Adrenal Insufficiency Symptoms, Diagnosis and Treatments Part 1 | El Paso, Tx (2022)

In this episode an expert will take us through the assessment and treatment methods of Adrenal Dysfunction. Explaining the clinical significance of common dysfunctional cortisol diurnal patterns and more!

We are excited you are taking positive steps to learn about health challenges affecting you and your family. There is the power in making educated decisions about your health by gaining high-level science-based truth and knowledge. We work to uncover the root causes of health issues. Our unique health approach uses functional wellness principles to identify and treat health issues’ potential underlying causes.

Our care plans are base on Functional Medicine as a systems approach based on biology that focuses on identifying and addressing the root cause of disease. We focus on the paradigm that symptom or differential diagnosis may be one of many contributing factors to an individual’s illness.

This approach shifts from the traditional disease-centered focus of most medical practices to a more holistic person-centered approach.

Our discussions team includes Integrative Doctors, Functional Medicine Experts, Nutritionists, Health Coaches, Chiropractors, Physical Medicine Doctors, Therapists, and Exercise Performance Specialists.
We provide clinical insights, treatment options, and methods to achieve clinically sound, specific measured goals.*

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✅ Heart Disease & Inflammation*
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✅ Complex Lower Back Pain Recovery Plans
✅ Severe Sciatica Syndromes
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We present, bridge, and connect these various health programs, functional medicine protocols, fitness methods, injury recovery programs, and offer complete wellness packages.

To that end, we shed light and offer treatment options and bring a deep understanding of the real underlying causes of those suffering from acute and interconnected chronic degenerative disorders.

Ultimately, we empower you to achieve and maintain your personalized, healthy way of living by understanding the root causes of disorders.

It is all about.

LIVING, LOVING & MATTERING

Join us in improving your health.

Blessings,

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
email: coach@elpasofunctionalmedicine.com phone:
phone: 915-850-0900

Licensed in Texas & New Mexico*

Notice: Our information scope is limited to musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present talks and clinical collaboration with specialists from a wide array of disciplines. Each specialist in our events is governed by their professional scope of practice and their jurisdiction of licensure.

The information in these events is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice.

Our presentations are designed to share knowledge and information from Dr. Jimenez’s research, experience, and collaborative functional medicine community. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional.
We use and discuss functional health & wellness protocols to treat and support the musculoskeletal system’s care for injuries or disorders. Our events, webinars, posts, topics, subjects, and insights cover clinical matters, issues, and issues that relate and support, directly or indirectly, our clinical scope of practice.*

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Gabapentin Medication For Sciatica: The Sciatica Clinic

Dr. Alex Jimenez

shot-of-a-young-businesswoman-experiencing-back-pa-2022-10-07-20-25-22-utc_02 — Shot of a young businesswoman experiencing back pain while working at her desk in a modern office.

The spine consists of multiple vertebral bones separated by gel-like discs. The discs are the shock absorbers, cushioning the vertebrae. Normal wear and tear, underlying conditions, and injuries can cause the discs to crack, tear, and leak out, also known as a slipped or herniated disc, which is the most common cause of sciatica. In certain cases, physicians are using a medication that is used to control seizures known as gabapentin. Gabapentin is an anticonvulsant used to treat nerve-related back pain, like sciatica.

Table of Contents

First Line Medications

Doctors’ first-line medications for sciatica include anti-inflammatories/NSAIDs such as naproxen or ibuprofen and corticosteroids.
Back spasms can accompany sciatica, increasing the sensations and pain; a muscle relaxer could be added.
If these treatments do not provide adequate symptom relief, a combination of gabapentin, naproxen, ibuprofen (NSAIDs), corticosteroids, and Tylenol could be recommended.
Before going to bed is the recommended time for taking the meds because of the potential for drowsiness.
This allows the patient to be more comfortable and get better sleep.

Gabapentin

Gabapentin is a non-narcotic prescription medication that is part of the anticonvulsant family. FDA approved for the following:

Seizures

It can be used with other medications for controlling epileptic seizures.

Postherpetic Neuralgia

Painful blisters caused by reactivation of herpes zoster virus, aka shingles.

Off-label uses include:

Nerve Pain

Treats sharp burning nerve pain often experienced from:
Shingles outbreak
Diabetes
Spinal cord injury

Restless Legs Syndrome

Manages the various sensations commonly experienced with the condition.

Fibromyalgia

It can be effective in treating pain symptoms.

Brain Signals

Gabapentin alters the way the brain and body transmit signals. It works by blocking the pain-causing neurotransmitters to calm the pain signals to the nerves. This is why it is used for sciatica and neurogenic pain. Individuals dealing with nerve pain, numbness, and tingling in the legs from sciatica or have diabetic neuropathy benefit the most. It is not recommended for chronic, non-specific low back pain. Gabapentin may take up to a month to provide maximum relief; individuals may start to experience some relief within the first week. However, notify a physician if significant pain persists after using Tylenol, NSAIDs, corticosteroids, and gabapentin.

What To Expect

The medication is available in a capsule, tablet with immediate or extended release, and liquid form.
Starting dosage is 300mg once a day.
A physician may increase the dosage up to three times a day.
The medication needs to be taken as prescribed.
Treating neuropathic sciatic pain with gabapentin is standard practice.
This is an off-label usage meaning the FDA has not determined if the medication is safe and effective for sciatica.

Side Effects and Interactions

The most common side effects include:

Dizziness
Fatigue
Tremors

Due to these potential side effects, Individuals should not drive or operate heavy machinery while taking gabapentin.

Rare but more serious side effects can include:

Vision changes
Confusion
Trouble breathing
Behavioral changes or suicidal ideation
Swelling

In 2019, the FDA released a statement cautioning the elderly and those with significant breathing conditions, such as chronic obstructive pulmonary disease/COPD, to use extreme caution when taking gabapentin and similar medications. Elderly individuals are more likely to experience side effects due to age-related changes, decreased kidney function, poor balance, and mobility issues. There is an increased risk of experiencing breathing problems when taking gabapentin with any of the following:

Alcohol
Opioids
CNS/Central Nervous System depressants slow brain activity for sleep, anxiety, and panic disorders.

The consumption of alcohol, opioids, or CNS depressants while taking gabapentin can increase the sedating effects of each substance and lead to respiratory depression. It is imperative that your physician knows all prescription and non-prescription medications, herbal supplements, and vitamins to prevent negative interactions between medications.

Does Gabapentin Work?

References

Center for Drug Evaluation and Research. (n.d.). Serious breathing difficulties with gabapentin and pregabalin. U.S. Food and Drug Administration. Retrieved September 30, 2022, from www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-serious-breathing-problems-seizure-and-nerve-pain-medicines-gabapentin-neurontin

Grice, Gloria R, and Marsha K Mertens. “Gabapentin as a potential option for treatment of sciatica.” Pharmacotherapy vol. 28,3 (2008): 397-402. doi:10.1592/phco.28.3.397

U.S. Department of Health and Human Services. (2022, March 22). Prescription CNS depressants DrugFacts. National Institutes of Health. Retrieved September 30, 2022, from nida.nih.gov/publications/drugfacts/prescription-cns-depressants

U.S. National Library of Medicine. (n.d.). Gabapentin: Medlineplus drug information. MedlinePlus. Retrieved September 30, 2022, from medlineplus.gov/druginfo/meds/a694007.html

U.S. National Library of Medicine. (n.d.). Pregabalin: Medlineplus drug information. MedlinePlus. Retrieved September 30, 2022, from medlineplus.gov/druginfo/meds/a605045.html

Yasaei R, Katta S, Saadabadi A. Gabapentin. [Updated 2022 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK493228/

Pain In Your Adductor Muscles? Could Be Myofascial Trigger Points

Dr. Alex Jimenez

Table of Contents

Introduction

The hips and thighs have a working relationship as their jobs are to maintain stability for the legs and pelvis while supporting the upper body’s weight. These two body groups have various muscles, tendons, and nerves that have specific jobs that allow mobility to the lower body. Many athletes in multiple sports events use their thighs to exert a huge amount of power to be the best. This is due to the adductor muscles in the thighs that allow the athlete to win the event. These adductor muscles are voluminous in size and can become overstretched if the muscles have been worked out too much or injuries have caused dysfunction in the surrounding muscles, causing mobility issues. To that point, the adductor muscles will develop myofascial trigger points and cause hip and thigh pain. Today’s article looks at the two adductor muscles (Longus and Magnus), how myofascial trigger points affect the adductor muscles, and available treatments to manage hip adductor trigger points. We refer patients to certified providers who incorporate multiple methods in the lower body extremities, like thigh and hip pain treatments correlating to myofascial trigger point pain, to aid individuals dealing with pain symptoms along the adductor muscles. We encourage and appreciate patients by referring them to associated medical providers based on their diagnosis, especially when appropriate. We understand that education is an excellent solution to asking our providers complex questions at the patient’s request. Dr. Jimenez, D.C., utilizes this information as an educational service only. Disclaimer

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Adductor Longus & Adductor Magnus

Have you been dealing with groin pain located near your thighs? Do you feel muscle tenderness or stiffness when stretching your inner thighs? Or have you been feeling unstable in your hips or thighs when walking? Many individuals, especially athletes and older adults, could be experiencing myofascial trigger points associated with groin pain along their adductor muscles. The thighs contain several muscles and functions that allow many people to bend and extend their knees and hips. The adductor muscles allow the legs to move inward toward one another. The adductor muscles have five muscles: magnus, brevi, longus, pectineus, and gracilis. These muscles enable functionality to the thighs and hips, and we will look at two adductor muscles in the inner thighs. The long adductor muscle is a large, fan-shaped muscle that starts from the superior aspect of the pubis bone and travels down to connect at the thigh bone. Studies reveal that the adductor longus is a long and thin muscle with many actions for the thighs, including external/lateral rotation and thigh flexion.

Now the adductor Magnus is a large triangular-shaped muscle of the inner thighs that are important for thigh and hip function and stabilizing the pelvis. Studies reveal that even though the adductor Magnus is a large muscle in the inner thighs, its primary function is to allow the thigh to move in a larger range of motion without any pain inflicted on the thigh muscles. However, the adductor muscle can succumb to various issues affecting the thighs and groin regions of the body that can be overstretched and strain the body.

Myofascial Trigger Points Affecting The Adductor Muscles

Groin pain is a multi-factorial pain issue that affects the lower limbs, and its often due to muscle strain in the inner thigh muscles. This pain increases during vigorous activities and when there is a sudden twist in the hips. When the adductor muscles suddenly change in motion when the body is active, they can be overstretched and correlate to myofascial trigger points that can affect the inner thigh and groin regions. According to “Myofascial Pain and Dysfunction,” by Dr. Travell, M.D., patients with active myofascial trigger points in the two adductor muscles (Longus and Magnus) would become frequently aware of the pain in their groin and medial thigh. When the adductor muscles have myofascial trigger points in the inner thigh, diagnosing is difficult since the individual thinks they are suffering from groin pain when the pain is in their inner thighs. To that point, studies reveal that many individuals participating in various sports would suffer from groin pain due to myofascial trigger points affecting the adductor muscles. Luckily, there are multiple treatments to reduce the pain in the adductor muscles.

Hip Adductors: Trigger Point Anatomy- Video

Have you been dealing with groin pain when you are walking? What about experiencing unquestionable thigh pain that affects your daily activities? Or does stretching your inner thigh muscles seem difficult, causing muscle tenderness? Many of these symptoms correlate with groin pain associated with myofascial trigger points affecting the adductor muscles in the inner thighs. The adductor muscles allow mobility function to the thighs and enable the hips to have a wide range of motion. When the adductor muscles are overstretched due to a sudden change of hip rotation or injury has occurred on the thighs can lead to referred pain in the groin and inner thighs and develop myofascial trigger points. The video above shows where the trigger points are located in the hip adductor muscles. The video also explains where the pain is localized in the adductor muscles and the symptoms it produces that can affect the lower body extremities. Fortunately, even though diagnosing myofascial trigger points are a bit challenging, available treatments can manage trigger points along the hip adductors.

Available Treatments To Manage Hip Adductor Trigger Points

When myofascial trigger points affect the hip adductor muscles, many individuals complain about stiffness in their inner thighs and how they feel miserable when they don’t have mobility from their thighs and hips. As stated earlier, trigger points are a bit challenging when diagnosed, but they are treatable when doctors examine patients dealing with myofascial pain in their hips and thigh muscles. Once the diagnosis is complete, doctors work with pain specialists who can locate the trigger points and devise a treatment plan to relieve the pain. Available treatments like trigger point injections can minimize the pain and reduce the chances of trigger points returning. Other available therapies like exercising or stretching, especially for the hips and thighs. Specific exercises for the hips and thigh muscles can help strengthen the adductor muscles from suffering pain and can help reduce the pain symptoms. Another treatment is applying moist heat on the hip adductor muscles to release the tension from the tight muscles and allow mobility back to the hip adductors.

Conclusion

The adductor muscles work with the hips and thighs to allow a wide range of motions and extension to the knees and hips. The hips and the thighs allow stability to the lower body and support the weight to the upper body. When injuries or sudden changes start to affect the adductor muscles, it can lead to symptoms of groin pain associated with myofascial trigger points. Myofascial trigger points produce tiny nodules in the affected muscle that causes referred pain to the muscle group. When this happens, it causes the body to be dysfunctional and can affect a person’s mobility to function in the world. Luckily myofascial trigger points are treatable through various techniques and treatments that can reduce the chances of trigger points from re-occurring in the body.

References

Jeno, Susan H, and Gary S Schindler. “Anatomy, Bony Pelvis and Lower Limb, Thigh Adductor Magnus Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 1 Aug. 2022, www.ncbi.nlm.nih.gov/books/NBK534842/.

Sedaghati, Parisa, et al. “Review of Sport-Induced Groin Injuries.” Trauma Monthly, Kowsar, Dec. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3864393/.

Shahid, Shahab. “Adductor Longus Muscle.” Kenhub, Kenhub, 30 June 2022, www.kenhub.com/en/library/anatomy/adductor-longus-muscle.

Simons, D. G., and L. S. Simons. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.

Takizawa, M, et al. “Why Adductor Magnus Muscle Is Large: The Function Based on Muscle Morphology in Cadavers.” Scandinavian Journal of Medicine & Science in Sports, U.S. National Library of Medicine, 27 Apr. 2012, pubmed.ncbi.nlm.nih.gov/22537037/.

van de Kimmenade, R J L L, et al. “A Rare Case of Adductor Longus Muscle Rupture.” Case Reports in Orthopedics, Hindawi Publishing Corporation, 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4397006/.

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Sciatica Foot and Ankle Issues: Sciatica Clinic

Dr. Alex Jimenez

Doctor performing shockwave therapy procedure in clinic — Close up of physiotherapist in sterile gloves using pain relief device while performing physiotherapy procedure on woman foot

It didn’t happen at work, school, or exercise, and there haven’t been any trips and/or falls, but you can’t pinpoint what is causing foot and ankle discomfort and sensations. However, the cause could be originating in the lumbar spinal region. Sciatica is a set of symptoms that refer to pain, numbness, and tingling radiating down the leg from the lower back, affecting the legs, hips, buttocks, and feet. Injury Medical Chiropractic and Functional Medicine Clinic can release the compressed nerve, massage circulation back into the nerve, and restore mobility and function.

Table of Contents

Sciatica Foot and Ankle

Sciatic nerve sensations can run down the back of the leg down into the foot.

Compression or irritation to any nerve roots can present with symptoms in the hip, thigh, calf, and foot.
Sciatica foot and ankle symptoms can accompany numbness and muscle weakness.
Sciatic nerve irritation mostly causes symptoms on the outside of the foot but can spread to other areas.

Nerve Roots

One or more of the lower spine’s sciatic nerve roots are being compressed or pinched. The foot symptoms location depends on which nerve root is affected.

If the S1 root is affected, symptoms will radiate to the sole and side of the foot.
If L5 is affected, symptoms will radiate to the top of the foot and the big toe.
If the L4 root is affected, symptoms can radiate to the medial or inside the ankle area.

Chiropractic Care and Relief

Foot Massage

A foot massage can be helpful.

A massage therapist finds points around the ankles that are tender.
Tenderness indicates a lymphatic blockage or muscle tension that needs to be worked out.
They will apply varying pressures to massage the muscles and get the circulation flowing.
The therapist will loosen the tarsal and metatarsal bones to loosen the muscles and nerves.
Moving the bones resupplies the joints, forces out inflammatory metabolic waste, opens the space for the nerves, and allows improved lymphatic drainage and blood flow to expedite healing.

Nerve Flossing

Nerve flossing exercises can help stretch and maintain the released nerve.

A chiropractor will perform and train the individual on targeted stretches to the Achilles tendon and plantar fascia.
They will stretch, release, and open the ankle and sciatic nerve.

Injections

A cortisone injection where the nerve is affected can help in certain cases.

Injections of a corticosteroid, an anti-inflammatory medicine, can offer relief for up to three months and are given under local anesthesia.
The medicine reduces the inflammation and swelling around the nerve roots.

Foot Orthotics

Custom foot orthotics can help support a postural foot or ankle problem.
Overpronation is when the ankles collapse inward, which creates an imbalance of leg lengths that affects the hips, pelvis, and spine.
Orthotics can help provide symptom relief.

Nutrition

Part of a treatment plan will include an anti-inflammatory and antioxidant nutritional plan.

A professional nutritionist will make recommendations based on the individual’s case.
Magnesium-rich foods are generally recommended for sciatica as this nutrient aids the body in releasing muscle contractions.
99 percent of the body’s magnesium is stored in the bones, muscles, and soft tissues, with only 1 percent concentrated in the blood.

Foods rich in magnesium include:

Avocado
Bananas
Apricots
Dried pumpkin seeds
Dairy
Dark chocolate
Dried figs
Black beans
Brown rice
Fish
Spinach
Swiss chard
Yogurt

Benefits of Custom Foot Orthotics

References

Davis, David, et al. “Sciatica.” StatPearls, StatPearls Publishing, 6 May 2022.

Ge, Phillip S et al. “Iatrogenic pseudoaneurysm of the superior gluteal artery presenting as pelvic mass with foot drop and sciatica: case report and review of the literature.” Vascular and endovascular surgery vol. 44,1 (2010): 64-8. doi:10.1177/1538574409351990

Hughes, Michael S et al. “Post-traumatic catamenial sciatica.” Orthopedics vol. 31,4 (2008): 400. doi:10.3928/01477447-20080401-15

Mayo Clinic. “Sciatica.” www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435?p=1

National Institutes of Health. “Sciatica.” medlineplus.gov/sciatica.html

Pan, Hung-Chuan, et al. “Magnesium supplement promotes sciatic nerve regeneration and down-regulates inflammatory response.” Magnesium research vol. 24,2 (2011): 54-70. doi:10.1684/mrh.2011.0280

Myofascial Pain Syndrome Affecting The Quadriceps Femoris

Dr. Alex Jimenez

Table of Contents

Introduction

The hips and the thighs have an established relationship where mobility and stability play a part in the body’s lower extremities. The lower extremities’ main job is to support the upper body’s weight while stabilizing the hips and allowing movement from the thighs to the legs and feet. When it comes to the thighs in the lower body, the various muscle surrounds the thighs and skeletal joints to allow the legs to move from one place to another. One of the muscle groups in the thighs is known as the quadriceps femoris. This muscle group is activated when a person is in motion and can succumb to injuries from trauma or normal factors. When this happens, issues like myofascial pain syndrome can affect the thigh muscle and cause referred pain to travel to the knees. Today’s article focuses on the quadriceps femoris, how myofascial pain syndrome is associated with thigh pain, and trigger point therapy on the quadriceps. We refer patients to certified providers who incorporate multiple methods in the lower body extremities, like thigh and hip pain treatments correlating to myofascial pain, to aid individuals dealing with pain symptoms along the quadriceps for muscle. We encourage and appreciate patients by referring them to associated medical providers based on their diagnosis, especially when appropriate. We understand that education is an excellent solution to asking our providers complex questions at the patient’s request. Dr. Jimenez, D.C., utilizes this information as an educational service only. Disclaimer

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What Are The Quadriceps Femoris?

Have you been dealing with knee issues when you are walking? What about muscle tenderness or soreness in your thighs? Or have you been experiencing knee complaints when you are running? These areas of complaint are correlated with trigger points associated with thigh pain along the quadriceps femoris. As one of the most voluminous muscles in the human body, the quadriceps femoris is a group of muscles predominant in the thighs and is extraordinarily important. This muscle group is essential for daily activities like climbing the stairs or getting up from a seated position, allowing repercussions on the knees and hip joints. The quadriceps femoris consist of four thigh muscles to allow extension to the knees:

Vatus medialis
Vatus lateralis
Vatus intermedius
Rectus femoris

Studies reveal that these four different muscles fuse to form the quadricep tendon and stabilize the patella and thigh flexion at the hips and knee extension. This muscle group is highly important for athletes participating in sports events but can succumb to injuries through muscle strain.

Myofascial Pain Syndrome Associated With Tigh Pain

When the thigh muscles, especially the quadriceps femoris, can be overstretched and overused when in motion. Thigh pain is nothing to be alarmed about in its acute form; however, it can develop small nodules along the four muscle fibers that can cause referred pain to the hips and knees. To that point, it can correlate through quadriceps muscle strain to the thighs. Studies reveal that normal factors like kicking, jumping, or a sudden change of direction of running can potentially cause the muscle fibers to be overstretched and develop pain due to localized swelling corresponding to loss of motion from myofascial pain syndrome.

In “Myofascial Pain and Dysfunction,” written by Dr. Janet G. Travell, M.D., the book states that myofascial pain syndrome can invoke referred pain to the affected muscle or muscle group, causing the body to be dysfunctional. Myofascial pain syndrome associated with thigh pain can be managed through various treatments and could allow mobility back to the thighs, legs, knees, and hips. The book even mentions how the four muscles in the quadriceps femoris cause different pain issues in various body parts due to myofascial pain syndrome. For the rectus femoris, many people would complain about knee pain and weakness when climbing stairs. The vatus medialis would initially produce a toothache-like pain deep within the knee joint, often misinterpreted as joint inflammation. The vatus intermedius causes many individuals to have difficulty fully straightening their knees and causes them to develop buckling knee syndrome. And finally, the vatus lateralis could cause many individuals to complain about feeling pain when walking and that the pain is being distributed on the lateral aspect of the thigh, including the knees.

Trigger Point Therapy: Stretching The Quadriceps- Video

Have you been dealing with pain in your thighs and knees? Do you find it difficult to climb up or down the stairs? Or have you been experiencing inflammation in your knee joints? All these symptoms that you are experiencing in your thighs, knees, and hips correlate with trigger points created by myofascial pain syndrome affecting the quadriceps femoris. The quadriceps femoris is a voluminous group of muscles that allows the individual to do daily activities like climbing up or down the stairs, running, jumping, and getting up from a seated position. When various issues can cause the quadricep femoris to become overstretched and overused, it could develop myofascial pain syndrome/trigger points along the muscle fibers to mimic knee pain and cause dysfunction in knee mobility. Even though myofascial pain syndrome is poorly diagnosed, individuals can manage it through various treatments that target myofascial trigger pain. The video above explains where the quadriceps femoris muscles are located on the thigh and where the trigger points are in the muscle fibers. The video also provides various stretching techniques on the quadriceps to reduce pain-like symptoms along the thighs.

Trigger Point Therapy On The Quadriceps

When it comes to releasing myofascial pain syndrome on the quadriceps, treatments like dry needling, acupuncture, or manual stretching can help loosen and lengthen the quadricep muscles from becoming shorten and can reduce myofascial trigger points from causing more issues on the knees and thighs. At the same time, treatment alone can only go so far in rehabilitation unless the person dealing with myofascial pains syndrome associated with thigh pain do some corrective actions to prevent trigger points from reproducing on the quads. Actions like:

Avoid prolonged sitting
Stretching the quads as part of your warm-up
Sleeping with a pillow between the knees

These actions allow the quadriceps to relax and prevent pain-like issues from affecting the knees. To that point, these actions can help many individuals have mobility back to their legs and allow them to bend their knees without feeling pain.

Conclusion

The quadriceps femoris consists of four thigh muscles that fuse to enable mobility functions in the knees without pain. As the most voluminous muscle group in the body, the quadriceps femoris allows the thighs to function when in motion and allow the knees to extend. When various issues cause the quadriceps femoris muscles to be overstretched, it can develop trigger points/myofascial pain syndrome that mimics knee pain and can affect how a person is walking. Thankfully, various treatments specializing in myofascial pain syndrome can reduce the pain symptoms from the quadriceps femoris and bring back knee mobility to the legs.

References

Bordoni, Bruno, and Matthew Varacallo. “Anatomy, Bony Pelvis and Lower Limb, Thigh Quadriceps Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 10 May 2022, www.ncbi.nlm.nih.gov/books/NBK513334/.

Kary, Joel M. “Diagnosis and Management of Quadriceps Strains and Contusions.” Current Reviews in Musculoskeletal Medicine, Humana Press Inc, 30 July 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC2941577/.

Rozenfeld, Evgeni, et al. “The Prevalence of Myofascial Trigger Points in Hip and Thigh Areas in Anterior Knee Pain Patients.” Journal of Bodywork and Movement Therapies, U.S. National Library of Medicine, 14 May 2019, pubmed.ncbi.nlm.nih.gov/31987560/.

Simons, D. G., and L. S. Simons. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.

Waligora, Andrew C, et al. “Clinical Anatomy of the Quadriceps Femoris and Extensor Apparatus of the Knee.” Clinical Orthopaedics and Related Research, Springer-Verlag, Dec. 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC2772911/.

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HORMONAL DYSFUNCTIONS Assessment and treatments | El Paso, Tx (2022)

Dr. Alex Jimenez

In this episode an expert will take us on the path of understanding Hormone Dysfunction, its assessment and treatments. He will also define the foundational PTSD Strategy steps to address hormone dysfunctions and more! Stay tuned for more episodes of this educational presentations.

We are excited you are taking positive steps to learn about health challenges affecting you and your family. There is the power in making educated decisions about your health by gaining high-level science-based truth and knowledge. We work to uncover the root causes of health issues. Our unique health approach uses functional wellness principles to identify and treat health issues’ potential underlying causes.

Our care plans are base on Functional Medicine as a systems approach based on biology that focuses on identifying and addressing the root cause of disease. We focus on the paradigm that symptom or differential diagnosis may be one of many contributing factors to an individual’s illness.

This approach shifts from the traditional disease-centered focus of most medical practices to a more holistic person-centered approach.

Our discussions team includes Integrative Doctors, Functional Medicine Experts, Nutritionists, Health Coaches, Chiropractors, Physical Medicine Doctors, Therapists, and Exercise Performance Specialists.
We provide clinical insights, treatment options, and methods to achieve clinically sound, specific measured goals.*

Functional & Integrative Health Live Events *

✅ Stress Hormones & Health
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✅ Weight Loss
✅ Body Composition Analysis
✅ Thyroid Dysfunction*
✅ Autoimmune Disorder*
✅ Heart Disease & Inflammation*
✅ Agility & Mobility
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✅ Complex Lower Back Pain Recovery Plans
✅ Severe Sciatica Syndromes
✅ Other Complex Health Challenges
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✅ Nutrigenomics, Proteomics, Metabalomics
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We present, bridge, and connect these various health programs, functional medicine protocols, fitness methods, injury recovery programs, and offer complete wellness packages.

To that end, we shed light and offer treatment options and bring a deep understanding of the real underlying causes of those suffering from acute and interconnected chronic degenerative disorders.

Ultimately, we empower you to achieve and maintain your personalized, healthy way of living by understanding the root causes of disorders.

It is all about.

LIVING, LOVING & MATTERING

Join us in improving your health.

Blessings,

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
email: coach@elpasofunctionalmedicine.com phone:
phone: 915-850-0900

Licensed in Texas & New Mexico*

Notice: Our information scope is limited to musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present talks and clinical collaboration with specialists from a wide array of disciplines. Each specialist in our events is governed by their professional scope of practice and their jurisdiction of licensure.

The information in these events is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice.

Our presentations are designed to share knowledge and information from Dr. Jimenez’s research, experience, and collaborative functional medicine community. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional.
We use and discuss functional health & wellness protocols to treat and support the musculoskeletal system’s care for injuries or disorders. Our events, webinars, posts, topics, subjects, and insights cover clinical matters, issues, and issues that relate and support, directly or indirectly, our clinical scope of practice.*

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Sugar Consumption Thickens Fascia: Sciatica Clinic

Dr. Alex Jimenez

Young beautiful woman with curly hair standing in modern kitchen taking support of counter holding her abdomen hard after suffering for pain and discomfort along with cramps in stomach

The fascia is important for connecting the musculoskeletal system, stabilizing function, and keeping the body healthy and balanced. Sugar consumption and the abundance of sugar in the body that doesn’t get burned directly negatively affect the fascia, making it lose its elasticity and affecting other connective tissues. Excess sugar in the blood leads to a pathological process called glycation. One effect of glycation is binding sugar molecules to fascial proteins, causing them to thicken and stiffen. The body sees the tangled molecules as foreign bodies initiating an inflammatory response to get rid of them. This can lead to chronic inflammation causing various symptoms. The Injury Medical Chiropractic and Functional Medicine Clinic Team will address soreness, pain, and discomfort associated with fascia problems.

Table of Contents

Myofascial Tissue

Myofascia or fascia is a layer of tissue that connects and supports the spine and muscles. It wraps and links internal body parts in bands, fusing them. This ensures the muscles can move freely without experiencing friction with other body parts.

Fascia is made of collagen, creating a tough and flexible texture that provides tension and elasticity.
Fascia is found around muscles, nerves, blood vessels, blood and cells, organs, and bones.

When the body stays or moves in repetitive patterns, the fascia can memorize certain positions/postures and hold the fascia in a contracted state. For example, sitting at a desk workstation causes the gluteal muscles, tendons, and ligaments to stretch and pull the muscles around them. The gluteal muscles can become restricted without releasing and training the fascia to return to a retracted position, causing tension and myofascial discomfort. When the body is in balance/homeostasis, and the fascia is healthy:

The viscoelastic gel flows without restriction in all directions.
The collagen fiber network moves freely.
Lymph and blood circulation flow correctly.
Communication between cells, the nervous system, and all tissues in the body work correctly.

In the event of an injury and activation of the healing process, specific components interact with cells to create the condition for healing and generate inflammation, allowing new cells to easily move and heal the tissue. An obstruction in the circulation increases pressure where the fluid sits stationary, preventing tissue communication. Sometimes the healing process doesn’t stop, and the inflammation response worsens and can become chronic.

Sugar Consumption

Many think of sugar as candy, sweets, chocolates, and desserts. However, all carbohydrates are sugar, and eating too much bread, pasta, grains, fruit, and cereals, contributes to a lot more sugar consumption.

Foods believed to be healthy such as wholemeal bread, low-fat alternatives, and granola cereal, have high amounts of sugar.
The connective tissues need collagen for the smooth functioning of joints.
High blood sugar exacerbates aches and pains and can lead to impaired joint movement and, eventually, arthritis.

Fascia Problems

Impaired flow and mobility
Fascia that has thickened and hardened impairs gliding ability.
The body feels heavy and sluggish.
Pain symptoms
Edema
Poor balance
In places where the body has become stiff and numb, the nervous system can’t transmit signals as quickly to control movements.
Muscles can constantly twitch or go into convulsions from misinterpreted signals.
A tight connective tissue chain can distort the skeleton causing the joints to wear faster.

Chiropractic Myofascial Massage Release

Chiropractic myofascial massage and release provides several benefits to the body’s health and well-being, including:

Relieves the overall effects of stress on the body.
Relieves soreness and pain.
Increases blood and lymph circulation.
Improves tissue recovery.
Improves joint range of motion.
Restores proper-length-tension relationships for dynamic movement.
Maintains normal functional muscular length.
Improves neuromuscular function.

Nutritional Guidelines Fascial Health

References

Barros-Neto, João Araújo et al. “Selenium and Zinc Status in Chronic Myofascial Pain: Serum and Erythrocyte Concentrations and Food Intake.” PloS one vol. 11,10 e0164302. 18 Oct. 2016, doi:10.1371/journal.pone.0164302

Dong, Shoubin, et al. “A three-dimensional collagen-fiber network model of the extracellular matrix for the simulation of the mechanical behaviors and microstructures.” Computer methods in biomechanics and biomedical engineering vol. 20,9 (2017): 991-1003. doi:10.1080/10255842.2017.1321113

Mattei, Giorgio et al. “Engineering Gels with Time-Evolving Viscoelasticity.” Materials (Basel, Switzerland) vol. 13,2 438. 16 Jan. 2020, doi:10.3390/ma13020438

Okumus, M et al. “The relationship between serum trace elements, vitamin B12, folic acid and clinical parameters in patients with myofascial pain syndrome.” Journal of back and musculoskeletal rehabilitation vol. 23,4 (2010): 187-91. doi:10.3233/BMR-2010-0264

Vlassara, Helen, and Jaime Uribarri. “Advanced glycation end products (AGE) and diabetes: cause, effect, or both?.” Current diabetes reports vol. 14,1 (2014): 453. doi:10.1007/s11892-013-0453-1

Inner Thigh Pain Associated With Trigger Points

Dr. Alex Jimenez

Table of Contents

Introduction

When many individuals begin to work out or start training for an event, they incorporate various muscles to give optimal output and strength when doing a set of exercises. Many athletes or individuals trying to train for an event or to better themselves have to do a pre-workout routine involving various stretches to warm up the muscles before the actual workout and do stretches post-workout again. This ensures that the muscles are ready to give it their all when a person is working out. The body has various parts with different functions and jobs that help the body’s motor function. The upper body has the shoulders, arms, hands, elbows, neck, head, and chest to allow movements and stability. At the same time, the lower body has the hips, low back, thighs, legs, knees, pelvis, and feet to support the upper body’s weight and stabilize the lower extremities from collapsing. When various factors affect the body, it can lead to dysfunction and causes referred pain to different body locations that can mask chronic conditions. Today’s article looks at one of the lower body muscles located at the inner thighs, known as the pectineus muscle, how trigger point pain affects the inner thighs, and various stretches to strengthen the hip adductors. We refer patients to certified providers who incorporate multiple methods in the lower body extremities, like thigh and hip pain treatments correlating to trigger point pain, to aid individuals dealing with pain symptoms along the pectineus muscle. We encourage and appreciate patients by referring them to associated medical providers based on their diagnosis, especially when appropriate. We understand that education is an excellent solution to asking our providers complex questions at the patient’s request. Dr. Jimenez, D.C., utilizes this information as an educational service only. Disclaimer

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What Is The Pectineus Muscle?

Have you been experiencing pain in your inner thighs? Do you find it difficult to play various sports? Do you feel tenderness or soreness in your thighs or near your groin? Most of these symptoms are associated with trigger point pain along the pectineus muscles that affect the thighs. The pectineus is part of the anterior thigh muscles that extend the leg to the knee joint. The pectineus works with another muscle known as the sartorius and a muscle group known as the quadriceps femoris. The pectineus muscle is responsible for flexion, adduction, and medial rotation since it is a hip adductor for the thighs. This muscle is important for various sports activities like running, skating, soccer, or basketball and can become overused due to overstretching the legs too far, thus developing trigger points in the pectineus muscle.

Trigger Point Pain Affecting The Inner Thighs

When athletes overuse their legs and overstretch the pectineus muscle, it can cause issues with the thighs, hips, and legs’ mobility causing referred pain to the lower body. This is known as trigger point pain and can be challenging when diagnosing where the pain is located. Studies reveal that trigger point pain affecting the inner thighs, especially the pectineus muscle, can mimic groin and hip pain, causing various symptoms in the lower extremities. The multiple symptoms can include:

Weak adductor muscles
Muscle fatigue
Decreased range of motion
Leg-length discrepancy

Various reasons can lead to the development of trigger point pain associated with the inner thighs along the pectineus; according to “Myofascial Pain and Dysfunction,” written by Dr. Janet G. Travell, M.D., stated that when patients are dealing with pectineus trigger points would complain about the referred pain surrounding the muscle but not the muscle itself. The book also mentioned that nerve entrapment could also be an issue since trigger points like to mimic other chronic conditions. Trigger points along the pectineus muscle can also develop associated with hip joint diseases like advanced osteoarthritis.

Treating Trigger Points In Hip Adductors- Video

Treating Trigger Points in the Hip Adductors

Are you experiencing issues when moving around constantly? Do you experience pain in your inner thighs and hips? Or do you have difficulty rotating your thighs or hips? If you have been dealing with these issues throughout your entire life, it could be due to your pectineus muscles being affected by trigger points along your inner thighs. Trigger points (myofascial pain syndrome) develop tiny nodules along the muscle fibers, causing referred pain to the surrounding muscles that can cause dysfunction in the lower extremities. Studies reveal that myofascial trigger points can cause the affected muscles to be intensely sensitive and irritable, predominantly near the reflex muscle. To that point, it causes hip and thigh disability in the lower body. Fortunately, there are ways to reduce the pain and manage the trigger point pain along the pectineus muscle, as shown in the video above. The hip adductor muscles are being stretched and treated for trigger point pain and allowing mobility back to the hips and inner thighs.

Various Stretches To Strengthen Hip Adductor

Since the pectineus muscle is part of the hip adductor muscles, various stretches can reduce the chances of trigger points from future development while minimizing the pain that it is causing along the surrounding muscles. Studies reveal that multiple exercises and stretches for the pectineus muscle can help with hip flexion and stabilization. These stretches can help stretch and strengthen the hip adductor muscles while preventing groin pain associated with trigger points. Incorporating these stretches before and after a workout can reduce trigger points and allow hip mobility and thigh rotation back to the legs. This ensures that the trigger points along the pectineus muscle are managed, and the individual doesn’t have to suffer from referred pain issues on the thighs and can move around without pain.

Conclusion

As part of the hip adductor muscles, the pectineus is a small muscle that extends the leg to the knees and allows the thighs to flex, adduct, and rotate without pain. This muscle is important for many athletes participating in sports and can be easily overstretched to cause referred pain around the thighs. To that point, it can develop trigger points along the pectineus muscles can correlate to groin pain in the lower extremities. All is not lost, as various stretches and exercises can strengthen the hip adductor muscles and improve thigh and hip mobility. This allows athletes and individuals to continue playing the sport they enjoy.

References

Giphart, J Erik, et al. “Recruitment and Activity of the Pectineus and Piriformis Muscles during Hip Rehabilitation Exercises: An Electromyography Study.” The American Journal of Sports Medicine, U.S. National Library of Medicine, July 2012, pubmed.ncbi.nlm.nih.gov/22523373/.

Khan, Ayesha, and Abdul Arain. “Anatomy, Bony Pelvis and Lower Limb, Anterior Thigh Muscles.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 10 June 2022, www.ncbi.nlm.nih.gov/books/NBK538425/.

Kiel, John, and Kimberly Kaiser. “Adductor Strain.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 21 June 2022, www.ncbi.nlm.nih.gov/books/NBK493166/.

Simons, D. G., and L. S. Simons. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.

Wada, Juliano T, et al. “An Anatomical Basis for the Myofascial Trigger Points of the Abductor Hallucis Muscle.” BioMed Research International, Hindawi, 22 Jan. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC6998759/.

Disclaimer

Biologics For Ankylosing Spondylitis: Sciatica Clinic

Dr. Alex Jimenez

Woman collecting blood samples for testing on different diseases, modern laboratory, copy space

Ankylosing spondylitis is an inflammatory condition that causes pain and stiffness in the spine’s joints. Over time, it can progress to fusing the bones of the spine/vertebrae, limiting the spine’s mobility and leading to discomfort symptoms. The condition is more common in men but also affects women. There is not a known, singular cause, but individuals with a particular gene, HLA-B27, have an increased risk of developing the condition. However, the gene itself does not mean an individual has ankylosing spondylitis; genetics and other outside and environmental factors also play a role. DMARDs, or Disease-Modifying Antirheumatic Drugs, suppress inflammation. An emerging DMARD treatment uses biologics that further target and suppresses specific inflammatory compounds.

Table of Contents

Biologics

Unlike regular medications, which are synthesized, biologics are made from and inside living sources.

They are grown in cultures or harvested from blood.
Biologics are complex and expensive.
Biologics provide some of the most powerful treatments for many conditions.
Two biologics commonly used to treat ankylosing spondylitis are:
TNF inhibitors.
IL-17 inhibitors.

TNF Inhibitors

TNF – tumor necrosis factor, TNF inhibitors are a biological medication that targets and suppresses TNF, which is involved in inflammatory processes throughout the body.
Blocking or suppressing TNF decreases inflammation and can delay the progression of ankylosing spondylitis.
It could be administered through an injection or infusion to provide the medication.

Side Effects

Side effects associated with this medication, along with other conditions, include:

Skin irritation – rashes or infections
Heart failure
Lupus
Lymphoma
Disorders that target the neurological system are known as demyelinating disorders. These can include conditions such as:
Multiple sclerosis
Guillain-Barré Syndrome

IL-17 Inhibitors

IL – interleukin – IL-17 is a protein involved in inflammatory processes and conditions.
IL-17 inhibitors suppress inflammation which are newer medications that have been shown to benefit those with ankylosing spondylitis.
Doctors often administer IL-17 inhibitors through an injection.

Side Effects

Minor side effects include:

Headaches
Runny nose
Irritation at the injection site.

More serious side effects include:

Certain cancers
Severe infections
High blood pressure

Other Treatments

Treatment goals for ankylosing spondylitis include:

Slowing the disorder’s progression.
Decreasing inflammation.
Reducing pain.
Improving or maintaining joint and spinal range of motion.

Biologics are not the first-line treatment for ankylosing spondylitis.

Providers usually first treat an initial diagnosis with anti-inflammatory medications, like NSAIDs, to decrease inflammation and slow the condition’s progression.
Chiropractic care and physical therapy are recommended to maintain and/or improve posture, muscle strength, and endurance.
Recommended lifestyle and nutritional modifications.
Posture training stretches and exercises.
Optimal movement strategies to safely and confidently complete everyday tasks.

Biologic Medications

Biologics for ankylosing spondylitis may or may not be suitable. These medications are meant to help relieve the inflammation associated with the condition and slow the disorder’s progression. Your healthcare team will work with you to determine the right treatment option/s and explain the benefits, risks, and types of treatment. They will monitor the condition, track progress, and adjust the plan accordingly.

Assessing Hormone Therapy

References

Ankylosing spondylitis. (n.d.) National Institute of Arthritis and Musculoskeletal and Skin Diseases. U.S. Department of Health and Human Services. Available at: www.niams.nih.gov/health-topics/ankylosing-spondylitis#:~:text=Ankylosing%20spondylitis%20is%20a%20type,the%20spine%20can%20cause%20stiffness (Accessed: October 12, 2022).

Chen C, Zhang X, Xiao L, Zhang X, Ma X. Comparative Effectiveness of Biologic Therapy Regimens for Ankylosing Spondylitis: A Systematic Review and a Network Meta-Analysis. Medicine (Baltimore). 2016 Mar;95(11):e3060. doi: 10.1097/MD.0000000000003060. PMID: 26986130; PMCID: PMC4839911.

Gerriets V, Goyal A, Khaddour K. Tumor Necrosis Factor Inhibitors. [Updated 2022 July 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK482425/

Lindström, U., Olofsson, T., Wedrén, S. et al. Biological treatment of ankylosing spondylitis: a nationwide study of treatment trajectories on a patient level in clinical practice. Arthritis Res Ther 21, 128 (2019). doi.org/10.1186/s13075-019-1908-9

Yin, Y., Wang, M., Liu, M. et al. Efficacy and safety of IL-17 inhibitors for the treatment of ankylosing spondylitis: a systematic review and meta-analysis. Arthritis Res Ther 22, 111 (2020). doi.org/10.1186/s13075-020-02208-w

Myofascial Trigger Pain Affecting The Sartorius Muscle

Dr. Alex Jimenez

Table of Contents

Introduction

The lower body extremities help provide stability to the various body parts, including the hips, thighs, pelvis, legs, knees, and feet. The hips and thighs comprise multiple muscles and nerves that provide mobility to the lower half and allow the host to move around in different locations. While the hip muscles act on the thigh muscles at the hip joint and stabilize the pelvis, the thigh muscles allow the lower body to bend, flex and rotate while bearing most of the upper body’s weight and keeping alignment with the hips and legs. One of the thigh muscles is the sartorius muscle, and if it becomes overused and injured can lead to complications in the form of myofascial pain syndrome. Today’s article post examines the sartorius muscle, how myofascial trigger pain is associated with the sartorius, and the effectiveness of myofascial pain treatment on the thighs. We refer patients to certified providers who incorporate multiple methods in the lower body extremities, like thigh pain treatments correlating to myofascial pain syndrome, to aid individuals dealing with pain symptoms along the sartorius muscle. We encourage and appreciate patients by referring them to associated medical providers based on their diagnosis, especially when appropriate. We understand that education is an excellent solution to asking our providers complex questions at the patient’s request. Dr. Jimenez, D.C., utilizes this information as an educational service only. Disclaimer

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What Is The Sartorius Muscle?

Are you experiencing pain in the upper, mid, or lower parts of your thighs? Do you have difficulty walking for long periods? Or do your knees hurt more than usual? Most of these issues correlate with myofascial trigger pain associated with the sartorius muscle. As the longest muscle that spans from the hips to the knee joints, the sartorius muscle, or the “tailor muscle,” serves as both a hip and knee flexor while working with other muscles that allow hip mobility. The sartorius shares its origin location with the TFL (tensor fascia latae) muscle at the anterior superior iliac spine and is responsible for internal rotation at the hips. In the book, “Myofascial Pain and Dysfunction,” the author Dr. Janet G. Travell, M.D., mentioned that the sartorius muscle assists the iliacus and the TFL muscles in hip flexion while assisting the short head of the bicep femoris in the knees for knee flexion, allowing the individual to walk for long distances. Even though this long muscle assists in hip and knee flexion, it can succumb to injuries and create issues with the hips and knees in the lower body.

Myofascial Trigger Pain Associated With The Sartorius Muscle

When traumatic forces or normal factors begin to affect the sartorius muscle, the surrounding muscles on the thighs and hips are also affected. The sartorius muscle allows the individual to move around and allows flexion to the hips and knees when injuries or the muscle is being overused; it can cause pain-like symptoms that correlate with hip and knee issues associated with myofascial trigger pain. Myofascial trigger pain along the sartorius muscle doesn’t usually occur in the muscle but can occur in conjunction with trigger point involvement in the surrounding muscles. Studies reveal that myofascial trigger pain is found in the hip muscles and can cause issues in the lumbopelvic-hip muscles of the lower body. This causes referred pain on the sartorius to be more diffused and superficial to the knees. When myofascial trigger pain is associated with the sartorius, many individuals often mistake it for knee pain. To that point, myofascial trigger pain could affect how a person walks and bends at the knees.

Anatomy & Palpation Of The Sartorius Muscle- Video

Are you experiencing issues when you are walking? Do your knees hurt constantly? Or are you experiencing tenderness or pain in your thighs? Most of these issues correlate with myofascial trigger pain associated with the sartorius muscle. The sartorius is a long muscle that connects the hips and spans to the knee joints to provide hip and knee flexion. The sartorius muscle works with the other muscles in the thighs and hips, allowing hip mobility and motor function to the legs. When multiple issues affect the sartorius and the surrounding muscles, it can develop into myofascial trigger pain and cause overlapping risk profiles to the knees and hips. To that point, it causes referred pain issues in the hips and knees, making the individual have difficulty walking from place to place. However, there are available treatments to reduce the pain in the hips and knees and manage the myofascial trigger pain from affecting the sartorius muscle on the thighs. The video above explains the anatomy of the sartorius muscle location and how palpation is used to locate the muscle to see if it is tight or could be affected by trigger points along the muscle fibers. This is one of the techniques that is used when a person is dealing with myofascial trigger pain associated with the sartorius muscle.

The Effectiveness Of Myofascial Pain Treatment On The Thighs

When a person is dealing with myofascial trigger pain in their thighs, and it is affecting the sartorius, many will often try to find available treatments to alleviate the pain. Treatments like dry needling are one of the various myofascial pain treatments that can reduce pain and related disability on the thighs, hips, and knees. Studies reveal that dry needling treatments can help manage knee pain syndrome associated with trigger points on the thighs. However, treatment alone can not be the only solution to reduce myofascial trigger pain in the thighs. Various hip stretches can loosen up tight hip flexors and help elongate the sartorius muscles to break up the nodules and improve mobility function to the hips and knees. People can even utilize self-ischemic compression to allow a more effective stretch on the sartorius muscle.

Conclusion

As the longest muscle in the thighs, the sartorius helps provide a service to hip and knee flexion while working with various muscles to keep the legs moving. When the sartorius muscles become overused and start to cause referred pain to the hips and knees, it can develop into myofascial trigger pain along the sartorius muscle. This can make many individuals believe they are suffering from knee pain when it’s their thigh muscle. However, myofascial trigger pain is treatable through treatments and corrective actions that people can incorporate into their daily activities to prevent pain from escalating and manage trigger points along the sartorius muscle. This can allow people to get back their mobility in their legs.

References

Rahou-El-Bachiri, Youssef, et al. “Effects of Trigger Point Dry Needling for the Management of Knee Pain Syndromes: A Systematic Review and Meta-Analysis.” Journal of Clinical Medicine, MDPI, 29 June 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7409136/.

Samani, Mahbobeh, et al. “Prevalence and Sensitivity of Trigger Points in Lumbo-Pelvic-Hip Muscles in Patients with Patellofemoral Pain Syndrome.” Journal of Bodywork and Movement Therapies, U.S. National Library of Medicine, 15 Oct. 2019, pubmed.ncbi.nlm.nih.gov/31987531/.

Simons, D. G., and L. S. Simons. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.

Walters, Benjamin B, and Matthew Varacallo. “Anatomy, Bony Pelvis and Lower Limb, Thigh Sartorius Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 29 Aug. 2022, www.ncbi.nlm.nih.gov/books/NBK532889/.

Disclaimer

Kidney Detox: Sciatica Clinic

Dr. Alex Jimenez

cropped view of doctor examining kidney of patient with ultrasound scan in clinic

Maintaining kidney health is important to the body’s overall health and well-being. The kidneys are fist-sized organs located beneath the rib cage on both sides of the spine. A kidney detox maintains health allowing the body to filter and expel waste properly and produce hormones to help the body function at its full potential.

Table of Contents

Kidney Health

The kidneys perform several functions that include:

Filters and cleanses out impurities from the blood.
Produces hormones that regulate blood pressure and control the production of red blood cells.
Filter’s waste products stored in the bladder and expelled through urine.
Filters toxins.
Expels excess water.
Regulates pH, salt, and potassium levels.
Balances electrolytes.
Activates vitamin D to support body absorption of calcium for bone repair and regulating muscle function.

Kidney Detox

A key measure of keeping the kidneys clean and healthy is to engage in a healthy nutrition plan. Doctors recommend implementing lifestyle changes to help the kidneys filter at full capacity. Certain foods can help detox the kidneys and promote their health.

Pumpkin seeds

Pumpkin seeds can help prevent the accumulation of uric acid, one of the compounds that cause kidney stones.

Grapes

These fruits contain a compound called resveratrol to reduce kidney inflammation.

Lemons

Lemons help with digestion.
They have vitamin C, which enhances the immune system and supports white blood cells to fight infections.
Citrate binds with calcium in the urine to stop the growth of calcium crystals, preventing kidney stones.

Carrots

Carrots have beta-carotene, alpha-carotene, and vitamin A.
Antioxidants for inflammation.

Ginger

Ginger can help in the dissolving process of kidney stones and prevents them from reforming.

Beets

Improves blood circulation to the kidneys.

Celery

Celery has alkaline and diuretic properties to help expel excess fluids.
It has coumarins which can help to increase vascular flow.
It is rich in vitamins D, C, and K.

Apples

Apples contain fiber to unclog the arteries, specifically the kidney arteries will improve filtration.

Maintain Hydration

The human body is almost 60 percent water, with every organ requiring water.

The kidneys (body filtration system) require water to secrete urine.
Urine is the primary waste product that allows the body to eliminate unwanted and unnecessary substances.
Low water intake means low urine volume.
Low urine output can lead to kidney dysfunction, like kidney stones.
Maintaining the body’s hydration is crucial so the kidneys can thoroughly flush out excess waste materials.
The recommended daily intake of fluids is around 3.7 liters a day for men and 2.7 liters a day for women.

Functional Medicine

This is an example of a two-day kidney cleanse to help strengthen the kidneys and detoxify the body.

Day 1

Breakfast

Smoothie made with:
8 ounces of fresh lemon, ginger, and beet juice
1/4 cup of sweetened dried cranberries

Lunch

Smoothie made with:
1 cup almond milk
1/2 cup tofu
1/2 cup spinach
1/4 cup berries
1/2 apple
Two tablespoons of pumpkin seeds

Dinner

Large mixed-greens salad
4 ounces of lean protein – chicken, fish, or tofu
Top with 1/2 cup of grapes
1/4 cup peanuts

Day 2

Breakfast

Smoothie made with:
1 cup soy milk
One frozen banana
1/2 cup spinach
1/2 cup blueberries
One teaspoon spirulina

Lunch

A bowl of:
1 cup orzo rice
1 cup fresh fruit
Two tablespoons of pumpkin seeds

Dinner

Large mixed-greens salad
4 ounces of lean protein – chicken, fish, or tofu
Top with 1/2 cup of cooked barley
Add fresh lemon juice
4 ounces each of unsweetened cherry juice and orange juice

Consult a healthcare provider, nutritionist, or dietitian to ensure it is safe.

Dietary Prescription

References

Chen, Teresa K et al. “Chronic Kidney Disease Diagnosis and Management: A Review.” JAMA vol. 322,13 (2019): 1294-1304. doi:10.1001/jama.2019.14745

Den Hartogh, Danja J, and Evangelia Tsiani. “Health Benefits of Resveratrol in Kidney Disease: Evidence from In Vitro and In Vivo Studies.” Nutrients vol. 11,7 1624. 17 Jul. 2019, doi:10.3390/nu11071624

nap.nationalacademies.org/read/10925/chapter/6

Pizzorno, Joseph. “The Kidney Dysfunction Epidemic, Part 1: Causes.” Integrative medicine (Encinitas, Calif.) vol. 14,6 (2015): 8-13.

Saldanha, Juliana F et al. “Resveratrol: why is it a promising therapy for chronic kidney disease patients?.” Oxidative medicine and cellular longevity vol. 2013 (2013): 963217. doi:10.1155/2013/963217

Tack, Ivan MD, Ph.D. Effects of Water Consumption on Kidney Function and Excretion. Nutrition Today: November 2010 – Volume 45 – Issue 6 – p S37-S40
doi: 10.1097/NT.0b013e3181fe4376

Myofascial Pain Syndrome On The Tensor Fasciae Latae

Dr. Alex Jimenez

Table of Contents

Introduction

The thighs in the lower half of the body work together with the hips to stabilize the legs when the body is in motion. The thighs and the hips also support the weight of the upper half of the body and are surrounded by muscles, ligaments, and nerve roots to supply blood and sensory-motor function to the legs. One of the thigh muscles that work with the hips is the tensor fasciae latae (TFL) muscle. When the thigh muscles are being overused or suffer from injuries, tiny nodules known as trigger points (myofascial pain syndrome) can affect a person’s ability to function worldwide. Today’s article examines what the tensor fasciae latae muscles do, how myofascial pain syndrome affects the thighs, and various stretches/techniques for the thighs. We refer patients to certified providers who incorporate multiple methods in the lower body extremities, like thigh pain treatments correlating to trigger points, to aid individuals dealing with pain symptoms along the tensor fasciae latae muscle. We encourage and appreciate patients by referring them to associated medical providers based on their diagnosis, especially when it is appropriate. We understand that education is an excellent solution to asking our providers complex questions at the patient’s request. Dr. Jimenez, D.C., utilizes this information as an educational service only. Disclaimer

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What Does The Tensor Fasciae Latae Muscle Do?

Do you have difficulty walking for a long period? So you feel that your hips feel unstable when you move? Or do you feel radiating pain down from your thighs to your knees? Thigh pain associated with these symptoms can affect a person’s ability to move around from one location to another due to trigger points affecting the tensor fasciae latae muscle. The tensor fasciae latae (TFL) muscles are located at the proximal anterolateral thigh and originate from the anterior superior iliac spine. The TFL muscle is between the superficial and deep muscle fibers of the iliotibial (IT) band, as its attachment assists with knee flexion and lateral rotation. The TFL muscles also work together with the gluteus muscles in various hip movements. Studies reveal that the primary function of the TFL muscles is providing balance to the body’s weight and the non-weight-bearing leg to walk. The TFL muscles allow the individual to walk, run, and assist with movement and stabilization to the hips and knees without pain inflicted on the joints and muscles.

Myofascial Pain Syndrome Affecting The Thighs

Since the TFL muscles allow the person to walk and run, this muscle can become overused and strained through repetitive motions causing many issues to the hips, knees, and thighs. When these issues affect the TFL muscles, they can develop nodules along the muscle fibers known as trigger points or myofascial pain syndrome. Myofascial pain syndrome is a musculoskeletal disorder that can invoke referred pain in one location of the body while affecting the surrounding muscles in a different body location. Myofascial pain syndrome associated with the TFL muscles can cause issues to the hips, thighs, and knees while affecting a person’s ability to walk. Studies reveal that the prevalence of myofascial pain syndrome on the TFL muscles correlates to pain and disability in the thighs. When myofascial pain syndrome affects the TFL muscles, it can mimic chronic knee osteoarthritis.

Even though myofascial pain syndrome is challenging to diagnose, it is treatable through various stretches and techniques. In Dr. Janet G. Travell, M.D.’s book, “Myofascial Pain and Dysfunction,” it mentioned that when patients have active trigger points in their TFL muscles, they become aware of the referred pain affecting their hip joints and are unable to lie comfortably on their sides due to the body-weight pressure pressing on the affected TFL muscle. The book also points out that when pain is referred to from trigger points associated with the TFL muscles, it can be mistaken for pain in the glutes.

Trigger Point Of The Week: Tensor Fasciae Latae- Video

Tensor Fascia Latae - Trigger Point of the Week

Have you been experiencing difficulty walking from one location to another? Do you feel pain in your thighs or knees? Or do you have a problem lying down on your side that is causing you pain? If you have been dealing with walking issues, it could be due to myofascial trigger pain in your tensor fasciae latae (TFL) muscles affecting your ability to walk. The TFL muscles help provide stability to the hips and thighs and assist with knee flexion and lateral rotation. This muscle also allows people to walk and run without any pain inflicted on the joints and muscles. When repetitive motions start to cause the TFL muscles to become overused and strained, it can lead to myofascial pain syndrome or trigger points developing, causing referred pain to the thighs. The video above explains where the TFL muscles are located and where the trigger points on the TFL muscles are causing pain to the thighs. Myofascial pain syndrome can mimic other chronic conditions like knee osteoarthritis, which causes pain and disability to the lower half of the body.

Various Stretches & Techniques For The Thighs

Now myofascial pain syndrome is challenging to diagnose in an examination due to the referred pain affecting one location of the body than the actual source of where the pain is coming. However, it is treatable through various techniques and stretches for the thighs to restore leg mobility. Studies reveal that direct stretching of the TFL (tensor fasciae latae) muscles can reduce long-term pain effects on the hips, thighs, and lower back and improve hip and thigh mobility. Various stretches like hip extensions and laterally rotating the hips can break the myofascial trigger points in the TFL muscle. Using a foam roller on the hips can gently stretch and loosen the muscle fibers on the TFL and help warm up the muscle before working out. Sitting down correctly in a chair can help the hips from causing more muscle strain to the thighs and prevent the TFL muscles from being shortened. Incorporating these stretches and techniques can improve hip and thigh mobility in the legs, allowing the individual to walk or run without pain.

Conclusion

The TFL (tensor fasciae latae) muscles are located on the proximal anterolateral thigh between the IT (iliotibial) band, which assists with knee flexion and lateral rotation. The TFL muscle also works with the gluteal muscles and allows the person to walk, run, and help with stability movement to the hips and knees with inflicted pain on the joints and surrounding muscles. When the TFL muscles become overused, they can develop myofascial trigger pain on the TFL, causing referred hip, knee, and thigh pain. This can cause the individual not to be able to walk for long periods and think they might have osteoarthritis in the knees. Fortunately, people can incorporate various stretches and techniques to reduce the pain in the thighs and hips while managing myofascial trigger pain along the TFL muscles. These various stretches and techniques allow mobility back to the hips and thighs so the individual can walk without pain.

References

Gottschalk, F, et al. “The Functional Anatomy of Tensor Fasciae Latae and Gluteus Medius and Minimus.” Journal of Anatomy, U.S. National Library of Medicine, Oct. 1989, www.ncbi.nlm.nih.gov/pmc/articles/PMC1256751/.

Ohtsuki, Keisuke. “A 3-Month Follow-up Study of the Long-Term Effects of Direct Stretching of the Tensor Fasciae Latae Muscle in Patients with Acute Lumbago Using a Single-Case Design.” Journal of Physical Therapy Science, The Society of Physical Therapy Science, May 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4047246/.

Simons, D. G., and L. S. Simons. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.

Sánchez Romero, Eleuterio A, et al. “Prevalence of Myofascial Trigger Points in Patients with Mild to Moderate Painful Knee Osteoarthritis: A Secondary Analysis.” Journal of Clinical Medicine, MDPI, 7 Aug. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7464556/.

Trammell, Amy P, et al. “Anatomy, Bony Pelvis and Lower Limb, Tensor Fasciae Muscle – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 8 Aug. 2022, www.ncbi.nlm.nih.gov/books/NBK499870/.

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THYROID DYSFUNCTION MUST WATCH (Assessment and treatment) | El Paso, Tx (2022)

Dr. Alex Jimenez

In this episode an expert will discuss the assessment and treatment of Thyroid Dysfunction including analyzing underlying causes for the high incidence of hypothyroid dysfunction in the general population. We will discuss important signs, symptoms and conditions as well as the most powerful laboratory tools to accurately assess individuals with thyroid dysfunction. Also we will cover the development of plans for prescribing nutraceuticals, diet and lifestyle interventions to modulate and balance overall production, transport, sensitivity and detoxification of thyroid hormones and more. Stay tuned for more episodes of this educational presentations brought to you by Dr. Alex Jimenez 2X.

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Subluxation Chiropractor: Sciatica Clinic

Dr. Alex Jimenez

physiotherapist treating the patient's shoulder

Subluxation is when a joint shifts out of alignment, which can happen to any joint in the body. Spinal subluxation indicates a misalignment of one or more portions of the spinal vertebrae. It is common in the spine from all the reaching, bending, twisting, and flexing the body goes through. Spinal subluxations, if left untreated, can cause disc degeneration, permanent nerve damage, neurological conditions, and chronic pain symptoms. A subluxation chiropractor will realign and decompress the spine combined with massage therapy to relax the muscles and restore mobility and function.

Table of Contents

Subluxation Chiropractor

Some subluxations don’t cause any problems or pain, but that doesn’t mean they aren’t affecting the back and body. A spinal subluxation can cause long-term problems by:

Advancing the disc degeneration process.
Gradually pushing, pulling, and/or compressing nerves.
Causing the body to compensate through unhealthy postures.
Delaying nervous system responses and signal transmissions.

Symptoms

While some spinal subluxations may not be symptomatic, the majority of them are and include:

Muscle tightness, weakness, or spasms around the back.
Back aching and pain.
Neck aching and discomfort.
Headaches.
Limited mobility.
Digestive issues.
Tingling or pain in the arms or legs.

Causes

Common causes include:

Unhealthy postures.
Sleeping in awkward positions.
Sitting or standing for long periods.
Lifting objects improperly.
Wearing a heavy bag on one shoulder for an extended
Heightened stress levels can cause the back muscles to tighten, which can cause subluxations.
Automobile accidents, falls, or other traumas.
Playing contact sports.
Edema
Hyperemia – lack of blood circulation.
Atrophy
Fibrosis

Effects

Research shows that spinal subluxations can affect many facets of the body. Long-term effects may include:

Sleep problems
Low energy
Brain fog
Mood swings
Anxiety and depression
Digestive issues
Respiratory problems
Bone spurs
Spinal arthritis

Chiropractic Care

When the spine is out of alignment, it can cause issues throughout the body. Changes in one area affect the rest of the body. A subluxation chiropractor looks at the spine’s neurological and mechanical components and aims to reset everything back into its proper position. Similar to the way a massage helps the mind and body relax and de-stress, a spinal adjustment helps by:

Increasing circulation
Relieving discomfort and pain
Releasing tension
Improving mood
Reducing stress levels
Improving sleep function
Increasing energy levels

When the spine is properly aligned, the body can operate at its full potential.

Adrenal Dysfunction

References

Brian S. Budgell, Reflex effects of subluxation: the autonomic nervous system, Journal of Manipulative and Physiological Therapeutics, Volume 23, Issue 2,
2000, Pages 104-106, ISSN 0161-4754, doi.org/10.1016/S0161-4754(00)90076-9. (www.sciencedirect.com/science/article/pii/S0161475400900769)

Green, J D et al. “Anterior subluxation of the cervical spine: hyperflexion sprain.” AJNR. American journal of neuroradiology vol. 2,3 (1981): 243-50.

Meyer, S. “Thoracic spine trauma.” Seminars in roentgenology vol. 27,4 (1992): 254-61. doi:10.1016/0037-198x(92)90004-l

Neva MH, Häkkinen A, Mäkinen H, et al. High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopedic surgeryAnnals of the Rheumatic Diseases 2006;65:884-888.

Nourollahi, Maryam, et al. “Awkward trunk postures and their relationship with low back pain in hospital nurses.” Work (Reading, Mass.) vol. 59,3 (2018): 317-323. doi:10.3233/WOR-182683

Vernon, Howard. “Historical overview and update on subluxation theories().” Journal of chiropractic humanities vol. 17,1 (2010): 22-32. doi:10.1016/j.echu.2010.07.001

Piriformis Syndrome & Myofascial Pain Syndrome

Dr. Alex Jimenez

Table of Contents

Introduction

The lumbar region of the spine has various muscles and nerve roots that work together with the lower body extremities, like the hips, buttocks, legs, knees, and feet, for mobility and walking function. The various muscles in the buttock region include the gluteal muscles. They have a casual relationship with the hip muscles as they work together for hip mobility and erect good posture in the body. These various muscles and nerves also supply sensory-motor function for the legs to be mobile and provide hip mobility. The piriformis is one of the muscles assisting in the hips and buttock region. When this muscle becomes overused, it can cause mobility issues in the legs and affect a person’s ability to walk. Today’s article looks at the piriformis muscle, how trigger points are associated with piriformis syndrome, and how to manage piriformis syndrome associated with trigger points. We refer patients to certified providers who incorporate multiple methods in the lower body extremities, like sciatic pain and piriformis syndrome treatments related to trigger points, to aid individuals dealing with pain symptoms along the piriformis muscle. We encourage and appreciate patients by referring them to associated medical providers based on their diagnosis, especially when it is appropriate. We understand that education is an excellent solution to asking our providers complex questions at the patient’s request. Dr. Jimenez, D.C., utilizes this information as an educational service only. Disclaimer

Download

What Is The Piriformis Muscle?

Have you been having issues walking from one place to another? Do you feel muscle tightness in your hips or buttock region? Or are you experiencing radiating pain traveling to your knees and feet? These pain symptoms are correlated with trigger points affecting the piriformis muscle. The piriformis is a flat, pear-shaped muscle, one of the six short rotator muscle groups in the gluteal region of the hips and thighs. The rotator muscle groups consist of the following:

Gemelli
Quadratus Femoris
Obturator Internus
Obturator Externus

This muscle is parallel to the posterior margins of the gluteus medius and deep into the gluteus maximus. This muscle is very important to the body as it provides lower-body movement by stabilizing the hip joint and can lift and rotate the thighs away from the body. The piriformis muscle also surrounds the sciatic nerve, as this long nerve runs deep beneath the piriformis and enters the gluteal region of the rear. When the piriformis muscle becomes overused or suffers from associated traumatic factors, it can aggravate the sciatic nerve and even develop tiny nodules known as trigger points, causing mobility issues.

Trigger Points Associated With Piriformis Syndrome

When abnormal factors affect the piriformis muscles, they can develop into trigger points associated with piriformis syndrome and cause issues in the pelvic and hip regions of the body. According to Dr. Janet G. Travell, M.D., “Myofascial Pain and Dysfunction,” trigger points can be activated when repetitive strain affects the piriformis muscle and causes symptoms of muscle weakness and pain in the hips. This causes overlapping issues in the surrounding muscles and the sciatic nerve, making diagnosing tricky for trigger points. Studies reveal that trigger points associated with piriformis syndrome may potentially cause muscle spasms or an inflammatory process to irritate the sciatic nerve that may be presented as identical to lumbar disk syndrome without neurological findings. Trigger points associated with piriformis syndrome may mimic chronic issues like fibromyalgia. Even though trigger points are tricky to pinpoint in a thorough examination, there are various ways to reduce the pain and prevent trigger points from affecting the piriformis muscle causing sciatic nerve pain.

Trigger Point Of The Week: Piriformis Muscle- Video

Have you been dealing with sciatic nerve pain? Have you found it difficult to walk for a short period? Or are you dealing with muscle tenderness or soreness in your buttock or hips? People experiencing these symptoms could be dealing with piriformis syndrome associated with trigger points. The piriformis is a small, fan-shaped muscle, one of the six short rotator muscle groups that help with hip and thigh mobility through stabilization. The piriformis muscles also surround the sciatic nerve and can succumb to injuries. When traumatic forces affect the hips and thighs, the piriformis muscle develops nodules known as trigger points, causing the muscle to irritate the sciatic nerve and cause pain in the legs. The video above shows where the piriformis muscle is located and how trigger points can mimic sciatic nerve pain in the leg without neurological findings. Studies reveal that trigger points could be a rare anatomical variation that can correlate with piriformis syndrome associated with sciatica. However, there is some good news, as there are ways to manage piriformis syndrome associated with trigger points.

Managing Piriformis Syndrome Associated With Trigger Points

Various techniques can help manage piriformis syndrome associated with trigger points to relieve the piriformis muscle. Studies reveal that Kinesio tape on the piriformis muscle can help reduce pain and improve many individuals’ hip joint range of motion. Other techniques like stretching or deep tissue massage can help loosen up the stiff muscles and relieve trigger points from forming on the piriformis. For sciatica pain associated with trigger points along the piriformis muscle, decompression therapy can help the piriformis muscle lay off pressure on the sciatic nerve and reduce aggravated pain. These techniques can help improve hip joint mobility and increase the range of motion to the hips and lower extremities.

Conclusion

The piriformis is a small muscle that provides hip and thigh mobility. This small muscle surrounds the sciatic nerve, which helps give motor function to the legs. When traumatic factors affect the piriformis muscle, it can develop trigger points and cause sciatic pain in the hips. This causes mobility issues and pain around the hips. Various treatments are provided to help reduce the trigger points along the piriformis muscle and reduce sciatic nerve pain from causing more problems to the hips and legs mobility.

References

Chang, Carol, et al. “Anatomy, Bony Pelvis and Lower Limb, Piriformis Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 3 Oct. 2022, www.ncbi.nlm.nih.gov/books/NBK519497/.

Pfeifer, T, and W F Fitz. “[The Piriformis Syndrome].” Zeitschrift Fur Orthopadie Und Ihre Grenzgebiete, U.S. National Library of Medicine, 1989, pubmed.ncbi.nlm.nih.gov/2618150/.

R;, Hashemirad F;Karimi N;Keshavarz. “The Effect of Kinesio Taping Technique on Trigger Points of the Piriformis Muscle.” Journal of Bodywork and Movement Therapies, U.S. National Library of Medicine, 8 Feb. 2016, pubmed.ncbi.nlm.nih.gov/27814861/.

Ro, Tae Hoon, and Lance Edmonds. “Diagnosis and Management of Piriformis Syndrome: A Rare Anatomic Variant Analyzed by Magnetic Resonance Imaging.” Journal of Clinical Imaging Science, Medknow Publications & Media Pvt Ltd, 21 Feb. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5843966/.

Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.