Can individuals support their parasympathetic nervous system to maintain a relaxed state and avoid excessive agitation, stress, anxiety, and dysregulation?

Parasympathetic Nervous System

The parasympathetic nervous system (PSNS) involves organs and cells that release neurotransmitters that help the body maintain essential functions like heart rate, breathing, digestion, relaxation, thinking, and sleep. It is part of the autonomic nervous system, which includes the nerves and neurotransmitters that control the body’s internal organs to maintain reliable function. The autonomic nervous system regulates a continual balance between the parasympathetic nervous system’s rest-and-digest functions and the sympathetic nervous system’s fight-or-flight responses.

Functions and Responses

The parasympathetic nervous system includes nerves and neurotransmitters (chemical messengers) distributed throughout the body and is often described as promoting the body's rest-and-digest state. The body's needs regulate the control and effects of the system. Certain medications and health issues can modify or alter the function of the autonomic nervous system, including sympathetic and parasympathetic areas. The parasympathetic and sympathetic nervous systems collaborate to control cells, tissues, and organs. The body requires constant functioning and adjustment of both systems. (McQuade J. D. et al., 2017) Functions include: (Valenti V. E. et al., 2024)

• Saliva secretion to break down food.
• Maintaining blood pressure, resting heart, and breathing rate.
• Producing enzymes in the stomach and intestines to break down food further and absorb nutrients.
• Kidney balancing of fluid and mineral levels by producing urine.
• Constricting pupils (making the dark circle in the eye smaller) to see details up close.
• Maintaining focus and concentration to think, remember, and make decisions.
• Releasing hormones to fall asleep and stay asleep.
• Providing consistent muscle stimulation to maintain endurance for muscle activity.

All functions are adjusted based on the body's needs.

Activation

The parasympathetic response constantly works to keep the body active, engaged, and healthy and can be stimulated simply by relaxing and resting. Individuals can sometimes focus on promoting their body’s parasympathetic activity through stretching, slow movements, relaxing sounds or music, meditation, and similar activities. Individuals who frequently feel anxious or stressed and have difficulty relaxing could benefit from guidance from a therapist or coach on learning to engage the parasympathetic nervous system. (Goren O. et al., 2024) This can involve activities such as guided meditation or talk therapy, which can help individuals work through fears and anxieties.

Dysregulation

Some medical conditions are associated with dysregulation. Heart disease, respiratory disease, sleep disorders, mental health conditions, and behavioral conditions can be associated with overactive or underactive parasympathetic or sympathetic nervous system regulation. (Veerakumar A. et al., 2022) Various mental health and physical health disorders can involve symptom fluctuations that affect the autonomic nervous system. For example, anxiety disorders can cause periods of overeating as well as loss of appetite and episodic indigestion, nausea, and vomiting. Symptoms of dysregulation can include: (McQuade J. D. et al., 2017)

• Excessive sleepiness
• Insomnia
• Difficulty concentrating
• Confusion
• Anxiety - nervousness or agitation
• A feeling of a rapid heart rate
• Shortness of breath
• Dry mouth
• Throat tightness
• Indigestion
• Stomachaches
• Nausea
• Vomiting
• Cold hands and feet
• Sweating or clammy hands
• Sadness
• Depression
• Dizziness or feeling physically off-balance

Any of these symptoms can develop and resolve quickly. Most individuals experience symptoms or parasympathetic nervous system dysfunction when an unexpected stressful event occurs, and the response is considered normal in traumatic, shocking, sad, or high-stress circumstances. (Veerakumar A. et al., 2022)

Medications may induce parasympathetic overactivity or underactivity until the medicine is broken down and removed from the body. (Valenti V. E. et al., 2024)

Nerves

The system comprises nerves that release hormones and neurotransmitters and nerves that respond to the hormones and neurotransmitters. Parasympathetic activation and response include: (Valenti V. E. et al., 2024)

• The nerves that activate the parasympathetic nervous system run throughout the body, primarily in the brain, heart, lungs, stomach, and intestines.
• The brain, heart, lungs, stomach, intestines, muscles, liver, kidneys, reproductive organs, eyes, and mouth are among the areas of the body that respond to stimulation.

The vagus nerve, one of the cranial nerves, is closely associated with parasympathetic nervous system activity. It runs from the brainstem down into the throat, heart, lungs, and digestive system. (Valenti V. E. et al., 2024) Surgical, medical, and alternative interventions are used to regulate the activity of the parasympathetic nervous system and are targeted toward regulating and controlling the activity of the vagus nerve. (Hernández-Domínguez R. A. et al., 2024)

PSNS Support

Living with any parasympathetic nervous system dysfunction can be challenging. For individuals with heart or lung disease, healthcare providers will evaluate the medical condition and recommend surgery or medication to control symptoms and avoid complications. (Hernández-Domínguez R. A. et al., 2024) Individuals who are living with a mental health disorder or behavioral disorder that is associated with any dysregulation of the parasympathetic nervous system activity may benefit from a combination of behavioral interventions and medication to help control symptoms long term. (Goren O. et al., 2024)

Injury Medical Chiropractic and Functional Medicine Clinic

The spinal cord has multiple functions in restoring, rejuvenating, and strengthening the nervous system. Chiropractic care has a highly responsive therapeutic effect on the nervous system because of its focus on the spine. Spinal decompression, traction, soft tissue manipulation, and other treatments help regulate and restore the function of the nervous system. Chiropractic benefits:

• Reduce and/or eliminate pain.
• Improves the quality of sleep.
• Increases energy.
• Improves cognition and clarity.
• Reduces or eliminates headaches and migraines.
• Improves digestive function.
• Improves balance and coordination.
• Increases flexibility and mobility.
• Regulates respiration.
• Regulates lower heart rate.

At Injury Medical Chiropractic and Functional Medicine Clinic, 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, Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Wellness & Nutrition, Functional Medicine Treatments, and in-scope care protocols. 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.

Chiropractic Secrets Exposed

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

McQuade, J. D., Penzel, T. E., Silk, J. S., & Lee, K. H. (2017). Parasympathetic Nervous System Reactivity Moderates Associations Between Children's Executive Functioning and Social and Academic Competence. Journal of abnormal child psychology, 45(7), 1355–1367. https://doi.org/10.1007/s10802-016-0246-5

Valenti, V. E., Vanderlei, L. C. M., & Godoy, M. F. (2024). Editorial: Understanding the role of the autonomic nervous system in health and disease. Frontiers in neuroscience, 18, 1446832. https://doi.org/10.3389/fnins.2024.1446832

Goren, O., Paz, A., Bar-Kalifa, E., Gilboa-Schectman, E., Wolff, M., & Atzil-Slonim, D. (2024). Clients' and therapists' parasympathetic interpersonal and intrapersonal regulation dynamics during psychotherapy for depression. Psychotherapy research : journal of the Society for Psychotherapy Research, 1–15. Advance online publication. https://doi.org/10.1080/10503307.2024.2378038

Veerakumar, A., Yung, A. R., Liu, Y., & Krasnow, M. A. (2022). Molecularly defined circuits for cardiovascular and cardiopulmonary control. Nature, 606(7915), 739–746. https://doi.org/10.1038/s41586-022-04760-8

Hernández-Domínguez, R. A., Herrera-Orozco, J. F., Salazar-Calderón, G. E., Chávez-Canales, M., Márquez, M. F., González-Álvarez, F., Totomoch-Serra, A., Reyes-Cruz, T., Lip, F., & Aceves-Buendía, J. J. (2024). Optogenetic modulation of cardiac autonomic nervous system. Autonomic neuroscience : basic & clinical, 255, 103199. https://doi.org/10.1016/j.autneu.2024.103199

Individuals dealing with symptoms like sudden pain, weakness, and tenderness in the back of the knee could have a hamstring injury. Can knowing the symptoms and performing self-care help bring relief?

Hamstring Pain Behind The Knee

The hamstrings consist of three long muscles that run down the back of the thigh, cross over the back of the knee, and connect to bones in that area. A hamstring injury, such as a strain or tear, tendonitis, or biceps femoris tendinopathy, can cause pain in the back of the knee, difficulty bending the knee, swelling, and bruising. A hamstring strain occurs when the muscle is stretched too far or torn completely. This can happen from sudden, forceful movements or overstretching. Hamstring tendonitis develops over time, usually after a sudden increase in activity, when the hamstring tissue cannot recover from too much loading. Pain is often felt after physical activity and exercise and, in severe cases, during the activity or throughout the day. Biceps femoris tendinopathy can also cause pain in the back of the knee. Strains, tendonitis, bursitis, and muscle tears are all possible explanations for a hamstring injury that leads to pain behind the knee. Discussing pain symptoms with a healthcare provider is recommended, especially if it occurs suddenly during physical activity or exercise. They can help identify the exact cause and offer guidance for rehabilitation, including physical therapy referrals.

Causes and Triggers

Individuals may experience hamstring pain behind the knee when the muscles in that area are overworked, inflamed, or injured, such as from activities like running, walking, dancing, soccer, or basketball. Possible types of injuries and their causes.

Tendonitis

• The hamstring tendons connect behind the knee.
• When the tendons become inflamed due to overuse, they can lead to swelling and pain that worsen with activity. (National Library of Medicine, 2017) (American Academy of Orthopaedic Surgeons, 2020)

Strain or Tear

• A muscle strain occurs when the muscle is stretched too much, and the fibers tear.
• A hamstring strain is also called a pulled hamstring. (American Academy of Orthopaedic Surgeons, 2021)

Bursitis

• This is inflammation of tiny fluid-filled sacs that help cushion joints during movement.
• Inflammation from bursitis can affect the nerves within the hamstring, resulting in pain. (American Academy of Orthopaedic Surgeons, 2020)

Pes anserine

• This is a specific type of bursitis which affects the knee tendons. (American Academy of Orthopaedic Surgeons, 2021)

Muscle Overload

• A primary cause of muscle strain occurs when the muscle is stretched too far or has to handle a sudden force like sprinting or kicking. (American Academy of Orthopaedic Surgeons, 2021)

Severe Cases

Most causes of pain behind the knee are easily treatable at home with self-care and rest. However, it can be more severe, signaling a blood clot, infection, torn muscle or tendon/ligament. Hamstring knee pain may be serious if any of the following is experienced (American Academy of Orthopaedic Surgeons, 2021)

• Sudden pain during physical activity, often during a full stride.
• Feeling a pop or sharp pain that causes falling or limping.
• Pain that worsens over time and prevents or hinders walking or exercising as normal.

If pain is severe and does not improve with rest and anti-inflammatory medications, evaluation by a healthcare professional is necessary.

Assesses Hamstring Pain

A healthcare provider will ask about symptoms and injury, including what happened when the pain began. They will perform a physical examination, which may include pressing on the back of the thigh to look for swelling, bruising, tenderness, or bunched-up muscles. (American Academy of Orthopaedic Surgeons, 2021) The healthcare provider will ask the patient to perform specific resisted movements, such as the manual muscle test, and measure the range of motion. Diagnostic testing includes an X-ray or MRI to determine the degree of the injury and which soft tissues or bones may be involved.

Self-Care

The first line of treating hamstring knee pain is the RICE protocol, which includes: (Mount Siani, 2024)

Rest

• Stop any activity that causes symptoms and pain.
• A healthcare provider may recommend crutches or a knee scooter in severe cases.

Ice

• Apply cold packs to the swollen or painful area for 20 minutes throughout the day.

Compression

• A knee brace, wrap, or bandage that applies gentle pressure to the injured area can help reduce and prevent swelling.

Elevation

• Lifting the leg higher than the heart will help reduce swelling and blood accumulation.
• Individuals may need to lie on a bed or sofa and elevate their legs with pillows.

Individuals can use at-home pain relievers like acetaminophen or NSAIDs like ibuprofen or naproxen. Over time, and depending on the severity of the injury, a healthcare provider will advise on gentle hamstring stretches and how to ease back into physical activity.

Professional Therapy and Surgical Treatments

Depending on the severity of the condition, a healthcare provider may recommend additional interventions, that include (American Academy of Orthopaedic Surgeons, 2021)

Immobilization

• A healthcare provider will advise immobilizing the knee to help with muscle healing, which could involve wearing a knee brace or using crutches.

Physical therapy

• A healthcare provider may refer the patient to a physical therapist, who will perform a personalized evaluation and prescribe targeted exercises to heal the injury and regain strength, flexibility, and movement.

Surgery

• Tendon avulsion injuries are when the hamstring tendon completely tears away from the bone, and surgery is required to reattach the tendon.

Platelet-rich plasma - PRP

• Platelet-rich plasma has become an additional treatment for hamstring muscle strain or tendonitis. (Seow D. et al., 2021)
• The treatment involves injecting a solution from the patient's blood into the muscle to heal the injury.

Recovery

Predicting how long a hamstring injury takes to heal and how long the pain will linger depends on the type, location, and severity. The most severe type is the hamstring coming unattached around the knee. This surgical repair and rehabilitation take at least three months before returning to sports and exercise (American Academy of Orthopaedic Surgeons, 2021). Lesser injuries like tendonitis or a mild strain can take less time to heal. However, it's essential to avoid reinjuring the area so the condition does not become chronic. This includes: (American Academy of Orthopaedic Surgeons, 2021)

• Stretching to encourage and maintain flexibility.
• Fixing muscle imbalances between the quadriceps and hamstring.
• Endurance and conditioning.
• Avoiding overuse.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. We focus on what works for you and use an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility, relieving pain and helping 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. Our providers use Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.

Chiropractic Care for Leg Instability

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 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 call 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 Library of Medicine. (2017). Tendinitis Also called: Tendonitis. Retrieved from https://medlineplus.gov/tendinitis.html

American Academy of Orthopaedic Surgeons. OrthoInfo. (2020). Sprains, strains, and other soft tissue injuries. https://orthoinfo.aaos.org/en/diseases--conditions/sprains-strains-and-other-soft-tissue-injuries/

American Academy of Orthopaedic Surgeons. OrthoInfo. (2021). Hamstring muscle injuries. https://orthoinfo.aaos.org/en/diseases--conditions/hamstring-muscle-injuries/

American Academy of Orthopaedic Surgeons. OrthoInfo. (2021). Pes aserine (knee tendon) bursitis. https://orthoinfo.aaos.org/en/diseases--conditions/pes-anserine-knee-tendon-bursitis/

Mount Siani. (2024). Hamstring strain - aftercare. https://www.mountsinai.org/health-library/selfcare-instructions/hamstring-strain-aftercare

Seow, D., Shimozono, Y., Tengku Yusof, T. N. B., Yasui, Y., Massey, A., & Kennedy, J. G. (2021). Platelet-Rich Plasma Injection for the Treatment of Hamstring Injuries: A Systematic Review and Meta-analysis With Best-Worst Case Analysis. The American journal of sports medicine, 49(2), 529–537. https://doi.org/10.1177/0363546520916729

Individuals experiencing pain, numbness, tingling, or a burning sensation in the front and outer thigh could have meralgia paresthetica, a nerve entrapment. Can understanding the condition help healthcare providers develop an effective treatment plan?

Meralgia Paresthetica

Meralgia paresthetica, or MP, is also known as Bernhardt-Roth syndrome, lateral femoral cutaneous nerve syndrome, or lateral femoral cutaneous neuralgia. It occurs when the lateral femoral cutaneous nerve, a sensory nerve that passes over the brim of the pelvis and down the front of the thigh, becomes compressed. The nerve supplies information about sensations over the front and outside of the thigh. This can happen for several reasons, including:

• Recent hip injuries, such as from a motor vehicle collision/accident.
• Repetitive hip activities, like cycling.
• Pregnancy
• Weight gain
• Wearing tight clothing.

The nerve entrapment condition causes tingling, numbness, and burning pain in the front and/or outer thigh. 

Causes

There can be several different causes of this condition, but it is frequently seen in pregnancy, sudden weight gain, wearing tight clothing or belts, and other conditions. (Ivins G. K. 2000) Sometimes, meralgia paresthetica can be caused by medical procedures. For example, the condition can present after an individual has surgery and is in an unusual position for a long period of time, where there is direct external pressure on the nerve. Also, the nerve can become damaged during a surgical procedure. (Cheatham S. W. et al., 2013) This can occur when a bone graft is obtained from the pelvis or anterior hip replacement surgery.

Symptoms

Individuals may experience some or all of the following symptoms (Chung K. H. et al., 2010)

• Numbness over the outside of the thigh.
• Pain or burning on the outside of the thigh.
• Sensitivity to lightly touching the outside of the thigh.
• Worsening of symptoms with certain positions.
• Increased symptoms when wearing belts, work belts, or tight-waist clothes.

The symptoms may come and go or be persistent. Some individuals are hardly noticeable and do not impact their lives or activities, while others can be very bothersome and cause significant pain. (Scholz C. et al., 2023)

Treatment

Treatment depends on how long the injury has been present and the frequency and severity of the condition.

Clothing Modifications

If the cause is due to tight clothing, belts, or work belts, then garment modification should alleviate symptoms.

Pregnancy

Pregnant women usually find complete relief of their symptoms after delivery. (Hosley, C. M., and McCullough, L. D. 2011)

Weight Loss Program

If recent weight gain is thought to contribute to the condition, then a weight loss program may be recommended.

Cortisone Injections

If simple steps do not relieve symptoms, a cortisone injection around the nerve area may be recommended. The goal is to reduce inflammation that contributes to nerve pressure (Houle S. 2012). Cortisone injections may be a definitive or temporary treatment.

Chiropractic

Chiropractic care can be an effective, natural, and safe treatment. Adjustments can help relieve pressure on the lateral femoral cutaneous nerve (LFCN) by realigning the spine and restoring nerve function. Chiropractors may also use soft tissue therapies, such as massage, to relieve muscle tension and support the body's healing process. Other chiropractic techniques that may be used include:

• Pelvic mobilizations
• Myofascial therapy
• Transverse friction massage
• Stretching exercises
• Stabilization exercises for the core and pelvis
• Therapeutic kinesiology tape

A chiropractic treatment program may include 10–15 treatments over 6–8 weeks, but the number of treatments needed will vary from person to person. If there's no noticeable progress after 3–4 weeks, it may be time to consult a specialist or surgeon.

Surgery

Surgery is rarely necessary. However, a surgical procedure may be considered when all conservative treatments fail to provide relief. (Schwaiger K. et al., 2018) A surgeon dissects and identifies the nerve, looks for compression locations, and tries to free the nerve from any areas where it may be pinched. Alternatively, some surgeons transect/cut the nerve so it no longer causes problems. If the transection procedure is performed, there will be a permanent area of numbness over the front of the thigh.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a customized treatment plan to relieve pain, treat injuries, improve flexibility, mobility, and agility, and help individuals return to optimal function. 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.

Chiropractic Care for Leg Instability

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 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

Ivins G. K. (2000). Meralgia paresthetica, the elusive diagnosis: clinical experience with 14 adult patients. Annals of surgery, 232(2), 281–286. https://doi.org/10.1097/00000658-200008000-00019

Cheatham, S. W., Kolber, M. J., & Salamh, P. A. (2013). Meralgia paresthetica: a review of the literature. International journal of sports physical therapy, 8(6), 883–893.

Chung, K. H., Lee, J. Y., Ko, T. K., Park, C. H., Chun, D. H., Yang, H. J., Gill, H. J., & Kim, M. K. (2010). Meralgia paresthetica affecting parturient women who underwent cesarean section -A case report-. Korean journal of anesthesiology, 59 Suppl(Suppl), S86–S89. https://doi.org/10.4097/kjae.2010.59.S.S86

Scholz, C., Hohenhaus, M., Pedro, M. T., Uerschels, A. K., & Dengler, N. F. (2023). Meralgia Paresthetica: Relevance, Diagnosis, and Treatment. Deutsches Arzteblatt international, 120(39), 655–661. https://doi.org/10.3238/arztebl.m2023.0170

Hosley, C. M., & McCullough, L. D. (2011). Acute neurological issues in pregnancy and the peripartum. The Neurohospitalist, 1(2), 104–116. https://doi.org/10.1177/1941875211399126

Houle S. (2012). Chiropractic management of chronic idiopathic meralgia paresthetica: a case study. Journal of chiropractic medicine, 11(1), 36–41. https://doi.org/10.1016/j.jcm.2011.06.008

Schwaiger, K., Panzenbeck, P., Purschke, M., Russe, E., Kaplan, R., Heinrich, K., Mandal, P., & Wechselberger, G. (2018). Surgical decompression of the lateral femoral cutaneous nerve (LFCN) for Meralgia paresthetica treatment: Experimental or state of the art? A single-center outcome analysis. Medicine, 97(33), e11914. https://doi.org/10.1097/MD.0000000000011914

Can physical therapies help treat a high steppage gait from injury or medical conditions and restore normal gait patterns for individuals who have or are developing one?

Neuropathic Gait

Neuropathic gait, aka equine or high steppage gait, is a type of walking abnormality that causes individuals to raise their hips to lift their legs higher than normal. It occurs when individuals have a foot drop or ankle equinus due to loss of dorsiflexion. As a result, the foot hangs with the toes pointing down, causing the toes to drag while walking. The foot may appear floppy when it drops. Foot drop is caused by weakness or paralysis of the anterior tibialis muscle in front of the shin bone. The anterior tibialis muscle contracts to help flex the foot and ankle while walking, ensuring the foot clears the floor and doesn’t drag. Individuals with anterior tibialis weakness or paralysis may have a neuropathic gait and excessively bend the hip and knee while stepping forward, lifting their leg high off the floor to clear the foot to avoid tripping. A physical therapy team can help with a high steppage gait pattern after illness or injury.

Causes

Conditions that can cause anterior tibialis weakness or paralysis and a high steppage gait pattern include:

Sciatica

• Pain caused by compression or irritation of the sciatic nerve starts in the lower back and travels down the back of the leg. (McCabe, F. J., McCabe, J. P. 2016)

Peroneal Nerve Injury

• Damage to the peroneal nerve branches from the sciatic nerve that help move the lower leg and foot. (Johns Hopkins Medicine. 2024)

Multiple Sclerosis

• An autoimmune disease that damages nerve cells in the brain and spinal cord. (Taylor, P. N. et al., 2016)

Stroke

• Interruption of blood circulation to part of the brain can cause disability. (Kaykisiz, E. K., Unluer, E. E. 2017)

A primary healthcare provider may refer a physical therapy team to help correct the neuropathic gait pattern.

Treatment

Treatment can involve various therapies that focus on the anterior tibialis muscle.

• Targeted ankle exercises can help strengthen the muscle.
• Calf stretches can help maintain the ankle's range of motion.
• Gait training exercises.
• Balance exercises will help improve overall proprioception, or the sense of the body’s position and movement.
• Neuromuscular electrical stimulation, or NMES, can help improve the function of the muscle. (Hollis, S., McClure, P. 2017)
• The electrical stimulation artificially contracts the muscle to restore proper function.
• For anterior tibialis weakness caused by sciatica, back decompression exercises may be prescribed to relieve pressure off the sciatic nerve.
• The exercises release the nerve to restore normal signal transmission up and down the nerve in the lower back.
• Neuromuscular electrical stimulation may also be used to help improve muscle function.

Assistive Walking Devices

A therapist may suggest using an assistive device to help the patient walk properly. This could include a wheeled walker or a quad cane. A temporary solution to anterior tibialis weakness is to elevate the foot while walking with an elastic band. Tie a band around the leg below the knee and secure it around the ball of the foot. When swinging the leg forward, the band pulls the foot up. Using it as a temporary solution may help maintain safe mobility. Sometimes, paralysis of the anterior tibialis muscle can become permanent. In this case, individuals may benefit from a special brace called an ankle-foot orthosis. The brace helps to lift the foot and toes off the ground.

For individuals concerned about losing their balance and falling, there are ways to improve walking patterns to stay safe. A healthcare provider may recommend physical therapy to correct gait, strengthen the anterior tibialis muscle, improve balance, and educate on injury prevention. Individuals should discuss symptoms and conditions with a primary physician, healthcare provider, or specialist to guide them in the right direction and determine the best treatment.

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. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Control Foot Motion and Posture

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 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

McCabe, F. J., & McCabe, J. P. (2016). An Unusual Presentation of Right-Sided Sciatica with Foot Drop. Case reports in orthopedics, 2016, 9024368. https://doi.org/10.1155/2016/9024368

Johns Hopkins Medicine. (2024). Peroneal nerve injury. https://www.hopkinsmedicine.org/health/conditions-and-diseases/peroneal-nerve-injury

Kaykisiz, E. K., & Unluer, E. E. (2017). An Unexpected Reason for Isolated Foot Drop: Acute Stroke. Pakistan journal of medical sciences, 33(5), 1288–1290. https://doi.org/10.12669/pjms.335.13593

Taylor, P. N., Wilkinson Hart, I. A., Khan, M. S., & Slade-Sharman, D. E. (2016). Correction of Footdrop Due to Multiple Sclerosis Using the STIMuSTEP Implanted Dropped Foot Stimulator. International journal of MS care, 18(5), 239–247. https://doi.org/10.7224/1537-2073.2015-038

Hollis, S., & McClure, P. (2017). Intramuscular Electrical Stimulation for Muscle Activation of the Tibialis Anterior After Surgical Repair: A Case Report. The Journal of orthopedic and sports physical therapy, 47(12), 965–969. https://doi.org/10.2519/jospt.2017.7368

Certain neurological disorders can cause acute episodes of peripheral neuropathy, and for individuals diagnosed with chronic peripheral neuropathy, can physical therapy help improve the ability to move around safely along with medications, procedures, and lifestyle adjustments to help control and manage symptoms?

Peripheral Neuropathy Treatments

Peripheral neuropathy treatment includes symptomatic therapies and medical management to help prevent worsening nerve damage.

• For acute types of peripheral neuropathy, medical interventions and therapies can treat the underlying process, improving the condition.
• For chronic types of peripheral neuropathy, medical interventions and lifestyle factors can help to prevent the condition's progression.
• Chronic peripheral neuropathy treatment focuses on controlling the pain symptoms and protecting areas of diminished sensation from damage or infection.

Self-Care and Lifestyle Adjustments

For individuals who have been diagnosed with peripheral neuropathy or are at risk of developing the condition, lifestyle factors play a significant role in managing symptoms and preventing nerve damage from worsening and can even prevent the condition from developing. (Jonathan Enders et al., 2023)

Pain Management

Individuals can try these self-care therapies and see if and which help reduce their discomfort and then develop a routine that they can work off of. Self-care for pain symptoms include:

• Placing a warm heating pad on painful areas.
• Placing a cooling pad (not ice) on painful areas.
• Covering the area or leaving it uncovered, depending on comfort levels.
• Wear loose-fitting clothes, socks, shoes, and/or gloves not made with material that can cause irritation.
• Avoid using lotions or soaps that can cause irritation.
• Use soothing creams or lotions.
• Keeping the painful areas clean.

Injuries Prevention

Diminished sensation is one of the most common effects that can lead to problems like stumbling, difficulty getting around, and injuries. Preventing and regularly checking for injuries can help avoid complications like infected wounds. (Nadja Klafke et al., 2023) Lifestyle adjustments to manage and prevent injuries include:

• Wear well-padded shoes and socks.
• Inspect feet, toes, fingers, and hands regularly to look for cuts or bruises that may not have been felt.
• Clean and cover cuts to avoid infections.
• Use extra caution with sharp utensils like cooking and work or gardening tools.

Disease Management

Lifestyle factors can help prevent disease progression and are closely correlated with the risks and underlying causes. To help prevent peripheral neuropathy or its progression can be done by: (Jonathan Enders et al., 2023)

• Maintain healthy glucose levels if you have diabetes.
• Avoid alcohol for any peripheral neuropathy.
• Maintain a well-balanced diet, which can include vitamin supplements, especially for vegetarians or vegans.

Over-the-Counter Therapies

A few over-the-counter therapies can help with painful symptoms and can be taken as needed. Over-the-counter pain therapies include: (Michael Überall et al., 2022)

• Topical lidocaine spray, patch, or creams.
• Capsaicin creams or patches.
• Topical Icy Hot
• Non-steroidal anti-inflammatory medications -  Advil/ibuprofen or Aleve/naproxen
• Tylenol/acetaminophen

These treatments can help relieve painful symptoms of peripheral neuropathy, but they do not help improve diminished sensation, weakness, or coordination problems. (Jonathan Enders et al., 2023)

Prescription Therapies

Prescription therapies for treating peripheral neuropathy include pain medications and anti-inflammatories. Chronic types of peripheral neuropathy include:

• Alcoholic neuropathy
• Diabetic neuropathy
• Chemotherapy-induced neuropathy

The prescription treatments for chronic types differ from the treatments for acute types of peripheral neuropathy.

Pain Management

Prescription treatments can help manage the pain and discomfort. Medications include (Michael Überall et al., 2022)

• Lyrica - pregabalin
• Neurontin - gabapentin
• Elavil - amitriptyline
• Effexor - venlafaxine
• Cymbalta - duloxetine
• In severe cases, intravenous/IV lidocaine may be necessary. (Sanja Horvat et al., 2022)

Sometimes, a prescription strength supplement or vitamin B12 given through injection can help prevent progression when peripheral neuropathy is associated with a severe vitamin deficiency. Prescription treatment can help treat the underlying process in some types of acute peripheral neuropathy. Treatment for acute peripheral neuropathy, such as Miller-Fisher syndrome or Guillain-Barré syndrome, can include:

• Corticosteroids
• Immunoglobulins - immune system proteins
• Plasmapheresis is a procedure that removes the liquid portion of blood, returning the blood cells, which modifies the overactivity of the immune system. (Sanja Horvat et al., 2022)
• Researchers believe there is an association between these conditions and inflammatory nerve damage, and modifying the immune system is beneficial for treating symptoms and the underlying disease.

Surgery

In some cases, surgical procedures can benefit individuals who have certain types of peripheral neuropathy. When another condition is exacerbating the symptoms or process of peripheral neuropathy, surgery may help relieve symptoms and prevent disease progression. This has proved effective when nerve entrapment or vascular insufficiency are factors. (Wenqiang Yang et al., 2016)

Complementary and Alternative Medicine

Some complementary and alternative approaches can help individuals cope with the pain and discomfort. These treatments can serve as an ongoing option for those who have chronic peripheral neuropathy. Options can include: (Nadja Klafke et al., 2023)

• Acupuncture involves the placement of needles in specific areas of the body to help reduce pain symptoms.
• Acupressure involves applying pressure on specific areas of the body to help reduce pain symptoms.
• Massage therapy can help relax muscle tension.
• Meditation and relaxation therapies can help manage symptoms.
• Physical therapy can also serve as an important component of living with chronic peripheral neuropathy and recovering from acute peripheral neuropathy.
• Physical therapy can help strengthen weak muscles, improve coordination, and learn how to adapt to sensory and motor changes to get around safely.

Individuals considering complementary or alternative treatment are encouraged to speak with their primary healthcare provider to determine whether it is safe for their condition. Injury Medical Chiropractic and Functional Medicine Clinic will work with the individual's healthcare provider and/or specialists to develop an optimal health and wellness treatment solution to relieve pain and improve quality of life.

Peripheral Neuropathy: A Successful Recovery Story

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 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

Enders, J., Elliott, D., & Wright, D. E. (2023). Emerging Nonpharmacologic Interventions to Treat Diabetic Peripheral Neuropathy. Antioxidants & redox signaling, 38(13-15), 989–1000. https://doi.org/10.1089/ars.2022.0158

Klafke, N., Bossert, J., Kröger, B., Neuberger, P., Heyder, U., Layer, M., Winkler, M., Idler, C., Kaschdailewitsch, E., Heine, R., John, H., Zielke, T., Schmeling, B., Joy, S., Mertens, I., Babadag-Savas, B., Kohler, S., Mahler, C., Witt, C. M., Steinmann, D., … Stolz, R. (2023). Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy (CIPN) with Non-Pharmacological Interventions: Clinical Recommendations from a Systematic Scoping Review and an Expert Consensus Process. Medical sciences (Basel, Switzerland), 11(1), 15. https://doi.org/10.3390/medsci11010015

Überall, M., Bösl, I., Hollanders, E., Sabatschus, I., & Eerdekens, M. (2022). Painful diabetic peripheral neuropathy: real-world comparison between topical treatment with lidocaine 700 mg medicated plaster and oral treatments. BMJ open diabetes research & care, 10(6), e003062. https://doi.org/10.1136/bmjdrc-2022-003062

Horvat, S., Staffhorst, B., & Cobben, J. M. G. (2022). Intravenous Lidocaine for Treatment of Chronic Pain: A Retrospective Cohort Study. Journal of pain research, 15, 3459–3467. https://doi.org/10.2147/JPR.S379208

Yang, W., Guo, Z., Yu, Y., Xu, J., & Zhang, L. (2016). Pain Relief and Health-Related Quality-of-Life Improvement After Microsurgical Decompression of Entrapped Peripheral Nerves in Patients With Painful Diabetic Peripheral Neuropathy. The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons, 55(6), 1185–1189. https://doi.org/10.1053/j.jfas.2016.07.004

Can physical therapy treatment protocols aimed at improving range of motion and flexibility around the hip and relieving inflammation around the sciatic nerve help individuals experiencing deep buttock pain or piriformis syndrome?

Deep Buttock Pain

• Piriformis syndrome, a.k .a. deep buttock pain, is described as sciatic nerve irritation from the piriformis muscle.
• The piriformis is a small muscle behind the hip joint in the buttocks.
• It is about one centimeter in diameter and functions in the hip joint's external rotation or turning outward.
• The piriformis muscle and tendon are close to the sciatic nerve, which supplies the lower extremities with motor and sensory functions.
• Depending on an individual's anatomic variation of the muscle and tendon:
• The two cross over, under, or through each other behind the hip joint in the deep buttock.
• This relationship is thought to irritate the nerve, leading to sciatica symptoms.

Piriformis Syndrome

• When diagnosed with piriformis syndrome, it is thought that the muscle and tendon bind to and/or spasm around the nerve, causing irritation and pain symptoms.
• The theory supported is that when the piriformis muscle and its tendon tighten, the sciatic nerve becomes compressed or pinched. This decreases blood circulation and irritates the nerve from the pressure. (Shane P. Cass 2015)

Symptoms

Common signs and symptoms include: (Shane P. Cass 2015)

• Tenderness with pressure on the piriformis muscle.
• Discomfort in the back of the thigh.
• Deep buttock pain behind the hip.
• Electric sensations, shocks, and pains travel down the back of the lower extremity.
• Numbness in the lower extremity.
• Some individuals develop symptoms abruptly, while others go through a gradual increase.

Diagnosis

• Doctors will order X-rays, MRIs, and nerve conduction studies, which is normal.
• Because piriformis syndrome can be challenging to diagnose, some individuals with minor hip pain may receive a piriformis syndrome diagnosis even if they don't have the condition. (Shane P. Cass 2015)
• It is sometimes referred to as deep buttock pain. Other causes of this type of pain include back and spinal problems like:

1. Herniated discs
2. Spinal stenosis
3. Radiculopathy - sciatica
4. Hip bursitis
5. A piriformis syndrome diagnosis is usually given when these other causes are eliminated.

• When the diagnosis is uncertain, an injection is administered in the area of the piriformis muscle. (Danilo Jankovic et al., 2013)
• Different medications can be used, but the injection itself is used to help determine the specific location of the discomfort.
• When an injection is given into the piriformis muscle or tendon, it is often administered by ultrasound guidance to ensure the needle delivers the medication to the correct location. (Elizabeth A. Bardowski, J. W. Thomas Byrd 2019)

Treatment

Common treatments include the following. (Danilo Jankovic et al., 2013)

Rest

• Avoiding activities that cause symptoms for at least a few weeks.

Physical Therapy

• Emphasize stretching and strengthening the hip rotator muscles.

Non-Surgical Decompression

• Gently pulls the spine to release any compression, allowing optimal rehydration and circulation and taking the pressure off the sciatic nerve.

Therapeutic Massage Techniques

• To relax and release muscle tension and increase circulation.

Acupuncture

• To help relax the piriformis muscle, sciatic nerve, and surrounding area.
• Relieve pain.

Chiropractic Adjustments

• Realignment rebalances the spine and musculoskeletal system to alleviate pain. 

Anti-Inflammatory Medication

• To decrease inflammation around the tendon.

Cortisone Injections

• Injections are used to decrease inflammation and swelling.

Botulinum Toxin Injection

• Injections of botulinum toxin paralyze the muscle to relieve pain.

Surgery

• Surgery can be performed in rare cases to loosen the piriformis tendon, known as a piriformis release. (Shane P. Cass 2015)
• Surgery is a last resort when conservative treatments have been tried for at least 6 months with little to no relief.
• Recovery can take several months.

Sciatica Causes and Treatment

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

Cass S. P. (2015). Piriformis syndrome: a cause of nondiscogenic sciatica. Current sports medicine reports, 14(1), 41–44. https://doi.org/10.1249/JSR.0000000000000110

Jankovic, D., Peng, P., & van Zundert, A. (2013). Brief review: piriformis syndrome: etiology, diagnosis, and management. Canadian journal of anaesthesia = Journal canadien d'anesthesie, 60(10), 1003–1012. https://doi.org/10.1007/s12630-013-0009-5

Bardowski, E. A., & Byrd, J. W. T. (2019). Piriformis Injection: An Ultrasound-Guided Technique. Arthroscopy techniques, 8(12), e1457–e1461. https://doi.org/10.1016/j.eats.2019.07.033

For individuals dealing with chronic pain, can undergoing a nerve block procedure help alleviate and manage symptoms?

Nerve Blocks

A nerve block is a procedure done to interrupt/block pain signals due to nerve dysfunction or injury. They can be used for diagnostic or treatment purposes, and their effects can be short or long-term, depending on the type being used.

• A temporary nerve block may involve the application or injection that stops pain signals from transmitting for a short time.
• For example, in pregnancy, an epidural injection can be used during labor and delivery.
• Permanent nerve blocks involve cutting/severing or removing certain parts of a nerve to stop pain signals.
• These are used in cases with severe injuries or other chronic pain conditions that have not improved with other treatment approaches.

Treatment Usage

When healthcare providers diagnose a chronic pain condition caused by nerve injury or dysfunction, they may use a nerve block to locate the area generating pain signals. They may perform electromyography and/or a nerve conduction velocity/NCV test to pinpoint the cause of chronic nerve pain. Nerve blocks can also treat chronic neuropathic pain, such as pain caused by nerve damage or compression. Nerve blocks are regularly used to treat back and neck pain caused by herniated discs or spinal stenosis. (Johns Hopkins Medicine. 2024)

Types

Three types include:

• Local
• Neurolytic
• Surgical

All three can be used for conditions that cause chronic pain. However, neurolytic and surgical blocks are permanent and are only used for severe pain that has worsened with other treatments unable to provide relief.

Temporary Blocks

• A local block is done by injecting or applying local anesthetics, like lidocaine, to a certain area.
• An epidural is a local nerve block that injects steroids or analgesics into an area around the spinal cord.
• These are common during pregnancy, labor, and delivery.
• Epidurals can also be used to treat chronic neck or back pain due to a compressed spinal nerve.
• Local blocks are usually temporary, but in a treatment plan, they can be repeated over time to manage chronic pain from conditions like arthritis, sciatica, and migraines. (NYU Langone Health. 2023)

Permanent Blocks

• A neurolytic block uses alcohol, phenol, or thermal agents to treat chronic nerve pain. (National Institute of Neurological Disorders and Stroke. 2023) These procedures damage certain areas of the nerve pathway on purpose so that pain signals cannot be transmitted. A neurolytic block is mainly used for severe chronic pain cases, like pain from cancer or complex regional pain syndrome/CRPS. They are sometimes used to treat ongoing pain from chronic pancreatitis and pain in the chest wall after surgery. (Johns Hopkins Medicine. 2024) (Alberto M. Cappellari et al., 2018)
• The neurosurgeon performs a surgical nerve block that involves surgically removing or damaging specific areas of the nerve. (National Institute of Neurological Disorders and Stroke. 2023) A surgical nerve block is only used for severe pain cases, such as cancer pain or trigeminal neuralgia.
• Although neurolytic and surgical nerve blocks are permanent procedures, pain symptoms, and sensations can come back if the nerves are able to regrow and repair themselves. (Eun Ji Choi et al., 2016) However, symptoms and sensations may not return months or years after the procedure.

Different Body Areas

They can be administered in most body areas, including: (Hospital for Special Surgery. 2023) (Stanford Medicine. 2024)

• Scalp
• Face
• Neck
• Collarbone
• Shoulders
• Arms
• Back
• Chest
• Ribcage
• Abdomen
• Pelvis
• Buttocks
• Legs
• Ankle
• Feet

Side Effects

These procedures can have the potential risk of permanent nerve damage. (Anthem BlueCross. 2023) Nerves are sensitive and regenerate slowly, so a tiny error can cause side effects. (D O'Flaherty et al., 2018) Common side effects include:

• Muscle paralysis
• Weakness
• Frequent numbness
• In rare cases, the block could irritate the nerve and cause added pain.
• Skilled and licensed health practitioners like surgeons, pain management physicians, anesthesiologists, and dentists are trained to perform these procedures carefully.
• There is always a risk of nerve damage or injury, but the majority of nerve blocks safely and successfully decrease and help manage chronic pain. (Anthem BlueCross. 2023)

What to Expect

• Individuals may feel numbness or soreness and/or notice redness or irritation near or around the area that is temporary.
• There can also be swelling, which compresses the nerve and requires time to improve. (Stanford Medicine. 2024)
• Individuals may be asked to rest for a certain amount of time after the procedure.
• Depending on the type of procedure, individuals may have to spend a few days in a hospital.
• Some pain may still be present, but that does not mean the procedure did not work.

Individuals should consult with a healthcare provider about the risks and benefits to ensure it is the right treatment.

Sciatica, Causes, Symptoms, and Tips

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

Johns Hopkins Medicine. (2024). Nerve blocks. (Health, Issue. https://www.hopkinsmedicine.org/health/conditions-and-diseases/nerve-blocks

NYU Langone Health. (2023). Nerve block for migraine (Education and Research, Issue. https://nyulangone.org/conditions/migraine/treatments/nerve-block-for-migraine

National Institute of Neurological Disorders and Stroke. (2023). Pain. Retrieved from https://www.ninds.nih.gov/health-information/disorders/pain#3084_9

Johns Hopkins Medicine. (2024). Chronic pancreatitis treatment (Health, Issue. https://www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-pancreatitis/chronic-pancreatitis-treatment

Cappellari, A. M., Tiberio, F., Alicandro, G., Spagnoli, D., & Grimoldi, N. (2018). Intercostal Neurolysis for The Treatment of Postsurgical Thoracic Pain: a Case Series. Muscle & nerve, 58(5), 671–675. https://doi.org/10.1002/mus.26298

Choi, E. J., Choi, Y. M., Jang, E. J., Kim, J. Y., Kim, T. K., & Kim, K. H. (2016). Neural Ablation and Regeneration in Pain Practice. The Korean journal of pain, 29(1), 3–11. https://doi.org/10.3344/kjp.2016.29.1.3

Hospital for Special Surgery. (2023). Regional anesthesia. https://www.hss.edu/condition-list_regional-anesthesia.asp

Stanford Medicine. (2024). Types of nerve blocks (For Patients, Issue. https://med.stanford.edu/ra-apm/for-patients/nerve-block-types.html

Anthem BlueCross. (2023). Peripheral nerve blocks for treatment of neuropathic pain. (Medical Policy, Issue. https://www.anthem.com/dam/medpolicies/abc/active/policies/mp_pw_c181196.html

O'Flaherty, D., McCartney, C. J. L., & Ng, S. C. (2018). Nerve injury after peripheral nerve blockade-current understanding and guidelines. BJA education, 18(12), 384–390. https://doi.org/10.1016/j.bjae.2018.09.004

Stanford Medicine. (2024). Common patient questions about nerve blocks. (For Patients, Issue. https://med.stanford.edu/ra-apm/for-patients/nerve-block-questions.html

Can individuals with sensory nerve dysfunction incorporate nonsurgical decompression to restore sensory-mobility function to their bodies?

Introduction

The spinal column in the musculoskeletal system comprises bones, joints, and nerves that work together with various muscles and tissues to ensure that the spinal cord is protected. The spinal cord is part of the central nervous system where the nerve roots are spread out to the upper and lower body parts that supply sensory-motor functions. This allows the body to move and function without pain or discomfort. However, when the body and spine ages or when a person is dealing with injuries, the nerve roots can become irritated and cause weird sensations like numbness or tingling, often correlating with body pain. This can cause a socio-economic burden on many individuals and, if not treated right away, can lead to chronic pain. To that point, it can lead to many individuals dealing with body extremity pain associated with sensory nerve dysfunction. This causes many individuals dealing with musculoskeletal disorders to start looking for treatment. Today’s article examines how nerve dysfunction affects the extremities and how nonsurgical decompression can help reduce nerve dysfunction to allow mobility back to the upper and lower limbs. We speak with certified medical providers who incorporate our patients’ information to provide nonsurgical solutions like decompression to help individuals with nerve dysfunction. We also inform patients how nonsurgical decompression can restore mobility-sensory to the upper and lower extremities. We encourage our patients to ask intricated and educational questions to our associated medical providers about the pain-like symptoms they are experiencing correlating with the sensory nerve dysfunction. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer.

How Nerve Dysfunction Affects The Extremities

Do you experience tingling or numb sensations in your hands or feet that don’t want to go away? Do you feel pain in different back portions that can only be relieved through stretching or resting? Or does it hurt to walk for long distances that you feel like you need to rest constantly? Many pain-like scenarios are associated with sensory nerve dysfunction that can affect the upper and lower extremities. When many individuals experience sensory nerve dysfunction and deal with weird sensations in their extremities, many think it is due to musculoskeletal pain in their neck, shoulders, or back. This is only part of the issue, as many environmental factors can be associated with sensory nerve pain, as the nerve roots are being compressed and agitated, causing sensory nerve dysfunction in the extremities. Since the nerve roots are spread out from the spinal cord, the brain sends the neuron information to the nerve roots to allow sensory-mobility function in the upper and lower extremities. This allows the body to be mobile without discomfort or pain and functional through daily activities. However, when many individuals start to do repetitive motions that cause the spinal disc to be compressed constantly, it can lead to potential disc herniation and musculoskeletal disorders. Since numerous nerve roots are spread to the different extremities, when the main nerve roots are aggravated, it can send pain signals to each extremity. Hence, many people are dealing with nerve entrapment that leads to lower back, buttock, and leg pain that can affect their daily routine. (Karl et al., 2022) At the same time, many people with sciatica are dealing with sensory nerve dysfunction that affects their walking ability. With sciatica, it can be associated with spinal disc pathology and causes many individuals to seek treatment. (Bush et al., 1992)

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care 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 a wide array of 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 support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has 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 feel free to ask 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*

Individuals experiencing headaches on top of the head could be caused by different factors. Can recognizing the what triggers pain or pressure help prevent this type of headache, and healthcare providers develop effective treatment plans?

Headache On Top of The Head

Various factors could cause a headache on top of the head; common causes include:

• Stress
• Sleep problems
• Eye strain
• Caffeine withdrawal
• Dental problems
• Hormonal changes
• Alcohol consumption

Causes

Many causes have to do with underlying issues happening in other parts of the body.

Stress

• Stress is a common cause of headaches, including one on top of the head.
• Researchers don't know exactly how stress causes headaches, but they think it causes tightening of the muscles in the back of the head or neck, which
• pulls the tissues down, resulting in pain or pressure in the scalp and/or forehead area.
• These are also called tension headaches.
• Headaches caused by stress generally feel like dull pressure rather than throbbing pain.

Sleep Problems

• Not getting enough sleep can induce a headache on top of the head.
• When the mind and body do not get proper sleep, it can interfere with body functions like temperature, hunger, and sleep-wake cycles, which can lead to headaches.
• It is common to feel more stressed when sleep-deprived, which can cause or compound a headache and other symptoms.

Eye Strain

• You may develop a headache on the top of your head after you've been reading, watching, or otherwise focusing on something for a while.
• Over time, your eye muscles tire and have to work harder, causing them to contract.
• These spasms can lead to headaches. Squinting can make the muscle contractions even worse.

Caffeine Withdrawl

• Individuals may feel pain on the top of their heads if they skip their regular coffee.
• Regular caffeine consumption can lead to dependency and withdrawal symptoms, which include headaches when intake is reduced or stopped.
• This type of headache can be moderate to severe and can feel worse with activity.
• Most individuals start to feel better from caffeine withdrawal after a week. (World Health Organization. 2016)

Dental Problems

• Teeth issues like cracks, cavities, or impaction can irritate the trigeminal nerve, setting off head pain.
• Teeth grinding can also lead to headaches.

Hormonal Changes

• Individuals who have a low level of thyroid hormone may experience headaches.
• This could be from having too little thyroid or a symptom of the condition.
• Like stress-induced headaches, this type is generally dull and not throbbing.
• Some women may feel pain on the top of their heads before menstruation triggered by estrogen levels dropping.

Alcohol

• Some individuals develop a headache on the top of their head or elsewhere within a few hours after drinking alcohol.
• This is known as a cocktail headache.
• Alcohol-induced headaches usually resolve within 72 hours.
• The mechanism behind this headache is not fully researched, but it's been thought that the widening of blood vessels in the brain/vasodilation when consuming alcohol may trigger head pain.
• This type of headache is different than a hangover headache that comes from overconsumption and is based on dehydration and the toxic effects of alcohol. (J G Wiese, M. G. Shlipak, W. S. Browner. 2000)

Rare Causes

Top-of-the-head pain can also result from more serious and rare causes:

Brain Tumor

• Headaches are one of the most common symptoms of brain tumors.
• A headache on the top of the head depends on the location and size of the tumor. (MedlinePlus. 2021)

Brain Aneurysm

• This is a weak or thin area in a brain artery that bulges and fills with blood, which can cause a life-threatening rupture.
• Headaches are the most common symptom. (Brigham and Women's Hospital. 2023)

Brain Bleed

• Also known as a brain hemorrhage, this condition can cause intensely painful and quick headaches.
• Brain bleeds can be caused by head trauma, high blood pressure, an aneurysm, a bleeding disorder, or liver disease. (New York-Presbyterian. 2023)

Treatment

Treatment for reducing a headache on top of the head includes:

• Putting an ice bag over the area to reduce inflammation.
• Getting an eye examination.
• Making healthy lifestyle adjustments like drinking more water throughout the day.
• Less caffeine intake.
• Changing sleep patterns for a healthier, rested mind and body. 
• Taking a therapeutic bath to relax the body.
• Gentle exercises like walking, pilates, or yoga.
• Practicing deep breathing.
• Mindfulness exercises like meditation.
• Taking non-steroidal anti-inflammatory medication or NSAIDs like aspirin, Advil/ibuprofen), or Aleve/naproxen.

Depending on the cause and symptoms, a doctor may suggest specialist treatment options like:

• Physical therapy
• Cognitive behavioral therapy
• Chiropractic therapy
• Acupuncture
• Prescription medication

A medical professional will be able to help identify the type of headache being experienced, offer treatment options, and advise on how to manage triggers.

Neck Injuries, El Paso, Texas

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 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

World Health Organization. (2016) Headache disorders.

Wiese, J. G., Shlipak, M. G., & Browner, W. S. (2000). The alcohol hangover. Annals of internal medicine, 132(11), 897–902. https://doi.org/10.7326/0003-4819-132-11-200006060-00008

MedlinePlus. (2021) Brain tumor.

Brigham and Women's Hospital. (2023) Brain aneurysm.

New York-Presbyterian. (2023) Brain hemorrhage.

For individuals about to engage in physical activity or exercise, how does warming up the body help prepare for the work ahead?

Central Nervous System Activation

A proper warm-up before physical activity or working out prepares the mind and body to reduce risks of injury, mentally and physically transition to physical activity work, and enhance performance. A well-designed warm-up also primes the central nervous system/CNS for activity. The central nervous system transmits messages to the muscles to prepare them for action. Central nervous system activation increases motor neuron recruitment and engages the sympathetic nervous system so the body can better handle the physical stressors. The process may seem complex, but priming the nervous system is as simple as warming up with light aerobic activity before getting into more explosive movements.

CNS

The CNS consists of the brain and spinal cord. This central communication system uses another part of the nervous system known as the peripheral nervous system or PNS to transmit and receive messages throughout the body. The PNS is connected to the entire body and the brain and spinal cord (CNS).

• Nerves run throughout the body, receiving signals from the CNS to the muscles, fibers, and organs, transmitting various information back to the brain. (Berkeley University. N.D.)
• There are two types of systems within the peripheral nervous system - somatic and autonomic.

1. Somatic nervous system actions are those controlled by the person through voluntary actions like choosing to pick something up.
2. The autonomic system is involuntary and generates actions like breathing or heartbeat. (Cleveland Clinic. 2020)

Properly preparing the body for an intense strength training session or other physical activity needs the correct messages to be sent through the autonomic nervous system.

Parasympathetic and Sympathetic States

The autonomic nervous system consists of two subcategories, which are parasympathetic and sympathetic.

• The sympathetic nervous system helps the body get ready to face stress which includes physical stress. (R. Bankenahally, H. Krovvidi. 2016)
• The fight, flight, or freeze response describes the sympathetic nervous system's aspect.
• The parasympathetic nervous system is responsible for relaxation and de-stressing.

Individuals are recommended to perform a few calming movements and actions after a workout to return the body to a parasympathetic state. This can be:

• Stretching
• Lying with the legs elevated
• Relaxing yoga poses
• Box breathing
• Taking a warm shower or bath
• Foam rolling
• Massage

Returning the mind and body to a calm state helps with recovery and reduces stress hormone production. (National Academy of Sports Medicine. 2022)

Why Activate the CNS

Activating the CNS can increase performance and prevent injuries. The process wakes up and alerts the body for the activity. Individuals are recommended before beginning a training session, to communicate to the body about the physical stress it is about to endure and to prepare for the work ahead. This is a concept known as post-activation potentiation/PAP. (Anthony J Blazevich, Nicolas Babault. 2019) PAP helps increase force and power production, which enhances physical performance.

• Whenever an individual trains, the brain adapts and learns what the body is doing and the purpose of the training.
• Muscle memory describes this interaction.
• Individuals who have started up a new strength training routine or after an extended break report feeling awkward for the first few sessions, or even weeks, depending on their experience. (David C Hughes, Stian Ellefsen, Keith Baar, 2018)
• However, after a few sessions, the body is more adept at performing the movements and ready to increase resistance, repetitions, or both.
• This has to do with the neural drive and muscle memory than it has to do with true potential physical abilities. (Simon Walker. 2021)
• Training the CNS to be alert and pay attention can increase the development of a healthy mind-muscle connection combined with muscle memory. (David C Hughes, Stian Ellefsen, Keith Baar, 2018)

General Warm-Up

The first step is a general warm-up that should use large muscle groups and be of low intensity so as not to exhaust the body before beginning the actual training. General warm-up benefits central nervous system activation and the entire body include: (Pedro P. Neves, et al., 2021) (D C. Andrade, et al., 2015)

• Increases blood circulation.
• Assists the release of oxygen from hemoglobin and myoglobin.
• Warms the muscles, so they contract more effectively.
• Increases nerve impulse speed.
• Increases nutrient delivery.
• Lowers joints' resistance through increased synovial fluid/joint lubrication.
• Increases joint range of motion.
• Improves joint resiliency.
• Removes metabolic waste quicker.
• Reduces risk of injury.

A general warm-up can be simple as any aerobic activity will work. This can include:

• Performing bodyweight movements - light jumping jacks or jogging in place.
• Treadmill
• Rowing machine
• Stair climber
• Elliptical trainer

It is recommended to use the rating perceived exertion scale/RPE to determine the general warm-up effort. An exertion rating of between 5 to 6 is equivalent to moderate walking or a slow jog. Individuals should be able to speak clearly without taking a pause.

Try this strategy before the next workout to see increased performance and reduced injury risks.

Ankle Sprains Recovery

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

The nervous system. Berkeley University.

Cleveland Clinic. Nervous system: What it is, types, symptoms.

Bankenahally R, Krovvidi H. (2016) Autonomic nervous system: anatomy, physiology, and relevance in anesthesia and critical care medicine. BJA Education. 16(11):381-387. doi:10.1093/bjaed/mkw011

National Academy of Sports Medicine. Sympathetic vs. parasympathetic overtraining.

Blazevich, A. J., & Babault, N. (2019). Post-activation Potentiation Versus Post-activation Performance Enhancement in Humans: Historical Perspective, Underlying Mechanisms, and Current Issues. Frontiers in physiology, 10, 1359. https://doi.org/10.3389/fphys.2019.01359

Hughes, D. C., Ellefsen, S., & Baar, K. (2018). Adaptations to Endurance and Strength Training. Cold Spring Harbor perspectives in medicine, 8(6), a029769. https://doi.org/10.1101/cshperspect.a029769

Walker S. (2021). Evidence of resistance training-induced neural adaptation in older adults. Experimental gerontology, 151, 111408. https://doi.org/10.1016/j.exger.2021.111408

P. Neves, P., R. Alves, A., A. Marinho, D., & P. Neiva, H. (2021). Warming-Up for Resistance Training and Muscular Performance: A Narrative Review. IntechOpen. doi: 10.5772/intechopen.96075

Andrade, D. C., Henriquez-Olguín, C., Beltrán, A. R., Ramírez, M. A., Labarca, C., Cornejo, M., Álvarez, C., & Ramírez-Campillo, R. (2015). Effects of general, specific, and combined warm-up on explosive muscular performance. Biology of sport, 32(2), 123–128. https://doi.org/10.5604/20831862.1140426

How does spinal decompression help reduce somatosensory pain associated with individuals dealing with back and leg pain?

Introduction

As we all know, the human body is a complex system that works together to perform various actions without feeling pain or discomfort. With muscles, organs, tissues, ligaments, bones, and nerve roots, each component has its job and interacts with other body parts. For instance, the spine collaborates with the central nervous system to instruct the muscles and organs to function correctly. Meanwhile, the nerve roots and muscles work together to provide mobility, stability, and flexibility to the upper and lower body extremities. However, as time passes, the body ages naturally, and this can lead to unwanted issues. Normal and traumatic factors can interfere with the neuron signals from the brain and cause somatosensory pain in the upper and lower extremities. This pain-like sensation can affect each body section, making the individual miserable. Luckily, there are ways to reduce somatosensory pain and provide relief to the body. Today’s article explores how somatosensory pain can impact the lower extremities, particularly the legs and back, and how non-surgical treatments like spinal decompression can alleviate somatosensory pain in the lower extremities. At the same time, we work hand-in-hand with certified medical providers who use our patient’s information to treat and mitigate somatosensory pain affecting the legs and back. We also inform them that non-surgical treatments like spinal decompression can help alleviate residual pain-like symptoms from the lower extremities. We encourage our patients to ask essential and important questions while seeking education from our associated medical providers about their pain. Dr. Alex Jimenez, D.C., incorporates this information as an educational service. Disclaimer

How Does Somatosensory Pain Affect The Legs & Back?

Are you experiencing numbness or tingling in your legs or back that disappears after a few minutes? Do you feel questionable pain in your lumbar spine after work? Or do you feel a warm sensation in the back of your legs that turns into sharp shooting pain? These issues may be related to the somatosensory system within the central nervous system, which provides voluntary reflexes to muscle groups. When normal movements or traumatic forces cause problems to the somatosensory system over time, it can lead to pain that affects the body’s extremities. (Finnerup, Kuner, & Jensen, 2021) This pain may be accompanied by burning, pricking, or squeezing sensations that affect the lumbar region. Many factors can be associated with somatosensory pain, which is part of the central nervous system and works with the spinal cord. When the spinal cord becomes compressed or aggravated due to injury or normal factors, it can lead to low back and leg pain. For example, a herniated disc in the lumbosacral area can cause nerve roots to send pain signals to the brain and cause abnormalities in the back and legs. (Aminoff & Goodin, 1988)

When people are dealing with back and leg pain from somatosensory pain, it can cause them to be miserable by reducing their quality of life and leading to a life of disability. (Rosenberger et al., 2020) At the same time, individuals dealing with somatosensory pain will also begin to feel inflammatory effects from the affected muscle area in the legs and back. Since inflammation is a body’s natural response when dealing with pain, the inflammatory cytokines can cause a cascading effect from the brain through the spinal cord, causing leg and back pain. (Matsuda, Huh, & Ji, 2019) To that point, somatosensory pain is associated with inflammation caused by normal or traumatic factors that can cause overlapping risk factors contributing to leg and back pain. Luckily, numerous treatments can reduce these overlapping risk factors caused by somatosensory pain and help restore the lower body extremities’ function.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care 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 a wide array of 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 support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has 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 feel free to ask 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*

A nerve becomes pinched/compressed when added pressure is placed on it by surrounding structures that can include muscles, bones, ligaments, tendons, or a combination. This injures and damages the nerve causing function problems and symptoms and sensations in that area or other parts of the body that are supplied by that nerve. Medical practitioners refer to this as nerve compression or entrapment. Although compressed nerves are more commonly associated with the neck, arms, hands, elbows, and lower back, any nerve in the body can experience irritation, spasms, inflammation, and compression. The causes and treatment of a compressed nerve in the knee.

Compressed Nerve In The Knee

There’s only one nerve that goes through the knee that has an increased risk of getting compressed. It’s a branch of the sciatic nerve called the peroneal nerve. The nerve goes around the outside of the knee before traveling down the outside of the lower leg. At the bottom of the knee, it lies between the bone and skin, making it vulnerable to irritation or compression by anything that can put pressure on the outside of the knee.

Causes

Traumatic injuries over time can lead to pressure on the nerve from inside the knee. Common causes of a compressed nerve in the knee include:

Frequently Crossing Legs

• Compression by the opposite knee, while the legs are crossed is the most common cause.

Knee Brace

• A too-tight or strong brace can compress the leg and nerve.

Thigh-High Compression Stockings

• Designed to maintain pressure on the legs, if too tight these stockings can compress the nerve.

Squatting Posture For Long Periods

• This position places pressure on the side of the knee.

Fractures

• A fracture of the large lower leg bone/tibia or sometimes the small bone/fibula near the knee can entrap the nerve.

Lower Leg Cast

• The portion of the cast around the knee can be tight and compress the nerve.
• Tell the doctor if a cast or brace feels tight or is causing numbness or pain in the leg.

Knee-High Boots

• The top of a boot can land right below the knee and be too tight pinching the nerve.

Knee Ligament Injury

• The nerve can become compressed due to bleeding or inflammation from an injured ligament.

Knee Surgery Complications

• This is rare, but the nerve can inadvertently get pinched during knee replacement surgery or an arthroscopic procedure.

Prolonged Bed Rest

• When lying down the legs tend to rotate outward and the knees flex.
• In this position, the mattress can place pressure on the nerve.

Tumors or Cysts

• Tumors or cysts can develop right on top or next to a nerve irritating and compressing the area.

Abdominal or Gynecologic Surgery

• The equipment used to keep the legs rotated outward and the knees flexed for gynecologic and abdominal surgeries can compress the nerve.

Symptoms

The peroneal nerve supplies sensation and movement to the outside of the lower leg and the top of the foot. When compressed, it becomes inflamed, which causes the symptoms of a compressed nerve. Usually, only the lining/myelin sheath around the nerve is what gets injured. However, when the nerve gets damaged, the symptoms are similar but more severe. Common symptoms include:

• Weakness that limits the ability to lift the foot toward the leg aka dorsiflexion.
• This causes dragging the foot when walking.
• The ability to turn the foot outward and extend the big toe is also affected.
• Symptoms can be felt on the outside of the lower leg and on the top of the foot and include:
• Tingling or pins and needles sensations.
• Numbness.
• Loss of sensation.
• Pain.
• Burning.
• For individuals that have had a pinched nerve for two or more weeks, the muscles supplied by the nerve can begin to waste away or atrophy.
• Symptoms can be intermittent or continuous depending on the cause.
• The other common cause is a pinched nerve in the lumbar/lower spine.
• When this is the cause, sensations, and pain will present in the lower back or the back and outside of the thigh.

Diagnosis

A doctor will look at medical history and perform an examination to make a diagnosis, determine the cause, and lay out a personalized treatment plan. The nerve in the knee can be felt as it travels around the top of the tibia, so a doctor may tap on it. If there is shooting pain down the leg, a pinched nerve may be present. Tests a doctor may order can include:

Knee X-ray

• Shows any bone fractures or abnormal masses.

Knee MRI

• Can confirm the diagnosis
• Shows masses within the nerve.
• Shows details of fractures or other problems in the bones.

Electromyogram - EMG

• Tests electrical activity in the muscles.

Nerve Conduction Test

• Tests the signal speed of the nerve.

Treatment

Treatment is aimed at reducing pain and improving mobility.

Over-the-Counter Pain Medication

• OTC medication can reduce inflammation and improve symptoms short term.

Ice and Heat

• Applying either heat or ice for 15 to 20 minutes at a time can provide relief from the symptoms.
• An ice pack can make symptoms worse if it adds more pressure on the nerve.

Chiropractic and Physical Therapy

• Chiropractic and physical therapy can release the compressed nerve, realign the structures, strengthen the muscles, and provide gait training.

Orthotic Boot

• If walking gait is affected because the foot cannot bend, an orthotic boot can help.
• This is a support that maintains the foot in a neutral position to walk normally.

Corticosteroid Injection

• A corticosteroid injection can reduce inflammation and relieve pressure on the nerve.

Surgery

• The nerve can suffer permanent damage if it has been pinched for a long time.
• If that happens, surgery cannot repair the damage.
• A doctor can perform surgery to correct a fracture, tumor, or other invasive problem causing a compressed nerve.
• If conservative treatment doesn’t work, a peroneal nerve decompression procedure can be done to remove the pressure.
• If surgery is needed, symptoms can disappear immediately, but it takes around four months to recover and rehabilitate.

Injury Rehabilitation

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

Krych, Aaron J et al. “Is peroneal nerve injury associated with worse function after knee dislocation?.” Clinical orthopedics and related research vol. 472,9 (2014): 2630-6. doi:10.1007/s11999-014-3542-9

Lezak B, Massel DH, Varacallo M. Peroneal Nerve Injury. [Updated 2022 Nov 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549859/

Soltani Mohammadi, Sussan, et al. “Comparing the squatting position and traditional sitting position for ease of spinal needle placement: a randomized clinical trial.” Anesthesiology and pain medicine vol. 4,2 e13969. 5 Apr. 2014, doi:10.5812/aapm.13969

Stanitski, C L. “Rehabilitation following knee injury.” Clinics in sports medicine vol. 4,3 (1985): 495-511.

Xu, Lin, et al. Zhongguo gu Shang = China Journal of Orthopedics and Traumatology vol. 33,11 (2020): 1071-5. doi:10.12200/j.issn.1003-0034.2020.11.017

Yacub, Jennifer N et al. “Nerve injury in patients after hip and knee arthroplasties and knee arthroscopy.” American Journal of physical medicine & Rehabilitation vol. 88,8 (2009): 635-41; quiz 642-4, 691. doi:10.1097/PHM.0b013e3181ae0c9d

Introduction

The central nervous system is responsible for sending neuron signals to all the organs and muscles in the body, allowing for mobility and proper functioning. These signals are constantly exchanged between the organs, muscles, and brain, informing of their activities. However, environmental factors and traumatic injuries can impact the nerve roots, disrupting the flow of signals and leading to musculoskeletal disorders. This can result in misalignments in the body and chronic pain if left untreated. Today’s article will inform us about peripheral neuropathy, a nerve injury correlated with back pain, and how spinal decompression can relieve this condition. We work with certified medical providers who use our patients’ valuable information to provide non-surgical treatments, including spinal decompression, to relieve pain-like symptoms associated with peripheral neuropathy. We encourage patients to ask essential questions and seek education about their condition. Dr. Jimenez, D.C., provides this information as an educational service. Disclaimer

What Is Peripheral Neuropathy?

Peripheral neuropathy refers to a range of conditions that affect the nerve roots and can cause chronic symptoms throughout the body, as research studies revealed. The nerve cells in our body transmit messages between the brain and other body parts. When these cells are damaged, it can disrupt communication between the central nervous system, leading to muscle and organ problems. Studies have linked peripheral neuropathy to pain and other symptoms, which can have a negative impact on daily activities, quality of life, and mental and physical well-being. Additionally, peripheral neuropathy may increase the risk of falls.

How Peripheral Neuropathy Correlates With Back Pain

Have you recently felt a tingling or sharp sensation when you stepped or experienced constant lower back pain? These symptoms could be related to peripheral neuropathy, which can cause back pain. “The Ultimate Spinal Decompression,” a book by Dr. Perry Bard, D.C. and Dr. Eric Kaplan, D.C., FIAMA, explains that peripheral neuropathy is nerve damage that affects the legs, causing numbness, pain, tingling, and oversensitivity to touch in the toes and feet. This can cause the muscles in the lower back to shift weight away from the painful areas, leading to low back pain. Research studies have revealed that chronic low back pain can involve both nociceptive and neuropathic pain mechanisms. Nociceptive pain is a response to tissue injury that activates the muscles. In contrast, neuropathic pain affects nerve roots branching from the spine and lower limbs, often resulting from damaged spinal discs. Fortunately, there are ways to manage peripheral neuropathy and its associated back pain.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care 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 a wide array of 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 support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has 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 feel free to ask 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*

Can determining whether arm numbness occurs suddenly or gradually and whether there are other symptoms help healthcare providers diagnose and treat the condition?

Arm Numbness

Arm numbness or tingling are common symptoms that various medical conditions can cause. Numbness can be caused by a sudden health emergency, nerve disorder, or nutritional deficiency. (National Institute of Neurological Disorders and Stroke, 2024) Sometimes, this symptom results from an arm falling asleep and could resolve after just a few minutes. The sensation may be temporary, caused by something like sleeping in the wrong position. However, arm numbness and tingling may also be caused by neuropathy and chronic and progressive nerve damage and can also suddenly occur due to serious conditions, such as a heart attack or a stroke.

Circulation Issues

 Deficient blood circulation in the arm could cause numbness and tingling as the nerves cannot receive enough oxygen. Conditions can interfere with normal blood flow and include: (Bryan L. and Singh A. 2024)

• Atherosclerosis - plaque buildup in the arteries that may require medication or surgery.
• Severe frostbite can damage the blood vessels but can be resolved with proper warming and wound care.
• Vasculitis - is inflammation of the blood vessels that can be treated with medication.

Sleeping Position

A common example of sudden numbness and tingling is the feeling that the arm has fallen asleep. This usually occurs after sleeping awkwardly or leaning on the arm for a long time. Known as paresthesia, this sensation is related to the compression or irritation of nerves. (Bryan L. and Singh A. 2024) Sleeping in certain positions has been associated with nerve compression, especially when the hands or wrists are tucked or curled under the body, as well as maintaining proper spine alignment when sleeping, is the best way to prevent arm numbness.

Nerve Injuries and Conditions

Numbness that persists may be related to an injury or underlying health problem that affects the brachial plexus, a group of nerves that runs from the lower neck to the upper shoulders and controls movement and sensation in the arms. (Mount Sinai, 2022) Possible injuries that affect these nerves include: (Smith, S. M. et al., 2021)

• A herniated disc caused by aging or trauma causes the disc to leak out and press on the nerve root.
• Burner or stinger injuries that affect the neck and shoulders.
• Backpacker's palsy is caused by pressure on the shoulders.
• Birth injuries such as Erb-Duchenne's palsy and Klumpke's palsy.
• Traumatic nerve root avulsion injury in which spinal nerves are damaged.

Diseases and disorders that can cause numbness in the arms include conditions that affect the nervous system, like multiple sclerosis, fibromyalgia, Raynaud phenomenon, and shingles. (National Heart, Lung, and Blood Institute, 2023) (Smith, S. M. et al., 2021)

Numbness and Serious Health Conditions

Stroke

• This is a medical emergency in which a blockage prevents blood from getting to the brain.
• One sign of a stroke is a tingling sensation on one side of the body.
• Individuals may also be unable to move one or more limbs. (Centers for Disease Control and Prevention, 2024)
• Seek emergency medical care.

Heart Disease

• When the heart is damaged, blood cannot circulate and can lead to a minor or major heart attack.
• Signs of a heart attack include numbness in one or both arms, and it is not always the left arm. (National Heart, Lung, and Blood Institute, 2022)
• Pressure pain in the chest and shortness of breath are other signs that require immediate medical attention.

Spinal Osteoarthritis

• Wear and tear in the spine's joints can lead to spinal stenosis, the narrowing of the spinal canal that causes the nerves to be compressed. (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023)
• Physical therapy and medication can manage spinal stenosis.

Cancer

• Neoplasm tumors can affect the brachial plexus nerves, causing loss of feeling in the arms.
• Breast and lung cancers are the most likely. (Smith, S. M. et al., 2021)

Diabetes

• Loss of feeling in the arms can be a sign of peripheral neuropathy, which can be caused by uncontrolled diabetes. (Johns Hopkins Medicine, 2024)
• Treatment requires managing blood sugar and oral and topical medications.

Medication Numbness

The relationship between arm numbness and medication usage can be complex. (Senderovich H. and Jeyapragasan G. 2018)

• Many medications, like gabapentin, can be used to alleviate the sensations of arm numbness.
• Some medications can cause numbness as a side effect.
• Some medications can cause complications, and arm numbness could be a symptom of those complications.

Inform healthcare providers about medications being taken to determine the relationship between them and any sensory changes.

Vitamin Deficiency

Peripheral neuropathy can also be caused by nutritional deficiencies and vitamin imbalances, which can damage nerves and cause sensation loss in the left or right arm. The most common sources are vitamin B12 deficiency and excess vitamin B6. (National Institute of Neurological Disorders and Stroke, 2024) Excessive alcohol consumption and other disorders that affect nutritional intake can also lead to nerve damage.

Injury Medical Chiropractic and Functional Medicine Clinic

At Injury Medical Chiropractic and Functional Medicine Clinic, 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 & Nutrition, Functional Medicine Treatments, and in-scope care protocols. We focus on what works for you to relieve pain and restore function. If other treatment is needed, individuals will be referred to a clinic or physician best suited to their injury, condition, and/or ailment.

Chiropractic Care: The Natural Way to Recover From Injuries

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 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. (2024). Paresthesia. Retrieved from https://www.ninds.nih.gov/health-information/disorders/glossary-neurological-terms#paresthesia

Bryan, L., Singh, A. Sleep Foundation. (2024). Numbness in Hands While Sleeping: Causes and Remedies. https://www.sleepfoundation.org/physical-health/numbness-in-hands-while-sleeping

Mount Sinai. (2022). Brachial plexopathy. https://www.mountsinai.org/health-library/diseases-conditions/brachial-plexopathy

Smith, S. M., McMullen, C. W., & Herring, S. A. (2021). Differential Diagnosis for the Painful Tingling Arm. Current sports medicine reports, 20(9), 462–469. https://doi.org/10.1249/JSR.0000000000000877

National Heart, Lung, and Blood Institute. (2023). Vasculitis. Retrieved from https://www.nhlbi.nih.gov/health/vasculitis/symptoms#:~:text=Nerve%20problems%2C%20including%20numbness%2C%20tingling,can%20also%20occur%20with%20vasculitis.

Centers for Disease Control and Prevention. (2024). Stroke signs and symptoms. Retrieved from https://www.cdc.gov/stroke/signs-symptoms/?CDC_AAref_Val=https://www.cdc.gov/stroke/signs_symptoms.htm

National Heart, Lung, and Blood Institute. (2022). What Is a Heart Attack? Retrieved from https://www.nhlbi.nih.gov/health/heart-attack

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2023). Spinal Stenosis Basics. Retrieved from https://www.niams.nih.gov/health-topics/spinal-stenosis/basics/symptoms-causes

Johns Hopkins Medicine. (2024). Peripheral Neuropathy. https://www.hopkinsmedicine.org/health/conditions-and-diseases/peripheral-neuropathy

Senderovich, H., & Jeyapragasan, G. (2018). Is there a role for combined use of gabapentin and pregabalin in pain control? Too good to be true?. Current medical research and opinion, 34(4), 677–682. https://doi.org/10.1080/03007995.2017.1391756

National Institute of Neurological Disorders and Stroke. (2024). Peripheral Neuropathy. Retrieved from https://www.ninds.nih.gov/health-information/disorders/peripheral-neuropathy

Can neurological physical therapy help individuals diagnosed with a recently acquired or chronic neurological condition gain strength and functioning?

Neurological Physical Therapy

Neurological physical therapy can be extremely beneficial. It aims to restore functional mobility, strength, balance, and coordination in those with neurological conditions that affect their quality of life and ability to move around. It also helps recover from neurological injuries or prevent the progression and worsening of chronic neurological conditions. Depending on the severity of the condition, individuals may receive this therapy as an inpatient or outpatient. Exercise can help improve mobility, increase independence, and decrease the need for assistance, all of which can improve one's quality of life.

Process

Neurological physical therapy is geared toward treating individuals with conditions affecting the brain and spinal cord, such as stroke, spinal cord injury, and Parkinson's disease, to help restore mobility and function. The therapy is performed in hospitals, private practice physical therapy clinics, doctors’ offices, rehabilitation facilities, or at a patient's home. Whether an individual needs inpatient or outpatient physical therapy will depend on the severity of the neurological condition.

• Newly acquired neurological conditions such as strokes or traumas like spinal cord injuries and traumatic brain injuries or TBIs often require inpatient rehabilitation.
• Once the patient gains enough strength, coordination, and independence with movements like standing and walking, they can progress to outpatient physical therapy.
• The patient will undergo a physical exam after a physical therapist has gathered enough information about medical history during the initial evaluation.
• The therapist will check muscle strength, coordination, range of motion, reflexes, and the muscle tone of the arms and legs. They may also perform neurological tests to examine coordination, such as following moving objects with the eyes, touching the finger to the nose, and rapidly alternating movements.
• The individual general level of attention, cognition, and sensation will also be assessed to determine if these areas have been affected by the neurological condition. (Cleveland Clinic, 2022)
• The therapist will then assess the patient's ability to perform movements called transfers, which are transitions to and from positions such as lying down to sitting up or standing up to sitting.
• They will note if the patient can perform these movements independently or if they need assistance.
• The initial evaluation will also include an assessment of balance, quality of gait, and whether the therapist needs to assist.
• Depending on the severity of the neurological condition, the therapist may provide the patient with or recommend purchasing an assistive device to help walk.

Treatment Sessions

During therapy sessions, patients may receive the following interventions:

Gait Training

• To improve walking ability, proper instruction on using assistive devices such as canes, walkers, and crutches.

Balance Training

• To improve static/stationary and dynamic/while moving balance, both sitting unsupported to improve core control and standing upright with or without handheld support.

Therapeutic Activities

• To improve independence with bed mobility skills like rolling and sitting up from lying down and transfers on and off beds, chairs, and toilets.
• Therapeutic exercises for stretching and strengthening muscles and improving coordination and motor control.

Endurance Training

• This can be done with cardiovascular equipment like treadmills, stationary bicycles, and ellipticals.

Vestibular Therapy Interventions

• Balance exercises with head movements and exercises to treat a common cause of dizziness are used to improve eye movement control.
• Examples are the Dix-Hallpike and Epley maneuvers.

Conditions

Neurological physical therapy can treat various conditions. Some neurological conditions are progressive, worsening over time, and require regular physical therapy and at-home exercises to maintain optimal health and wellness. Neurological conditions that can be treated with physical therapy include: (Cleveland Clinic, 2022)

• Strokes - loss of blood supply to the brain.
• Spinal cord injuries - damage to part of the central nervous system resulting in loss of movement and control.
• Polyneuropathies -  damage to the peripheral nerves.
• Traumatic brain injuries - for example, concussions.
• Cerebral palsy - a group of disorders affecting movement, balance, and posture.
• Multiple sclerosis - a disabling disease of the brain and spinal cord.
• Parkinson’s disease - a progressive nervous system disorder.
• Guillain-Barre syndrome - an autoimmune disease attacking the nerves.
• Amyotrophic lateral sclerosis/ALS, also known as Lou Gehrig's disease.
• Vertigo, including benign paroxysmal positional vertigo or BPPV.

Neurological conditions, like an automobile collision, can occur suddenly or be progressive, such as Parkinson's. Physical therapy helps those individuals by increasing their use of weakened muscles, improving their motor control, coordination, and balance, and facilitating their independence with daily tasks and movements. Always seek immediate medical attention for any sudden, unexplained muscle weakness. Individuals who experience skeletal muscle weakness should discuss the type and duration of symptoms with their doctor, specialist, physical therapist, or chiropractor, as this might be a sign of a medical condition such as a neuromuscular disorder. 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, improving flexibility, mobility, and agility, relieving pain, and helping 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.

Personal Injury Rehabilitation

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

Cleveland Clinic. (2022). Neurological Exam. https://my.clevelandclinic.org/health/diagnostics/22664-neurological-exam

Can understanding the location of the funny bone and how pain can be managed after injury help expedite recovery and prevention for individuals who have hit their funny bone?

Elbow Funny Bone Nerve Injury

Behind the elbow is an area known as the "funny bone," where the ulnar nerve has less tissue and bone protection. This is where part of the ulnar nerve passes around the back of the elbow. Because less tissue and bone protect the nerve in this area, taking a hit like bumping into something can cause an electric shock-like pain and a tingling sensation down the arm and to the outside fingers typical of an irritated nerve. Most injuries to the funny bone resolve quickly, and the pain disappears after a few seconds or minutes, but sometimes, an ulnar nerve injury can lead to more persistent symptoms.

Anatomy

The funny bone is not a bone but the ulnar nerve. The nerve runs down the arm, passing around the back of the elbow. (Dimitrova, A. et al., 2019) Because the ulnar nerve is on top of the elbow and there is very little fatty cushion, lightly bumping this spot can cause pain and tingling sensations down the forearm. Three bones comprise the junction of the elbow that include:

• Humerus - arm bone
• Ulna and radius - forearm bones

The humerus has a groove that protects and holds the ulnar nerve as it passes behind the joint. This is where the nerve can be injured or irritated when the nerve is hit or pinched against the end of the bone, causing the funny bone pain.

Electrical Pain Sensation

When hitting the ulnar nerve or funny bone where the ulnar nerve provides sensation, pain, and electrical/tingling sensations are experienced from the forearm to the outside fingers. This part of the arm and hand is called the ulnar nerve distribution. (American Academy of Orthopaedic Surgeons. 2024) The ulnar nerve provides sensation into most of the pinky finger and about half of the ring finger. Other nerves, including the median and radial nerve, supply sensation to the rest of the hand.

Treatment

Usually, a sharp jolt to the elbow quickly resolves. Some recommendations to help symptoms improve faster include:

• Shaking the forearm and hand out.
• Straightening out and bending the elbow to stretch the nerve.
• Decreasing mobility of the elbow.
• Applying ice to the area.
• Taking anti-inflammatory medications.

Treating Long-Lasting Pain

In rare circumstances, injuries to the ulnar nerve can cause more persistent symptoms, a condition known as cubital tunnel syndrome. Cubital tunnel syndrome can happen after an injury or from elbow overuse. Individuals with cubital tunnel syndrome may benefit from wearing a splint at night. Standard-sized splints can be ordered online, but most are fabricated by an occupational or hand therapist. If symptoms become more long-lasting, surgery may be recommended to relieve pressure and tension on the ulnar nerve (American Academy of Orthopaedic Surgeons, 2024). The procedure decompresses the nerve by relieving any tight constrictions around it and releasing them. In severe cases, the nerve is repositioned to an area that doesn't place as much pressure on the nerve, known as an ulnar nerve transposition.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution that helps individuals return to normal. Our providers create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles through an integrated approach to treat injuries and chronic pain syndromes to improve ability through flexibility, mobility, and agility programs to relieve pain. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Chiropractic Treatment For Carpal Tunnel Syndrome

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

Dimitrova, A., Murchison, C., & Oken, B. (2019). Local effects of acupuncture on the median and ulnar nerves in patients with carpal tunnel syndrome: a pilot mechanistic study protocol. Trials, 20(1), 8. https://doi.org/10.1186/s13063-018-3094-5

American Academy of Orthopaedic Surgeons. (2024). Ulnar nerve entrapment at the elbow. https://orthoinfo.aaos.org/en/diseases--conditions/ulnar-nerve-entrapment-at-the-elbow-cubital-tunnel-syndrome/

For individuals experiencing pelvic pain, it could be a disorder of the pudendal nerve known as pudendal neuropathy or neuralgia that leads to chronic pain. The condition can be caused by pudendal nerve entrapment, where the nerve becomes compressed or damaged. Can knowing the symptoms help healthcare providers correctly diagnose the condition and develop an effective treatment plan?

Pudendal Neuropathy

The pudendal nerve is the main nerve that serves the perineum, which is the area between the anus and the genitalia - the scrotum in men and the vulva in women. The pudendal nerve runs through the gluteus muscles/buttocks and into the perineum. It carries sensory information from the external genitalia and the skin around the anus and perineum and transmits motor/movement signals to various pelvic muscles. (Origoni, M. et al., 2014) Pudendal neuralgia, also referred to as pudendal neuropathy, is a disorder of the pudendal nerve that can lead to chronic pelvic pain.

Causes

Chronic pelvic pain from pudendal neuropathy can be caused by any of the following (Kaur J. et al., 2024)

• Excessive sitting on hard surfaces, chairs, bicycle seats, etc. Bicyclists tend to develop pudendal nerve entrapment.
• Trauma to the buttocks or pelvis.
• Childbirth.
• Diabetic neuropathy.
• Bony formations that push against the pudendal nerve.
• Thickening of ligaments around the pudendal nerve.

Symptoms

Pudendal nerve pain can be described as stabbing, cramping, burning, numbness, or pins and needles and can present (Kaur J. et al., 2024)

• In the perineum.
• In the anal region.
• In men, pain in the scrotum or penis. 
• In women, pain in the labia or vulva.
• During intercourse.
• When urinating.
• During a bowel movement.
• When sitting and goes away after standing up.

Because the symptoms are often hard to distinguish, pudendal neuropathy can often be hard to differentiate from other types of chronic pelvic pain.

Cyclist’s Syndrome

Prolonged sitting on a bicycle seat can cause pelvic nerve compression, which can lead to chronic pelvic pain. The frequency of pudendal neuropathy (chronic pelvic pain caused by entrapment or compression of the pudendal nerve) is often referred to as Cyclist’s Syndrome. Sitting on certain bicycle seats for long periods places significant pressure on the pudendal nerve. The pressure can cause swelling around the nerve, which causes pain and, over time, can lead to nerve trauma. Nerve compression and swelling can cause pain described as burning, stinging, or pins and needles. (Durante, J. A., and Macintyre, I. G. 2010) For individuals with pudendal neuropathy caused by bicycling, symptoms can appear after prolonged biking and sometimes months or years later.

Cyclist's Syndrome Prevention

A review of studies provided the following recommendations for preventing Cyclist's Syndrome (Chiaramonte, R., Pavone, P., Vecchio, M. 2021)

Rest

• Take breaks at least 20–30 seconds after each 20 minutes of riding.
• While riding, change positions frequently.
• Stand up to pedal periodically.
• Take time off between riding sessions and races to rest and relax the pelvic nerves. 3–10 day breaks can help in recovery. (Durante, J. A., and Macintyre, I. G. 2010)
• If pelvic pain symptoms are barely starting to develop, rest and see a healthcare provider or specialist for an examination.

Seat

• Use a soft, wide seat with a short nose.
• Have the seat level or tilted slightly forward.
• Seats with cutout holes place more pressure on the perineum.
• If numbness or pain is present, try a seat without holes.

Bike Fitting

• Adjust the seat height so the knee is slightly bent at the bottom of the pedal stroke.
• The body's weight should rest on the sitting bones/ischial tuberosities.
• Keeping the handlebar height below the seat can reduce pressure.
• The Triathlon bike's extreme-forward position should be avoided.
• A more upright posture is better.
• Mountain bikes have been associated with an increased risk of erectile dysfunction than road bikes.

Shorts

• Wear padded bike shorts.

Treatments

A healthcare provider may use a combination of treatments.

• The neuropathy can be treated with rest if the cause is excessive sitting or cycling.
• Pelvic floor physical therapy can help relax and lengthen the muscles.
• Physical rehabilitation programs, including stretches and targeted exercises, can release nerve entrapment.
• Chiropractic adjustments can realign the spine and pelvis.
• The active release technique/ART involves applying pressure to muscles in the area while stretching and tensing. (Chiaramonte, R., Pavone, P., Vecchio, M. 2021)
• Nerve blocks may help relieve pain caused by nerve entrapment. (Kaur J. et al., 2024)
• Certain muscle relaxers, antidepressants, and anticonvulsants may be prescribed, sometimes in combination.
• Nerve decompression surgery may be recommended if all conservative therapies have been exhausted. (Durante, J. A., and Macintyre, I. G. 2010)

Injury Medical Chiropractic and Functional Medicine Clinic care plans and clinical services are specialized and focused on injuries and the complete recovery process. Our areas of practice include Wellness and nutrition, 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, and Functional Medicine Treatments. If the individual requires other treatment, they will be referred to a clinic or physician best suited for their condition, as Dr. Jimenez has teamed with the top surgeons, clinical specialists, medical researchers, therapists, trainers, and premiere rehabilitation providers.

Pregnancy and Sciatica

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

Origoni, M., Leone Roberti Maggiore, U., Salvatore, S., & Candiani, M. (2014). Neurobiological mechanisms of pelvic pain. BioMed research international, 2014, 903848. https://doi.org/10.1155/2014/903848

Kaur, J., Leslie, S. W., & Singh, P. (2024). Pudendal Nerve Entrapment Syndrome. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/31334992

Durante, J. A., & Macintyre, I. G. (2010). Pudendal nerve entrapment in an Ironman athlete: a case report. The Journal of the Canadian Chiropractic Association, 54(4), 276–281.

Chiaramonte, R., Pavone, P., & Vecchio, M. (2021). Diagnosis, Rehabilitation and Preventive Strategies for Pudendal Neuropathy in Cyclists, A Systematic Review. Journal of functional morphology and kinesiology, 6(2), 42. https://doi.org/10.3390/jfmk6020042

For individuals living with cyclical or chronic endometriosis symptoms, can incorporating support therapies help in disease management?

Support Therapies

Endometriosis is a disorder in which tissue similar to the uterine lining begins to grow outside the uterus where it does not belong. Endometriosis support therapies involve a comprehensive approach to treatment. It involves non-invasive treatments to help manage symptoms that can include:

• Pelvic floor physical therapy
• Massage
• Medication
• Transcutaneous Electrical Nerve Stimulation
• Acupuncture
• Chiropractic

Pelvic Floor Physical Therapy - PFPT

• Endometriosis can cause or contribute to pelvic floor dysfunction, causing pain, urinary disorders, bowel problems, and painful sexual intercourse.
• Pelvic floor physical therapy improves the strength and function of the pelvic floor muscles.
• Example support therapies can include kegel exercises and biofeedback. (Christine Mansfield et al., 2022)

Therapeutic Massage

A physical therapist uses various pressures, stretching, and/or trigger point release. This helps: (Sylvia Mechsner, 2022)

• Release muscle tension
• Lower cortisol - stress hormone
• Improve circulation
• Release endorphins - the body's natural painkillers

Medications

Nonsteroidal anti-inflammatory drugs or NSAIDs and hormonal contraceptives - birth control are the first line of treatment. Advil and Motrin are over-the-counter NSAIDs. If those don't manage pain effectively, a healthcare provider may recommend prescription NSAIDs. (Sylvia Mechsner, 2022) Hormonal suppression agents or estrogen modulators are a second line of treatment for endometriosis and can include: (Christian M. Becker et al., 2022)

• Gonadotropin-releasing hormone agonists (GnRH)
• Antigonadotropic meds
• Aromatase inhibitors
• Selective estrogen receptor modulators (SERMs)

Other medications include:(Sylvia Mechsner, 2022)

• Valium - diazepam suppositories - Muscle-relaxing medications.
• Gabapentinoids - Medications that treat nerve pain.
• Antidepressants - these can increase the pain-reducing effect of other medications.

An endometriosis specialist. (Endometriosis Foundation of America. 2015) may suggest seeing a pain management specialist who provides nerve blocks or Botox injections. (Augusto Pereira et al., 2022)

Birth Control

Hormonal contraceptives suppress or regulate periods. They are effective for management, but not everyone can take them because of medical history, side effects, or fertility disorders and conditions. (Mert Ilhan et al., 2019) A healthcare provider can recommend alternative support therapies.

Transcutaneous Electrical Nerve Stimulation

• A transcutaneous electrical nerve stimulation utilizes a battery-operated device that delivers low-voltage electrical stimulation to nerve fibers through electrodes placed on the skin.
• Sessions are usually 15 to 30 minutes and work by disrupting pain signals. (Sylvia Mechsner, 2022)

Acupuncture

• Acupuncture is a therapy in which a practitioner inserts thin needles into specific acupoints on the body to promote the flow of energy and alleviate pain. (Nora Giese et al., 2023)

Chiropractic

• Chiropractic care focuses on spinal adjustments and alignment to enhance nervous system function, help alleviate pelvic discomfort and nerve pain - sciatica - and improve overall well-being. (Robert J. Trager et al., 2021)
• Non-surgical decompression could be recommended to gently stretch the spine, relieve pressure, and flood the spine with added nutrients.

Movement Medicine: Chiropractic Care

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

Mansfield, C., Lenobel, D., McCracken, K., Hewitt, G., & Appiah, L. C. (2022). Impact of Pelvic Floor Physical Therapy on Function in Adolescents and Young Adults with Biopsy-Confirmed Endometriosis at a Tertiary Children's Hospital: A Case Series. Journal of pediatric and adolescent gynecology, 35(6), 722–727. https://doi.org/10.1016/j.jpag.2022.07.004

Mechsner S. (2022). Endometriosis, an Ongoing Pain-Step-by-Step Treatment. Journal of clinical medicine, 11(2), 467. https://doi.org/10.3390/jcm11020467

Ilhan, M., Gürağaç Dereli, F. T., & Akkol, E. K. (2019). Novel Drug Targets with Traditional Herbal Medicines for Overcoming Endometriosis. Current drug delivery, 16(5), 386–399. https://doi.org/10.2174/1567201816666181227112421

Becker, C. M., Bokor, A., Heikinheimo, O., Horne, A., Jansen, F., Kiesel, L., King, K., Kvaskoff, M., Nap, A., Petersen, K., Saridogan, E., Tomassetti, C., van Hanegem, N., Vulliemoz, N., Vermeulen, N., & ESHRE Endometriosis Guideline Group (2022). ESHRE guideline: endometriosis. Human reproduction open, 2022(2), hoac009. https://doi.org/10.1093/hropen/hoac009

Endometriosis Foundation of America. (2015). Seeking a doctor: finding the right endometriosis specialist. https://www.endofound.org/preparing-to-see-a-doctor

Pereira, A., Herrero-Trujillano, M., Vaquero, G., Fuentes, L., Gonzalez, S., Mendiola, A., & Perez-Medina, T. (2022). Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy. Journal of personalized medicine, 12(1), 101. https://doi.org/10.3390/jpm12010101

Giese, N., Kwon, K. K., & Armour, M. (2023). Acupuncture for endometriosis: A systematic review and meta-analysis. Integrative medicine research, 12(4), 101003. https://doi.org/10.1016/j.imr.2023.101003

Trager, R.J., Prosak, S.E., Leonard, K.A. et al. (2021). Diagnosis and management of sciatic endometriosis at the greater sciatic foramen: a case report. SN Comprehensive Clinical Medicine, 3. https://doi.org/doi:10.1007/s42399-021-00941-0

For individuals starting to lift weights, motor units are important for muscle movement. Can building more motor units help build strength and maintain muscle mass?

Motor Units

Motor units control the skeletal muscles and are the force behind every body movement. (C J. Heckman, Roger M. Enoka 2012)
This includes voluntary movements like lifting weights and involuntary movements like breathing. When lifting objects and weights, the body adapts to motor unit needs, meaning that individuals must consistently increase the weight to progress. 

• Lifting weights regularly trains the body to generate more motor units and force.
• General guidelines recommend lifting weights for all muscle groups two to three non-consecutive days a week.
• Consistency helps maintain muscle mass.
• Regular progression increases the risk of plateauing.

What They Are

Exercise increases the body's muscle strength, while sedentariness and inactivity weaken them. A motor unit is a single nerve cell/neuron that supplies the nerves to innervate a group of skeletal muscles. The neuron receives signals from the brain that stimulate all the muscle fibers in that particular motor unit to generate movement.

• Muscles comprise different fiber types.
• They are attached to the bones with connective tissue, which is stronger than the muscle.
• Multiple motor units are dispersed throughout the muscle.
• The motor units help ensure muscle contraction force is evenly spread throughout the muscle.
• Motor units are different sizes and operate differently depending on where and what they do.
• Small motor units might only innervate five or ten fibers. For example, to blink or sniff.
• Large motor units can comprise hundreds of muscle fibers for swinging or jumping movements.

How They Work

The number of units activated depends on the task. Stronger muscle contractions require more. However, fewer units are needed to accomplish the movement for individuals expending less effort.

Contraction

• Once a unit receives a signal from the brain, the muscle fibers contract simultaneously.
• The force generated depends on how many units are required to accomplish the task. (Purves D. et al., 2001)
• For example, picking up small objects like a pen and paper requires only a few units to generate the force needed.
• If picking up a heavy barbell, the body needs more units because more force is needed to lift the heavier load.
• The body can generate more force with stronger muscles.
• This happens when lifting weights on a regular basis and overloading the muscles with more weight than they can handle.
• This process is known as adaptation.

Adaptation

The purpose of lifting weights is to challenge the muscles so they adapt to the new challenge and grow in strength and mass. Motor units are a major part of the adaptation process. (Dr. Erin Nitschke. American Council on Exercise. 2017)

• When first starting weight training, the brain recruits more units every time a muscle is contracted. (Pete McCall. American Council on Exercise. 2015)
• As individuals continue working out, their ability to generate more force increases and units activate more rapidly.
• This makes movements more efficient.
• Individuals can increase motor unit recruitment by consistently increasing the weight challenge to their muscles.
• The development creates movement memory.
• A relationship between the brain, muscles, and motor units is established even if the individual stops working out. The pathways are still there no matter how long the individual takes off.
• When returning to training, the body will remember how to ride a bike, do a bicep curl, or squat.
• However, the muscles will not have the same strength as the strength needs to be built back along with endurance that may have been lost.
• It is the movement memory that remains.

Military Training and Chiropractic Care: Maximizing Performance

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

Heckman, C. J., & Enoka, R. M. (2012). Motor unit. Comprehensive Physiology, 2(4), 2629–2682. https://doi.org/10.1002/cphy.c100087

Purves D, Augustine GJ, Fitzpatrick D, et al., editors. (2001). Neuroscience. 2nd edition. Sunderland (MA): Sinauer Associates; 2001. The Motor Unit. Available from: https://www.ncbi.nlm.nih.gov/books/NBK10874/

Dr. Erin Nitschke. American Council on Exercise. (2017). How Muscle Grows (Exercise Science, Issue. https://www.acefitness.org/resources/everyone/blog/6538/how-muscle-grows/

Pete McCall. American Council on Exercise. (2015). 10 Things to Know About Muscle Fibers (Exercise Science, Issue. https://www.acefitness.org/resources/pros/expert-articles/5411/10-things-to-know-about-muscle-fibers/

Individuals experiencing pain symptoms like shooting, stabbing, or electrical sensations to the latissimus dorsi of the upper back could be caused by a nerve injury to the thoracodorsal nerve. Can knowing the anatomy and symptoms help healthcare providers develop an effective treatment plan?

Thoracodorsal Nerve

Also known as the middle subscapular nerve or the long subscapular nerve, it branches out from a part of the brachial plexus and provides motor innervation/function to the latissimus dorsi muscle.

Anatomy

The brachial plexus is a network of nerves that stem from the spinal cord in the neck. The nerves supply most of the sensation and movement of the arms and hands, with one on each side. Its five roots come from the spaces between the fifth through eighth cervical vertebrae and the first thoracic vertebra. From there, they form a larger structure, then divide, re-combine, and divide again to form smaller nerves and nerve structures as they travel down the armpit. Through the neck and chest, the nerves eventually join and form three cords that include:

• Lateral cord
• Medial cord
• Posterior cord

The posterior cord produces major and minor branches that include:

• Axillary nerve
• Radial nerve

The minor branches include:

• Superior subscapular nerve
• Inferior subscapular nerve
• Thoracodorsal nerve

Structure and Position

• The thoracodorsal nerve branches off the posterior cord in the armpit and travels down, following the subscapular artery, to the latissimus dorsi muscle.
• It connects to the upper arm, stretches across the back of the armpit, forming the axillary arch, and then expands into a large triangle that wraps around the ribs and the back.
• The thoracodorsal nerve lies deep in the latissimus dorsi, and the lower edge typically reaches close to the waist.

Variations

• There is a standard location and course of the thoracodorsal nerve, but individual nerves are not the same in everyone.
• The nerve typically branches off the posterior cord of the brachial plexus from three different points.
•  However, different subtypes have been identified.
• The thoracodorsal nerve supplies the teres major muscle in about 13% of individuals. (Brianna Chu, Bruno Bordoni. 2023)
• The lats can have a rare anatomical variation known as a Langer’s arch, which is an extra part that connects to muscles or connective tissue of the upper arm beneath the common connecting point.
• In individuals with this abnormality, the thoracodorsal nerve supplies function/innervation) to the arch. (Ahmed M. Al Maksoud et al., 2015)

Function

The latissimus dorsi muscle cannot function without the thoracodorsal nerve. The muscle and nerve help:

• Stabilize the back.
• Pull the body weight up when climbing, swimming, or doing pull-ups.
• Assist with breathing by expanding the rib cage during inhalation and contracting when exhaling. (Encyclopaedia Britannica. 2023)
• Rotate the arm inward.
• Pull the arm toward the center of the body.
• Extend the shoulders by working with the teres major, teres minor, and posterior deltoid muscles.
• Bring down the shoulder girdle by arching the spine.
• To bend to the side by arching the spine.
• Tilt the pelvis forward.

Conditions

The thoracodorsal nerve can be injured anywhere along its path by trauma or disease. Symptoms of nerve damage can include: (U.S. National Library of Medicine: MedlinePlus. 2022)

• Pain that can be shooting, stabbing, or electrical sensations.
• Numbness, tingling.
• Weakness and loss of function in the associated muscles and body parts, including wrist and finger drop.
• Because of the nerve's path through the armpit, doctors have to be cautious of the anatomical variants so they don’t inadvertently damage a nerve during breast cancer procedures, including axillary dissection.
• The procedure is performed to examine or remove lymph nodes and is used in staging breast cancer and in treatment.
• According to a study, 11% of individuals with axillary lymph node dissection suffered damage to the nerve. (Roser Belmonte et al., 2015)

Breast Reconstruction

• In breast reconstruction surgery, the lats can be used as a flap over the implant.
• Depending on the circumstances, the thoracodorsal nerve can be left intact or severed.
• The medical community has not agreed on which method has the best outcomes. (Sung-Tack Kwon et al., 2011)
• There is some evidence that leaving the nerve intact can cause the muscle to contract and dislocate the implant.
• An intact thoracodorsal nerve may also cause atrophy of the muscle, which can lead to shoulder and arm weakness.

Graft Uses

A portion of the thoracodorsal nerve is commonly used in nerve graft reconstruction to restore function after injury, which includes the following:

• Musculocutaneous nerve
• Accessory nerve
• Axillary nerve
• The nerve can also be used to restore nerve function to the triceps muscle in the arm.

Rehabilitation

If the thoracodorsal nerve is injured or damaged, treatments can include:

• Braces or splints.
• Physical therapy to improve range of motion, flexibility, and muscle strength.
• If there is compression, surgery may be required to alleviate the pressure.

Exploring Integrative Medicine

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.