat if the individual waits too long. (University of Utah Health, 2021) At Injury Medical Chiropractic and Functional Medicine Clinic, we passionately focus on treating patients’ injuries and chronic pain syndromes and improving ability through flexibility, mobility, and agility programs tailored to the individual. Our providers use an integrated approach to create personalized care plans that include Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine protocols. Our goal is to relieve pain naturally by restoring health and function to the body. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with the top surgeons, clinical specialists, medical researchers, and premier rehabilitation providers to provide the most effective clinical treatments. General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies that are available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to contact Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References American Society for Surgery of the Hand. (2015). Jammed finger. https://www.assh.org/handcare/condition/jammed-finger Carruthers, K. H., Skie, M., & Jain, M. (2016). Jam Injuries of the Finger: Diagnosis and Management of Injuries to the Interphalangeal Joints Across Multiple Sports and Levels of Experience. Sports Health, 8(5), 469–478. https://doi.org/10.1177/1941738116658643 Won, S. H., Lee, S., Chung, C. Y., Lee, K. M., Sung, K. H., Kim, T. G., Choi, Y., Lee, S. H., Kwon, D. G., Ha, J. H., Lee, S. Y., & Park, M. S. (2014). Buddy taping: is it a safe method for treatment of finger and toe injuries?. Clinics in orthopedic surgery, 6(1), 26–31. https://doi.org/10.4055/cios.2014.6.1.26 University of Utah Health. (2021). University of Utah Health. Should I worry about a jammed finger? University of Utah Health. https://healthcare.utah.edu/the-scope/all/2021/03/should-i-worry-about-jammed-finger
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Scooped by
Dr. Alex Jimenez
March 22, 8:54 PM
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Those experiencing neck pain, stiffness, headache, shoulder and back pain may suffer from a whiplash injury. Can knowing whiplash signs and symptoms help individuals recognize the injury and help healthcare providers develop an effective treatment plan? Whiplash Signs and Symptoms Whiplash is a neck injury that typically occurs after a motor vehicle collision or accident but can happen with any injury that rapidly whips the neck forward and backward. It is a mild to moderate injury of the neck muscles. Common whiplash signs and symptoms include: - Neck pain
- Neck stiffness
- Headache
- Dizziness
- Shoulder pain
- Back pain
- Tingling sensations in the neck or down the arms. (Johns Hopkins Medicine. 2024)
- Some individuals can develop chronic pain and headaches.
The symptoms and treatment depend on the severity of the injury. Treatment can include over-the-counter pain medicines, ice and heat therapy, chiropractic, physical therapy, and stretching exercises. Frequent Signs and Symptoms The sudden whipping movement of the head can affect several structures within the neck. These structures include: - Muscles
- Bones
- Joints
- Tendons
- Ligaments
- Intervertebral discs
- Blood vessels
- Nerves.
- Any or all of these can be affected by a whiplash injury. (MedlinePlus, 2017)
Statistics Whiplash is a neck sprain that occurs from a fast neck-jerking motion. Whiplash injuries account for more than half of vehicle traffic collision injuries. (Michele Sterling, 2014) Even with a minor injury, the most frequent symptoms include: (Nobuhiro Tanaka et al., 2018) - Neck pain
- Next stiffness
- Neck tenderness
- Limited range of motion of the neck
Individuals can develop neck discomfort and pain shortly after an injury; however, the more intense pain and stiffness typically do not occur right after the injury. Symptoms tend to worsen the next day or 24 hours later. (Nobuhiro Tanaka et al., 2018) Beginning Symptoms Researchers have found that approximately more than half of individuals with whiplash develop symptoms within six hours of the injury. Around 90% develop symptoms within 24 hours, and 100% develop symptoms within 72 hours. (Nobuhiro Tanaka et al., 2018) Whiplash vs. Traumatic Cervical Spine Injury Whiplash describes a mild to moderate neck injury without significant skeletal or neurological symptoms. Significant neck injuries can lead to fractures and dislocations of the spine that can affect the nerves and spinal cord. Once an individual develops neurological problems associated with a neck injury, the diagnosis changes from whiplash to traumatic cervical spine injury. These differences can be confusing as they are on the same spectrum. To better understand the severity of a neck sprain, the Quebec classification system divides neck injury into the following grades (Nobuhiro Tanaka et al., 2018) Grade 0 - This means there are no neck symptoms or physical examination signs.
Grade 1 - There is neck pain and stiffness.
- Very few findings from the physical examination.
Grade 2 - Indicates neck pain and stiffness
- Neck tenderness
- Decreased mobility or neck range of motion on physical examination.
Grade 3 - Involves muscle pain and stiffness.
- Neurologic symptoms include:
- Numbness
- Tingling
- Weakness in the arms
- Decreased reflexes
Grade 4 - Involves a fracture or dislocation of the bones of the spinal column.
Other Symptoms Other whiplash signs and symptoms that can be associated with the injury but are less common or only occur with a severe injury include (Nobuhiro Tanaka et al., 2018) - Tension headache
- Jaw pain
- Sleep problems
- Migraine headache
- Difficulty concentrating
- Reading difficulties
- Blurred vision
- Dizziness
- Driving difficulties
Rare Symptoms Individuals with severe injuries can develop rare symptoms that often indicate traumatic cervical spine injury and include: (Nobuhiro Tanaka et al., 2018) - Amnesia
- Tremor
- Voice changes
- Torticollis - painful muscle spasms that keep the head turned to one side.
- Bleeding in the brain
Complications Most individual generally recover from their symptoms within a few weeks to a few months. (Michele Sterling, 2014) However, whiplash complications can occur, especially with severe grade 3 or grade 4 injuries. The most common complications of a whiplash injury include chronic/long-term pain and headaches. (Michele Sterling, 2014) Traumatic cervical spine injury can affect the spinal cord and be associated with chronic neurological problems, including numbness, weakness, and difficulty walking. (Luc van Den Hauwe et al., 2020) Treatment The pain is typically more severe the next day than after the injury. Whiplash musculoskeletal injury treatment depends on whether it is an acute injury or the individual has developed chronic neck pain and stiffness. - Acute pain can be treated with over-the-counter medicines like Tylenol and Advil, which effectively treat the pain.
- Advil is a nonsteroidal anti-inflammatory that can be taken with the pain reliever Tylenol, which works in different ways.
- The mainstay of treatment is encouraging regular activity with stretching and exercise. (Michele Sterling, 2014)
- Physical therapy uses various range of motion exercises to strengthen the neck muscles and relieve the pain.
- Chiropractic adjustments and non-surgical decompression can help realign and nourish the spine.
- Acupuncture can cause the body to release natural hormones that provide pain relief, help relax the soft tissues, increase circulation, and reduce inflammation. The cervical spine can return to alignment when the soft tissues are no longer inflamed and spasming. (Tae-Woong Moon et al., 2014)
General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References Medicine, J. H. (2024). Whiplash Injury. https://www.hopkinsmedicine.org/health/conditions-and-diseases/whiplash-injury MedlinePlus. (2017). Neck Injuries and Disorders. Retrieved from https://medlineplus.gov/neckinjuriesanddisorders.html#cat_95 Sterling M. (2014). Physiotherapy management of whiplash-associated disorders (WAD). Journal of physiotherapy, 60(1), 5–12. https://doi.org/10.1016/j.jphys.2013.12.004 Tanaka, N., Atesok, K., Nakanishi, K., Kamei, N., Nakamae, T., Kotaka, S., & Adachi, N. (2018). Pathology and Treatment of Traumatic Cervical Spine Syndrome: Whiplash Injury. Advances in orthopedics, 2018, 4765050. https://doi.org/10.1155/2018/4765050 van Den Hauwe L, Sundgren PC, Flanders AE. (2020). Spinal Trauma and Spinal Cord Injury (SCI). In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the Brain, Head and Neck, Spine 2020–2023: Diagnostic Imaging [Internet]. Cham (CH): Springer; 2020. Chapter 19. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554330/ doi: 10.1007/978-3-030-38490-6_19 Moon, T. W., Posadzki, P., Choi, T. Y., Park, T. Y., Kim, H. J., Lee, M. S., & Ernst, E. (2014). Acupuncture for treating whiplash associated disorder: a systematic review of randomised clinical trials. Evidence-based complementary and alternative medicine : eCAM, 2014, 870271. https://doi.org/10.1155/2014/870271
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Scooped by
Dr. Alex Jimenez
February 22, 9:11 PM
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For individuals dealing with knee pain symptoms from injury and/or arthritis, can incorporating an acupuncture and/or electroacupuncture treatment plan help in pain relief and management? Acupuncture For Knee Pain Acupuncture involves inserting very thin needles into the skin at specific acupoints on the body. It is based on the premise that the needles restore the flow of the body’s energy to activate and promote healing, relieve pain, and help the body relax. - Acupuncture can help address various health conditions, including knee pain caused by arthritis or injury.
- Depending on the type and severity of pain, treatments can help reduce the pain for days or weeks.
- Acupuncture is often used as a complementary therapy - treatment in addition to other treatment or therapy strategies like massage and chiropractic.
Acupuncture Benefits Knee pain caused by osteoarthritis or injury can reduce flexibility, mobility, and quality of life. Acupuncture can help provide relief. When the acupuncture needles are placed on the body, a signal is sent along the spinal cord to the brain, which triggers a release of endorphins/pain hormones. Medical researchers believe this helps reduce pain. (Qian-Qian Li et al., 2013) Acupuncture also helps decrease the production of cortisol, a hormone that helps control inflammation. (Qian-Qian Li et al., 2013) With reduced pain sensations and less inflammation after acupuncture treatments, knee function and mobility can be improved. - Various factors play a role in the pain relief experienced from acupuncture. Some evidence suggests that an individual's expectations may impact the results of acupuncture treatment. (Stephanie L. Prady et al., 2015)
- Researchers are currently assessing whether the expectation that acupuncture is beneficial contributes to a better outcome after treatment. (Zuoqin Yang et al., 2021)
- In 2019, acupuncture was recommended in treating knee osteoarthritis in the American College of Rheumatology/Arthritis Foundation guidelines for hand, hip, and knee osteoarthritis pain management. (Sharon L. Kolasinski et al., 2020)
Research - Different clinical studies support acupuncture’s ability to help in knee pain relief and management.
- One study found that acupuncture helps manage various conditions that cause chronic pain. (Andrew J. Vickers et al., 2012)
- A scientific review analyzed previous studies on pain management interventions after knee surgery and found supporting evidence that the treatments delayed and reduced the use of medications for pain relief post-surgery. (Dario Tedesco et al., 2017)
Osteoarthritis - A systematic review analyzed randomized control studies to determine whether or not acupuncture reduced pain and improved joint function in individuals with chronic osteoarthritis knee pain. (Xianfeng Lin et al., 2016)
- Individuals received six to twenty-three weekly acupuncture sessions for three to 36 weeks.
- The analysis determined that acupuncture can improve short and long-term physical function and mobility and provide up to 13 weeks of pain relief in individuals with chronic knee pain caused by osteoarthritis.
Rheumatoid Arthritis - Rheumatoid arthritis is a chronic disease that affects joints, including the knee joint, causing pain and stiffness.
- Acupuncture is beneficial in treating rheumatoid arthritis/RA.
- A review found that acupuncture alone and in combination with other treatment modalities benefits individuals with RA. (Pei-Chi, Chou Heng-Yi Chu 2018)
- Acupuncture is believed to have anti-inflammatory and antioxidant effects to help regulate immune system function.
Chronic Knee Pain - Various conditions and injuries can cause chronic knee pain, making mobility difficult.
- Individuals with joint pain often turn to complementary therapies for pain relief management, with acupuncture being one of the popular modalities. (Michael Frass et al., 2012)
- A study showed modest improvements in pain relief at 12 weeks. (Rana S. Hinman et al., 2014)
- Acupuncture resulted in modest improvements in mobility and function at 12 weeks.
Safety Side Effects - Side effects can include soreness, bruising, or bleeding at the site of needle insertion and dizziness.
- Less common side effects include fainting, increased pain, and nausea. (Harvard Medical School. 2023)
- Working with a licensed, professional acupuncture practitioner can reduce the risk of unwanted side effects and complications.
Types Other acupuncture options that may be offered include: Electroacupuncture - A modified form of acupuncture where a mild electrical current passes through the needles, providing additional stimulation to the acupoints.
- In one research study, individuals with knee osteoarthritis reported significant improvements in their pain, stiffness, and physical function after electroacupuncture treatment. (Ziyong Ju et al., 2015)
Auricular - Auricular or ear acupuncture works on acupoints in the ear corresponding to the body's different parts.
- A research review analyzed several studies on auricular acupuncture for pain relief and found that it can provide relief within 48 hours of pain onset. (M. Murakami et al., 2017)
Battlefield Acupuncture - The military and veteran healthcare facilities use a unique form of auricular acupuncture for pain management.
- Studies show that it is effective at providing immediate pain relief, but more research is necessary to determine long-term pain relief effectiveness. (Anna Denee Montgomery, Ronovan Ottenbacher 2020)
Before trying acupuncture, consult a healthcare professional for guidance, as it may be integrated with other therapies and lifestyle adjustments. General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to contact Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com Licensed in: Texas & New Mexico* References Li, Q. Q., Shi, G. X., Xu, Q., Wang, J., Liu, C. Z., & Wang, L. P. (2013). Acupuncture effect and central autonomic regulation. Evidence-based complementary and alternative medicine : eCAM, 2013, 267959. https://doi.org/10.1155/2013/267959 Prady, S. L., Burch, J., Vanderbloemen, L., Crouch, S., & MacPherson, H. (2015). Measuring expectations of benefit from treatment in acupuncture trials: a systematic review. Complementary therapies in medicine, 23(2), 185–199. https://doi.org/10.1016/j.ctim.2015.01.007 Yang, Z., Li, Y., Zou, Z., Zhao, Y., Zhang, W., Jiang, H., Hou, Y., Li, Y., & Zheng, Q. (2021). Does patient's expectation benefit acupuncture treatment?: A protocol for systematic review and meta-analysis. Medicine, 100(1), e24178. https://doi.org/10.1097/MD.0000000000024178 Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W. F., Hawker, G., Herzig, E., Kwoh, C. K., Nelson, A. E., Samuels, J., Scanzello, C., White, D., Wise, B., … Reston, J. (2020). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis care & research, 72(2), 149–162. https://doi.org/10.1002/acr.24131 Vickers, A. J., Cronin, A. M., Maschino, A. C., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., Witt, C. M., Linde, K., & Acupuncture Trialists' Collaboration (2012). Acupuncture for chronic pain: individual patient data meta-analysis. Archives of internal medicine, 172(19), 1444–1453. https://doi.org/10.1001/archinternmed.2012.3654 Tedesco, D., Gori, D., Desai, K. R., Asch, S., Carroll, I. R., Curtin, C., McDonald, K. M., Fantini, M. P., & Hernandez-Boussard, T. (2017). Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. JAMA surgery, 152(10), e172872. https://doi.org/10.1001/jamasurg.2017.2872 Lin, X., Huang, K., Zhu, G., Huang, Z., Qin, A., & Fan, S. (2016). The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis. The Journal of bone and joint surgery. American volume, 98(18), 1578–1585. https://doi.org/10.2106/JBJS.15.00620 Chou, P. C., & Chu, H. Y. (2018). Clinical Efficacy of Acupuncture on Rheumatoid Arthritis and Associated Mechanisms: A Systemic Review. Evidence-based complementary and alternative medicine : eCAM, 2018, 8596918. https://doi.org/10.1155/2018/8596918 Frass, M., Strassl, R. P., Friehs, H., Müllner, M., Kundi, M., & Kaye, A. D. (2012). Use and acceptance of complementary and alternative medicine among the general population and medical personnel: a systematic review. Ochsner journal, 12(1), 45–56. Hinman, R. S., McCrory, P., Pirotta, M., Relf, I., Forbes, A., Crossley, K. M., Williamson, E., Kyriakides, M., Novy, K., Metcalf, B. R., Harris, A., Reddy, P., Conaghan, P. G., & Bennell, K. L. (2014). Acupuncture for chronic knee pain: a randomized clinical trial. JAMA, 312(13), 1313–1322. https://doi.org/10.1001/jama.2014.12660 National Center for Complementary and Integrative Health. (2022). Acupuncture in depth. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know Harvard Medical School. (2023). Acupuncture: what is it? Harvard Health Publishing Harvard Medical School Blog. https://www.health.harvard.edu/a_to_z/acupuncture-a-to-z#:~:text=The%20most%20common%20side%20effects,injury%20to%20an%20internal%20organ. Ju, Z., Guo, X., Jiang, X., Wang, X., Liu, S., He, J., Cui, H., & Wang, K. (2015). Electroacupuncture with different current intensities to treat knee osteoarthritis: a single-blinded controlled study. International journal of clinical and experimental medicine, 8(10), 18981–18989. Murakami, M., Fox, L., & Dijkers, M. P. (2017). Ear Acupuncture for Immediate Pain Relief-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain medicine (Malden, Mass.), 18(3), 551–564. https://doi.org/10.1093/pm/pnw215 Montgomery, A. D., & Ottenbacher, R. (2020). Battlefield Acupuncture for Chronic Pain Management in Patients on Long-Term Opioid Therapy. Medical acupuncture, 32(1), 38–44. https://doi.org/10.1089/acu.2019.1382
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Scooped by
Dr. Alex Jimenez
January 29, 8:49 PM
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Chiropractic care has been utilized as an alternative treatment option for injuries or aggravated conditions resulting from an automobile accident. Aside from property damages and lost wages from missed days at work, an auto condition can have serious effects on an individual's health if left untreated. Chiropractic focuses on restoring the victim's original state of well-being as well as promoting a faster recovery. For more information, please feel free to ask Dr. Jimenez or contact us at (915) 850-0900.