Accidents and Injuries

Can physical therapies help relieve muscle contractures in individuals who have endured prolonged bed rest, inactivity, or lack of use of certain muscle groups?

Muscle Contracture

A muscle contracture, or contracture deformity, is caused when a muscle loses elasticity. This causes permanent shortening and tightening of muscle fibers, which reduces flexibility and makes movement difficult. Muscles that cannot move and stretch cause the surrounding joints to lose mobility and develop pain symptoms. When trying to stretch the contracted muscle, the individual will feel the muscle become very rigid, which can increase pain. (Lieber, R. L., and Fridén, J. 2019) Delaying treatment can potentially cause irreversible and chronic symptoms.

Commonly Affected Muscles

Flexor muscles bend the joints and are those most affected by contractures. The stiffening and tightening prevent the body parts from moving out and away. The most common include:

Wrist and Finger Flexors

• Muscle groups that bend the wrist and fingers.

Biceps

• The primary elbow flexor that bends the arm.

Gastrocnemius and Soleus

• The calf muscles which allow the ankle to point the foot/plantarflexion.

Hamstrings

• A group of three muscles behind the thigh that bend the knee.

Causes

The permanent shortening of muscle fibers and changes in muscle structure cause muscle contractures or stiffer-than-normal tissue that is difficult to stretch. Sarcomeres are structural units of muscles that cause fibers to contract.

With contractures, the sarcomeres overly lengthen when the muscle fibers tighten. This increase in sarcomere length prevents the muscle from contracting normally, resulting in weakness. Muscle fibers are encased in an extracellular matrix, a mesh composed of collagen and other proteins that help transmit force and provide muscle contraction. Muscle contractures cause the amount of collagen within the extracellular matrix to increase, causing a stiffening of fibers that restricts movement. (Lieber, R. L., and Fridén, J. 2019)

Muscle contractures also form from decreased satellite cells. Satellite cells are specialized stem cells that can rebuild muscle and are necessary for muscle regeneration and repair. Without the proper amount of satellite cells, other cells like fibroblasts significantly increase in the muscle tissue, causing the fibers to become stiff and fibrotic or more fibrous. These changes to the sarcomeres, collagen within the extracellular matrix, and decreased satellite cells all result from conditions in which neurological input to the brain and spinal cord muscles becomes reduced. This is caused by lack of use, injury, or neurological and neuromuscular conditions. (Lieber, R. L., and Fridén, J. 2019)

Cerebral Palsy

Contractures often occur from upper motor neuron lesions, which prevent signals from the brain and spinal cord from reaching the motor neurons that control muscle contraction. When these signals are weakened or blocked, muscles become stiff and weak from lack of stimulation. (Lieber, R. L., and Fridén, J. 2019)

Cerebral palsy is a group of disorders affecting mobility caused by an upper motor neuron lesion that is present at birth and is the most common motor disability in children. It causes:

• Cognitive impairment
• Decreased muscle strength
• Problems with movement, coordination, and functional motions.

Because cerebral palsy prevents the muscles of the legs from being sufficiently stimulated, contractures commonly develop in the hips, knees, and ankles.  Individuals can have a 75% decrease in satellite cells to repair muscle tissue and prevent muscle fibrosis or stiffening. Specific genes linked to collagen production are also altered, causing irregular changes to the extracellular matrix of muscles. (Lieber, R. L., and Fridén, J. 2019)

Muscular Dystrophy

Muscular dystrophy is a group of inherited neuromuscular disorders characterized by muscle weakness and wasting. Deficient nerve supply to muscles causes them to become stiff and tight, inhibiting the functional range of motion needed to move joints and activate muscles to move. Clinical research suggests that individuals with muscular dystrophy have decreased levels of satellite cells to repair, increasing the risk of developing muscle contracture. (Lieber, R. L., and Fridén, J. 2019)

Disuse-induced Muscle Wasting or Disuse Atrophy

When muscles are not used for some time because of hospitalization, prolonged bed rest, or immobilization from wearing braces, splints, or casts after injuries, the blood circulation and electrical signaling from nerves to muscles decreases. This results in weakness, increased muscle tightness and stiffness, and muscle wasting/atrophy. Over time, stiff and tight muscles can progress to contractures that become extremely difficult to stretch.

Trauma or Injury

Muscle or tendon injuries can cause contractures as scar tissue develops, joining muscle fibers and joints together. This can significantly restrict movement. Large burns can also cause skin, muscles, and joint contractures. The range of motion can become significantly limited, and the changes can become irreversible if not aggressively treated.

Other Causes

Other forms of upper motor neuron lesions that can cause contractures because of weak or blocked electrical input to muscles as a result of brain or spinal cord damage include:

• Stroke
• Traumatic brain injuries
• Spinal cord injuries (Lieber, R. L., and Fridén, J. 2019)
• Neuromuscular disorders like spinal muscular atrophy - SMA.
• Conditions that cause inflammation and joint stiffening, like juvenile rheumatoid arthritis.
• A history of diabetes also increases the risk of developing contractures affecting finger flexors, like Dupuytren’s contractures and stenosing tenosynovitis
  or trigger finger. (Lieber, R. L., and Fridén, J. 2019)

Symptoms

Symptoms include:

• Extremely stiff and tight muscles resistant to stretching.
• Pain from the inability to stretch.
• Loss of range of motion.
• Impaired joint mobility.
• Severe contractures can interfere with the functional range of motion needed to move joints to complete normal tasks and movements, such as standing up from a chair and walking.

Treatment

Physical Therapy

• Physical therapies can help reduce the severity through stretching and soft tissue mobilization to decrease tightness. (Lieber, R. L., and Fridén, J. 2019)

Exercise

Regular exercise can:

• Reduce joint stiffening and muscle tightening.
• Help maintain joint mobility and range of motion.
• Improve blood circulation and muscle activation. (Lieber, R. L., and Fridén, J. 2019)

Braces and Splints

• Specialized braces or splints can be custom-made to fit different body parts.
• These provide a prolonged low-intensity stretch over a period of time to increase muscle length.
• Once the muscle has stretched, a new brace or splint may be needed to adjust to the increased range of motion. (Lieber, R. L., and Fridén, J. 2019)

Surgery

In severe cases where muscle contractures limit the functional range of motion needed for activities of daily living or ADLs, surgical release of the contracted tissue may be recommended. This surgery can improve functional movements like walking, getting in and out of bed, and standing up from chairs. The tight muscles can be surgically cut, and the tendons can be lengthened to allow more mobility. (Lieber, R. L., and Fridén, J. 2019)

The causes of muscle contracture are not always avoidable, but various treatment options are available to help loosen up tight muscles and preserve or restore the range of motion. It’s important to move daily and stretch common areas like the fingers, arms, and legs to reduce the risk of muscle tightness and prevent contractures from developing. It is imperative to seek medical treatment for severe contractures resulting from neuromuscular disorders, including physical and occupational therapy, to prevent contractures from worsening and regaining as much functional range as possible.

Injury Medical Chiropractic and Functional Medicine Clinic uses an integrated approach personalized to the individual that focuses on what works for them and treats injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers use an integrated approach to create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Our goal is to relieve pain naturally by restoring health and function to the body. If another treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Chiropractic Treatment for Cerebral Palsy

General Disclaimer *

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

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

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

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Lieber, R. L., & Fridén, J. (2019). Muscle contracture and passive mechanics in cerebral palsy. Journal of applied physiology (Bethesda, Md. : 1985), 126(5), 1492–1501. https://doi.org/10.1152/japplphysiol.00278.2018

Can knowing treatment options for a dislocated hip help individuals expedite rehabilitation and recovery?

Dislocated Hip

A dislocated hip is an uncommon injury but can happen due to trauma or following hip replacement surgery. It usually occurs after severe trauma, including motor vehicle collisions, falls, and sometimes sports injuries. (Caylyne Arnold et al., 2017) A dislocated hip can also occur after hip replacement surgery. Other injuries like ligament tears, cartilage damage, and bone fractures can occur alongside the dislocation. Most hip dislocations are treated with a joint reduction procedure that resets the ball into the socket. It is usually done with sedation or general anesthesia. Rehabilitation takes time and could be a few months before full recovery. Physical therapy can help restore motion and strength in the hip.

What Is It?

If the hip is only partially dislocated, it's called a hip subluxation. When this happens, the hip joint head only partially emerges from the socket. A dislocated hip is when the head or ball of the joint shifts or pops out of the socket. Because an artificial hip differs from a normal hip joint, the risk of dislocation increases after joint replacement. A study found that around 2% of individuals who undergo total hip replacement will experience hip dislocation within a year, with the cumulative risk increasing by approximately 1% over five years. (Jens Dargel et al., 2014) However, new technological prosthetics and surgical techniques are making this less common.

Hip Anatomy

• The hip ball-and-socket joint is called the femoroacetabular joint.
• The socket is called the acetabulum.
• The ball is called the femoral head.

The bony anatomy and strong ligaments, muscles, and tendons help to create a stable joint. Significant force must be applied to the joint for a hip dislocation to occur. Some individuals report feeling a snapping sensation of the hip. This usually is not a hip dislocation but indicates a different disorder known as snapping hip syndrome. (Paul Walker et al., 2021)

Posterior Hip Dislocation

• Around 90% of hip dislocations are posterior.
• In this type, the ball is pushed backward from the socket.
• Posterior dislocations can result in injuries or irritation to the sciatic nerve. (R Cornwall, T E Radomisli 2000)

Anterior Hip Dislocation

• Anterior dislocations are less common.
• In this type of injury, the ball is pushed out of the socket.

Hip Subluxation

• A hip subluxation occurs when the hip joint ball starts to come out of the socket partially.
• Also known as a partial dislocation, it can turn into a fully dislocated hip joint if not allowed to heal properly.

Symptoms

Symptoms can include:

• The leg is in an abnormal position.
• Difficulty moving.
• Severe hip pain.
• Inability to bear weight.
• Mechanical lower back pain can create confusion when making a proper diagnosis.
• With a posterior dislocation, the knee and foot will be rotated towards the body's midline.
• An anterior dislocation will rotate the knee and foot away from the midline. (American Academy of Orthopaedic Surgeons. 2021)

Causes

A dislocation can cause damage to the structures that hold the ball in the socket and can include:

• Cartilage damage to the joint - 
• Tears in the labrum and ligaments.
• Fractures of the bone at the joint.
• Injury to the vessels that supply blood can later lead to avascular necrosis or osteonecrosis of the hip. (Patrick Kellam, Robert F. Ostrum 2016)
• A hip dislocation increases the risk of developing joint arthritis following the injury and can raise the risk of needing a hip replacement later in life. (Hsuan-Hsiao Ma et al., 2020)

Developmental Dislocation of the Hip

• Some children are born with developmental dislocation of the hip or DDH.
• Children with DDH have hip joints that did not form correctly during development.
• This causes a loose fit in the socket.
• In some cases, the hip joint is completely dislocated.
• In others, it's prone to becoming dislocated.
• In milder cases, the joint is loose but not prone to becoming dislocated. (American Academy of Orthopaedic Surgeons. 2022)

Treatment

Joint reduction is the most common way to treat a dislocated hip. The procedure repositions the ball back into the socket and is usually done with sedation or under general anesthesia. Repositioning a hip requires significant force.  A hip dislocation is considered an emergency, and reduction should be performed immediately after the dislocation to prevent permanent complications and invasive treatment. (Caylyne Arnold et al., 2017)

• Once the ball is back in the socket, the healthcare provider will look for bone, cartilage, and ligament injuries.
• Depending on what the healthcare provider finds, further treatment may be necessary.
• Fractured or broken bones may need to be repaired to keep the ball within the socket.
• Damaged cartilage may have to be removed.

Surgery

Surgery could be necessary to return the joint to its normal position. Hip arthroscopy can minimize the invasiveness of certain procedures. A surgeon inserts a microscopic camera into the hip joint to help the surgeon repair the injury using instruments inserted through other small incisions.

Hip replacement surgery replaces the ball and socket, a common and successful orthopedic surgical procedure. This surgery may be performed for various reasons, including trauma or arthritis, as it is common to develop early arthritis of the hip after this type of trauma. This is why many who have a dislocation ultimately need hip replacement surgery. As a major surgical procedure, it is not without risks. Possible complications include:

• Infection
• Aseptic loosening (the loosening of the joint without infection)
• Hip dislocation

Recovery

Recovering from a hip dislocation is a long process. Individuals will need to walk with crutches or other devices early in recovery. Physical therapy will improve the range of motion and strengthen the muscles around the hip. Recovery time will depend on whether other injuries, such as fractures or tears, are present. If the hip joint was reduced and there were no other injuries, it may take six to ten weeks to recover to the point where weight can be placed on the leg. It could be between two and three months for a full recovery. Keeping weight off the leg is important until the surgeon or physical therapist gives the all-clear. Injury Medical Chiropractic and Functional Medicine Clinic will work with an individual's primary healthcare provider and other surgeons or specialists to develop an optimal personalized treatment plan.

Chiropractic Solutions for Osteoarthritis

General Disclaimer *

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

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

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

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Arnold, C., Fayos, Z., Bruner, D., Arnold, D., Gupta, N., & Nusbaum, J. (2017). Managing dislocations of the hip, knee, and ankle in the emergency department [digest]. Emergency medicine practice, 19(12 Suppl Points & Pearls), 1–2.

Dargel, J., Oppermann, J., Brüggemann, G. P., & Eysel, P. (2014). Dislocation following total hip replacement. Deutsches Arzteblatt international, 111(51-52), 884–890. https://doi.org/10.3238/arztebl.2014.0884

Walker, P., Ellis, E., Scofield, J., Kongchum, T., Sherman, W. F., & Kaye, A. D. (2021). Snapping Hip Syndrome: A Comprehensive Update. Orthopedic reviews, 13(2), 25088. https://doi.org/10.52965/001c.25088

Cornwall, R., & Radomisli, T. E. (2000). Nerve injury in traumatic dislocation of the hip. Clinical orthopaedics and related research, (377), 84–91. https://doi.org/10.1097/00003086-200008000-00012

American Academy of Orthopaedic Surgeons. (2021). Hip dislocation. https://orthoinfo.aaos.org/en/diseases--conditions/hip-dislocation

Kellam, P., & Ostrum, R. F. (2016). Systematic Review and Meta-Analysis of Avascular Necrosis and Posttraumatic Arthritis After Traumatic Hip Dislocation. Journal of orthopaedic trauma, 30(1), 10–16. https://doi.org/10.1097/BOT.0000000000000419

Ma, H. H., Huang, C. C., Pai, F. Y., Chang, M. C., Chen, W. M., & Huang, T. F. (2020). Long-term results in the patients with traumatic hip fracture-dislocation: Important prognostic factors. Journal of the Chinese Medical Association : JCMA, 83(7), 686–689. https://doi.org/10.1097/JCMA.0000000000000366

American Academy of Orthopaedic Surgeons. (2022). Developmental dislocation (dysplasia) of the hip (DDH). https://orthoinfo.aaos.org/en/diseases--conditions/developmental-dislocation-dysplasia-of-the-hip-ddh/

Can physical therapy with instrument-assisted soft tissue mobilization or IASTM improve mobility, flexibility, and health for individuals with musculoskeletal injuries or illnesses?

Instrument Assisted Soft Tissue Mobilization

Instrument-assisted soft tissue mobilization or IASTM is also known as the Graston technique. It is a myofascial release and massage technique used in physical therapy where the therapist uses metal or plastic tools to improve soft tissue mobility in the body. The ergonomically shaped tool is gently or vigorously scraped and rubbed across the injured or painful area. The rubbing is used to locate and release tightness in the fascia/collagen covering the muscles and the tendons. This helps reduce pain and improve movement.

Massage and Myofascial Release

Instrument-assisted soft tissue mobilization rehabilitation helps:

• Improve soft tissue mobility.
• Release of restrictions in tight fascia.
• Decrease muscle spasms.
• Improve flexibility.
• Increased circulation to the tissues.
• Relieve pain. (Fahimeh Kamali et al., 2014)

Individuals often develop tissue tightness or restrictions in the muscles and fascia after an injury. These soft tissue restrictions can limit the range of motion - ROM and can trigger pain symptoms. (Kim J, Sung DJ, Lee J. 2017)

History

The Graston technique of instrument-assisted soft tissue mobilization was developed by an athlete who created their instruments to treat soft tissue injuries. The practice has grown with input from medical experts, trainers, researchers, and clinicians.

• Physical therapists use different types of tools to perform IASTM.
• These massage instruments comprise various types for specific massage and release.
• The Graston company designs some of the tools.
• Other companies have their version of metal or plastic scraping and rubbing tools.
• The objective is to help release soft tissue and myofascial restrictions to improve body movement. (Kim J, Sung DJ, Lee J. 2017)

How It Works

• The theory is that scraping the tissues causes microtrauma to the affected area, activating the body's natural inflammatory response. (Kim J, Sung DJ, Lee J. 2017)
• The body activates to reabsorb the tightened or scar tissue, causing the restriction.
• The therapist can then stretch the adhesions to alleviate pain and improve mobility.

Treatment

Certain conditions respond well to instrument-assisted soft tissue mobilization, including (Kim J, Sung DJ, Lee J. 2017)

• Limited mobility
• Decreased muscle recruitment
• Loss of range of motion - ROM
• Pain with movement
• Excessive scar tissue formation

Augmented soft tissue mobilization or ASTM techniques can treat certain injuries and medical conditions that include:

• Musculoskeletal imbalance/s
• Ligament sprains
• Plantar fasciitis
• Myofascial pain
• Tendonitis and tendinopathy
• Scar tissue from surgery or trauma (Morad Chughtai et al., 2019)

Benefits and Side Effects

Benefits include: (Kim J, Sung DJ, Lee J. 2017)

• Improved range of motion
• Increased tissue flexibility
• Improved cell activity at the site of injury
• Reduced pain
• Reduced scar tissue formation

Side effects may include:

• Redness of the skin at the treatment site
• Bruising(Kim J, Sung DJ, Lee J. 2017)
• Worsening of the pain

Research

• A review compared hands-on myofascial release to instrument myofascial release for chronic low back pain. (Williams M. 2017)
• Little difference was found between the two techniques for pain relief.
• Another review compared IASTM to other methods for treating pain and function loss. (Matthew Lambert et al., 2017)
• The researchers concluded that IASTM could positively affect blood circulation and tissue flexibility and reduce pain.
• Another study examined the use of IASTM, pseudo-fake ultrasound therapy, and spinal manipulation for patients with thoracic/upper back pain. (Amy L. Crothers et al., 2016)
• All groups improved over time with no significant negative events.
• The researchers concluded that instrument-assisted soft tissue mobilization is no more or less effective than spinal manipulation or pseudo-ultrasound therapy for thoracic back pain.

Every case is different, and musculoskeletal conditions respond differently to various treatments. For any questions or concerns, contact your primary healthcare provider to determine if IASTM is an appropriate treatment that can help.

From Injury To 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 studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

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

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

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Kamali, F., Panahi, F., Ebrahimi, S., & Abbasi, L. (2014). Comparison between massage and routine physical therapy in women with sub acute and chronic nonspecific low back pain. Journal of back and musculoskeletal rehabilitation, 27(4), 475–480. https://doi.org/10.3233/BMR-140468

Kim, J., Sung, D. J., & Lee, J. (2017). Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application. Journal of exercise rehabilitation, 13(1), 12–22. https://doi.org/10.12965/jer.1732824.412

Chughtai, M., Newman, J. M., Sultan, A. A., Samuel, L. T., Rabin, J., Khlopas, A., Bhave, A., & Mont, M. A. (2019). Astym® therapy: a systematic review. Annals of translational medicine, 7(4), 70. https://doi.org/10.21037/atm.2018.11.49

Williams M. (2017). Comparing pain and disability outcomes of instrumental versus hands-on myofascial release in individuals with chronic low back pain: a meta-analysis. Doctoral dissertation, California State University, Fresno. https://repository.library.fresnostate.edu/bitstream/handle/10211.3/192491/Williams_csu_6050D_10390.pdf?sequence=1

Matthew Lambert, Rebecca Hitchcock, Kelly Lavallee, Eric Hayford, Russ Morazzini, Amber Wallace, Dakota Conroy & Josh Cleland (2017) The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review, Physical Therapy Reviews, 22:1-2, 76-85, DOI: 10.1080/10833196.2017.1304184

Crothers, A. L., French, S. D., Hebert, J. J., & Walker, B. F. (2016). Spinal manipulative therapy, Graston technique® and placebo for non-specific thoracic spine pain: a randomised controlled trial. Chiropractic & manual therapies, 24, 16. https://doi.org/10.1186/s12998-016-0096-9

Individuals may not realize they have a cracked rib until symptoms like pain when taking in a deep breath begin to present. Can knowing the symptoms and causes of cracked or broken ribs help in diagnosis and treatment?

Cracked Rib

A broken/fractured rib describes any break in the bone. A cracked rib is a type of rib fracture and is more a description than a medical diagnosis of a rib that has been partially fractured. Any blunt impact to the chest or back can cause a cracked rib, including:

• Falling
• Vehicle collision
• Sports injury
• Violent coughing

1. The main symptom is pain when inhaling.
2. The injury typically heals within six weeks.

Symptoms

Cracked ribs are usually caused by a fall, trauma to the chest, or intense violent coughing. Symptoms include:

• Swelling or tenderness around the injured area.
• Chest pain when breathing/inhaling, sneezing, laughing, or coughing. 
• Chest pain with movement or when lying down in certain positions.
• Possible bruising.
• Although rare, a cracked rib can cause complications like pneumonia.
• See a healthcare provider immediately if experiencing difficulty breathing, severe chest pain, or a persistent cough with mucus, high fever, and/or chills.

Types

In most cases, a rib usually gets broken in one area, causing an incomplete fracture, which means a crack or break that does not go through the bone. Other types of rib fractures include:

Displaced and Nondisplaced Fractures

• Completely broken ribs may or may not shift out of place.
• If the rib does move, this is known as a displaced rib fracture and is more likely to puncture lungs or damage other tissues and organs. (Yale Medicine. 2024)
• A rib that stays in place usually means the rib is not completely broken in half and is known as a nondisplaced rib fracture.

Flail Chest

• A section of the ribcage can break away from the surrounding bone and muscle, although this is rare.
• If this happens, the ribcage will lose stability, and the bone will move freely as the individual inhales or exhales.
• This broken ribcage section is called a flail segment.
• This is dangerous as it can puncture the lungs and cause other serious complications, like pneumonia.

Causes

Common causes of cracked ribs include:

• Vehicle collisions
• Pedestrian accidents
• Falls
• Impact injuries from sports
• Overuse/Repetitive stress brought on by work or sports
• Severe coughing
• Older individuals can experience a fracture from a minor injury due to the progressive loss of bone minerals. (Christian Liebsch et al., 2019)

The Commonality of Rib Fractures

• Rib fractures are the most common type of bone fracture.
• They account for 10% to 20% of all blunt trauma injuries seen in emergency rooms.
• In cases where an individual seeks care for a blunt injury to the chest, 60% to 80% involve a broken rib. (Christian Liebsch et al., 2019)

Diagnosis

A cracked rib is diagnosed with a physical exam and imaging tests. During the examination, a healthcare provider will listen to the lungs, press gently on the ribs, and watch as the rib cage moves. The imaging test options include: (Sarah Majercik, Fredric M. Pieracci 2017)

• X-rays - These are for detecting recently cracked or broken ribs.
• CT Scan - This imaging test comprises multiple X-rays and can detect smaller cracks.
• MRI - This imaging test is for soft tissues and can often detect smaller breaks or cartilage damage.
• Bone Scan - This imaging test uses a radioactive tracer to visualize the structure of bones and can show smaller stress fractures.

Treatment

In the past, treatment used to involve wrapping the chest with a band known as a rib belt. These are rarely used today as they can restrict breathing, increasing the risk of pneumonia or even a partial lung collapse. (L. May, C. Hillermann, S. Patil 2016). A cracked rib is a simple fracture that requires the following:

• Rest
• Over-the-counter or prescription medications can help manage pain symptoms.
• Nonsteroidal anti-inflammatory drugs - NSAIDs like ibuprofen or naproxen are recommended.
• If the break is extensive, individuals may be prescribed stronger pain medication depending on the severity and underlying conditions.
• Physical therapy can expedite the healing process and help maintain the range of motion of the chest wall.
• For patients who are frail and elderly individuals, physical therapy can help the patient walk and normalize certain functions.
• A physical therapist can train the individual to transfer between bed and chairs safely while maintaining awareness of any movements or positioning that make the pain worse.
• A physical therapist will prescribe exercises to keep the body as strong and limber as possible.
• For example, lateral twists can help improve the range of motion in the thoracic spine.

1. During the early stages of recovery, it is recommended to sleep in an upright position.
2. Lying down can add pressure, causing pain and possibly worsen the injury.
3. Use pillows and bolsters to help support sitting up in bed.
4. An alternative is to sleep in a reclining chair.
5. Healing takes at least six weeks. (L. May, C. Hillermann, S. Patil 2016)

Other Conditions

What may feel like a cracked rib may be a similar condition, which is why it's important to get checked out. Other possible symptom causes can include:

• Bruised ribs - This occurs when the ribs are not cracked, but the smaller blood vessels around the region burst and leak into surrounding tissues. (Sarah Majercik, Fredric M. Pieracci 2017)
• Popped ribs - This is when the rib cartilage tears and breaks, causing it to slip out of position. (Sarah Majercik, Fredric M. Pieracci 2017)
• Pulled muscle - A muscle strain, or pulled muscle, occurs when the muscle gets overstretched, which can lead to a tear. The ribs are not affected, but it can feel like they are. (Sarah Majercik, Fredric M. Pieracci 2017)

Emergency

The most common complication is being unable to take a deep breath because of the pain. When the lungs cannot breathe deeply enough, mucous and moisture can build up and lead to an infection like pneumonia. (L. May, C. Hillermann, S. Patil 2016). Displaced rib fractures can also damage other tissues or organs, increasing the risk of a collapsed lung/pneumothorax or internal bleeding. It is recommended to seek immediate medical attention if symptoms develop like:

• Shortness of breath
• Difficulty breathing
• A bluish color of the skin caused by lack of oxygen
• A persistent cough with mucus
• Chest pain when breathing in and out
• Fever, sweating, and chills
• Rapid heart rate

The Power of Chiropractic Care In 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 discuss the subject matter above further, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

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

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Yale Medicine. (2024). Rib fracture (broken rib).

Liebsch, C., Seiffert, T., Vlcek, M., Beer, M., Huber-Lang, M., & Wilke, H. J. (2019). Patterns of serial rib fractures after blunt chest trauma: An analysis of 380 cases. PloS one, 14(12), e0224105. https://doi.org/10.1371/journal.pone.0224105

May L, Hillermann C, Patil S. (2016). Rib fracture management. BJA Education. Volume 16, Issue 1. Pages 26-32, ISSN 2058-5349. doi:10.1093/bjaceaccp/mkv011

Majercik, S., & Pieracci, F. M. (2017). Chest Wall Trauma. Thoracic surgery clinics, 27(2), 113–121. https://doi.org/10.1016/j.thorsurg.2017.01.004

When a groin strain injury happens, can knowing the symptoms help in the diagnosis, treatment, and recovery times?

Groin Strain Injury

A groin strain is an injury to an inner thigh muscle. A groin pull is a type of muscle strain affecting the adductor muscle group (the muscles help pull the legs apart). (Parisa Sedaghati, et al., 2013) The injury is caused when the muscle is stretched beyond its normal range of motion, creating superficial tears. Severe strains can tear the muscle in two. (Parisa Sedaghati, et al., 2013)

• A groin muscle pull causes pain and tenderness that worsens when squeezing the legs together.
• There may also be swelling or bruising in the groin or inner thigh.
• An uncomplicated groin pull takes four to six weeks to heal with proper treatment. (Andreas Serner, et al., 2020)

Symptoms

A groin pull can be painful, interfering with walking, navigating stairs, and/or driving a car. In addition to pain, other symptoms around the injured area include: (Parisa Sedaghati et al., 2013)

• A popping sound or snapping sensation when the injury occurs.
• Increased pain when pulling the legs together.
• Redness
• Swelling
• Bruising of the groin or inner thigh.

Groin pulls are graded by severity and how much they impact mobility:

Grade 1

• Mild discomfort but not enough to limit activities.

Grade 2

• Moderate discomfort with swelling or bruising that limits running and/or jumping.

Grade 3

• Severe injury with significant swelling and bruising can cause pain while walking and muscle spasms.

Signs of a severe groin strain

• Difficulty walking
• Groin pain while sitting or resting
• Groin pain at night
• A healthcare provider should see severe groin pulls because the muscle may have ruptured or be on the verge of rupturing.
• In severe cases, surgery is necessary to reattach the torn ends.

Groin pulls are sometimes accompanied by a stress fracture of the pubis/forward-facing pelvic bones, which can significantly extend healing and recovery time. (Parisa Sedaghati et al., 2013)

Causes

Groin pulls are often experienced by athletes and individuals who play sports where they must stop and change directions quickly, placing excessive strain on the adductor muscles. (Parisa Sedaghati et al., 2013) The risk is increased in individuals who: (T. Sean Lynch et al., 2017)

• Have weak hip abductor muscles.
• Are not in adequate physical condition.
• Have a previous groin or hip injury.
• Pulls can also occur from falls or extreme activities without the proper conditioning.

Diagnosis

A healthcare provider will perform a thorough investigation to confirm the diagnosis and characterize the severity. This involves: (Juan C. Suarez et al., 2013)

Medical History Review 

• This includes any previous injuries and specifics about where and when the symptoms started.

Physical Examination

• This involves palpating - lightly touching and pressing the groin region and manipulating the leg to understand better where and how extensive the injury is.

Imaging Studies

• Ultrasound or X-rays.
• If a muscle rupture or fracture is suspected, an MRI scan may be ordered to visualize soft tissue injuries and stress fractures better.

Differential Diagnosis

Certain conditions can mimic a groin pull and require different treatments. These include: (Juan C. Suarez, et al., 2013)

Sports Hernia

• This type of inguinal hernia occurs with sports and work injuries.
• It causes a portion of the intestine to pop through a weakened muscle in the groin.

Hip Labral Tear

• This is a tear in the cartilage ring of the labrum outside the rim of the hip joint socket.

Hip Osteoarthritis 

• This is the wear-and-tear form of arthritis that can present with groin pain symptoms.

Osteitis Pubis

• This is inflammation of the pubic joint and surrounding structures, usually caused by the overuse of the hip and leg muscles.

Referred Groin Pain

• This nerve pain originates in the lower back, often due to a pinched nerve, but is felt in the groin.

Treatment

Beginning treatment is conservative and includes rest, ice application, physical therapy, and prescribed gentle stretching and exercises.

• Individuals may need crutches or a walking device to reduce pain and prevent further injury if the pain is significant. (Andreas Serner, et al., 2020)
• Physical therapy will be a part of the treatment plan.
• Over-the-counter pain medications like Tylenol/acetaminophen or Advil/ibuprofen can help with pain relief short term.
• If there is severe pain from a grade 3 injury, prescription medications may be used for a short period to help minimize pain. (Andreas Serner, et al., 2020)
• Surgery is not usually necessary. (Andreas Serner, et al., 2020)

Recovery

Recovery times can vary based on the injury's severity and physical condition before the injury.

• Most injuries will heal within four to six weeks with rest and proper treatment.
• Severe groin strains can take up to 12 weeks or longer if surgery is involved. (Andreas Serner, et al., 2020)

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

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

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Sedaghati, P., Alizadeh, M. H., Shirzad, E., & Ardjmand, A. (2013). Review of sport-induced groin injuries. Trauma monthly, 18(3), 107–112. https://doi.org/10.5812/traumamon.12666

Serner, A., Weir, A., Tol, J. L., Thorborg, K., Lanzinger, S., Otten, R., & Hölmich, P. (2020). Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthopaedic journal of sports medicine, 8(1), 2325967119897247. https://doi.org/10.1177/2325967119897247

Lynch, T. S., Bedi, A., & Larson, C. M. (2017). Athletic Hip Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 25(4), 269–279. https://doi.org/10.5435/JAAOS-D-16-00171

Suarez, J. C., Ely, E. E., Mutnal, A. B., Figueroa, N. M., Klika, A. K., Patel, P. D., & Barsoum, W. K. (2013). Comprehensive approach to the evaluation of groin pain. The Journal of the American Academy of Orthopaedic Surgeons, 21(9), 558–570. https://doi.org/10.5435/JAAOS-21-09-558

When individuals experience a neuromusculoskeletal injury strain, can following basic pulled muscle treatment protocols help in healing and a full recovery?

Pulled Muscle Treatment

A pulled muscle or muscle strain occurs when a muscle is stretched beyond its ability resulting in discomfort symptoms and mobility issues. Microscopic tears can occur within the muscle fibers potentially worsening the injury. This type of injury usually causes mild to severe pain, bruising, and immobility, and nerve injuries can develop as well. Common muscle strains include:

• Pulled hamstrings
• Groin strains
• Pulled abdominal muscles
• Calf strains

Pulled muscle treatment requires patience to promote proper healing and restoration of optimal function.

• Individuals need to focus on the different stages of healing.
• Gradually increase activity levels as the body allows to prevent stiffness and atrophy which can cause complications.

Symptoms

The usual symptoms of this type of injury include:

• Pain
• Limited mobility
• Muscle spasms 
• Swelling
• Bruising
• Often individuals will feel a sudden grabbing or tearing sensation and are then unable to continue the activity.

Grading

Muscle strain injuries are graded by severity: (Hospital for Special Surgery. 2019)

Grade I

• Mild discomfort.
• Often there is no disability.
• Usually does not limit activity.

Grade II

• Moderate discomfort
• Can limit the ability to perform certain activities.
• May have moderate swelling and bruising.

Grade III

• Severe injury that can cause significant pain.
• Muscle spasms.
• Swelling.
• Significant bruising.

Basic Treatment Protocols

Most pulled muscle strain injuries heal with simple treatment. Following the right steps can ensure an expedited recovery. In the early stages after the injury, there is a balance between doing too much or not enough. The amount of activity an individual will be able to do, and the time required for recovery depends on the severity of the injury. Here are some guidelines in the right direction.

Rest

• Rest is recommended for the early recovery stage.
• Depending on the severity of the injury this could last from one to five days.
• Immobilization is usually not necessary, and not moving at all can lead to muscle and joint stiffness.
• This can be harmful and interfere with mobility. (Joel M. Kary. 2010)
• If immobilization is necessary, like using a splint or cast, careful supervision should be monitored by a healthcare provider.

Cold Therapy

• Cold therapy should begin as soon as possible after sustaining a pulled muscle.
• The therapy/ice helps reduce swelling, bleeding, and pain. (Gerard A Malanga, Ning Yan, Jill Stark. 2015)
• Cold therapy applications can be done frequently, but should not exceed 15 minutes at a time.

Stretching

• Stretching is important to relax the muscles and for pre-mobilization.
• Muscles that maintain flexibility help prevent further injury.

Strengthening

• The injury and the rest period can decrease the strength of the muscle.
• It is important to rebuild strength before returning to physical activities.
• Strengthened muscles help prevent re-injury.

Increased Activity to Prevent Muscle Fatigue

• Fatigued muscles are more likely to sustain injuries. (S. D. Mair, A. V. Seaber, R. R. Glisson, W. E. Garrett Jr. 1996)
• To avoid injuries make sure the muscles are not over-exerted.
• Gradually increase activity levels when starting an exercise program to build endurance.

Properly Warming Up

• Warming up before taking on physical activities will help loosen the muscles and prevent injuries.
• Beginning work or exercise with stiff muscles can lead to an increased chance of strain.
• Studies have shown that temperature can influence the stiffness of a muscle. (K. W. Ranatunga. 2018)
• Maintaining body and muscle warmth helps prevent injury and re-injury.

Injuries and Chiropractic: The Road To 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

Hospital for Special Surgery, Muscle Strain: What You Need to Know About Pulled Muscles.

Kary J. M. (2010). Diagnosis and management of quadriceps strains and contusions. Current reviews in musculoskeletal medicine, 3(1-4), 26–31. https://doi.org/10.1007/s12178-010-9064-5

Malanga, G. A., Yan, N., & Stark, J. (2015). Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate medicine, 127(1), 57–65. https://doi.org/10.1080/00325481.2015.992719

Mair, S. D., Seaber, A. V., Glisson, R. R., & Garrett, W. E., Jr (1996). The role of fatigue in susceptibility to acute muscle strain injury. The American journal of sports medicine, 24(2), 137–143. https://doi.org/10.1177/036354659602400203

Ranatunga K. W. (2018). Temperature Effects on Force and Actin⁻Myosin Interaction in Muscle: A Look Back on Some Experimental Findings. International journal of molecular sciences, 19(5), 1538. https://doi.org/10.3390/ijms19051538

Can chiropractic treatment protocols diagnose what's causing head pressure in individuals, and provide effective treatment?

Head Pressure

Head pressure can have various causes and symptoms that affect different areas depending on whether the cause is a headache, allergies, injury, illness, or disease. The location of the pressure or pain can help a doctor of chiropractic determine the cause.

• The underlying factor is usually not life-threatening, but the pressure that has built can be the result of serious conditions like a head injury or brain tumor.
• Chiropractic ​care, which includes a combination of spinal manipulation, active and passive exercises, and massage, is often used for headache management and prevention. (Moore Craig, et al., 2018)
• Chiropractic therapy is often sought out for tension and cervicogenic headaches, migraines, and each responds differently to the treatment.

The Head

• The head is made up of a complex system of lobes, sinuses/channels, blood vessels, nerves, and ventricles. (Thau L, et al., 2022)
• The pressure of these systems is regulated and any disruption to this balance can be noticeable.
• Diagnosis can be difficult to figure out what is causing discomfort or head pressure.
• Pain, pressure, irritability, and nausea are all symptoms that can occur with headaches. (Rizzoli P, Mullally W. 2017)

Location

• Head pressure in more than one spot is possible with a migraine or a severe cold. (American Migraine Foundation 2023)
• Pain can present in more than one area if there has been a head injury.
• If the pressure is more specific in a certain region, it can help provide clues about the cause of the symptoms.
• Medical issues can cause pressure in different areas. (Rizzoli P, Mullally W. 2017)
• An example is a sinus infection which can cause pressure under the eyes and around the nose.
• A migraine or tension headache can present as: (MedlinePlus. Migraine 2021)
• A tight band around the head.
• Pain or pressure behind the eyes.
• Stiffness and pressure in the back of the head and/or neck.

Causes of Pressure

The root cause of the problem is not always clear. There can be a number of potential causes.

Tension Headache

Tension headaches are the most common that feels like pressure squeezing the head. They usually develop because of tightening scalp muscles caused by:

• Stress
• Depression
• Anxiety
• Head injuries
• Unusual positioning of the head or illness can cause tension headaches.

Other than muscle tension, tension headaches can develop from: (MedlinePlus. Tension headache.)

• Physical stress
• Emotional stress
• Eye strain
• Fatigue
• Overexertion
• Overuse of caffeine
• Caffeine withdrawal
• Over alcohol use
• Sinus infections
• A cold or flu
• Smoking
• Tension headaches can also run in families. (MedlinePlus. Tension headache.)

Sinus Headache

• A sinus headache - rhinosinusitis - is caused by a viral or bacterial infection in the sinus cavities. (American Migraine Foundation 2023)
• There are sinus cavities on each side of the nose, between the eyes, in the cheeks, and on the forehead.
• The location of where these headaches cause pressure varies, depending on which sinuses are infected. (Cedars Sinai. Sinus Conditions and Treatments)
• Sinus infection headaches are obvious from the discolored nasal drainage.
• Individuals can have facial pain and pressure, lose their sense of smell, or have a fever. (American Migraine Foundation 2023)

Ear Conditions

• The ears help the body sense movement and balance.
• A problem in the inner ear that helps control balance can cause a type of migraine known as a vestibular migraine. (American Speech-Language-Hearing Association)
• This type of migraine doesn't always present with pain symptoms.
• Problems with balance and feelings of vertigo/sense of spinning are common with these types of migraines. (American Migraine Foundation)
• An ear infection can also cause feelings of head pressure and/or pain.
• Infections can cause pressure to build on the delicate structures of the middle and inner ear.
• These infections are usually caused by viral illness or bacteria. (FamilyDoctor.org)

Neurological Causes

• Neurological diseases and conditions can lead to increased pressure in the head.
• The pain symptoms depend on the specific cause.
• For example, a stroke can affect the whole head, while decreased brain fluid levels may affect just the base of the skull.
• The latter condition is known as intracranial hypertension which means increased pressure in the brain. (Schizodimos, T et al., 2020)
• For some individuals, there is no clear cause, this is known as idiopathic intracranial hypertension. (Wall, Michael. 2017) (National Health Service 2023)

Other causes of increased intracranial pressure include:

• Medications
• Hormones
• Head injury
• Fluid buildup inside the brain - hydrocephalus (National Institute of Neurological Disorders and Stroke, 2023)
• Brain infections like meningitis or encephalitis
• Brain blood clots 
• Brain tumors

Other

• Head pressure can also occur only at times when standing up, bending down to pick up an object, or otherwise changing posture in some way that blood pressure is affected.

Chiropractic Treatment

The Injury Medical team will develop a personalized treatment plan to help relieve pressure symptoms through a multidisciplinary approach that can include. (Moore Craig, et al., 2018)

• Spinal manipulation
• Low-load craniocervical mobilization
• Joint mobilization
• Deep neck flexion exercises
• Neuromuscular massage
• Physical therapy exercises
• Relaxation techniques
• Stress management
• Nutritional recommendations

Multidisciplinary Evaluation and Treatment

General Disclaimer *

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

Moore, C., Leaver, A., Sibbritt, D., & Adams, J. (2018). The management of common recurrent headaches by chiropractors: a descriptive analysis of a nationally representative survey. BMC neurology, 18(1), 171. https://doi.org/10.1186/s12883-018-1173-6

Thau, L., Reddy, V., & Singh, P. (2022). Anatomy, Central Nervous System. In StatPearls. StatPearls Publishing.

Rizzoli, P., & Mullally, W. J. (2018). Headache. The American journal of medicine, 131(1), 17–24. https://doi.org/10.1016/j.amjmed.2017.09.005

American Migraine Foundation. Is it a migraine or a sinus headache?

MedlinePlus. Migraine.

MedlinePlus. Tension headache.

Cedars Sinai. Sinus conditions and treatments.

American Speech-Language-Hearing Association. Dizziness and balance.

American Migraine Foundation. What to know about vestibular migraine.

FamilyDoctor.org. Ear infection.

Schizodimos, T., Soulountsi, V., Iasonidou, C., & Kapravelos, N. (2020). An overview of the management of intracranial hypertension in the intensive care unit. Journal of Anesthesia, 34(5), 741–757. https://doi.org/10.1007/s00540-020-02795-7

Wall M. (2017). Update on Idiopathic Intracranial Hypertension. Neurologic Clinics, 35(1), 45–57. https://doi.org/10.1016/j.ncl.2016.08.004

National Health Service. Intracranial hypertension.

National Institute of Neurological Disorders and Stroke. Hydrocephalus. https://www.ninds.nih.gov/health-information/disorders/hydrocephalus

A joint is where two bones meet. The two sacroiliac or SI joints connect the spine, pelvis, and hips. This strong joint balances and transmits stress from the upper body to the pelvis and legs. The joints can suffer a sprain causing pain and discomfort symptoms. There can also be the feeling of tightness wrapping around the waist and dull aching across the low back as the surrounding muscles tighten up as a form of protection, also known as muscle guarding. A correct diagnosis is vital to avoid any potentially serious complications. Chiropractors are experts on neuromusculoskeletal problems and can treat, heal, and strengthen the body through various MET, mobilization, and manipulation techniques.

Sacroiliac Sprain

The main function is to balance the upper and lower body forces. The sacroiliac joints are surrounded by muscle, connective tissue, nerves designed to withstand large stresses and a complex system of ligaments, further strengthening the joints.

Injury Causes

Sacroiliac sprains can be caused by direct trauma to the pelvis from a fall or automobile collision or jobs and sports that involve a lot of bending and twisting. However, sometimes there is no distinct cause. Common causes include:

• Repetitive microtrauma is excessive/repetitive movements like prolonged twisting, bending, or lifting at work, home, physical activities, and sports.
• The joint can be pushed out of alignment.
• Muscular imbalance or weakness in the muscles surrounding the sacroiliac joints can cause problems to develop over time, presenting little or no symptoms.
• The tissues around a sacroiliac joint also can be stretched or torn.
• Trauma such as a fall or road traffic accidents
• Problems with the hips, knees, and feet can generate increased pressure on the joint, which can become painful over time due to repetitive strain.
• Pregnancy hormones released to promote pelvis relaxation can increase the risk of SI sprain injury.

Excessive stress on the joint can cause microscopic damage to the ligaments surrounding the joint. The joint then becomes inflamed and presents with pain and sensations of discomfort. The body responds by contracting the muscles to prevent further damage. However, the muscle spasms may not stop, resulting in more pain. Referred pain is common from the muscles that go into spasm, with the most affected being the piriformis, gluteal/buttock, and psoas muscles.

Signs and Symptoms

• Tenderness over the affected joint and area.
• Pain symptoms on one or both sides above the joints and into the buttocks.
• Standing or working with increased weight on one leg increases pain symptoms.
• Pain after lifting or twisting that develops a little while later.
• Pain travels to the back of the leg, front of the thigh, and the groin.
• Pain gets worse when sitting and bending forward.
• Lying down eases the symptoms.
• Most cases report no loss of strength, tingling, or numbing sensations.

Chiropractic Treatment

Chiropractic treatment will relieve the pain symptoms, but there are stages of treatment, each with specific goals before moving to the next.

• The objective of the initial stage is to decrease pain and inflammation.
• The second stage is stabilizing and restoring proper musculoskeletal function.
• Rehabilitation and targeted stretches and exercises will be introduced as the treatment continues.
• In the maintenance stage, there should be no pain, and the individual should be able to perform normal daily activities and return to normal life.
• Recovery time for a sacroiliac sprain can be 4-6 weeks but can take months to heal completely.

Chiropractic Approach for Pain Relief

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

BIDWELL, A M. “Treatment of sacroiliac sprain by manipulation.” The Medical World vol. 65,1 (1947): 14-6.

Evans, P. “Sacroiliac sprain.” American family physician vol. 48,8 (1993): 1388; author replies 1390.

LeBlanc, K E. “Sacroiliac sprain: an overlooked cause of back pain.” American family physician vol. 46,5 (1992): 1459-63.

Sun, Chao, et al. “Cost and outcome analyses on the timing of first independent medical evaluation in patients with a work-related lumbosacral sprain.” Journal of Occupational and environmental medicine vol. 49,11 (2007): 1264-8. doi:10.1097/JOM.0b013e318156ecdb

There is a multitude of reasons why back muscles tighten and stiffen up. Muscles pull the bones and joints. Overuse and/or injuries can pull the bones, joints, and tendons out of place, thus causing the muscles to stay in a flexed or stretched position, the inability for the muscles to relax and return to their normal position, resulting in symptoms of discomfort, stiffness, and pain. Individuals can have reoccurring bouts of tight muscles, eventually becoming chronic. Chronic muscle tension can pull the spine out of alignment even if there is no specific injury. The Injury Medical Chiropractic and Functional Wellness Team can relieve tight back muscle tension and restore positioning, mobility, and function.

Muscles are the Key

Muscles make the body move and greatly impact the skeletal and nervous systems. When a muscle is overstretched or pulled, there is not just injury to the muscles but the potential for injury to the bones and tendons in the area. This, in turn, can pinch nerves and cause problems with the nervous system, especially in pain signal transmissions.

Symptoms

Symptoms will depend on the cause and severity. The most common include:

• Constant or chronic muscle achiness, soreness, stiffness, and tightness.
• Even after stretching or flexing, there is a dull aching or pain.

More serious symptoms may include:

• Electrical or burning sensations
• Sharp or stabbing pain.
• Weakness in the legs or arms
• Tingling or numbness in the legs, arms, or chest.
• Chest discomfort symptoms.

Causes

Aging

The older a person is, the more likely they will experience back discomfort symptoms. Back issues most likely occur in 30- to 50-year-olds.

• The aging process naturally wears the body.
• Thinning bones
• Muscle mass reduction
• Fluid loss between joints in the spine.
• All these can cause back issues and problems.

Unhealthy posture

Constant pressure on the spine can lead to general back discomfort symptoms. Practicing unhealthy posture can generate this pressure. The muscles and ligaments must work harder to keep the body balanced because the muscles are out of position, and the other muscles can't perform their job properly. Overworking and overuse lead to tight back muscles, aches, and pain.

Muscle sprain or strain

Sprains are the tearing or stretching of ligaments. Strains are the tearing or stretching of muscles and tendons. Lifting heavy objects without proper form can easily cause a back sprain or strain. Sprains and strains can also occur after an awkward, sudden, or jerking movement.

Herniated disc

A herniated, slipped, or ruptured disc puts pressure on a nerve/s. This can stress the surrounding muscles causing tension to build up.

Fall or other injuries

Tight back muscles can result from the following:

• A fall
• Vehicle accident
• Force Trauma
• Sports accident

Weight gain

Added weight stresses and pulls the body down. This causes unhealthy posture and muscle tension.

Chiropractic Functional Wellness

Usually, tight muscles can be relieved with a hot bath or cold therapy. Reoccurring bouts of, or chronically tense back muscles, are signals that something is wrong and should not be ignored. Chiropractic care can release and relax tight back muscles and get them back into a natural state by re-aligning the spine through tissue manipulation, decompression, massage, and adjustments. The various treatment methods will relieve the discomfort, pain, tension, and realign the spinal column, and strengthen the body. When spinal components are put back into their proper place, the surrounding muscles no longer need to provide a counter-balance to the misalignment and begin to relax. Chiropractors can also recommend ways to improve posture and strengthen muscles to incur less wear and tear.

Chiropractic Back Therapy

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 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 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

Furlan, Andrea D et al. "Complementary and alternative therapies for back pain II." Evidence report/technology assessment,194 (2010): 1-764.

Geneen, Louise J et al. "Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews." The Cochrane database of systematic reviews vol. 4,4 CD011279. 24 Apr. 2017, doi:10.1002/14651858.CD011279.pub3

Mayo Clinic Staff. (2017). Back pain: Symptoms. mayoclinic.org/diseases-conditions/back-pain/basics/symptoms/con-20020797

Miake-Lye, Isomi M et al. "Massage for Pain: An Evidence Map." Journal of alternative and complementary medicine (New York, N.Y.) vol. 25,5 (2019): 475-502. doi:10.1089/acm.2018.0282

Nahian, Ahmed, et al. "Osteopathic Manipulative Treatment: Facial Muscle Energy, Direct MFR, and BLT Procedure – for TMJ Dysfunction." StatPearls, StatPearls Publishing, 12 September 2022.

Rahman Shiri, Jaro Karppinen, Päivi Leino-Arjas, Svetlana Solovieva, Eira Viikari-Juntura, The Association Between Obesity and Low Back Pain: A Meta-Analysis, American Journal of Epidemiology, Volume 171, Issue 2, 15 January 2010, Pages 135–154, https://doi.org/10.1093/aje/kwp356

Injury Medical Spinal Decompression: Spinal decompression therapy/treatment can be surgical or non-surgical, with differences in the procedure, recovery time, and results. Individuals who experience compression-related problems can have severe and prolonged spinal conditions that can lead to various health issues. Individuals experiencing persistent or chronic neck, back, or leg pain should know the differences between surgical and non-surgical spinal decompression. Spinal decompression aims to relieve pressure on the discs and reduce stress on the nerves to eliminate the pain associated with compression on the spine, restoring optimal circulation and improving spinal function.

Surgical Procedure

• It is invasive, must be performed by a surgeon, and can have a recovery time of up to 6 weeks.
• Surgery is usually suggested as a last resort after alternative therapies have not succeeded or when the compression is so severe that surgery is the only option.
• Surgical spinal decompression is directed towards removal to reduce pressure instead of adjusting or stretching the discs.
• In cases of severe nerve compression, surgery can be an effective option.
• Risks include infection, damage to the spinal cord, and blood clots.

Types of Spinal Decompression Surgery

Types of surgeries; spinal fusion could be necessary to stabilize the spine. Common types of back surgery:

Discectomy

• This procedure removes a portion of the disc to relieve pressure on nerves.

Laminotomy

• The procedure removes a small portion of the bone or a section of the bony arch to increase the size of the spinal canal and relieve pressure.

Laminectomy

• The procedure removes the entire bony arch or lamina to increase the size of the spinal canal and relieve pressure.

Foraminotomy

• This procedure removes bone and other tissue to widen the openings for the nerve roots to pass through.

Osteophyte Removal

• The procedure involves removing bony growths.

Corpectomy

• The procedure removes a vertebral body along with discs.

Injury Medical Spinal Decompression

Surgery for a damaged/injured spine is not always necessary. Treatment regimes vary depending on each individual’s medical condition. Non-surgical motorized spinal decompression is a non-invasive back treatment that uses a mechanized decompression table to slowly and gently stretch the spine. The therapy gradually relieves the pressure on the compressed nerve root/s resulting in reduced or complete alleviation of pain.

Non-Surgical Spinal Decompression Treats

• Neck pain
• Back pain
• Sciatica
• Injured, damaged, or diseased nerve roots
• Damaged discs
• Deteriorated discs
• Bulging or Herniated discs
• Osteoarthritis
• Facet Joint Syndrome

Benefits

• Painless
• Non-invasive
• Sessions only take 30-45 minutes
• Feel immediate results

Decompression Program

An Injury Medical Spinal Decompression program incorporates:

Injury Medical Spinal Decompression Sessions

• Decompression treatment sessions last about 30-45 minutes for 4-6 weeks.
• The sessions are conducted in the chiropractor's office.

Post Decompression Treatment

• This is necessary to ensure that the injured areas are fully relaxed and conditioned for chiropractic manual adjustments.
• Massage therapy
• Percussive massage
• Cold laser
• Heat and/or ice
• These treatments facilitate blood and nerve circulation.

Chiropractic Adjustments

• Chiropractic adjustments enhance decompression by fine-tuning mechanical and structural misalignments.

Health Coaching

Supplements and essential vitamins:

• Support, repair, and restore the discs
• Decrease inflammation
• Increase healing

Core Strengthening/Postural Rehabilitation 

• Core exercises are recommended to strengthen the muscles and soft tissues.
• Posture exercises

Oxygen, water, and nutrients circulate abundantly, promoting healing as the discs re-hydrate, and are re-nourished, improving and enhancing spine function. Individuals can enjoy increased levels of mobility, strength in the spine and muscles, and more flexibility.

Descompresión Espinal Con La DRX9000

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, or licensed physician, and is not medical advice. We encourage you to make your own 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 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*

References

American Spinal Decompression Association: "Spinal Decompression Therapy."

Daniel, D.M. Chiropractic and Osteopathy, 2007.

Macario, Alex, and Joseph V Pergolizzi. “Systematic literature review of spinal decompression via motorized traction for chronic discogenic low back pain.” Pain practice: the official journal of World Institute of Pain vol. 6,3 (2006): 171-8. doi:10.1111/j.1533-2500.2006.00082.x

O'Hara K, editor. Decompression: a treatment for back pain. Vol. 11. National Association of Healthcare Professionals; 2004. pp. 1-2.http://www.naohp.com/menu/publications/mccu/bibliography.htm#10 [Google Scholar]

Sometimes the bones or vertebrae of the spine can crack and collapse under their weight. This is known as a compression fracture, vertebral compression fracture, or VCF. There are almost 1 million compression fractures every year, usually because the bones become weakened and crack under the weight of the vertebrae above them. These fractures can cause spinal weakness affect posture and the ability to stand up straight. They are often the cause for individuals to hunch over, also called kyphosis.

Compression Fracture

Compression fractures are small breaks or cracks in the vertebrae. The breaks occur in the vertebral body, the thick rounded part on the front of each vertebra. These fractures cause the spine to weaken and collapse. With time, these fractures affect posture as the spine curves forward. The fractures are often found in the middle/thoracic spine in the lower area. They often result from osteoporosis but can also happen after a trauma like an automobile accident, work, sports injury, or a tumor on the spine.

Symptoms

Compression fracture symptoms range from mild to severe or no symptoms. Many individuals can stand or walk without pain. They are often discovered when X-rays are taken for another condition. Symptoms include:

• Back pain can come on suddenly and last for a significant time, often diagnosed as chronic back pain.
• It usually develops between the shoulders and the lower back.
• The pain and discomfort decrease when lying down and worsen when standing or walking.
• Decreased mobility or flexibility in the spine. Individuals are unable to twist or bend.
• Hunched over appearance, known as dowager's hump or hunchback.
• Loss of height from the vertebrae compression and the spine curving.
• Pinched nerves
• Nerve damage can cause tingling, numbness, and difficulty walking.
• Loss of bladder or bowel control with severe, untreated fractures.

Individuals At Risk

• Individuals who have had a compression fracture are more likely to have another one.
• Women over 50 have a higher risk due to osteoporosis.
• With age, the risk increases for men and women.

Diagnosis

A doctor will perform an examination and ask about symptoms. The exam will include:

• Checking spinal alignment.
• Posture analysis.
• Gently palpates different areas of the back to identify the source of pain.
• Examine for signs of nerve damage that include numbness, tingling, or muscle weakness.

A doctor will order imaging studies to examine the backbones, muscles, and soft tissues. Imaging studies include:

• CT scan, X-ray, or MRI of the spine.
• DEXA scan is a type of X-ray that measures bone loss bone density.
• A myelogram is a procedure used along with imaging studies. A contrast dye is injected into the spine before the scan making the images easier to see.
• A triple-phase bone scan is an imaging study that takes three sets of pictures.

Treatment

Compression fracture treatment focuses on relieving pain, stabilizing the vertebrae, and ongoing fracture prevention. Treatment depends on the severity of the fracture and the individual's overall health. Treatment can include:

Pain Medication

• A doctor can recommend over-the-counter non-steroidal anti-inflammatory medication.
• A doctor may prescribe muscle relaxers or prescription medication.
• Follow instructions carefully when taking medications.

Back Brace

• A special type of back brace helps to support the vertebrae.
• The brace can also relieve pain by reducing how much the spine moves.

Strengthening Meds

• Medications known as bisphosphonates can help slow down bone loss, stabilize the bones and prevent fractures.
• These medications include ibandronic acid and alendronic acid.

Vertebroplasty or Kyphoplasty

• This minimally invasive procedure relieves pain, stabilizes the bones, and improves mobility.
• During vertebroplasty, the doctor inserts a needle in the vertebra and injects bone cement.
• During kyphoplasty, the doctor inserts an inflatable device that they fill with cement.
• Both are outpatient procedures allowing the individual to go home the same day.

Individuals over 65 or that have osteoporosis or a history of cancer are recommended to see their doctor. Individuals who present with sudden back pain that doesn't get better after a day or two are advised to see a doctor and evaluate for back pain so the doctor can determine the cause and develop a treatment plan.

Body Composition

Vitamin D To Build Muscle

Skeletal Muscle Mass decreases as the body ages, primarily due to decreased physical activity. Vitamin D has been reported to influence muscle quality. This could be helpful for adults as they age. Muscle loss diminishes functional performance on activities that require strength and coordination. When this loss of muscle mass becomes significant, it becomes a condition known as sarcopenia. Treatments include:

• Healthy diet
• Exercise
• Vitamin D supplementation
• All were found to slow down muscle loss and help regain muscle mass and strength.
• Vitamin D supplementation is effective, especially in older adults whose blood levels are low.

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*

References

American Academy of Orthopaedic Surgeons. Osteoporosis and Spinal Fractures. (https://orthoinfo.aaos.org/en/diseases--conditions/osteoporosis-and-spinal-fractures/) Accessed 10/25/2021.

American Association of Neurological Surgeons. Vertebral Compression Fractures. (https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Vertebral-Compression-Fractures) Accessed 10/25/2021.

Bischoff-Ferrari, H A et al. "Vitamin D receptor expression in human muscle tissue decreases with age." Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research vol. 19,2 (2004): 265-9. doi:10.1359/jbmr.2004.19.2.265

Donnally III CJ, DiPompeo CM, Varacallo M. Vertebral Compression Fractures. [Updated 2021 Nov 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448171/

Hassan-Smith, Zaki K et al. "25-hydroxyvitamin D3, and 1,25-dihydroxyvitamin D3 exert distinct effects on human skeletal muscle function and gene expression." PloS one vol. 12,2 e0170665. 15 Feb. 2017, doi:10.1371/journal.pone.0170665

McCarthy, Jason, and Amy Davis. "Diagnosis and Management of Vertebral Compression Fractures." American family physician vol. 94,1 (2016): 44-50.

Any job-related back injury can significantly complicate an individual's life. Dealing with the pain, trying to figure out how to get things done while in recovery, and workers' compensation to protect individuals who are injured on the job, getting them healthy without the stress of worrying about losing money from missing work.

Job-Related Injury

According to the Occupational Safety and Health Administration or O.S.H.A, a job-related injury is one that either contributed to or is caused by something in the work environment that injures an individual or exacerbates/worsens a previous injury. This is a general overview of the definition, and there are some exceptions. For example, being at the place of work as a general public citizen and not working when an injury happens will not be covered. If not sure whether a back injury is job-related, it's better to be cautious and report the incident as soon as it happens.

Common Back Injuries

Back injuries are the most common job-related injuries. Back injuries are the number one reason individuals cannot work, whether they hurt their back at home or on the job. The Bureau of Labor Statistics found that nearly 40% of all musculoskeletal injuries that resulted in lost workdays were because of back injuries. The most common back injuries include:

• Sprains
• Strains
• Herniated Discs
• Whiplash
• Spinal Cord Injuries
• Vertebral Fractures

Compensation

Every state's workers' compensation program is different; however, the basic components are the same throughout. This means that if a workers' compensation claim is approved and an individual cannot work because of their injury, they can expect to receive a regular base salary during treatment, rehabilitation, and recovery. Individuals also continue to receive medical coverage through the company, while the workers' compensation fund should pay for treatment and diagnostics related to the injury.

When A Back Injury Occurs at Work

When a back happens at work, inform the employer as soon as possible. Do not be embarrassed or feel as it is not a big deal to seek workers' compensation.  It is an insurance program for both the individual and the employer. An employer pays into the state's workers' compensation program for limited liability when employees get injured. Individuals don't pay for the program, but it protects the individual in case something happens.

Letting an injury go untreated might not be anything at first, but months and years later, it can come back and be worse than when it first happened, causing greater damage, added medical costs, and procedures that the individual has to pay for out of their pocket. 

Once an individual knows they have a back injury, it is recommended to seek treatment as soon as possible to prevent worsening the injury or create new ones and develop a treatment, rehabilitation, and strengthening program. If an individual needs emergency care, tell the doctors about the work injury and precisely what happened. Emergency medical care should be sought out when:

• There is a loss of function in any of the limbs.
• There is a persistent numbness with the back pain.
• There is nausea, dizziness, or vomiting after the injury.
• There is a fever with back pain.
• Loss of consciousness.
• Loss of bowel or bladder control.

If the injury is not immediate and progresses gradually, but suspect that it is from work, it should be reported and examined by a medical professional.

Treatment

Proper treatment for a back injury depends on the severity of the injury. Those that prefer non-invasive, medication-free treatment are able to recover with chiropractic or physical therapy. Chiropractic doctors are experts in the spine and the musculoskeletal system. Chiropractic treatment is safe, proven, and can help relieve the pain, restore function, to get back to work safely.

Body Composition

Resistance Exercise

Resistance workouts are made to stress the muscles resulting in muscle gain. Resistance exercise makes the body adapt by growing the muscles to make them more capable of handling intense forces without strain. The stress of resistance exercise causes the muscle fibers to tear at the cellular level. Then, special muscle cells, known as satellite cells, jump into action to repair, rebuild, and grow the muscle. These types of exercises include high-intensity workouts or compound exercises that increase muscle growth. However, there needs to be a healthy balance between workouts and rest to support healthy hormone levels and maximize muscle gain.

Hormones

There are three primary hormones that stimulate muscle hypertrophy. They are:

• Insulin-like growth factor 1 IGF-1
• Growth hormone GH
• Testosterone

Muscle protein synthesis is a critical process in muscle hypertrophy and happens after weight training. The hormones signal to the muscle to repair and rebuild after workout sessions. GH is released in high quantities during sleep, which is why proper sleep is needed to help reach body composition goals. When nutrition, workouts, and hormonal effects are combined, muscle-building happens. Figuring out the right balance is essential for reaching health goals.

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*

References

Burton, A K, and E Erg. "Back injury and work loss. Biomechanical and psychosocial influences." Spine vol. 22,21 (1997): 2575-80. doi:10.1097/00007632-199711010-00021

https://www.osha.gov/laws-regs/regulations/standardnumber/1904/1904.5

https://www.bls.gov/opub/ted/2018/back-injuries-prominent-in-work-related-musculoskeletal-disorder-cases-in-2016.htm

Marjorie L Baldwin, Pierre Côté, John W Frank, William G Johnson, Cost-effectiveness studies of medical and chiropractic care for occupational low back pain: a critical review of the literature, The Spine Journal, Volume 1, Issue 2, 2001, Pages 138-147, ISSN 1529-9430, https://doi.org/10.1016/S1529-9430(01)00016-X.(https://www.sciencedirect.com/science/article/pii/S152994300100016X)

Randall, Sara. "1. Avoiding back injury." The practicing midwife vol. 17,11 (2014): 10, 12-4.

Cervicogenic headaches can be easily confused with migraine headaches. They can have various underlying triggers/causes that require different treatment approaches for pain management and recovery.

• These types of headaches are related to excessive neck stress
• It could be the result of cervical osteoarthritis (spondylosis)
• Damaged disc/s
• Injury
• Whiplash
• Type of movement that irritates or compresses a cervical nerve

Headaches

A cervicogenic headache is regarded as a secondary headache brought on by an underlying trigger. They start in the neck and back of the head. Individuals usually describe the feeling primarily as muscle tension. This tension causes pain in the back of the skull that radiates/spreads up and outward to the front of the head. It is common for individuals to only notice the headache pain and not realize the underlying trigger in the neck. Symptoms associated with this type of headache include:

• Stiffness in the neck limiting movement
• Neck pain presents by certain movements or positioning
• Tenderness in the shoulders, neck, and back of the skull
• Pain around the eyes, neck
• Pain on one side of the head
• Nausea
• Sensitivity to light

Causes

A common underlying trigger is a structural problem with the cervical spine/neck. This can cause:

• Poor nerve flow
• Muscle imbalances
• Connective tissue strain
• All can generate upper neck stiffness

Structural issues can come from:

• A previous neck injury
• Work occupation that strains the neck and back
• Prolonged sitting, combined with poor posture work
• Manual labor
• Hairstylists
• Automobile accidents, sports injuries causing whiplash are the primary causes for this type of pain.

Getting Chiropractic Treatment

A typical treatment from traditional medicine is pain medication/s. However, this will not alleviate the underlying neck issues that are causing the pain that can lead to chronic pain. Restoring alignment of the cervical spine is essential to bring back balance and optimal nerve health to the entire body. This will reduce symptoms and increase long-term healing.

A highly recommended treatment option for spinal re-alignment is chiropractic care. Chiropractors are expertly trained to use science-based treatment techniques that are highly effective and bring positive results. Individuals are able to recover and educated on how to manage headaches/pain. As spinal alignment is achieved a chiropractor will make recommendations on natural pain management, stretching, exercise, posture, diet, and more.

Body Composition

Lean Body Mass vs Muscle Mass

Lean Body Mass is also known as lean mass is the total weight of the body minus all the weight due to fat mass.

Lean Body Mass LBM = Total Weight – Fat Mass

Lean Body Mass includes weight of the:

• Bones
• Skin
• Organs
• Body Water
• Muscle Mass

Lean Body Mass correctly describes the entire weight of the body minus the fat. Because Lean Body Mass comprises many areas, any change in weight can be recorded as changes in Lean Body Mass. Remember that the weight of the organs will not change significantly. Bone density decreases over time, but it will not significantly affect the weight of Lean Body Mass. 

Two major areas to focus on are body water and muscle mass. When discussing gaining muscle by consuming more protein or muscle-building exercise/workouts, what they are talking about is gaining or building Skeletal Muscle Mass. The three major muscle types include:

• Cardiac
• Smooth
• Skeletal muscle mass is the only type of muscle that can actively grow and develop through exercise and nutrition.

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 musculoskeletal system’s injuries or disorders. 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, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico

References

Fredriksen, Torbjørn A et al. “Cervicogenic headache: too important to be left un-diagnosed.” The journal of headache and pain vol. 16 (2015): 6. doi:10.1186/1129-2377-16-6

Chaibi, Aleksander, and Michael Bjørn Russell. “Manual therapies for cervicogenic headache: a systematic review.” The journal of headache and pain vol. 13,5 (2012): 351-9. doi:10.1007/s10194-012-0436-7

Rubio-Ochoa, J et al. “Physical examination tests for screening and diagnosis of cervicogenic headache: A systematic review.” Manual therapy vol. 21 (2016): 35-40. doi:10.1016/j.math.2015.09.008

Individuals suffering from a jammed finger: Can knowing the signs and symptoms of a finger that is not broken or dislocated allow for at-home treatment and when to see a healthcare provider?

Jammed Finger Injury

A jammed finger, also known as a sprained finger, is a common injury when the tip of a finger is forcefully pushed toward the hand, causing the joint to become compressed. This can cause pain and swelling in one or more fingers or finger joints and cause ligaments to stretch, sprain, or tear. (American Society for Surgery of the Hand. 2015) A jammed finger can often heal with icing, resting, and taping. This is often enough to allow it to heal in a week or two if no fractures or dislocations are present. (Carruthers, K. H. et al., 2016) While painful, it should be able to move. However, if the finger cannot wiggle, it may be broken or dislocated and require X-rays, as a broken finger or joint dislocation can take months to heal.

Treatment

Treatment consists of icing, testing, taping, resting, seeing a chiropractor or osteopath, and progressive regular use to regain strength and ability. 

Ice

• The first step is icing the injury and keeping it elevated.
• Use an ice pack or a bag of frozen vegetables wrapped in a towel.
• Ice the finger in 15-minute intervals.
• Take the ice off and wait until the finger returns to its normal temperature before re-icing.
• Do not ice a jammed finger for over three 15-minute intervals in one hour.

Try To Move The Affected Finger

• If the jammed finger does not move easily or the pain gets worse when trying to move it, you need to see a healthcare provider and have an X-ray to check for a ​bone fracture or dislocation. (American Society for Surgery of the Hand. 2015)
• Try to move the finger slightly after swelling, and the pain subsides.
• If the injury is mild, the finger should move with little discomfort for a short time.

Tape and Rest

• If the jammed finger is not broken or dislocated, it can be taped to the finger next to it to keep it from moving, known as buddy taping. (Won S. H. et al., 2014)
• Medical-grade tape and gauze between the fingers should be used to prevent blisters and moisture while healing.
• A healthcare provider may suggest a finger splint to keep the jammed finger lined up with the other fingers.
• A splint can also help prevent a jammed finger from re-injury.

Resting and Healing

• A jammed finger must be kept still to heal at first, but eventually, it needs to move and flex to build strength and flexibility.
• Targeted physical therapy exercises can be helpful for recovery.
• A primary care provider might be able to refer a physical therapist to ensure the finger has a healthy range of motion and circulation as it heals.
• A chiropractor or osteopath can also provide recommendations for helping rehabilitate the finger, hand, and arm to normal function.

Easing The Finger Back to Normal

• Depending on the extent of the injury, the finger and hand can be sore and swollen for a few days or weeks.
• It can take some time to start feeling normal.
• Once the healing process begins, individuals will want to return to using it normally.
• Avoiding using a jammed finger will cause it to lose strength, which can, over time, further weaken it and increase the risk of re-injury.

If the pain and swelling persist, see a healthcare provider to get it checked for a possible fracture, dislocation, or other complication as soon as possible, as these injuries are harder to treat if the individual waits too long. (University of Utah Health, 2021)

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

Treatment for Carpal Tunnel Syndrome

General Disclaimer *

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

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

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

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

American Society for Surgery of the Hand. (2015). Jammed finger. https://www.assh.org/handcare/condition/jammed-finger

Carruthers, K. H., Skie, M., & Jain, M. (2016). Jam Injuries of the Finger: Diagnosis and Management of Injuries to the Interphalangeal Joints Across Multiple Sports and Levels of Experience. Sports Health, 8(5), 469–478. https://doi.org/10.1177/1941738116658643

Won, S. H., Lee, S., Chung, C. Y., Lee, K. M., Sung, K. H., Kim, T. G., Choi, Y., Lee, S. H., Kwon, D. G., Ha, J. H., Lee, S. Y., & Park, M. S. (2014). Buddy taping: is it a safe method for treatment of finger and toe injuries?. Clinics in orthopedic surgery, 6(1), 26–31. https://doi.org/10.4055/cios.2014.6.1.26

University of Utah Health. (2021). University of Utah Health. Should I worry about a jammed finger? University of Utah Health. https://healthcare.utah.edu/the-scope/all/2021/03/should-i-worry-about-jammed-finger

Those experiencing neck pain, stiffness, headache, shoulder and back pain may suffer from a whiplash injury. Can knowing whiplash signs and symptoms help individuals recognize the injury and help healthcare providers develop an effective treatment plan?

Whiplash Signs and Symptoms

Whiplash is a neck injury that typically occurs after a motor vehicle collision or accident but can happen with any injury that rapidly whips the neck forward and backward. It is a mild to moderate injury of the neck muscles. Common whiplash signs and symptoms include:

• Neck pain
• Neck stiffness
• Headache
• Dizziness
• Shoulder pain
• Back pain
• Tingling sensations in the neck or down the arms. (Johns Hopkins Medicine. 2024)
• Some individuals can develop chronic pain and headaches.

The symptoms and treatment depend on the severity of the injury. Treatment can include over-the-counter pain medicines, ice and heat therapy, chiropractic, physical therapy, and stretching exercises.

Frequent Signs and Symptoms

The sudden whipping movement of the head can affect several structures within the neck. These structures include:

• Muscles
• Bones
• Joints
• Tendons
• Ligaments
• Intervertebral discs
• Blood vessels
• Nerves. 
• Any or all of these can be affected by a whiplash injury. (MedlinePlus, 2017)

Statistics

Whiplash is a neck sprain that occurs from a fast neck-jerking motion. Whiplash injuries account for more than half of vehicle traffic collision injuries. (Michele Sterling, 2014) Even with a minor injury, the most frequent symptoms include: (Nobuhiro Tanaka et al., 2018)

• Neck pain
• Next stiffness
• Neck tenderness
• Limited range of motion of the neck

Individuals can develop neck discomfort and pain shortly after an injury; however, the more intense pain and stiffness typically do not occur right after the injury. Symptoms tend to worsen the next day or 24 hours later. (Nobuhiro Tanaka et al., 2018)

Beginning Symptoms

Researchers have found that approximately more than half of individuals with whiplash develop symptoms within six hours of the injury. Around 90% develop symptoms within 24 hours, and 100% develop symptoms within 72 hours. (Nobuhiro Tanaka et al., 2018)

Whiplash vs. Traumatic Cervical Spine Injury

Whiplash describes a mild to moderate neck injury without significant skeletal or neurological symptoms. Significant neck injuries can lead to fractures and dislocations of the spine that can affect the nerves and spinal cord. Once an individual develops neurological problems associated with a neck injury, the diagnosis changes from whiplash to traumatic cervical spine injury. These differences can be confusing as they are on the same spectrum. To better understand the severity of a neck sprain, the Quebec classification system divides neck injury into the following grades (Nobuhiro Tanaka et al., 2018)

Grade 0

• This means there are no neck symptoms or physical examination signs.

Grade 1

• There is neck pain and stiffness.
• Very few findings from the physical examination.

Grade 2

• Indicates neck pain and stiffness
• Neck tenderness
• Decreased mobility or neck range of motion on physical examination.

Grade 3

• Involves muscle pain and stiffness.
• Neurologic symptoms include:
• Numbness
• Tingling
• Weakness in the arms
• Decreased reflexes

Grade 4

• Involves a fracture or dislocation of the bones of the spinal column.

Other Symptoms

Other whiplash signs and symptoms that can be associated with the injury but are less common or only occur with a severe injury include (Nobuhiro Tanaka et al., 2018)

• Tension headache
• Jaw pain
• Sleep problems
• Migraine headache
• Difficulty concentrating
• Reading difficulties
• Blurred vision
• Dizziness
• Driving difficulties

Rare Symptoms

Individuals with severe injuries can develop rare symptoms that often indicate traumatic cervical spine injury and include: (Nobuhiro Tanaka et al., 2018)

• Amnesia
• Tremor
• Voice changes
• Torticollis - painful muscle spasms that keep the head turned to one side.
• Bleeding in the brain

Complications

Most individual generally recover from their symptoms within a few weeks to a few months. (Michele Sterling, 2014) However, whiplash complications can occur, especially with severe grade 3 or grade 4 injuries. The most common complications of a whiplash injury include chronic/long-term pain and headaches. (Michele Sterling, 2014) Traumatic cervical spine injury can affect the spinal cord and be associated with chronic neurological problems, including numbness, weakness, and difficulty walking. (Luc van Den Hauwe et al., 2020) 

Treatment

The pain is typically more severe the next day than after the injury. Whiplash musculoskeletal injury treatment depends on whether it is an acute injury or the individual has developed chronic neck pain and stiffness.

• Acute pain can be treated with over-the-counter medicines like Tylenol and Advil, which effectively treat the pain.
• Advil is a nonsteroidal anti-inflammatory that can be taken with the pain reliever Tylenol, which works in different ways.
• The mainstay of treatment is encouraging regular activity with stretching and exercise. (Michele Sterling, 2014)
• Physical therapy uses various range of motion exercises to strengthen the neck muscles and relieve the pain.
• Chiropractic adjustments and non-surgical decompression can help realign and nourish the spine.
• Acupuncture can cause the body to release natural hormones that provide pain relief, help relax the soft tissues, increase circulation, and reduce inflammation. The cervical spine can return to alignment when the soft tissues are no longer inflamed and spasming. (Tae-Woong Moon et al., 2014)

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

Medicine, J. H. (2024). Whiplash Injury. https://www.hopkinsmedicine.org/health/conditions-and-diseases/whiplash-injury

MedlinePlus. (2017). Neck Injuries and Disorders. Retrieved from https://medlineplus.gov/neckinjuriesanddisorders.html#cat_95

Sterling M. (2014). Physiotherapy management of whiplash-associated disorders (WAD). Journal of physiotherapy, 60(1), 5–12. https://doi.org/10.1016/j.jphys.2013.12.004

Tanaka, N., Atesok, K., Nakanishi, K., Kamei, N., Nakamae, T., Kotaka, S., & Adachi, N. (2018). Pathology and Treatment of Traumatic Cervical Spine Syndrome: Whiplash Injury. Advances in orthopedics, 2018, 4765050. https://doi.org/10.1155/2018/4765050

van Den Hauwe L, Sundgren PC, Flanders AE. (2020). Spinal Trauma and Spinal Cord Injury (SCI). In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the Brain, Head and Neck, Spine 2020–2023: Diagnostic Imaging [Internet]. Cham (CH): Springer; 2020. Chapter 19. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554330/ doi: 10.1007/978-3-030-38490-6_19

Moon, T. W., Posadzki, P., Choi, T. Y., Park, T. Y., Kim, H. J., Lee, M. S., & Ernst, E. (2014). Acupuncture for treating whiplash associated disorder: a systematic review of randomised clinical trials. Evidence-based complementary and alternative medicine : eCAM, 2014, 870271. https://doi.org/10.1155/2014/870271

For individuals experiencing lower back pain can understanding the anatomy and function of the multifidus muscle help in injury prevention and in the development of a highly effective treatment plan?

Multifidus Muscle

The multifidus muscles are long and narrow on either side of the spinal column, which helps stabilize the lower region of the spine or lumbar spine. (Maryse Fortin, Luciana Gazzi Macedo 2013) Sitting too much, practicing unhealthy postures, and lack of movement can progress to the multifidus muscle weakening or atrophy, which can lead to spinal instability, vertebral compression, and back pain. (Paul W. Hodges, Lieven Danneels 2019)

Anatomy

Known as the deep layer, it is the innermost layer of the three muscle layers of the back and controls the movement of the spine. The other two layers, known as the intrinsic and superficial, are responsible for the thoracic cage/rib cage and shoulder movement. (Anouk Agten et al., 2020) The multifidus has attachment points at:

• The thoracic spine of the middle back.
• The lumbar spine of the lower back.
• The iliac spine - the base of the wing-shaped iliac bone of the pelvis.
• Sacrum - series of bones at the base of the spine connected to the tailbone.
• When standing or moving, the multifidus muscle works with the transversus abdominus and pelvic floor muscles to stabilize the lumbar spine. (Christine Lynders 2019)

Muscle Function

The main function is to stabilize the lower back, but it also helps extend the lower spine whenever reaching or stretching. (Jennifer Padwal et al., 2020) Because the muscle has numerous attachment points and is serviced by a specific branch of nerves known as the posterior rami, it allows each vertebra to work individually and more efficiently.

• This protects against spinal deterioration and the development of arthritis. (Jeffrey J Hebert et al., 2015)
• The multifidus muscle works with two other deep muscle groups to stabilize and move the spine. (Jeffrey J Hebert et al., 2015)
• The rotatores muscle enables unilateral rotation, turning from side to side, and bilateral extension or bending backward and forward.
• The semispinalis muscle above the multifidus allows extension and rotation of the head, neck, and upper back.
• The multifidus muscle ensures spinal strength because it has more attachment points to the spine than the other layers, which reduces spinal flexibility and rotation but increases strength and stability. (Anouk Agten et al., 2020)

Lower Back Pain

A weak multifidus muscle destabilizes the spine and provides less support to the vertebra. This adds pressure on muscles and connective tissues between and adjacent to the spinal column, increasing the risk of lower back pain symptoms. (Paul W. Hodges, Lieven Danneels 2019) The loss of muscle strength and stability can cause atrophy or wasting away. This can cause compression and other back problems. (Paul W. Hodges et al., 2015) Back problems associated with multifidus muscle deterioration include (Paul W. Hodges, Lieven Danneels 2019)

• Herniated discs - also bulging or slipped discs.
• Nerve entrapment or compression pinched nerve.
• Sciatica
• Referred pain - nerve pain originating from the spine felt in other areas.
• Osteoarthritis - wear-and-tear arthritis
• Spinal osteophytes - bone spurs
• Weak abdominal or pelvic floor muscles can compromise the core, increasing the risk of chronic lower back pain and injury.

Individuals are recommended to consult a physical therapist and chiropractor who can help develop the appropriate treatment, rehabilitation, and strengthening plan based on age, injury, underlying conditions, and physical abilities.

Can Core Exercises Help with Back Pain?

General Disclaimer *

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

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

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

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Fortin, M., & Macedo, L. G. (2013). Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: a systematic review with a focus on blinding. Physical therapy, 93(7), 873–888. https://doi.org/10.2522/ptj.20120457

Hodges, P. W., & Danneels, L. (2019). Changes in Structure and Function of the Back Muscles in Low Back Pain: Different Time Points, Observations, and Mechanisms. The Journal of orthopedic and sports physical therapy, 49(6), 464–476. https://doi.org/10.2519/jospt.2019.8827

Agten, A., Stevens, S., Verbrugghe, J., Eijnde, B. O., Timmermans, A., & Vandenabeele, F. (2020). The lumbar multifidus is characterized by larger type I muscle fibers compared to the erector spinae. Anatomy & cell biology, 53(2), 143–150. https://doi.org/10.5115/acb.20.009

Lynders C. (2019). The Critical Role of Development of the Transversus Abdominis in Preventing and Treatment Low Back Pain. HSS journal: The Musculoskeletal Journal of Hospital for Special Surgery, 15(3), 214–220. https://doi.org/10.1007/s11420-019-09717-8

Padwal, J., Berry, D. B., Hubbard, J. C., Zlomislic, V., Allen, R. T., Garfin, S. R., Ward, S. R., & Shahidi, B. (2020). Regional differences between superficial and deep lumbar multifidus in patients with chronic lumbar spine pathology. BMC musculoskeletal disorders, 21(1), 764. https://doi.org/10.1186/s12891-020-03791-4

Hebert, J. J., Koppenhaver, S. L., Teyhen, D. S., Walker, B. F., & Fritz, J. M. (2015). The evaluation of lumbar multifidus muscle function via palpation: reliability and validity of a new clinical test. The Spine Journal: official North American Spine Society journal, 15(6), 1196–1202. https://doi.org/10.1016/j.spinee.2013.08.05

Hodges, P. W., James, G., Blomster, L., Hall, L., Schmid, A., Shu, C., Little, C., & Melrose, J. (2015). Multifidus Muscle Changes After Back Injury Are Characterized by Structural Remodeling of Muscle, Adipose and Connective Tissue, but Not Muscle Atrophy: Molecular and Morphological Evidence. Spine, 40(14), 1057–1071. https://doi.org/10.1097/BRS.0000000000000972