What type of concussion tests are there to help establish the extent of head injuries and help assess improvement during recovery?

Concussion Tests

A concussion is a temporary change in brain function that occurs from a traumatic brain injury or TBI. It can cause problems with thinking and mood and can take weeks to years to heal. Concussion tests are done after a suspected head injury and are also used after diagnosis to assess healing progress. They are noninvasive tests that measure brain functions. Several tests vary in how they are given and what they measure.

Tests

A mild or moderate traumatic brain injury can cause damage to the brain that is not detectable with brain imaging tests. However, the damage can cause serious symptoms, including headaches, emotional changes, difficulty concentrating, and memory problems. (Haider M. N. et al., 2021) The effects of a concussion can be hard to describe, but concussion testing can help identify and quantify these changes. For individuals who don't have time to heal or experience further brain injuries while recovering, the effects can be prolonged and worsen. This is one reason why concussion testing is vital to get a diagnosis and follow medical recommendations to avoid further injury to the brain. Diagnosis can help set goals, adjust, and assess how the effects improve over time. With improvement, individuals can participate in rehabilitation and follow their doctor's instructions for gradually returning to work, school, and other activities.

Measurements

Concussion tests can measure subtle aspects of brain function, like visual or auditory perception and response speed (Joyce A. S. et al., 2015). The damage sustained can impair these abilities, like slow decision-making. A traumatic brain injury can be associated with serious injuries, like a skull fracture, swelling, bruise, or bleeding in the brain. These injuries can be detected with imaging tests and often require surgery or other interventions. Brain damage from bleeding or swelling would cause focal neurological symptoms and signs, including partial vision loss, numbness, and weakness. Individuals can have a concussion along with detectable brain injuries or in the absence of detectable brain injuries.

Types of Tests

There are several types of concussion tests. Individuals may have one or more of these, depending on the standard test that is used in their school, sports league, or by their doctor. These can include:

Online Checklists

• Several different online checklists are available for concussion screening.
• These tests may include questions about symptoms and are often used as self-tests but are not intended to replace an evaluation by a medical professional.

Baseline and Post-Injury Tests

• Many schools and sports leagues conduct preseason skill measurements, including memory tests or tests of speed and accuracy, either in an interview form or with computer testing.
• Individuals might be asked to retake the test that is used as a comparison if they have experienced a traumatic brain injury.

Standardized Assessment of Concussion - SAC

• This five-minute test can be done on the sidelines after a sports injury or later.
• It evaluates orientation, immediate memory, neurologic function, concentration, and delayed recall. (Kaufman M. W. et al., 2021)

King-Devick Concussion Test

• This two-minute test can be performed on the sidelines after a sports injury or later to assess language, eye movement, and attention. (Krause D. A. et al., 2022)

Post-Concussion Symptom Scale

• This test includes 22 questions involving neurocognitive factors, including difficulty concentrating or remembering, physical symptoms like headaches and dizziness, and emotional symptoms like sadness or irritability. (Langevin P. et al., 2022)

Sport Concussion Assessment Tool - SCAT

• This test includes an on-field assessment noting concussion symptoms, memory assessment using Maddocks questions (a short list of specific questions), Glasgow Coma Scale (GCS), and cervical spine assessment.
• An off-field assessment involves the evaluation of cognitive, neurological, balance, and delayed recall. (Kaufman M. W. et al., 2021)

Buffalo Concussion Physical Examination - BCPE

• A modified physical examination that assesses neck tenderness and range of motion, head, jaw, and face abnormalities, eye movements examination, and coordination. (Haider M. N. et al., 2021)
• After a concussion, individuals will also have a physical examination, including a full neurological examination, in a doctor’s office.

Results

A doctor will diagnose based on symptoms, physical examination, and concussion test results. For example, for individuals who have broken several bones and are taking powerful pain medications, concussion test results can be abnormal even if they did not experience a concussion. The results of concussion testing can be compared with results before the head injury. Often, baseline testing is required for participation in certain sports leagues at professional and amateur levels. A low score can indicate that head injury has impaired brain function. Sometimes, testing can be done within a few hours of the head trauma and then again a few days later. Responses of individuals who did not have measurements taken before a head injury can be compared with the average results of people their age.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Lumbar Spine Injuries in Sports: Chiropractic Healing

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies that are available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Haider, M. N., Cunningham, A., Darling, S., Suffoletto, H. N., Freitas, M. S., Jain, R. K., Willer, B., & Leddy, J. J. (2021). Derivation of the Buffalo Concussion Physical Examination risk of delayed recovery (RDR) score to identify children at risk for persistent postconcussive symptoms. British journal of sports medicine, 55(24), 1427–1433. https://doi.org/10.1136/bjsports-2020-103690

Joyce, A. S., Labella, C. R., Carl, R. L., Lai, J. S., & Zelko, F. A. (2015). The Postconcussion Symptom Scale: utility of a three-factor structure. Medicine and science in sports and exercise, 47(6), 1119–1123. https://doi.org/10.1249/MSS.0000000000000534

Kaufman, M. W., Su, C. A., Trivedi, N. N., Lee, M. K., Nelson, G. B., Cupp, S. A., & Voos, J. E. (2021). The Current Status of Concussion Assessment Scales: A Critical Analysis Review. JBJS reviews, 9(6), e20.00108. https://doi.org/10.2106/JBJS.RVW.20.00108

Krause, D. A., Hollman, J. H., Breuer, L. T., & Stuart, M. J. (2022). Validity Indices of the King-Devick Concussion Test in Hockey Players. Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine, 32(3), e313–e315. https://doi.org/10.1097/JSM.0000000000000938

Langevin, P., Frémont, P., Fait, P., & Roy, J. S. (2022). Responsiveness of the Post-Concussion Symptom Scale to Monitor Clinical Recovery After Concussion or Mild Traumatic Brain Injury. Orthopaedic journal of sports medicine, 10(10), 23259671221127049. https://doi.org/10.1177/23259671221127049

For individuals and athletes with a gluteal contusion with severe bruising, can a healthcare provider determine if there are any other injuries to underlying structures, including muscle or tendon tears?

Gluteal Contusion

A gluteal contusion is an injury, in this case, a bruise to the buttocks' gluteal muscles caused by damage to muscle fibers and blood vessels. A buttock bruise is caused by direct bodily impact, typically from falls, automobile collisions, accidents, bumping into something, or being struck by an object or person. Like all bruises, a gluteal bruise most often results in pain and visible discoloration of the skin at the injury site, varying in severity from grade I to grade III, with higher-graded bruises requiring more time to heal. Most butt bruises can heal on their own with time and rest, but if bruising is severe, individuals may require physical therapy to restore full muscle function.

Symptoms

A contusion is a muscle injury that can affect the body's skeletal muscles. A gluteal contusion can be painful, with a black and blue mark that changes color over time. Other symptoms may include: (Mount Sinai, 2024)

• Tenderness to touch over the injury site
• Increased pain with contraction of the glutes
• Swelling
• Discomfort with sitting

Causes

A contusion occurs from direct trauma and forceful impact on the gluteal muscles, causing damage to underlying blood vessels, muscle fibers, and sometimes bone, resulting in bleeding under the skin. (MedlinePlus, 2016) Direct impacts to the gluteal muscles that can cause a contusion include:

• Falls
• Car accidents
• Direct hits to the buttocks from a piece of sports equipment or person. 
• Bumping into furniture, a door, or a counter. 
• Intramuscular injections into the gluteal muscles.
• Individuals who take blood thinners or anticoagulant medication have an increased risk of bruising from direct contact injuries.

Diagnosis

A gluteal contusion is usually diagnosed through a physical examination and is generally straightforward to diagnose based on physical appearance, symptoms, and type of injury. Contusions can be graded based on the severity according to the following criteria (Fernandes, T. L. et al., 2015)

Grade I

• An injury that affects only a small amount of muscle fibers, resulting in minimal pain, tenderness, and possible swelling.
• Causes minimal or no loss of strength in the affected muscle or range of motion limitations.
• Muscle use is typically unaffected.

Grade II

• An injury that causes significant damage to muscle fibers, resulting in increased pain and impaired muscle contraction.
• A small muscle defect can be felt to the touch.
• Discoloration increases over the first few days after injury.

Grade III

• An injury that involves extensive muscle fiber damage and bleeding across an entire area of a muscle that results in severe, and sometimes total, loss of muscle function.
• Causes severe pain and significant discoloration of the skin.

1. When contusions are larger, deeper, and involve significant blood pooling and swelling, they are called hematomas.
2. If the bruising is severe, a diagnostic ultrasound, CT scan, or MRI may be used to determine whether any underlying structures are damaged.

Treatment

Contusions are generally mild injuries. Treatment typically involves rest to allow the muscles to heal from the bleeding and the bruising to dissipate.

• Applying ice to the injury site can help relieve pain and inflammation.
• If the bruising is severe, significant physical activity like sports, dancing, running, jumping, and weight lifting should be avoided until the muscles heal. (Mount Sinai, 2024)
• With more severe bruising, contraction and stretching of the glutes are painful and can require longer healing and recovery time.
• Physical therapy rehabilitation may be needed for more significant injuries to restore muscle function.

Prognosis

A mild injury usually heals on its own with time and rest. More significant injuries take longer to heal and may require physical therapy to build strength and range of motion if muscle function is affected.

Healing Time and Recovery

Healing and recovery times for gluteal contusions vary depending on the severity of the injury (Fernandes T. L. et al., 2015)

Grade I

• Minor injuries that cause minimal discomfort typically heal fully in five days to two weeks.

Grade II

• During the first two to three days, contusions develop, increasing discoloration under the skin, and complete healing can take two to three weeks.
• Return to sport is typically resumed after a month.

Grade III

• Contusions can take up to four to six weeks to heal, often requiring rehabilitation to restore muscle strength and range of motion.

Injury Medical Chiropractic and Functional Medicine Clinic

At Injury Medical Chiropractic and Functional Medicine Clinic, we passionately focus on treating patients’ injuries and chronic pain syndromes. We focus on improving ability through flexibility, mobility, and agility programs tailored to the individual. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes. Our providers use an integrated approach to create personalized care plans that include Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Our goal is to relieve pain naturally by restoring health and function to the body. If he feels the individual needs other treatment, they will be referred to a clinic or physician best suited for them as Dr. Jimenez has teamed up with the top surgeons, clinical specialists, medical researchers, and premier rehabilitation providers to provide our community with the best clinical treatments.

Building a Stronger Body

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

Mount Sinai. (2024). Bruise. https://www.mountsinai.org/health-library/injury/bruise

MedlinePlus. (2016). Bruises. Retrieved from https://medlineplus.gov/bruises.html

Fernandes, T. L., Pedrinelli, A., & Hernandez, A. J. (2015). MUSCLE INJURY - PHYSIOPATHOLOGY, DIAGNOSIS, TREATMENT AND CLINICAL PRESENTATION. Revista brasileira de ortopedia, 46(3), 247–255. https://doi.org/10.1016/S2255-4971(15)30190-7

Competitive swimmers, recreational, and swimming enthusiasts who experience pinching and sharp shoulder pain while swimming may suffer from shoulder impingement. Can understanding symptoms can help healthcare providers develop an effective treatment program?

Swimmer's Shoulder

Swimmer's shoulder, medically known as rotator cuff impingement syndrome, is a common injury among swimmers. It can limit swimming ability and normal arm use for functional tasks. It is caused by persistent and abnormal rubbing and pinching of the structures in the shoulder, causing pain and irritation of the shoulder's rotator cuff tendons and the bursa. The injury affects 40% to 90% of swimmers at some point. (Wanivenhaus F. et al., 2012) Self-care treatment involves rest, anti-inflammatory medication, and exercise to restore normal shoulder mobility. Most cases resolve within a few months, but physical therapy may be needed along with continued exercises and stretches to maintain pain relief.

Anatomy

The shoulder is a complex joint with extreme mobility. It is comprised of three bones:

• The scapula or shoulder blade.
• The clavicle or collar bone.
• The humerus or upper arm bone.

These three bones combine at various places to make up the joint. Several muscles attach to and move the joint. (Kadi R. et al., 2017) The rotator cuff is one group of four muscles deep in the shoulder surrounding the joint. When lifting the arm, these muscles contract to hold the ball in the joint's socket, allowing the arm to be raised in a fluid and smooth motion. Several ligaments hold the shoulder joint together and connect the various bones of the shoulder, giving the joint stability when moving. (Kadi R. et al., 2017)

Symptoms

Common symptoms include: (Wanivenhaus F. et al., 2012)

• Swelling in the front or top of the shoulder
• Difficulty reaching up overhead
• Shoulder pain
• Shoulder pain when bearing weight through the arm.
• Symptoms tend to be worse during or immediately after swimming.

This is due to the position of the arms and upper extremities while swimming. (Wanivenhaus F. et al., 2012) Reaching overhead and turning the hand inward can cause the rotator cuff tendons or shoulder bursa to become pinched underneath the acromion process of the shoulder blade, similar to the motion that occurs during the crawl or freestyle stroke. When pinching/impingement occurs, the tendons or bursa can become inflamed, leading to pain and difficulty with normal arm use. (Struyf F. et al., 2017) The condition may also occur due to the laxity of the shoulder ligaments. (Wanivenhaus F. et al., 2012) It is theorized that the ligaments in swimmers become stretched and lax, leading to shoulder joint instability. This can cause the shoulder joint to become loose and compress the shoulder structures.

Diagnosis

A clinical examination can diagnose cases of swimmer's shoulder. (Wanivenhaus F. et al., 2012) The exam can include:

• Palpation
• Strength test
• Specialized tests

One shoulder test that is often used is called Neer's test. A physician elevates the arm overhead to the maximum degree during this examination. If this results in pain, the rotator cuff tendons may be compressed, and the test is positive. Individuals may begin treatment after the examination, but a doctor may also refer them for diagnostic testing. An X-ray may be taken to examine the bone structures, and an MRI may be used to examine the soft tissue structures, such as the rotator cuff tendons and the bursa.

Treatment

Appropriate treatment of swimmer's shoulder involves managing pain and inflammation in your shoulder and improving the way your shoulder moves so you avoid pinching structures inside the joint. (Wanivenhaus F. et al., 2012) There are various treatments available and can include:

• Rest
• Physical therapy
• Acupuncture
• Non-surgical decompression
• Targeted exercises and stretches
• Medications
• Injections
• Surgery for serious cases

Physical Therapy

A physical therapist can treat shoulder impingement. They can assess the condition and prescribe treatments and exercises to improve mobility and strength. (Cleveland Clinic, 2023) They may use various treatment modalities to decrease pain and improve circulation to facilitate and expedite healing. Physical therapy treatments can include:

• Ice
• Heat
• Trigger point release
• Joint mobilizations
• Stabilization
• Stretching
• Exercise
• Electrical stimulation
• Ultrasound
• Taping

Medication

Medication may include over-the-counter anti-inflammatory medicine to help decrease pain and inflammation. A physician may prescribe stronger medication to manage inflammation if the condition is severe. While taking medication, the shoulder will need rest, so avoiding swimming or other shoulder movements for a week or two may be necessary.

Injections

Cortisone is a powerful anti-inflammatory medicine. Individuals may benefit from cortisone injections into their shoulders. (Wanivenhaus F. et al., 2012) When injected, cortisone decreases pain, reduces swelling in the rotator cuff and bursa, and improves shoulder mobility.

Surgery

If symptoms are persistent and fail to be alleviated with conservative treatments, surgery may be recommended. An arthroscopic procedure called subacromial decompression may be performed. (Cleveland Clinic, 2023) This type of surgery is done with small incisions, inserting a camera, and tiny tools. During this procedure, inflamed tissue and bone spurs are removed from the underside of the acromion process of the shoulder blade, allowing more space to the shoulder joint. Post-surgery, individuals can gradually return to swimming and all other activities in about eight weeks.

Recovery

Most episodes last about eight to ten weeks, and severe cases last up to three months. (Struyf F. et al., 2017) Often, the symptoms slowly resolve with rest and gentle stretching. As symptoms improve, individuals can slowly return to normal activity and swimming. However, performing prescribed exercises two to three times a week may be necessary to maintain shoulder strength and mobility and help prevent future episodes of shoulder impingement. Individuals experiencing any of these symptoms should visit their physician for an accurate diagnosis of their condition to begin proper treatment. Discuss goals with a healthcare professional and physical therapist.

Sports Injuries 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 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

Wanivenhaus, F., Fox, A. J., Chaudhury, S., & Rodeo, S. A. (2012). Epidemiology of injuries and prevention strategies in competitive swimmers. Sports Health, 4(3), 246–251. https://doi.org/10.1177/1941738112442132

Kadi, R., Milants, A., & Shahabpour, M. (2017). Shoulder Anatomy and Normal Variants. Journal of the Belgian Society of Radiology, 101(Suppl 2), 3. https://doi.org/10.5334/jbr-btr.1467

Struyf, F., Tate, A., Kuppens, K., Feijen, S., & Michener, L. A. (2017). Musculoskeletal dysfunctions associated with swimmers' shoulders. British journal of sports medicine, 51(10), 775–780. https://doi.org/10.1136/bjsports-2016-096847

Cleveland Clinic. (2023). Swimmer's shoulder. https://my.clevelandclinic.org/health/diseases/17535-swimmers-shoulder

For wrestling athletes or those thinking about getting into the sport, can knowing about common injuries help in rehabilitation and prevention?

Wrestling Injuries

Wrestling is an intense and demanding sport. Studies have found that football and wrestling are the two high school sports with the highest risk of serious injury to athletes (Center for Injury Research and Policy, 2009). The injury rate for college wrestlers is 9 injuries per 1,000 athlete exposures. (Kroshus, E. et al., 2018) While most wrestling injuries include strains and sprains, there can also be serious traumatic and unusual injuries. Using proper safety gear and learning correct techniques can significantly reduce the risk of injuries. The majority occur during competition.

Common

The most common wrestling injuries are similar to those in other sports and include:

Muscle Soreness

• Muscle soreness that is experienced 12 to 48 hours after an intense workout or competition.
• Resting is often all that is needed to recover.

Bruises and Contusions

• Sparring, take-downs, and hard landings can result in various bruises and contusions.

Sprains and Strains

• Rest, ice, compression, and elevation are recommended to treat sprains and strains immediately.

Ankle Sprains

• Ankle sprains occur when surrounding ligaments stretch and tear around the joint.

Wrist Sprains

• Typically, it occurs when stretching or tearing the ligaments.
• Falling or landing on the hands is a common cause.

Overtraining Syndrome

• Frequently occurs in athletes who train beyond the body's ability to recover.

Dehydration

• When trying to make weight, dehydration can be a serious health problem that many wrestlers experience.

Other Injuries

Other injuries common in wrestling:

• Wrist tendinitis
• Finger fractures
• Iliotibial band syndrome
• Meniscus tears
• Groin pull
• Hamstring pull or tear
• Pulled calf muscle
• Achilles tendonitis
• Achilles tendon rupture
• Clavicle/Collarbone fracture
• Concussion

Serious

The forcing of a joint beyond its normal range of motion is the most common cause of serious injuries. The most serious wrestling injuries affect the neck, shoulder, elbow, and knee and include:

Neck

• The cervical vertebrae are often forced into vulnerable positions during various techniques and movements, which can result in a neck injury. Common types include:
• Neck Strain
• Whiplash
• Cervical Fracture

Shoulder

• A combination of leverage and twisting causes most upper body and shoulder injuries during competition. Types of shoulder injuries include:
• Rotator cuff injury
• Shoulder separation
• Shoulder dislocation

Elbow Dislocation

• Elbows are under tremendous strain when maneuvering.
• Dislocations of the radial head are often related to the athlete bracing for a fall on an outstretched arm during take-downs.

Knee

• Most knee injuries occur to the ligaments of the knee joint.
• These include anterior and posterior cruciate ligament or ACL/PCL injuries.

Safety

Wrestling requires flexibility, strength, and proper technique to prevent injury, combined with thorough instruction and coaching and following basic safety precautions. Some tips include.

Safety Gear

• Wear appropriate headgear and mouthguards during practices, meets, and tournaments.

Improving Joint Flexibility

• Wrestlers with a high degree of shoulder flexibility have fewer injuries.
• The flexibility of the lower back, hamstrings, elbows, and cervical spine should also be worked on.​

Gain or Lose Weight Safely

• Avoid dramatic weight loss and weight-gaining strategies by maintaining healthy nutrition and hydration during the season.

Avoiding Dangerous Holds and Slam Moves

• Safe wrestling techniques need to be followed as these can generate severe injuries.

Regardless of how common or seemingly not serious an injury or medical condition is, it's important to rest and recover and tell a coach and health care professional, as some injuries and conditions can become serious if left untreated. Injury Medical Chiropractic and Functional Medicine Clinic focuses on and treats injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers use an integrated approach to create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Our goal is to relieve pain naturally by restoring health and function to the body. If 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.

Perseverance and Power

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Nationwide Children’s Hospital. (2024). Center for Injury Research and Policy. https://www.nationwidechildrens.org/research/areas-of-research/center-for-injury-research-and-policy

Kroshus, E., Utter, A. C., Pierpoint, L. A., Currie, D. W., Knowles, S. B., Wasserman, E. B., Dompier, T. P., Marshall, S. W., Comstock, R. D., & Kerr, Z. Y. (2018). The First Decade of Web-Based Sports Injury Surveillance: Descriptive Epidemiology of Injuries in US High School Boys' Wrestling (2005-2006 Through 2013-2014) and National Collegiate Athletic Association Men's Wrestling (2004-2005 Through 2013-2014). Journal of athletic training, 53(12), 1143–1155. https://doi.org/10.4085/1062-6050-154-17

For individuals who lift weights, are there ways to protect the wrists and prevent injuries when lifting weights?

Wrist Protection

The wrists are complex joints. The wrists significantly contribute to stability and mobility when performing tasks or lifting weights. They provide mobility for movements using the hands and stability to carry and lift objects securely and safely (National Library of Medicine, 2024). Lifting weights is commonly performed to strengthen and stabilize the wrists; however, these movements can cause wrist pain and lead to injuries if not performed correctly. Wrist protection can keep wrists strong and healthy and is key to avoiding strains and injuries.

Wrist Strength

The wrist joints are set between the hand and forearm bones. Wrists are aligned in two rows of eight or nine total small bones/carpal bones and are connected to the arm and hand bones by ligaments, while tendons connect the surrounding muscles to the bones. Wrist joints are condyloid or modified ball and socket joints that assist with flexion, extension, abduction, and adduction movements. (National Library of Medicine. 2024) This means the wrists can move in all planes of motion:

• Side to side
• Up and down
• Rotate

This provides a wide range of motion but can also cause excessive wear and tear and increase the risk of strain and injury. The muscles in the forearm and hand control finger movement necessary for gripping. These muscles and the tendons and ligaments involved run through the wrist. Strengthening the wrists will keep them mobile, help prevent injuries, and increase and maintain grip strength.  In a review on weightlifters and powerlifters that examined the types of injuries they sustain, wrist injuries were common, with muscle and tendon injuries being the most common among weightlifters. (Ulrika Aasa et al., 2017)

Protecting the Wrists

Wrist protection can use a multi-approach, which includes consistently increasing strength, mobility, and flexibility to improve health and prevent injuries. Before lifting or engaging in any new exercise, individuals should consult their primary healthcare provider, physical therapist, trainer, medical specialist, or sports chiropractor to see which exercises are safe and provide benefits based on injury history and current level of health.

Increase Mobility

Mobility allows the wrists to have a full range of motion while retaining the stability necessary for strength and durability. Lack of mobility in the wrist joint can cause stiffness and pain. Flexibility is connected to mobility, but being overly flexible and lacking stability can lead to injuries. To increase wrist mobility, perform exercises at least two to three times a week to improve range of motion with control and stability. Also, taking regular breaks throughout the day to rotate and circle the wrists and gently pull back on the fingers to stretch them will help relieve tension and stiffness that can cause mobility problems.

Warm-Up

Before working out, warm up the wrists and the rest of the body before working out. Start with light cardiovascular to get the synovial fluid in the joints circulating to lubricate the joints, allowing for smoother movement. For example, individuals can make fists, rotate their wrists, perform mobility exercises, flex and extend the wrists, and use one hand to pull back the fingers gently. Around 25% of sports injuries involve the hand or wrist. These include hyperextension injury, ligament tears, front-inside or thumb-side wrist pain from overuse injuries, extensor injuries, and others. (Daniel M. Avery 3rd et al., 2016)

Strengthening Exercises

Strong wrists are more stable, and strengthening them can provide wrist protection. Exercises that improve wrist strength include pull-ups, deadlifts, loaded carries, and Zottman curls. Grip strength is vital for performing daily tasks, healthy aging, and continued success with weightlifting. (Richard W. Bohannon 2019) For example, individuals who have difficulty increasing the weight on their deadlifts because the bar slips from their hands could have insufficient wrist and grip strength.

Wraps

Wrist wraps or grip-assisting products are worth considering for those with wrist issues or concerns. They can provide added external stability while lifting, reducing grip fatigue and strain on the ligaments and tendons. However, it is recommended not to rely on wraps as a cure-all measure and to focus on improving individual strength, mobility, and stability. A study on athletes with wrist injuries revealed that the injuries still occurred despite wraps being worn 34% of the time prior to the injury. Because most injured athletes did not use wraps, this pointed to potential preventative measures, but the experts agreed more research is needed. (Amr Tawfik et al., 2021)

Preventing Overuse Injuries

When an area of the body undergoes too many repetitive motions without proper rest, it becomes worn, strained, or inflamed faster, causing overuse injury. The reasons for overuse injuries are varied but include not varying workouts enough to rest the muscles and prevent strain. A research review on the prevalence of injuries in weightlifters found that 25% were due to overuse tendon injuries. (Ulrika Aasa et al., 2017) Preventing overuse can help avoid potential wrist problems.

Proper Form

Knowing how to perform movements correctly and using proper form during each workout/training session is essential for preventing injuries. A personal trainer, sports physiotherapist, or physical therapist can teach how to adjust grip or maintain correct form.

Be sure to see your provider for clearance before lifting or starting an exercise program. Injury Medical Chiropractic and Functional Medicine Clinic can advise on training and prehabilitation or make a referral if one is needed.

Fitness Health

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

Erwin, J., & Varacallo, M. (2024). Anatomy, Shoulder and Upper Limb, Wrist Joint. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30521200

Aasa, U., Svartholm, I., Andersson, F., & Berglund, L. (2017). Injuries among weightlifters and powerlifters: a systematic review. British journal of sports medicine, 51(4), 211–219. https://doi.org/10.1136/bjsports-2016-096037

Avery, D. M., 3rd, Rodner, C. M., & Edgar, C. M. (2016). Sports-related wrist and hand injuries: a review. Journal of orthopaedic surgery and research, 11(1), 99. https://doi.org/10.1186/s13018-016-0432-8

Bohannon R. W. (2019). Grip Strength: An Indispensable Biomarker For Older Adults. Clinical interventions in aging, 14, 1681–1691. https://doi.org/10.2147/CIA.S194543

Tawfik, A., Katt, B. M., Sirch, F., Simon, M. E., Padua, F., Fletcher, D., Beredjiklian, P., & Nakashian, M. (2021). A Study on the Incidence of Hand or Wrist Injuries in CrossFit Athletes. Cureus, 13(3), e13818. https://doi.org/10.7759/cureus.13818

For individuals experiencing eye problems, can acupuncture treatment help and benefit overall eye health?

Acupuncture For Eye Health

Acupuncture is an alternative medical practice that involves inserting thin needles at specific points on the body. The objective is to restore balance and health by restoring and balancing energy circulation through pathways throughout the body. These pathways, known as meridians, are separate from nerve and blood pathways.

• Studies have shown that the insertion of needles manipulates local accumulations of certain neurotransmitters by nearby nerves, which causes beneficial health effects of acupuncture. (Heming Zhu 2014)
• Scientists are not sure exactly how acupuncture works, but it has been shown to provide pain relief and alleviation of cancer treatment nausea. (Weidong Lu, David S. Rosenthal 2013)
• Studies have shown that acupuncture can help treat eye conditions like dry eye syndrome. (Tae-Hun Kim et al., 2012)

Eye Problems

For some individuals, a body imbalance can be caused by eye problems or disease. With acupuncture, imbalance-causing symptoms are addressed. Acupuncture promotes the circulation of energy and blood around the eyes.

• Acupuncture has been used as an alternative treatment for chronic dry eye syndrome. (Tae-Hun Kim et al., 2012)
• Studies have shown acupuncture helps reduce the eye surface's temperature to reduce the evaporation of tears.
• The procedure is also sometimes used to treat glaucoma.
• Glaucoma is an optic nerve disease usually caused by above-normal eye pressure levels.
• One study found eye pressure significantly decreased after acupuncture. (Simon K. Law, Tianjing Li 2013)
• Another study showed successful reduced allergic and inflammatory eye disease symptoms. (Justine R. Smith et al., 2004)

Eye Acupoints

 The following acupoints are for eye health.

Jingming

• Jingming - UB-1 is located in the inner corner of the eye.
• This point is thought to increase energy and blood and to help with problems such as blurry vision, cataracts, glaucoma, night blindness, and conjunctivitis. (Tilo Blechschmidt et al., 2017)

Zanzhu

• The Zanzhu point - UB-2 is in the crease at the inner end of the eyebrow.
• This acupoint is used when individuals complain of headaches, blurred vision, pain, tearing, redness, twitching, and glaucoma. (Gerhard Litscher 2012)

Yuyao

• Yuyao is in the middle of the eyebrow, above the pupil.
• This point is used for treating eye strain, eyelid twitching, ptosis, or when the upper eyelid droops over, cloudiness of the cornea, redness, and swelling. (Xiao-yan Tao et al., 2008)

Sizhukong

• The Sizhukog - SJ 23 area is in the hollow area outside the eyebrow.
• It is thought to be a point where acupuncture can help with eye and facial pain, including headaches, redness, pain, blurred vision, toothache, and facial paralysis. (Hongjie Ma et al., 2018)

Tongzilia

• The Tongzilia - GB 1 is located on the outside corner of the eye.
• The point helps brighten the eyes.
• Acupuncture also helps treat headaches, redness, eye pain, light sensitivity, dry eyes, cataracts, and conjunctivitis. (GladGirl 2013)

Early studies with acupuncture have shown promise for improving eye health. Individuals considering acupuncture are recommended to consult their primary healthcare provider to see if it can be an option for those who have not found a resolution by traditional means.

Neck 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 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

Zhu H. (2014). Acupoints Initiate the Healing Process. Medical acupuncture, 26(5), 264–270. https://doi.org/10.1089/acu.2014.1057

Lu, W., & Rosenthal, D. S. (2013). Acupuncture for cancer pain and related symptoms. Current pain and headache reports, 17(3), 321. https://doi.org/10.1007/s11916-013-0321-3

Kim, T. H., Kang, J. W., Kim, K. H., Kang, K. W., Shin, M. S., Jung, S. Y., Kim, A. R., Jung, H. J., Choi, J. B., Hong, K. E., Lee, S. D., & Choi, S. M. (2012). Acupuncture for the treatment of dry eye: a multicenter randomised controlled trial with active comparison intervention (artificial teardrops). PloS one, 7(5), e36638. https://doi.org/10.1371/journal.pone.0036638

Law, S. K., & Li, T. (2013). Acupuncture for glaucoma. The Cochrane database of systematic reviews, 5(5), CD006030. https://doi.org/10.1002/14651858.CD006030.pub3

Smith, J. R., Spurrier, N. J., Martin, J. T., & Rosenbaum, J. T. (2004). Prevalent use of complementary and alternative medicine by patients with inflammatory eye disease. Ocular immunology and inflammation, 12(3), 203–214. https://doi.org/10.1080/092739490500200

Blechschmidt, T., Krumsiek, M., & Todorova, M. G. (2017). The Effect of Acupuncture on Visual Function in Patients with Congenital and Acquired Nystagmus. Medicines (Basel, Switzerland), 4(2), 33. https://doi.org/10.3390/medicines4020033

Litscher G. (2012). Integrative laser medicine and high-tech acupuncture at the medical university of graz, austria, europe. Evidence-based complementary and alternative medicine : eCAM, 2012, 103109. https://doi.org/10.1155/2012/103109

Tao, X. Y., Sun, C. X., Yang, J. L., Mao, M., Liao, C. C., Meng, J. G., Fan, W. B., Zhang, Y. F., Ren, X. R., & Yu, H. F. (2008). Zhongguo zhen jiu = Chinese acupuncture & moxibustion, 28(3), 191–193.

Ma, H., Feng, L., Wang, J., & Yang, Z. (2018). Zhongguo zhen jiu = Chinese acupuncture & moxibustion, 38(3), 273–276. https://doi.org/10.13703/j.0255-2930.2018.03.011

GladGirl The Lash & Brow Expert Blog. Acupuncture for Eye Health. (2013). https://www.gladgirl.com/blogs/lash-brow-expert/acupuncture-for-eye-health

Individuals who participate in physical and sports activities could suffer an Achilles tendon tear. Can understanding the symptoms and risks help in treatment and return the individual back to their sports activity sooner?

Achilles Tendon

This is a common injury that occurs when the tendon attaching the calf muscle to the heel gets torn.

About the Tendon

• The Achilles tendon is the largest tendon in the body.
• In sports and physical activities, intense explosive movements like running, sprinting, quickly shifting positions, and jumping are exerted on the Achilles.
• Males are more likely to tear their Achilles and sustain a tendon rupture. (G. Thevendran et al., 2013)
• The injury often occurs without any contact or collision but rather the running, starting, stopping, and pulling actions placed on the feet.
• Certain antibiotics and cortisone shots can increase the likelihood of Achilles tear injuries.
• A specific antibiotic, fluoroquinolones, has been shown to increase the risk of Achilles tendon problems. 
• Cortisone shots are also associated with Achilles tears, which is why many healthcare providers don't recommend cortisone for Achilles tendonitis. (Anne L. Stephenson et al., 2013)

Symptoms

• A tendon tear or rupture causes sudden pain behind the ankle.
• Individuals may hear a pop or a snap and often report the feeling as being kicked in the calf or heel.
• Individuals have difficulty pointing their toes downward.
• Individuals may have swelling and bruising around the tendon.
• A healthcare provider will examine the ankle for continuity of the tendon.
• Squeezing the calf muscle is supposed to cause the foot to point downwards, but in individuals with a tear, the foot will not move, resulting in positive results on the Thompson test.
• A defect in the tendon can usually be felt after a tear.
• X-rays may be used to rule out other conditions, including ankle fracture or ankle arthritis.

Risk Factors

• Achilles tendon ruptures are most seen in men around 30 or 40. (David Pedowitz, Greg Kirwan. 2013)
• Many individuals have symptoms of tendonitis prior to sustaining a tear.
• The majority of individuals have no history of previous Achilles tendon problems.
• The majority of Achilles tendon tears are associated with ball sports. (Youichi Yasui et al., 2017)

Other risk factors include:

• Gout
• Cortisone injections into the Achilles tendon
• Fluoroquinolone antibiotic use

Fluoroquinolone antibiotics are commonly used for the treatment of respiratory infections, urinary tract infections, and bacterial infections. These antibiotics are associated with Achilles tendon rupture, but further research is needed to determine how they affect the Achilles tendon. Individuals taking these medications are advised to consider an alternative medication if Achilles tendon problems begin to develop. (Anne L. Stephenson et al., 2013)

Treatment

Depending on the severity of the injury, treatment can consist of non-surgical techniques or surgery.

• The benefit of surgery is there is usually less immobilization.
• Individuals can often return to sports activities sooner, and there is less chance of re-rupturing the tendon.
• Non-surgical treatment avoids the potential surgical risks, and the long-term functional results are similar. (David Pedowitz, Greg Kirwan. 2013)

Treating Ankle Sprains

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

Thevendran, G., Sarraf, K. M., Patel, N. K., Sadri, A., & Rosenfeld, P. (2013). The ruptured Achilles tendon: a current overview from biology of rupture to treatment. Musculoskeletal surgery, 97(1), 9–20. https://doi.org/10.1007/s12306-013-0251-6

Stephenson, A. L., Wu, W., Cortes, D., & Rochon, P. A. (2013). Tendon Injury and Fluoroquinolone Use: A Systematic Review. Drug safety, 36(9), 709–721. https://doi.org/10.1007/s40264-013-0089-8

Pedowitz, D., & Kirwan, G. (2013). Achilles tendon ruptures. Current reviews in musculoskeletal medicine, 6(4), 285–293. https://doi.org/10.1007/s12178-013-9185-8

Yasui, Y., Tonogai, I., Rosenbaum, A. J., Shimozono, Y., Kawano, H., & Kennedy, J. G. (2017). The Risk of Achilles Tendon Rupture in the Patients with Achilles Tendinopathy: Healthcare Database Analysis in the United States. BioMed research international, 2017, 7021862. https://doi.org/10.1155/2017/7021862

For individuals experiencing a turf toe injury, can knowing the symptoms help athletes and non-athletes with treatment, recovery time, and returning to activities?

Turf Toe Injury

A turf toe injury affects the soft tissue ligaments and tendons at the base of the big toe under the foot. This condition usually occurs when the toe is hyperextended/forced upward, such as when the ball of the foot is on the ground and the heel is lifted. (American Academy of Orthopaedic Surgeons. 2021) The injury is common among athletes who play sports on artificial turf, which is how the injury got its name. However, it can also affect non-athletes, like individuals working on their feet all day.

• Recovery time after turf toe injury depends on the severity and the type of activities the individual plans to return to.
• Returning to high-level sports activities after a severe injury can take six months.
• These injuries vary in severity but usually improve with conservative treatment. In severe cases, surgery could be required.
• Pain is the primary issue that stops physical activities after a grade 1 injury, while grades 2 and 3 can take weeks to months to heal completely.

Meaning

A turf toe injury refers to a metatarsophalangeal joint strain. This joint comprises ligaments that connect the bone on the sole of the foot, below the big toe/proximal phalanx, to the bones that connect the toes to the larger bones in the feet/metatarsals. The injury is usually caused by hyperextension that often results from a pushing-off motion, like running or jumping.

Grading

Turf toe injuries can range from mild to severe and are graded as follows: (American Academy of Orthopaedic Surgeons. 2021)

• Grade 1 - The soft tissue is stretched, causing pain and swelling.
• Grade 2 - The soft tissue is partially torn. Pain is more pronounced, with significant swelling and bruising, and it is difficult to move the toe.
• Grade 3 - Soft tissue is completely torn, and symptoms are severe.

Is This What's Causing My Foot Pain?

Turf toe can be an:

• Overuse injury - caused by repeating the same motion repeatedly for an extended period, that causes symptoms to worsen.
• Acute injury - that occurs suddenly, causing immediate pain.

Symptoms can include the following: (Mass General Brigham. 2023)

• Limited range-of-motion.
• Tenderness in the big toe and surrounding area.
• Swelling.
• Pain in the big toe and surrounding area.
• Bruising.
• Loose joints can indicate there is a dislocation.

Diagnosis

If experiencing turf toe symptoms, see a healthcare provider for a proper diagnosis so they can develop a personalized treatment plan. They will perform a physical exam to assess pain, swelling, and range of motion. (American Academy of Orthopaedic Surgeons. 2021) If the healthcare provider suspects tissue damage, they may recommend imaging with X-rays and (MRI) to grade the injury and determine the proper course of action.

Treatment

A healthcare provider will determine the best treatment based on the severity of the injury. All turf toe injuries can benefit from the RICE protocol: (American College of Foot and Ankle Surgeons. Foot Health Facts. 2023)

1. Rest - Avoid activities that worsen symptoms. This can include using an assistive device like a walking boot or crutches to reduce pressure.
2. Ice - Apply ice for 20 minutes, then wait 40 minutes before reapplying.
3. Compression - Wrap the toe and foot with an elastic bandage to support and reduce swelling.
4. Elevation - Prop the foot above the level of the heart to help decrease swelling.

Grade 1

Grade 1 turf toe is classified by stretched soft tissue, pain, and swelling. Treatments can include: (Ali-Asgar Najefi et al., 2018)

• Taping to support the toe.
• Wearing shoes with a rigid sole.
• Orthotic support, like a turf toe plate.

Grades 2 and 3

Grades 2 and 3 come with partial or complete tissue tearing, severe pain, and swelling. Treatments for more severe turf toe can include: (Ali-Asgar Najefi et al., 2018)

• Limited weight bearing
• Using assistive devices like crutches, a walking boot, or a cast.

Other Treatment

• Less than 2% of these injuries require surgery. It is usually recommended if there is instability in the joint or when conservative treatments are unsuccessful. (Ali-Asgar Najefi et al., 2018) (Zachariah W. Pinter et al., 2020)
• Physical therapy is beneficial for decreasing pain and improving the range of motion and strength after injury. (American Academy of Orthopaedic Surgeons. 2021)
• Physical therapy also includes proprioception and agility training exercises, orthotics, and wearing recommended shoes for specific physical activities. (Lisa Chinn, Jay Hertel. 2010)
• A physical therapist can also help ensure that the individual does not return to physical activities before the injury is fully healed and prevent the risk of re-injury.

Recovery Time

Recovery depends on injury severity. (Ali-Asgar Najefi et al., 2018)

• Grade 1 - Subjective as it varies depending on the individual's pain tolerance.
• Grade 2 - Four to six weeks of immobilization.
• Grade 3 - Eight weeks minimum of immobilization.
• It can take up to six months to return to normal function.

Returning To Normal Activities

After a grade 1 turf toe injury, individuals can return to normal activities once the pain is under control. Grades 2 and 3 take longer to heal. Returning to sports activities after a grade 2 injury can take around two or three months, while grade 3 injuries and cases that require surgery can take up to six months. (Ali-Asgar Najefi et al., 2018)

Sports Chiropractic 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, don't hesitate to contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

American Academy of Orthopaedic Surgeons. (2021). Turf toe.

Mass General Brigham. (2023). Turf toe.

American College of Foot and Ankle Surgeons. Foot Health Facts. (2023). RICE protocol.

Najefi, A. A., Jeyaseelan, L., & Welck, M. (2018). Turf toe: A clinical update. EFORT open reviews, 3(9), 501–506. https://doi.org/10.1302/2058-5241.3.180012

Pinter, Z. W., Farnell, C. G., Huntley, S., Patel, H. A., Peng, J., McMurtrie, J., Ray, J. L., Naranje, S., & Shah, A. B. (2020). Outcomes of Chronic Turf Toe Repair in Non-athlete Population: A Retrospective Study. Indian journal of orthopaedics, 54(1), 43–48. https://doi.org/10.1007/s43465-019-00010-8

Chinn, L., & Hertel, J. (2010). Rehabilitation of ankle and foot injuries in athletes. Clinics in sports medicine, 29(1), 157–167. https://doi.org/10.1016/j.csm.2009.09.006

Individuals' feet will heat up when walking or running; however, burning feet could be a symptom of medical conditions like athlete's foot or a nerve injury or damage. Can awareness of these symptoms help identify solutions to relieve and heal the underlying condition?

Burning Feet

Walkers and runners often experience heat in their feet. This is natural from the increased circulation, heart rate, warm or hot sidewalks, and pavement. But the feet could experience an abnormal hot or burning sensation. Usually, the overheating is caused by socks and shoes and fatigue after a long workout. The first self-care steps include trying new or specialized footwear and workout adjustments. If burning feet persist or there are signs of infection, tingling, numbness, or pain, individuals should see their healthcare provider. (Mayo Clinic. 2018) 

Footwear

The shoes and how they are worn may be the cause.

• First, look at the material of the shoes. They could be shoes and/or insoles that don't circulate air. They can get hot and sweaty without proper air circulation around the feet.
• When choosing running shoes, consider a mesh material that allows airflow to keep the feet cool.
• Consider getting fitted for shoes that are the right size, as the feet swell when running or walking.
• If the shoes are too small, air can't circulate, creating more friction between the foot and the shoe.
• Shoes that are too large can also contribute to friction as the feet move around too much.
• Insoles could also contribute.
• Some insoles can make the feet hot, even if the shoes are breathable.
• Swap the insoles from another pair of shoes to see if they are contributing, and if so, look into new insoles.

Tips to help prevent hot feet:

Topical Ointments

• Use an anti-blister/chafing topical cream to lubricate and protect the feet.
• This will reduce friction and prevent blisters.

Lace Properly

• Individuals may be lacing the shoes too tight, constricting circulation or irritating the nerves at the top of the foot.
• Individuals should be able to slide one finger under the knot.
• Remember that the feet will swell as walking or running commences
• Individuals may need to loosen their laces after warming up.
• Individuals are recommended to learn lacing techniques that will ensure they are not too tight over the sensitive areas.

Cushioning

• Fatigue from long workouts or long days standing/moving can result in burning feet.
• Individuals may need added cushioning in the shoes.
• Look for work and athletic shoes that have added cushioning.

Shoe Allergies

 Individuals may have an allergic reaction or a sensitivity to the fabric, adhesives, dyes, or other chemicals. (Cleveland Clinic. 2023) The chemicals used in production vary for leather compared to fabric and are different by brand and manufacturer.

• A shoe material allergy may also result in burning, itching, and swelling.
• It's recommended to note whether symptoms only happen when wearing a specific pair of shoes.
• Recommendations are to try different kinds and brands of shoes.

Socks

The sock fabric could be contributing to hot or burning feet. Steps to take can include:

Avoid cotton

• Cotton is a natural fiber but is not recommended for walking and running as it holds sweat that can keep the feet wet.
• It is recommended to use socks made of Cool-Max and other artificial fibers that wick sweat away and cool them down.

Wool

• Wool socks can also cause itching and burning sensations.
• Consider athletic socks made from itch-free wool.

Mindfulness

• Individuals could be sensitive to other fabrics or dyes in socks.
• Take note of which socks cause hot or burning feet symptoms.
• Individuals could also be sensitive to laundry products and are recommended to try a different brand or type.

Medical Conditions

In addition to shoes and socks, medical conditions could cause and contribute to symptoms.

Athlete's Foot

• Athlete's foot is a fungal infection.
• Individuals may feel a burning sensation in the affected area.
• Typically, it is itchy, red, scaling, or cracking.

1. Rotate shoes.
2. The fungus grows in damp places, therefore, it is recommended to rotate shoes to allow them to dry out between workouts.
3. Wash and dry the feet after walking or running.
4. Try home and over-the-counter solutions, powders, and remedies to treat athlete's foot.

Peripheral Neuropathy

Individuals frequently experiencing burning feet apart from when they have been exercising could be due to nerve damage known as peripheral neuropathy. (National Institute of Neurological Disorders and Stroke. 2023) Peripheral neuropathy symptoms include pins and needles, numbness, tickling, tingling, and/or burning sensations.

Examination

• Diabetes is one of the most common causes of peripheral neuropathy.
• Diabetes can come on at any age.
• Individuals need to learn how to protect their feet, as exercise is recommended for diabetes.

Other conditions that can produce peripheral neuropathy include:

• Vitamin B-12 deficiency
• Alcohol abuse
• Circulatory disorders
• AIDS
• Heavy metal poisoning

Massage and Movement

• Massaging the feet also increases circulation.
• Exercise such as walking is recommended for peripheral neuropathy as it improves circulation to the feet.

Other Causes

Symptoms could also be caused by other conditions including: (Cleveland Clinic. 2023)

Nerve Entrapment

• Degenerative changes in the spine or back trauma can cause injury/damage to the nerves that can cause pain, tingling, and numbness in the feet.

Tarsal Tunnel Syndrome

• Compression of the posterior tibial nerve in your lower leg can cause tingling and burning in your feet.

Morton’s Neuroma

• Morton’s neuroma, which is caused by thickened nerve tissue, can cause pain and burning at the base of the toes.

Autoimmune Diseases

• Diseases such as multiple sclerosis or Lupus can also cause burning feet.

Self-Care

Adjustments or additions to routines and habits can help.

1. Don't walk or run in worn-out shoes.
2. Protect the feet by using the right socks, foot powder, and ointments, and cover any areas where rubbing and friction occur.
3. Immediately change out of shoes and socks after exercise, allowing thorough air drying.
4. This will help reduce the risk of the athlete's foot fungus growth.
5. Soak the feet in cool water. Do not use ice, as it could damage the skin.
6. Soak the feet in Epsom salts to relieve pain and inflammation and dry up blisters.
7. Elevate the feet after exercising.
8. Rotate the shoes and socks between workout sessions and during the day.
9. Try different shoes, socks, and insoles.
10. Overtraining can worsen symptoms.
11. Try gradually building on distance while monitoring symptoms.

See a doctor or specialist healthcare provider if symptoms continue and are not associated with walking or running exercise.

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.

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

Mayo Clinic. (2018). Burning Feet.

National Institute of Neurological Disorders and Stroke. (2023). Peripheral Neuropathy.

Cleveland Clinic. (2023) Burning Feet Syndrome.

Individuals that experience nerve pain in the foot could be caused by a number of different conditions, can recognizing the most common causes help in developing an effective treatment plan?

Nerve Pain In The Foot

These sensations can feel like a burning, shooting, electrical, or stabbing pain and can happen while in motion or at rest. It can occur on the top of the foot or through the arch. The area closest to the nerve may be sensitive to the touch. A number of different conditions can cause nerve pain in the foot, including:

• Morton's neuroma
• Pinched nerve
• Tarsal tunnel syndrome
• Diabetic peripheral neuropathy
• Herniated disc

Morton's Neuroma

Morton's neuroma involves the nerve that runs between the third and fourth toes, but can sometimes occur between the second and third toes becoming thicker. Typical symptoms include a burning or shooting pain in the area, usually while walking. (Nikolaos Gougoulias, et al., 2019) Another common symptom is the sensation of pressure beneath the toes like the sock is bunched up underneath. Treatments can include:

• Arch supports
• Cortisone injections to decrease swelling
• Footwear modifications - can include lifts, orthotics combined with metatarsal pads, and rocker soles, to provide cushion where needed.

Things that increase the risk of developing the condition include:

• Regularly wearing high-heels - the condition occurs more frequently in women.
• Shoes that are too tight.
• Participating in high-impact sports like running.
• Having flat feet, high arches, bunions, or hammertoes.

Pinched Nerve

A pinched nerve can feel like shooting or burning pain. Nerve entrapment can occur in various regions of the foot or the area on top of the foot may feel sensitive. Causes can be caused by: (Basavaraj Chari, Eugene McNally. 2018)

• Trauma that causes swelling.
• Blunt impact.
• Tight shoes. 

Treatment can include:

• Massage
• Physical therapy
• Rest
• Footwear modifications
• Anti-inflammatories.

Things that increase the risk of developing a pinched nerve in the foot include:

• Poor-fitting footwear.
• Repetitive stress injury.
• Trauma to the foot.
• Obesity.
• Rheumatoid arthritis.

Tarsal Tunnel Syndrome

Another type of nerve entrapment is tarsal tunnel syndrome. Tarsal tunnel syndrome is "anything that produces compression on the posterior tibial nerve." (American College of Foot and Ankle Surgeons. 2019) The tibial nerve is located near the heel. Symptoms include numbness and foot cramps, burning, tingling, or shooting sensations that often radiate from the instep/arch. Both can worsen while the foot is at rest, like when sitting or sleeping. Treatment can consist of:

• Placing padding in the shoe where the foot is being compressed to relieve the pain.
• Custom foot orthotics.
• Cortisone shots or other anti-inflammatory treatments.
• Surgery may be necessary to release the nerve.

Conditions that compress the tibial nerve and can lead to tarsal tunnel syndrome include:

• Flat feet
• Fallen arches
• Ankle sprain
• Diabetes
• Arthritis
• Varicose veins
• Bone spurs

Diabetic Peripheral Neuropathy

Long-term high blood sugar/glucose associated with diabetes can lead to a form of nerve damage known as peripheral neuropathy. (Centers for Disease Control and Prevention. 2022) Neuropathy pain feels like burning or shooting pain, or the sensation of walking on bubble wrap that usually shows up overnight. The pain can come and go as well as a gradual loss of feeling in the feet that begins in the toes and moves up the foot. It's estimated that around half of individuals with diabetes will eventually develop neuropathy. (Eva L. Feldman, et al., 2019) Treatments can include:

• Physical therapy massage to increase circulation.
• Topical treatments with capsaicin.
• Vitamin B.
• Blood sugar management.
• Alpha lipoic acid.
• Medication.

Individuals with diabetes have an increased risk of developing peripheral neuropathy if:

• Blood sugar is not well-controlled.
• Diabetes has been present for many years.
• Kidney disease.
• Smoke.
• Overweight or obese.

Herniated Disc

Nerve pain in the foot can be caused by spinal issues. A herniated disc in the lower back can irritate and compress the nerves, causing pain that radiates down the leg and foot. Additional symptoms usually include muscle weakness in the legs and/or numbness and tingling. Most herniated discs don't require surgery and get better with conservative treatment. (Wai Weng Yoon, Jonathan Koch. 2021) If symptoms don't improve or worsen, a healthcare provider may recommend surgery. Herniated discs are most common in young and middle-aged adults. Increased chances of developing a herniated disc can come from:

• Degenerative changes in the spine from normal age wear and tear.
• Physically demanding job.
• Lifting incorrectly.
• Overweight or obese.
• Genetic predisposition - family history of herniated discs.

Spinal Stenosis

Spinal stenosis occurs when the spaces in the spine begin to narrow, creating pressure on the spinal cord and nerve roots. It is usually caused by wear and tear on the spine as the body ages. Stenosis in the lower back can cause burning pain in the buttocks and leg. As it progresses pain can radiate into the feet along with numbness and tingling. Conservative treatment consists of physical therapy exercises and non-steroidal anti-inflammatory medications/NSAIDs. (Jon Lurie, Christy Tomkins-Lane. 2016) Cortisone injections can be beneficial and if the condition worsens, surgery may be an option. Risk factors include:

• Age 50 or older.
• A narrow spinal canal.
• Previous injury.
• Previous spinal surgery.
• Osteoarthritis that is affecting the back.

Other Possible Causes

Other conditions can result in nerve damage and pain symptoms and sensations. Examples include: (Nathan P. Staff, Anthony J. Windebank. 2014)

• Vitamin deficiencies (Nathan P. Staff, Anthony J. Windebank. 2014)
• Physical trauma - after surgery or an automobile or sports accident.
• Certain cancer, antiviral medications, or antibiotics.
• Complex regional pain syndrome.
• Tumors that irritate and/or compress a nerve.
• Liver or kidney disease.
• Infectious diseases - Lyme disease complications or viral infections.

Nerve pain in the foot is definitely a reason to see a healthcare provider. Early diagnosis can help prevent symptom progression and future problems. Once the cause of the pain has been identified, the healthcare team can work together to develop a personalized treatment plan to release compressed nerves and restore mobility and function. See a healthcare provider right away if the pain and symptoms worsen, or if there are difficulties standing or walking.

Chiropractic After Accidents and 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 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

Gougoulias, N., Lampridis, V., & Sakellariou, A. (2019). Morton's interdigital neuroma: instructional review. EFORT open reviews, 4(1), 14–24. https://doi.org/10.1302/2058-5241.4.180025

Chari, B., & McNally, E. (2018). Nerve Entrapment in Ankle and Foot: Ultrasound Imaging. Seminars in musculoskeletal radiology, 22(3), 354–363. https://doi.org/10.1055/s-0038-1648252

American College of Foot and Ankle Surgeons. Tarsal tunnel syndrome.

Centers for Disease Control and Prevention. Diabetes and nerve damage.

Feldman, E. L., Callaghan, B. C., Pop-Busui, R., Zochodne, D. W., Wright, D. E., Bennett, D. L., Bril, V., Russell, J. W., & Viswanathan, V. (2019). Diabetic neuropathy. Nature reviews. Disease primers, 5(1), 42. https://doi.org/10.1038/s41572-019-0097-9

Yoon, W. W., & Koch, J. (2021). Herniated discs: when is surgery necessary?. EFORT open reviews, 6(6), 526–530. https://doi.org/10.1302/2058-5241.6.210020

Lurie, J., & Tomkins-Lane, C. (2016). Management of lumbar spinal stenosis. BMJ (Clinical research ed.), 352, h6234. https://doi.org/10.1136/bmj.h6234

Staff, N. P., & Windebank, A. J. (2014). Peripheral neuropathy due to vitamin deficiency, toxins, and medications. Continuum (Minneapolis, Minn.), 20(5 Peripheral Nervous System Disorders), 1293–1306. https://doi.org/10.1212/01.CON.0000455880.06675.5a

Golfing wrist injuries are common with treatment requiring 1-3 months of rest and immobilization and if tears are present surgery. Can chiropractic treatment help avoid surgery, expedite recovery, and rehabilitation?

Golfing Wrist Injuries

Golfing Wrist Injuries: According to a study, there are over 30,000 golf-related injuries treated in American emergency rooms every year. (Walsh, B. A. et al, 2017) Nearly a third are related to a strain, sprain, or stress fracture.

• One of the most common causes of wrist pain is overuse. (Moon, H. W. et al, 2023)
• Repeated swinging generates added stress on the tendons and muscles, leading to inflammation and pain.
• Improper swing techniques can cause the wrists to twist uncomfortably, resulting in inflammation, soreness, and injuries.
• Golfers who grip the club too tightly can add unnecessary strain on their wrists, leading to pain and weakened grip.

Wrist Tendonitis

• The most common wrist injury is an inflammation of the tendons. (Ray, G. et al, 2023)
• This condition is often caused by overuse or repetitive motion.
• It usually develops in the leading hand from bending the wrist forward on the backswing and then extends backward at the finish.

Wrist Sprains

• These can occur when the golf club hits an object, like a tree root, and makes the wrist bend and/or twist awkwardly. (Zouzias et al., 2018)

Hamate Bone Fractures

• When the club hits the ground abnormally it can compress the handle against the bony hooks at the end of the smaller hamate/carpal bones.

Ulnar Tunnel Syndrome

• This can cause inflammation, and numbness, and is usually caused by an improper or loose grip.
• It causes nerve damage to the wrist from repeated bumping of the golf club handle against the palm.

de Quervain's Tenosynovitis

• This is a repetitive motion injury below the thumb at the wrist. (Tan, H. K. et al, 2014)
• This causes pain and inflammation and is usually accompanied by a grinding sensation when moving the thumb and wrist.

Chiropractic Treatment

Given the nature of these injuries, medical attention should be sought out for image scans to look at any damage and properly immobilize the wrist. Once a fracture has been ruled out or healed, golfing wrist injuries can benefit from chiropractic and physical therapy. (Hulbert, J. R. et al, 2005) A typical treatment may involve a multifaceted approach involving various therapies including:

• Active release therapy, myofascial release, athletic taping, corrective exercise, and stretching. 
• A chiropractor will examine the wrist and its functioning to determine the nature of the injury.
• A chiropractor may recommend using a splint to immobilize the wrist, particularly in cases of overuse.
• They will relieve pain and swelling first, then focus on strengthening the joint.
• They may recommend a regimen of icing the hand.
• Adjustments and manipulations will relieve pressure on the nerves to reduce swelling and restore mobility.

Peripheral Neuropathy Successful 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

Walsh, B. A., Chounthirath, T., Friedenberg, L., & Smith, G. A. (2017). Golf-related injuries treated in United States emergency departments. The American journal of emergency medicine, 35(11), 1666–1671. https://doi.org/10.1016/j.ajem.2017.05.035

Moon, H. W., & Kim, J. S. (2023). Golf-related sports injuries of the musculoskeletal system. Journal of exercise rehabilitation, 19(2), 134–138. https://doi.org/10.12965/jer.2346128.064

Ray, G., Sandean, D. P., & Tall, M. A. (2023). Tenosynovitis. In StatPearls. StatPearls Publishing.

Zouzias, I. C., Hendra, J., Stodelle, J., & Limpisvasti, O. (2018). Golf Injuries: Epidemiology, Pathophysiology, and Treatment. The Journal of the American Academy of Orthopaedic Surgeons, 26(4), 116–123. https://doi.org/10.5435/JAAOS-D-15-00433

Tan, H. K., Chew, N., Chew, K. T., & Peh, W. C. (2014). Clinics in diagnostic imaging (156). Golf-induced hamate hook fracture. Singapore medical journal, 55(10), 517–521. https://doi.org/10.11622/smedj.2014133

Hulbert, J. R., Printon, R., Osterbauer, P., Davis, P. T., & Lamaack, R. (2005). Chiropractic treatment of hand and wrist pain in older people: systematic protocol development. Part 1: informant interviews. Journal of chiropractic medicine, 4(3), 144–151. https://doi.org/10.1016/S0899-3467(07)60123-2

Individuals can become overly passionate about exercising. However, constantly training the body without taking enough time to rest and recover can impact athletes and fitness enthusiasts physically and mentally and lead to overtraining syndrome. Excessive training can cause decreases in athletic physical performance that can be long-lasting, sometimes taking several weeks or months to recover. Individuals who don't learn to manage overtraining can have injuries and more frequent illnesses and infections. And the psychological effects can also lead to negative mood changes. Learn the signs and how to cut back to prevent injury and/or burnout.

Overtraining Syndrome

Athletes and fitness lovers often exercise longer and harder than average to reach peak performance. Even individuals just getting started with exercise can push their limits as they try to figure out what works for them. This means taking into consideration the following:

• The mental side of training.
• How to get and stay motivated.
• How to set up a safe and effective program with balanced cardio and strength training.
• How to avoid skipping workouts when things get in the way.
• Exercising too much is a mistake many beginners make, putting themselves at risk for injury.

Overtraining syndrome is when the body goes through and feels:

• Extreme fatigue.
• Physical performance problems.
• Mood changes.
• Sleep disturbances.
• Other issues due to working out or training too much and/or too hard without giving the body enough time to rest.

Overtraining is common among athletes who train beyond their body's ability to recover, usually when preparing for a competition or event. Conditioning for athletes and enthusiasts requires a balance between work and recovery.

Signs and Symptoms

There are several signs to look for, with the more common symptoms being:

• Mild muscle or joint soreness, general aches, and pains.
• Decreased training capacity, intensity, or performance.
• Lack of energy, constantly tired, and/or drained.
• Brain fog.
• Insomnia.
• Decreased appetite or weight loss.
• Loss of enthusiasm for the sport or exercise.
• Irregular heart rate or heart rhythm.
• Increased injuries.
• Increased headaches.
• Feeling depressed, anxious, or irritable.
• Sexual dysfunction or decreased sex drive.
• Lower immunity with an increase in colds and sore throats.

Prevent Overtraining

• Predicting whether there is a risk of overtraining can be tricky because every person responds differently to various training routines.
• Individuals have to vary their training throughout and schedule adequate time for rest.
• Individuals who believe they may be training too hard should try the following strategies to prevent overtraining syndrome.

Take Note of Mental and Mood Changes

Methods exist to test for overtraining objectively.

• One is taking note of psychological signs and symptoms associated with changes in an individual's mental state can be an indicator.
• Decreased positive feelings for exercise, physical activities, and sports.
• Increased negative emotions, like depression, anger, fatigue, and irritability, can appear after a few days of intense training.
• If these feelings and emotions begin to present, it is time to rest or dial the intensity down.

Training Log

• A training log that notes how the body feels daily.
• It can help individuals notice downward trends and decreased enthusiasm.
• This can help individuals learn to listen to their body's signals and rest when necessary.

Monitor Heart Rate

• Another option is to track changes in heart rate over time.
• Monitor heart rate at rest and specific exercise intensities while training, and record it.
• If the heart rate increases at rest or a given intensity, this could be a risk indicator, especially if symptoms develop.
• Track resting heart rate each morning.
• Individuals can manually take a pulse for 60 seconds immediately after waking up.
• Individuals can also use a heart rate monitor or fitness band.
• Any marked increase from the norm may indicate that the body has not fully recovered.

Treatment

Rest and Recovery

• Reduce or stop the exercise and allow the mind and body a few rest days.
• Research on overtraining shows that complete rest is the primary treatment.

Take Extra Rest Days

• Starting anything new will usually make the body sore.
• Be prepared for the aches and take extra rest days when needed.
• The body won't have the same energy levels from day to day or even from week to week.

Consult A Trainer

• Not sure where to start or how to approach working out safely.
• This is the time to meet with a professional who can look at physical and medical history, fitness level, and goals.
• They can develop a customized program to meet specific needs.

Nutrition and Hydration

• Maintain optimal body hydration with plenty of H2O/water and rehydrating drinks, vegetables, and fruits.
• Staying properly hydrated is key to both recovery and prevention.
• Getting enough protein and carbohydrates supports muscle recovery.
• Carbs are important for endurance, and protein is important for muscular strength and power.

Sports Chiropractic Massage

• Research shows that sports massage benefits muscle recovery and can improve delayed onset muscle soreness/DOMS.
• Massage keeps muscles loose and flexible and increases blood circulation for expedited recovery.

Relaxation Techniques

• Stress-reduction techniques such as deep breathing and progressive muscle relaxation exercises can improve rest and recovery.

Total recovery from overtraining syndrome can take a few weeks or longer, depending on the individual's health status and how long the excessive training has gone on. A physician can refer individuals to a physical therapist or sports chiropractor, who can develop a personalized recovery plan to get the body back to top form.

Military Training and Chiropractic

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, 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

Bell, G W. "Aquatic sports massage therapy." Clinics in sports medicine vol. 18,2 (1999): 427-35, ix. doi:10.1016/s0278-5919(05)70156-3

Carrard, Justin, et al. "Diagnosing Overtraining Syndrome: A Scoping Review." Sports Health vol. 14,5 (2022): 665-673. doi:10.1177/19417381211044739

Davis, Holly Louisa, et al. "Effect of sports massage on performance and recovery: a systematic review and meta-analysis." BMJ open sport & exercise medicine vol. 6,1 e000614. 7 May. 2020, doi:10.1136/bmjsem-2019-000614

Grandou, Clementine, et al. "Symptoms of Overtraining in Resistance Exercise: International Cross-Sectional Survey." International Journal of sports physiology and Performance vol. 16,1 (2021): 80-89. doi:10.1123/ijspp.2019-0825

Meeusen, Romain, et al. "Brain neurotransmitters in fatigue and overtraining." Applied physiology, nutrition, and metabolism = Physiologie applique, nutrition et metabolisme vol. 32,5 (2007): 857-64. doi:10.1139/H07-080

Peluso, Marco Aurélio Monteiro, and Laura Helena Silveira Guerra de Andrade. "Physical activity and mental health: the association between exercise and mood." Clinics (Sao Paulo, Brazil) vol. 60,1 (2005): 61-70. doi:10.1590/s1807-59322005000100012

Weerapong, Pornratshanee, et al. "The mechanisms of massage and effects on performance, muscle recovery, and injury prevention." Sports medicine (Auckland, N.Z.) vol. 35,3 (2005): 235-56. doi:10.2165/00007256-200535030-00004

Percussive massage guns have become a standard tool in osteopathy, physical and massage therapy, and chiropractic care. They provide rapid bursts of force into muscle tissues to quickly loosen and relax the muscles to alleviate soreness, stiffness and increase circulation. Percussive massager therapy devices can be a healthy part of an exercise and recovery routine. They allow individuals to give themselves quick, powerful massages anytime and anywhere. But they need to be used correctly to reap the benefits.

Percussive Massager

These devices can be found in stores and online. Many are on the market, making it tough to separate high-quality massagers from low-quality ones. With a little research and advice from a physical therapist or chiropractic professional, they can help the individual get the right one and training on how to use them to maintain a healthy musculoskeletal system.

Percussive Therapy

Massage guns utilize percussive therapy or vibration therapy, sometimes simultaneously. Percussion and vibration therapy are slightly different. They are soft tissue manipulation, which reduces muscle soreness and post-physical activity, and workout fatigue.

• Vibration therapy uses vibration movements to relax the body, alleviate stress and improve circulation.
• Vibration therapy applies force to targeted areas but with less intensity.
• This type of soft tissue therapy is generally defined as reaching eight to 10 millimeters into the soft tissues.
• Vibration therapy is often recommended for individuals with chronic pain conditions, overly sensitive muscles, or a medical condition that prevents them from using percussive therapy.
• Percussive therapy involves the application of force to muscles and fascia to break up adhesions and increase circulation to sore and sensitive areas.
• Percussive therapy extends deeper into the muscles and reaches deep into soft tissue, estimated to be about 60% deeper.

Using It Properly

It's important to know how to use the machine to get the most out of a percussive massager. Using the massager incorrectly can lead to further injury or the development of new injuries.

Before Workouts

A pre-workout massage session can help warm up the body by increasing circulation and improving the range of motion of the muscles that will be engaged during the workout. Spend one to two minutes massaging each muscle group that will be worked out, plus 30 seconds on supporting muscle groups. For example, here is a pre-workout massage for a leg workout.

• Sixty seconds on each quadricep.
• Sixty seconds on each hamstring.
• Thirty seconds on the lower back.
• Thirty seconds on each calf.

Circulation increases in less than five minutes, and the muscles are ready for exercise. However, this does not replace proper warming-up like dynamic stretching and light cardio to increase heart rate.

After Workouts

After working out, a percussive massage can be part of the cool-down.

• Post-workout percussive therapy can help return the body from a heightened state to a resting state.
• Percussive therapy helps reduce inflammation, which helps reduce post-workout muscle soreness is thought to occur due to microscopic tears in muscle fibers and inflammation in the tissues.
• Percussive therapy maintains increased circulation after a workout, providing oxygen and nutrients to tired muscles.
• The massage helps relax the nervous system by reducing soreness and pain signals, similar to a TENS unit.

Sore Muscles

The muscles may still be sore a day or two after working out. This is called delayed-onset muscle soreness/DOMS.

• A percussive massage can help but may not completely alleviate DOMS but it will provide temporary relief.
• The massager's speed and depth settings should be adjusted to where they don't cause pain.
• Sore muscles tend to remain sensitive, and it is recommended to use the lower settings.
• Once a setting feels good, use the massager for one to two minutes on each sore area.

How Not to Use

Individuals are recommended to consult a doctor if not sure of percussive massage therapy and should avoid using a percussive massager on:

• Musculoskeletal injuries - sprains and strains.
• Bony areas.
• Areas of severe or unexplained pain.
• Sensitive areas.
• Bruises or open wounds.
• Individuals with arthritis, osteoporosis, fibromyalgia, or other musculoskeletal conditions.

Percussive massage devices are safe to use for muscle soreness and as a tool to improve fitness. Individuals can safely use a percussive massager every day as long as they use proper techniques and don’t exceed the recommended usage time, usually provided with instructions on how long to use the device during a session. And some massagers have an automatic shut-off so the individual doesn't exceed the recommended time.

Revitalize and Rebuild with Chiropractic

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, 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

Cheatham, Scott W et al. “Mechanical Percussion Devices: A Survey of Practice Patterns Among Healthcare Professionals.” International journal of sports physical therapy vol. 16,3 766-777. 2 Jun. 2021, doi:10.26603/001c.23530

Dupuy, Olivier, et al. “An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis.” Frontiers in physiology vol. 9 403. 26 Apr. 2018, doi:10.3389/fphys.2018.00403

García-Sillero, Manuel et al. “Acute Effects of a Percussive Massage Treatment on Movement Velocity during Resistance Training.” International journal of environmental research and public health vol. 18,15 7726. 21 Jul. 2021, doi:10.3390/ijerph18157726

Hotfiel, Thilo, et al. “Advances in Delayed-Onset Muscle Soreness (DOMS): Part I: Pathogenesis and Diagnostics.” “Delayed Onset Muscle Soreness – Teil I: Pathogenese und Diagnostik.” Sportverletzung Sportschaden : Organ der Gesellschaft fur Orthopadisch-Traumatologische Sportmedizin vol. 32,4 (2018): 243-250. doi:10.1055/a-0753-1884

Imtiyaz, Shagufta, et al. “To Compare the Effect of Vibration Therapy and Massage in Prevention of Delayed Onset Muscle Soreness (DOMS).” Journal of Clinical and diagnostic research: JCDR vol. 8,1 (2014): 133-6. doi:10.7860/JCDR/2014/7294.3971

Konrad, Andreas, et al. “The Acute Effects of a Percussive Massage Treatment with a Hypervolt Device on Plantar Flexor Muscles' Range of Motion and Performance.” Journal of sports science & Medicine vol. 19,4 690-694. 19 Nov. 2020

For individuals dealing with finger injuries, which can occur from various causes, including overuse, jobs, sports, and more, can knowing the cause of finger pain help healthcare providers determine what steps to take for treatment?

Finger Injuries

Finger injuries are common and can range from minor to serious. (van Veenendaal L. M. et al., 2014) Symptoms can result from an acute injury, including broken fingers and sprains, or chronic conditions like arthritis.

Fractures

Finger fractures can vary and can be serious and lead to permanent damage, deformity, and loss of function if not treated properly. What is important is that fractures are appropriately diagnosed so the proper treatment plan can be initiated. Most finger fractures can be addressed with simple treatments, while others may require surgery. (Oetgen M. E., and Dodds S. D. 2008)

Sprain and Dislocation

Sprains and dislocations are common finger injuries. (Prucz R. B. and Friedrich J. B. 2015) Both damage the ligaments that support the finger joints. In more severe injuries, a dislocation can occur, necessitating the finger to be put back into place or reduced. Individuals with a sprain or dislocation often notice finger swelling or stiffness for months after the injury.

Ligament Damage

Some call this injury skier's or gamekeeper's thumb, which results from a specific type of thumb dislocation. Here, the ulnar collateral ligament of the thumb is damaged. This ligament helps keep the thumb stable and supports grip and hand strength. However, this type of ligament injury often requires surgery. (Christensen T. et al., 2016)

Arthritis

Arthritis causes damage to normal joint surfaces where two bones come together. Fingers are one of the most common locations where arthritis occurs. (Spies C. K. et al., 2018) Two types of arthritis commonly affect the fingers: osteoarthritis and rheumatoid arthritis.

Arthritis of The Thumb 

Arthritis of the thumb usually occurs at the joint where the thumb meets the wrist. This joint called the carpometacarpal/CMC joint, helps with gripping and pinching. Thumb arthritis is more common in women than men and increases in frequency over 40. (Deveza L. A. et al., 2017)

Trigger Finger

Trigger finger or stenosing tenosynovitis, is a common injury that causes pain and snapping of the fingers' tendons, resulting in a sensation of locking or catching when bending and straightening the digits. (Makkouk A. H. et al., 2008) Other symptoms include pain and stiffness in the fingers and thumb. Treatments can vary from observation, rest, splinting, injections, and surgery.

Tendon Injuries

Mallet finger

A mallet finger is an injury to the tip of the finger. Usually, it occurs when the end of a straightened finger or thumb is hit, jamming the finger. After the injury, the individual may notice that they cannot fully straighten the tip of the finger. Treatment almost always uses a splint that has to stay on for about six weeks without removal. (Alla, S. R., Deal, N. D., and Dempsey, I. J. 2014) Very rarely is a surgical procedure necessary.

Jersey Finger

This is an injury to the finger flexor tendon. The flexor tendon pulls the finger into the palm when contracting the forearm flexor muscles. The injury occurs at the tip of the finger; typically, the tendon snaps back to the finger's base or into the palm.

Ring Injuries

Injuries to the finger while wearing wedding bands or other finger jewelry can lead to serious complications. Even minor injuries can have devastating complications if the severity of the injury is not recognized and addressed. If an injury occurs while wearing the jewelry and there is soft tissue damage, including blood circulation being cut off, immediate medical attention is necessary.

Other Injuries

Bruises

The most common finger injury is caused by direct trauma to the skin and muscles. Symptoms include pain, swelling, tenderness, and discoloration of the skin.

Cuts and Scrapes

These can range from minor to more serious, such as injuries that cut through blood vessels, nerves, and tendons.

Injury Medical Chiropractic and Functional Medicine Clinic

After the initial inflammation and swelling have subsided, a doctor will recommend a treatment plan that usually involves physical therapy, self-performed physical rehabilitation, or supervision by a physical therapist or team. 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.

Sports 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 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

van Veenendaal, L. M., de Klerk, G., & van der Velde, D. (2014). A painful finger as first sign of a malignancy. Geriatric orthopaedic surgery & rehabilitation, 5(1), 18–20. https://doi.org/10.1177/2151458514522125

Oetgen, M. E., & Dodds, S. D. (2008). Non-operative treatment of common finger injuries. Current reviews in musculoskeletal medicine, 1(2), 97–102. https://doi.org/10.1007/s12178-007-9014-z

Prucz, R. B., & Friedrich, J. B. (2015). Finger joint injuries. Clinics in sports medicine, 34(1), 99–116. https://doi.org/10.1016/j.csm.2014.09.002

Christensen, T., Sarfani, S., Shin, A. Y., & Kakar, S. (2016). Long-Term Outcomes of Primary Repair of Chronic Thumb Ulnar Collateral Ligament Injuries. Hand (New York, N.Y.), 11(3), 303–309. https://doi.org/10.1177/1558944716628482

Spies, C. K., Langer, M., Hahn, P., Müller, L. P., & Unglaub, F. (2018). The Treatment of Primary Arthritis of the Finger and Thumb Joint. Deutsches Arzteblatt international, 115(16), 269–275. https://doi.org/10.3238/arztebl.2018.0269

Deveza, L. A., Hunter, D. J., Wajon, A., Bennell, K. L., Vicenzino, B., Hodges, P., Eyles, J. P., Jongs, R., Riordan, E. A., Duong, V., Min Oo, W., O'Connell, R., & Meneses, S. R. (2017). Efficacy of combined conservative therapies on clinical outcomes in patients with thumb base osteoarthritis: protocol for a randomised, controlled trial (COMBO). BMJ open, 7(1), e014498. https://doi.org/10.1136/bmjopen-2016-014498

Makkouk, A. H., Oetgen, M. E., Swigart, C. R., & Dodds, S. D. (2008). Trigger finger: etiology, evaluation, and treatment. Current reviews in musculoskeletal medicine, 1(2), 92–96. https://doi.org/10.1007/s12178-007-9012-1

Alla, S. R., Deal, N. D., & Dempsey, I. J. (2014). Current concepts: mallet finger. Hand (New York, N.Y.), 9(2), 138–144. https://doi.org/10.1007/s11552-014-9609-y

Individuals who engage in sports and physical activities that involve lunging forward while running or jumping can sustain a plantaris muscle injury. Can understanding the anatomy of the back of the leg and the symptoms help diagnose and treat plantar muscle injuries?

Plantaris Muscle

The plantaris muscle is a long, narrow muscle in the calf that runs along the back of the leg. It's part of the Triceps Surae, a group of muscles in the calf that, along with the gastrocnemius and soleus muscles, makes up the bulk of the back of the leg. It is located in the superficial posterior compartment of the leg. Strains or tears of the plantaris muscle at the back of the leg can cause pain and swelling, similar to a calf strain or Achilles tendon tear. Individuals may feel immediate pain, cramping, and other symptoms.

Anatomy

The gastrocnemius and soleus muscles are the major muscles, with the soleus located deeper in the leg. Together, they form the Achilles tendon, which blends into a tendon in the back of the heel and attaches to the heel bone/calcaneus. When the calf muscles contract, they point the foot downward, propelling the body forward when walking, running, and sprinting. The plantaris muscle and tendon sit more or less in the center of the calf, between the two heads of the gastrocnemius. Around 7% to 20% of the population are born without plantaris muscles. There are variations, such as having a double- or triple-headed plantaris muscle. (Olewnik Ł. et al., 2020) However, individuals that do not have the muscle or have a variation have not been shown to affect long-term or short-term mobility.

Symptoms

Plantaris muscle ruptures are the most common injury and occur often during running or jumping. (Spang C. et al., 2016) Many who sustain this injury are athletes who have to lunge forward. Common symptoms include:

• Sudden onset pain behind the calf.
• Swelling of the calf muscle.
• Muscle knots or myofascial trigger points of the calf muscle.
• Swelling and bruising in the back of the calf area.
• Cramping in the calf muscle.
• Spasm sensations of the calf muscle.
• Symptoms of a plantaris muscle strain are less severe, with the common signs being tightness and pain during and after physical activity.

Diagnosis

Plantaris muscle tears differ from Achilles tendon tears because the foot can be pointed downward following the rupture, whereas an Achilles tear cannot. Plantaris ruptures can also be confused with a blood clot in the large veins of the calf, called deep vein thrombosis/DVT. (Rohilla S. et al., 2013) Tests like MRI or ultrasound can be performed to confirm or exclude a plantaris rupture. Both can be useful for verifying whether the injury is a strain or tear and identifying other possible causes of calf pain.

Treatment

Treatment is typically non-surgical. While the injuries can cause pain and disability, the symptoms almost always resolve with conservative treatments and therapies. Rest, ice, compression, and elevation are the first line used and may be all that is needed for a muscle strain. Short-term use of NSAIDs may be recommended for a strain or tear to reduce pain and inflammation. (Morelli K. M. et al., 2018) If the pain is profound or there is a tear, patients may require short-term immobilization or the use of a crutch for the pain to subside. With the assistance of a physical therapist, sports chiropractor, and athletic trainer, gradual increases in mobility and strength can be obtained. Symptoms usually gradually resolve over several weeks. Full recovery may take up to eight weeks, depending on the severity of the injury.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop customized treatment programs through an integrated approach to treating 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.

Control Foot Motion with Custom Orthotics

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

Olewnik, Ł., Zielinska, N., Karauda, P., Tubbs, R. S., & Polguj, M. (2020). A three-headed plantaris muscle: evidence that the plantaris is not a vestigial muscle? Surgical and radiologic anatomy: SRA, 42(10), 1189–1193. https://doi.org/10.1007/s00276-020-02478-8

Spang, C., Alfredson, H., Docking, S. I., Masci, L., & Andersson, G. (2016). The plantaris tendon: a narrative review focusing on anatomical features and clinical importance. The bone & joint journal, 98-B(10), 1312–1319. https://doi.org/10.1302/0301-620X.98B10.37939

Rohilla, S., Jain, N., & Yadav, R. (2013). Plantaris rupture: why is it important? BMJ case reports 2013, bcr2012007840. https://doi.org/10.1136/bcr-2012-007840

Morelli, K. M., Brown, L. B., & Warren, G. L. (2018). Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. The American journal of sports medicine, 46(1), 224–233. https://doi.org/10.1177/0363546517697957

Can athletic individuals with ACL injuries find relief through non-surgical treatments to restore knee mobility?

Introduction

The body’s lower extremities help the individuals to be mobile but also help stabilize the body’s upper weight. From the hips to the feet, many people are on their feet and using every muscle group to allow functionality. Athletic individuals use their lower extremities to do various physical activities and are susceptible to injuries. An ACL injury is one of the most common and feared injuries that can impact an athletic person’s performance. These types of injuries affect the knees of the individual and can make a person feel miserable. However, numerous surgical and non-surgical treatments can help the recovery process of an ACL injury while helping the individual restore their motion to their lower extremities. Today’s article looks at what an ACL injury is, how it affects the knees, and how non-surgical treatments can help restore knee mobility from ACL injuries. We discuss with certified associated medical providers who consolidate our patients’ information to assess ACL injuries affecting their mobility. We also inform and guide patients while asking their associated medical provider intricate questions to integrate and provide them with numerous non-surgical treatments to be incorporated into their personalized treatment plan. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

What Is An ACL Injury?

Do you feel aches or pains around your knees after a long exercise regime? Do you feel or hear a loud popping sensation in your knees? Or do you experience pain and swelling affecting your ability to be mobile? Many of these pain-like scenarios are correlated with ACL injuries, that is amongst the most common and feared injuries for athletic individuals and non-athletic individuals. However, we must look at the ACL itself to better understand ACL injuries. The ACL (anterior cruciate ligament) plays an important role as it helps with knee joint stabilization, prevents excessive forward movements from the tibia (shin bone), and limits rotational knee movements. (Yoo & Marappa-Ganeshan, 2024) This ligament is one of the most injured structures affecting athletic performance. ACL injuries and tears can lead to many individuals having knee instability and an increased risk of future knee osteoarthritis. (Atik, 2024) This is because ACL injuries typically occur during physical activities involving sudden stops, jumps, or directional impacts to the knees.

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*

What are the healing times of common sports injuries for athletes and individuals who engage in recreational sports activities?

Healing Times for Sports Injuries

Healing time from sports injuries depends on various factors, such as the location and extent of the injury and the health of the skin, joints, tendons, muscles, and bones. It is also important to take the time to recuperate or not rush back into physical sports activities before the bones or tissues have fully healed. To prevent re-injury, ensure the doctor clears health before returning to sports or strenuous physical activity.

According to CDC research, an average of 8.6 million sports and recreation-related injuries occur annually. (Sheu, Y., Chen, L. H., and Hedegaard, H. 2016) However, most sports injuries are superficial or caused by low-grade strains or sprains; at least 20% of injuries result from bone fractures or more serious injuries. Bone fractures take longer than sprains or strains, and complete tendon or muscle ruptures can take months before one can fully return to activities. Individuals in decent physical shape with no underlying illness or impairment, here is what they can expect when recovering from the following sports injuries:

Bone Fractures

In sports, the highest rate of bone fractures occurs with football and contact sports. Most are centered around the lower extremities but can involve the neck and shoulder blades, arms, and ribs.

Simple Fractures

• Depends on the individual's age, health, type, and location.
• Generally, takes at least six weeks to heal.

Compound Fractures

• In this case, a bone is broken in several places.
• It may require surgery to stabilize the bone.
• Healing time can take up to eight months.

Fractured Clavicle/Collarbone

• It may require the immobilization of the shoulder and upper arm.
• It can take five to ten weeks to heal fully.
• Fractured fingers or toes can heal in three to five weeks.

Fractured Ribs

• Part of the treatment plan includes breathing exercises.
• Painkillers may be needed short term.
• Usually, it takes around six weeks to heal.

Neck Fractures

• It may involve any one of the seven neck vertebrae.
• A neck brace or a halo device that is screwed into the skull for stability may be used.
• It can take up to six weeks to heal.

Sprains and Strains

According to the CDC report, sprains and strains account for 41.4% of all sports injuries. (Sheu, Y., Chen, L. H., and Hedegaard, H. 2016)

• A sprain is the stretching or tearing of ligaments or the tough bands of fibrous tissue that connect two bones at a joint.
• A strain is the overstretching or tearing of muscles or tendons.

Sprained Ankles

• It can heal in five days if there are no complications.
• Severe sprains involving torn or ruptured tendons can take three to six weeks to heal.

Calf Strains

• Classified as grade 1 - a mild strain can heal in two weeks.
• A grade 3 - severe strain may require three months or more to heal completely.
• The use of calf suppression sleeves can expedite the recovery of strains and sprains in the lower leg.

Acute Neck Strain

• A tackle, impact, fall, quick shifting, or whipping motion can cause a whiplash injury.
• Healing time can take a couple of weeks to six weeks.

Other Injuries

ACL Tears

• Involving the anterior cruciate ligament.
• Usually, it requires months of recuperation and rehabilitation, depending on several factors, including the type of sports activity.
• Full recovery from surgery takes six to 12 months.
• Without surgery, there is no specific timeline for rehabilitation.

Achilles Tendon Ruptures

• It is a serious injury.
• These occur when the tendon is either partially or completely torn.
• Individuals will more than likely require surgery.
• Recovery time is four to six months.

Cuts and Lacerations

• Depends on the depth and location of the injury.
• It can take anywhere from a week to a month to heal.
• If there are no accompanying injuries, stitches can be removed within two to three weeks.
• If a deep cut requires stitches, more time is necessary.

Mild Contusions/Bruises

• Are caused by a trauma to the skin, causing blood vessels to break.
• In most cases, a contusion will take five to seven days to heal.

Shoulder Separations

• When treated properly, it usually takes around two weeks of rest and recovery before the patient returns to activity.

Multidisciplinary Treatment

After the initial inflammation and swelling have subsided, a doctor will recommend a treatment plan that usually involves physical therapy, self-performed physical rehabilitation, or supervision by a physical therapist or team. Fortunately, athletes and individuals who regularly exercise tend to have a faster healing time because they are in top physical shape, and their cardiovascular system provides a stronger blood supply that speeds up the healing process. At El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately focus on treating patients' injuries and chronic pain syndromes. We focus on improving ability through flexibility, mobility, and agility programs tailored to the individual. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes.

Our providers use an integrated approach to create personalized care plans that include Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Our goal is to relieve pain naturally by restoring health and function to the body.

If the chiropractor feels the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with the top surgeons, clinical specialists, medical researchers, and premier rehabilitation providers to provide the top clinical treatments for our community. Providing highly noninvasive protocols is our priority, and our personalized patient-based clinical insight is what we provide.

Lumbar Spine Injuries in Sports: Chiropractic Healing

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

Sheu, Y., Chen, L. H., & Hedegaard, H. (2016). Sports- and Recreation-related Injury Episodes in the United States, 2011-2014. National Health Statistics Reports, (99), 1–12.

For athletes and sports enthusiasts, a torn triceps can be a serious injury. Can knowing their symptoms, causes, risk factors, and potential complications help healthcare providers develop an effective treatment plan?

Torn Triceps Injury

The triceps is the muscle on the back of the upper arm that allows the elbow to straighten. Fortunately, triceps tears are uncommon, but they can be serious. The injury affects men more often than women and usually occurs from trauma, sports, and/or exercise activities. Depending on the extent and severity of the injury, a torn triceps injury can require splinting, physical therapy, and possibly surgery to regain movement and strength. Recovery after a triceps tear typically lasts around six months. (The Ohio State University Wexner Medical Center. 2021)

Anatomy

The triceps brachii muscle, or triceps, runs along the back of the upper arm. It is named tri- because it has three heads - the long, medial, and lateral head. (Sendic G. 2023) The triceps originates at the shoulder and attaches to the shoulder blade/scapula and upper arm bone/humerus. At the bottom, it attaches to the point of the elbow. This is the bone on the pinky side of the forearm, known as the ulna. The triceps cause movement at the shoulder and the elbow joint. At the shoulder, it performs extension or backward movement of the arm and adduction or moving the arm toward the body. The main function of this muscle is at the elbow, where it performs extension or straightening of the elbow. The triceps work the opposite of the biceps muscle on the front of the upper arm, which conducts flexion or bending of the elbow.

Triceps Tear

Tears can occur anywhere along the length of a muscle or tendon, which is the structure that attaches the muscle to the bones. Triceps tears commonly occur in the tendon connecting the triceps to the back of the elbow. Muscle and tendon tears are graded from 1 to 3 based on severity. (Alberto Grassi et al., 2016)

Grade 1 Mild

• These small tears cause pain that worsens with movement.
• There is some swelling, bruising, and minimal loss of function.

Grade 2 Moderate

• These tears are larger and have moderate swelling and bruising.
• The fibers are partially torn and stretched.
• Up to 50% loss of function.

Grade 3 Severe

• This is the worst type of tear, where the muscle or tendon is completely torn.
• These injuries cause severe pain and disability.

Symptoms

Triceps tears cause immediate pain in the back of the elbow and upper arm that worsens when trying to move the elbow. Individuals might also feel and/or hear a popping or tearing sensation. There will be swelling, and the skin will likely be red and/or bruised. With a partial tear, the arm will feel weak. If there is a complete tear, there will be significant weakness when straightening the elbow. Individuals may also notice a lump on the back of their arm where the muscles have contracted and knotted together.

Causes

Triceps tears usually occur during trauma, when the muscle is contracted and an external force pushes the elbow into a bent position. (Kyle Casadei et al., 2020) One of the most common causes is by falling on an outstretched arm. Triceps tears also occur during sports activities like:

• Throwing a baseball
• Blocking in a football game
• Gymnastics
• Boxing
• When a player falls and lands on their arm.
• Tears can also happen when using heavy weights during triceps-targeted exercises, such as the bench press.
• Tears can also occur from direct trauma to the muscle, like a motor vehicle accident, but are less common.

Long-Term

Triceps tears can develop over time as a result of tendonitis. This condition usually occurs from repetitive use of the triceps muscle during activities like manual labor or exercise. Triceps tendonitis is sometimes referred to as weightlifter's elbow. (Orthopedic & Spine Center. N.D.) The strain on tendons causes tiny tears that the body typically heals. However, if more strain is placed on the tendon than it can keep up with, the small tears can begin to grow.

Risk Factors

Risk factors can increase the risk of a triceps tear. Underlying medical conditions can weaken tendons, increasing the risk of injury, and can include: (Tony Mangano et al., 2015)

• Diabetes
• Rheumatoid arthritis
• Hyperparathyroidism
• Lupus
• Xanthoma - fatty deposits of cholesterol under the skin.
• Hemangioendothelioma - cancerous or noncancerous tumors caused by abnormal growth of blood vessel cells.
• Chronic kidney failure
• Chronic tendonitis or bursitis in the elbow.
• Individuals who have had cortisone shots in the tendon.
• Individuals using anabolic steroids.

Triceps tears tend to occur more commonly in males between 30 and 50. (Ortho Bullets. 2022) This comes from participating in activities like football, weightlifting, bodybuilding, and manual labor, which also increases the risk of injury.

Treatment

Treatment depends on which part of the triceps is affected and the extent of the damage. It may only need resting for a few weeks, physical therapy, or require surgery.

Nonsurgical

Partial tears in the triceps that involve less than 50% of the tendon can often be treated without surgery. (Mehmet Demirhan, Ali Ersen 2016) Initial treatment includes:

• Splinting the elbow with a slight bend for four to six weeks allows the injured tissue to heal. (Ortho Bullets. 2022)
• During this time, ice can be applied to the area for 15 to 20 minutes several times daily to help decrease pain and swelling.
• Non-steroidal anti-inflammatory medications/NSAIDs - Aleve, Advil, and Bayer can help reduce inflammation.
• Other over-the-counter medications like Tylenol can help decrease the pain.
• Once the splint is removed, physical therapy will help restore movement and strength in the elbow.
• Full movement is expected to return within 12 weeks, but full strength will not return until six to nine months after the injury. (Mehmet Demirhan, Ali Ersen 2016)

Surgery

Triceps tendon tears that involve more than 50% of the tendon require surgery. In some cases, however, surgery may still be recommended for tears smaller than 50% if the individual has a physically demanding job or plans to resume playing sports at a high level. Tears in the muscle belly or area where the muscle and tendon join are typically sewn back together. If the tendon is no longer attached to the bone, it is screwed back on. Recovery and physical therapy after surgery depend on the specific surgeon's protocols. In general, individuals will spend a couple of weeks in a brace. Around four weeks after surgery, individuals will be able to start moving the elbow again. However, they won't be able to start doing heavy lifting for four to six months. (Ortho Bullets. 2022) (Mehmet Demirhan, Ali Ersen 2016)