Sacroiliac Joint Surgery: Sciatica Clinic

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

Male doctor shows on the spine model the place where the intervertebral hernia appears

The function of the SI joints is to allow torsional or twisting movements when moving the legs that act as levers. Without the sacroiliac joints and the pubic symphysis at the front of the pelvis, which allow these precision movements, the pelvis would be at higher risk of a fracture. The sacroiliac joints transmit body weight and all the physical forces down through the sacrum to the hips and legs. Individuals, especially athletes with pain in the lower back, hip, groin, or leg, could be experiencing SIJ/sacroiliac joint dysfunction. A physician or surgeon could recommend sacroiliac joint surgery for severe SI joint dysfunction and pain that has not resolved with conservative treatment.

Sacroiliac Joint Surgery

There are two sacroiliac joints. They connect the large iliac bones that make up the sides of the pelvis and the sacrum or triangle-shaped vertebrae between the iliac bones at the base of the spine. Pain in this area can come from sacroiliitis or inflammation of an SI joint, and referred pain may present. A doctor will consider causes such as:

Trauma
Sports
Biomechanical abnormalities
Wear and tear from weight-bearing stress
Pregnancy
Leg length discrepancy
Hypermobility
Systemic inflammatory conditions
Degenerative joint disease
Scoliosis
Infection, but this is rare.

Sports

There is a pathology of sacroiliac joint dysfunction in athletes. Sports that require repetitive and/or asymmetric loading that includes:

Kicking
Swinging
Throwing
Single-leg stance

Any athlete can develop sacroiliac joint dysfunction, but the highest prevalence activities include:

Soccer
Football
Basketball
Gymnastics
Golfing
Powerlifting
Cross-country skiing
Step aerobics
Stair stepper machines
Elliptical machines

Fusion Surgery

Surgery is not for patients with less than six months of confirmed localized pain or impairment with other causes ruled out. Surgery is the last option for SI joint pain unless it is an emergency. Doctors and surgeons will recommend non-invasive treatment methods before recommending surgery. Surgery recommendations come when the pain has become intolerable, and the individual can no longer move or operate.

Sacroiliac joint fusion is a minimally invasive procedure involving a small incision less than two inches long.
Under image guidance, titanium implants are inserted across the sacroiliac joint to provide stability.
Holes in the hardware allow for adding bone or for the bone to grow naturally across or onto the area to maintain stability.
This surgery can be either outpatient or overnight, depending on surgeon preference and the type of support available.

Surgery Recovery Time

For most individuals, recovery time is around three weeks on crutches.

Pain management depends on whether screws or bolts are involved; bolts tend to be more uncomfortable.
Post-op pain dissipates in a few days or a couple of weeks.
Fusion itself takes six or more months to complete.

Conservative Treatment Options

Conservative treatment modalities to reduce the inflammation can include:

Chiropractic
Physical therapy
Nonsurgical spinal decompression
Medications
Injections

Rest

Staying off your feet for a few days can help decrease pressure on the SI joint.
Using an ice or heating pad on the lower back and/or buttocks.
Massaging the surrounding muscles may help if the apparent cause is an injury.
A doctor could suggest using a cane, walker, or crutches under medical supervision.

Medications

Medications include anti-inflammatories such as ibuprofen, naproxen, or prescription alternatives.
Acetaminophen helps with pain but not inflammation.

Corticosteroids

Steroids are the most powerful anti-inflammatory.
A common nonsurgical treatment is cortisol steroids, injected under X-ray guidance.
Injections go directly to the source.
Oral steroids spread throughout the body but can cause undesirable side effects.

Chiropractic and Physical Therapy

Depending on the severity of the condition, chiropractic and physical therapy may be able to strengthen the muscles around the area and realign the joint.
A chiropractor will level the pelvis through sacroiliac joint manipulation and mobilization.

Sacroiliac Support Belt

Wearing a sacroiliac support belt may help remove the joint’s strain and relieve symptoms.
It works by applying compression around the hip and across the joint.

Back, Hip, and Radiating Pain

References

Brolinson, P Gunnar, et al. “Sacroiliac joint dysfunction in athletes.” Current sports medicine reports vol. 2,1 (2003): 47-56. doi:10.1249/00149619-200302000-00009

Heil, Jessica. “Load-Induced Changes of Inter-Limb Asymmetries in Dynamic Postural Control in Healthy Subjects.” Frontiers in human neuroscience vol. 16 824730. 11 Mar. 2022, doi:10.3389/fnhum.2022.824730

International Journal of Spine Surgery. (2020*) “International Society for the Advancement of Spine Surgery Policy 2020 Update—Minimally Invasive Surgical Sacroiliac Joint Fusion (for Chronic Sacroiliac joint Pain): Coverage Indications, Limitations, and Medical Necessity.” https://doi.org/10.14444/7156

Peebles, Rebecca DO1; Jonas, Christopher E. DO, FAAFP2. Sacroiliac Joint Dysfunction in the Athlete: Diagnosis and Management. Current Sports Medicine Reports: 9/10 2017 – Volume 16 – Issue 5 – p 336-342
doi: 10.1249/JSR.0000000000000410

Myofascial Trigger Pain Affecting The Quadratus Lumborum

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

Table of Contents

Introduction

The lower back works with the body’s lower extremities by stabilizing the hips and helping support the upper body’s weight. The lower back also has many functions when it comes to mobility. The lower back allows the person to bend, twist, and rotate the torso without any pain inflicted on the body. When normal factors or traumatic issues start to cause low back pain in the individual, the pain-like symptoms can correlate to the development of trigger points in the lower back muscles. Today’s article examines the quadratus lumborum, how myofascial trigger pain affects the low back, and how to manage myofascial trigger pain through various treatments. We refer patients to certified providers who incorporate multiple techniques in low back pain therapies related to trigger points to aid individuals dealing with pain symptoms along the quadratus lumborum in the lower back. We encourage and appreciate patients by referring them to our 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 Is The Quadratus Lumborum?

Have you been experiencing low back pain? Do you feel relief when you stretch your lower back, only to have the pain return later? Do you feel tenderness or soreness on the sides? Many of these complaints are correlated with low back pain associated with trigger points along the quadratus lumborum. The quadratus lumborum is a flat, quadrangular-shaped muscle in the iliac crest and deep back. This muscle plays an important part in the thoracolumbar fascia that covers the posterior body area while involving the lower and upper parts of the limbs. According to “Myofascial Pain and Dysfunction: The Trigger Point Manual,” written by Dr. Janet G. Travell, M.D., mentioned that the quadratus lumborum functions to control the side bending to the opposite side by lengthening contraction. Other studies reveal that various actions on the lumbar spine have been attributed to the quadratus lumborum. When the quadratus lumborum goes through these different actions, it can cause the muscles to become overused, or when injuries occur in the lower back, it can lead to various issues that can develop into overlapping conditions in the lower back.

Myofascial Trigger Pain Affecting The Low Back

When it comes to the lower back, many individuals worldwide experience some pain in their backs, and low back pain is common. Various factors cause low back pain from lifting heavy objects, over-exerting the sides with rapid turning, or even normal wear and tear of the body, which can cause lower back pain. When low back pain affects the quadratus lumborum, it can develop trigger points or myofascial trigger pain. Studies reveal that low back pain from the quadratus lumborum can present myofascial pain, causing the individual to have an acute pain episode in their lower back. Myofascial trigger pain is developed when the affected muscle has been overused and causes tiny knots to form along the muscle fibers. When myofascial trigger pain is in the quadratus lumborum, it becomes activated acutely through awkward movements or sudden trauma in the lower back, affecting the mobility of the lower back and the hips. Additional studies reveal that the prevalence of myofascial trigger pain in the quadratus lumborum, when being diagnosed, can display significantly less hip abduction strength. Low back pain associated with myofascial trigger pain can correlate with other chronic issues affecting the body’s lower extremities.

Trigger Point Release: Quadratus Lumborum- Video

Are you experiencing mobility issues in your hips? Do you feel symptoms of tenderness or stiffness in your lower back? Does it hurt when you are bending down to pick up an item? Most of these symptoms correlate with low back pain, potentially involving trigger points along the quadratus lumborum. Trigger points are formed when the muscle has been overused or been through a traumatic event like an auto accident, and since low back pain is common worldwide, it can mask other chronic conditions that overlap the pain. The video explains where the quadratus lumborum is located in the back, where the trigger points are marked, and how to manage the trigger points through manual manipulation while reducing pain away from the lower body. When myofascial trigger pain begins to wreak havoc on the affected muscles in the lower back. Various treatments applied to the lower back can help alleviate the symptoms caused by trigger points associated with the lower back along the quadratus lumborum.

Managing Myofascial Trigger Pain Through Various Treatments

Since low back pain is common worldwide and can potentially lead to the development of trigger points along the various lower back muscles, especially the quadratus lumborum, many individuals would utilize medication specifically for low back pain to reduce the pain symptoms; however, it only masks the pain caused by myofascial trigger pain. Studies reveal manual trigger-point therapy techniques that healthcare providers use to assess patients who are in pain from myofascial trigger pain. Many will go to a pain specialist to manage trigger points when the pain becomes too much for the individual. Another method that many people should utilize as part of their daily practice is doing gentle side stretching on the quadratus lumborum to loosen up the stiff muscles and reduce the chances of trigger points forming in the affected muscle in the future.

Conclusion

The quadratus lumborum is a flat, quadrangular-shaped muscle in the iliac crest and deep back. This muscle helps with posterior mobility of the lower extremities and, when overused, can develop myofascial trigger pain associated with the low back. This can lead to various common back pain issues that affect how a person moves and become unstable when in motion. Fortunately, low back pain associated with myofascial trigger pain is treatable through various treatments that can reduce the pain and manage trigger points located in the low back. When people incorporate treatments to alleviate pain in their lower back, they will begin to experience relief and have their sense of purpose back in their lives.

References

Bordoni, Bruno, and Matthew Varacallo. “Anatomy, Abdomen and Pelvis, Quadratus Lumborum.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 18 July 2022, https://www.ncbi.nlm.nih.gov/books/NBK535407/.

de Franca, G G, and L J Levine. “The Quadratus Lumborum and Low Back Pain.” Journal of Manipulative and Physiological Therapeutics, U.S. National Library of Medicine, Feb. 11AD, https://pubmed.ncbi.nlm.nih.gov/1826922/.

Grover, Casey, et al. “Atraumatic Back Pain Due to Quadratus Lumborum Spasm Treated by Physical Therapy with Manual Trigger Point Therapy in the Emergency Department.” Clinical Practice and Cases in Emergency Medicine, University of California Irvine, Department of Emergency Medicine Publishing Western Journal of Emergency Medicine, 29 May 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6682240/.

Phillips, S, et al. “Anatomy and Biomechanics of Quadratus Lumborum.” Proceedings of the Institution of Mechanical Engineers. Part H, Journal of Engineering in Medicine, U.S. National Library of Medicine, Feb. 2008, https://pubmed.ncbi.nlm.nih.gov/18441751/.

Roach, Sean, et al. “Prevalence of Myofascial Trigger Points in the Hip in Patellofemoral Pain.” Archives of Physical Medicine and Rehabilitation, U.S. National Library of Medicine, Mar. 2013, https://pubmed.ncbi.nlm.nih.gov/23127304/.

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

Disclaimer

Muscle Recovery Supplements: Chiropractic Sciatica Clinic

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

Sports woman takes supplements or vitamins at gym — Athletic woman takes supplements or vitamins in the form of capsules after training in the gym. Concept of additional nutrition during training

Workout recovery is as important as working out. Pushing muscle past its normal levels creates tiny tears in the muscle tissue. It is the repairing process that generates muscle growth. Muscles that aren’t allowed to recover will not grow or gain muscle mass, and muscle strength could be reduced, making working out a struggle and hindering health goal progress. The body needs time to repair the muscles to reduce the risk of injury. Allowing enough time for recovery reduces overuse-related muscle breakdown and injuries. Muscle recovery supplements can expedite the healing process.

Table of Contents

Muscle Recovery Supplements

Reasons for taking supplements include their ability to heal damaged muscles faster, aid in injury recovery, reduce muscle soreness, reduce muscle fatigue, and provide the muscle cells with energy during recovery.

Certain supplements work by supporting or enhancing muscle protein synthesis.
Protein synthesis is the muscle cells’ process to make more protein.
Protein is the building block for muscle.
Increasing protein synthesis gives the body more blocks to use.
Other supplements help to reduce muscle soreness.
Sore muscles are common.
Soreness that occurs soon after working out is usually from lactic acid buildup.
There are supplements to help the body get rid of lactic acid faster.
There is delayed onset muscle soreness, or DOMS, which lasts longer.
Some supplements work on both types of sore muscles.

Supplement Types

The type of recovery supplements depends on the individual and their goals. Here are a few to consider.

Protein Supplement

Protein is the most useful supplement for muscle recovery.
It helps the muscle repair faster and more effectively after an intense workout.
It is important if there is a lack of protein in an individual’s diet.
Whey protein is the most popular because it includes essential amino acids.
Other options include soy, egg, rice, hemp, and pea.

Branched-Chain Amino Acid – BCAA

The body makes certain amino acids; there are a few it cannot make.
A BCAA supplement provides these essential amino acids that aid in recovery.
This supplement promotes muscle growth, helps ease sore muscles, and reduces muscle fatigue.

Fatty Acid

Fatty acids supply energy but also reduce inflammation.
A medium-chain triglyceride – MCT fatty acid helps reduce lactic acid buildup.
Omega-3 fatty acid reduces muscle fatigue and muscle soreness and provides injury protection.
Fatty acid supplements should be stored in a dark, cool place to maintain quality.

Creatine

Creatine turns into creatine phosphate, which the body uses for energy.
Some studies have found that taking a creatine supplement may aid muscle recovery and greater muscle strength during recovery.

Citrulline Malate

Citrulline is a non-essential amino acid found in watermelon that converts into nitric oxide.
Nitric oxide helps open blood vessels and improve blood circulation.
This allows oxygen and nutrients to reach the muscle faster, speeding the recovery process.
Citrulline also improves the bioavailability of L-arginine, another amino acid that aids protein synthesis.

Magnesium

Magnesium assists with muscle recovery by helping the muscles relax.
When the body doesn’t have enough magnesium, there is a greater chance of muscle cramps.
Magnesium helps support healthy muscle contraction.

Tart Cherry Juice Extract

This extract works by reducing inflammation in the muscle.
Inflammation is normal, but too much can increase muscle soreness and the risk of injury.
One study found that cherry juice helps minimize post-exercise muscle pain.

Supplement Plan

After selecting a supplement plan that is the most beneficial for the individual, the next step is to devise a schedule for taking them.

When using a muscle recovery supplement can either be a pre-workout supplement or a post-workout supplement.
The recommended time to take a specific supplement is based on the type.
Individuals should talk with their doctor and a nutritionist before starting any new supplement regimen.
This helps ensure the supplements are safe and minimize negative side effects given health and medical conditions.

Nutrition In Recovery

References

Cooke, M.B., Rybalka, E., Williams, A.D. et al. Creatine supplementation enhances muscle force recovery after eccentrically-induced muscle damage in healthy individuals. J Int Soc Sports Nutr 6, 13 (2009). https://doi.org/10.1186/1550-2783-6-13

DiNicolantonio, James J et al. “Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis.” Open heart vol. 5,1 e000668. 13 Jan. 2018, doi:10.1136/openhrt-2017-000668

Gough, Lewis A et al. “A critical review of citrulline malate supplementation and exercise performance.” European journal of applied physiology vol. 121,12 (2021): 3283-3295. doi:10.1007/s00421-021-04774-6

Kuehl, Kerry S et al. “Efficacy of tart cherry juice in reducing muscle pain during running: a randomized controlled trial.” Journal of the International Society of Sports Nutrition vol. 7 17. 7 May. 2010, doi:10.1186/1550-2783-7-17

Vitale, Kenneth C et al. “Tart Cherry Juice in Athletes: A Literature Review and Commentary.” Current sports medicine reports vol. 16,4 (2017): 230-239. doi:10.1249/JSR.0000000000000385

Weinert, Dan J. “Nutrition and muscle protein synthesis: a descriptive review.” The Journal of the Canadian Chiropractic Association vol. 53,3 (2009): 186-93.

Wolfe, Robert R. “Branched-chain amino acids and muscle protein synthesis in humans: myth or reality?.” Journal of the International Society of Sports Nutrition vol. 14 30. 22 Aug. 2017, doi:10.1186/s12970-017-0184-9

Zhang, Shihai, et al. “Novel metabolic and physiological functions of branched-chain amino acids: a review.” Journal of animal science and biotechnology vol. 8 10. 23 Jan. 2017, doi:10.1186/s40104-016-0139-z

Trigger Points Affecting The Lower Torso

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

Table of Contents

Introduction

The body’s lower extremities have a very important role as it helps support the upper body’s weight and provide stability to the lower body. The lower half of the body consists of the lower abdominals, hips, pelvic, and buttock regions, which have various muscles surrounding the lumbar and pelvic areas of the spine. These muscles help protect the lower vital organs and work with the central nervous system to utilize the sensory-motor function of the legs and feet. When normal factors like prolonged sitting or standing begin to affect the lower body, it can cause referred pain to travel down to the legs and push the lower extremities to develop symptoms associated with trigger points on the lower torso. Today’s article looks at the lower torso, how trigger points affect the lower torso, and therapeutic ways to manage trigger points in the lower torso. We refer patients to certified providers who incorporate various techniques in more inadequate body pain treatments related to trigger points to aid people suffering from pain-like symptoms along the lower torso muscles along the body’s lower extremities. We encourage and appreciate patients by referring them to our 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 Is The Lower Torso?

Have you been feeling stiffness around your hips lately? Have you noticed that you are leaning forward constantly, causing strain on your lower back? Or have you been experiencing pain in one location in your lower half? When dealing with these issues in the lower half of the body, it could correlate with somato-visceral symptoms associated with trigger points in the lower torso. The lower torso of the human body, or the lower abdominals, is defined as the anterior region of the trunk between the thoracic diaphragm and serves as the cavity to house the digestive, urinary, endocrine, and parts of the reproductive system. The lower torso has various muscles and nerves that surround the lower back, the hips, the pelvis, and the buttock region of the body that stabilizes the legs when in motion and supports the upper body. The muscles in the lower torso also surround the lumbar and pelvic areas of the spine to protect the joints and vertebrae from becoming dysfunctional. When issues begin to rise and affect the lower torso, it can lead to overlapping problems affecting the body’s lower extremities.

How Do Trigger Points Affect The Lower Torso?

Some of the issues affecting the lower torso that most people don’t realize are that prolonged sitting or standing can cause problems to the legs, hips, pelvis, and feet. This causes the blood supply to pool into the legs and feet, thus causing swelling and muscle weakness in the lower torso muscles. Another issue is when the lower torso has been through a traumatic event that can cause the affected muscles to develop tiny nodules known as trigger points to cause problems in the lower back, hips, pelvis, and buttock region of the body. Studies reveal that trigger points are often characterized by pain causing a limited range of motion in the joints while causing muscular contracture and mimicking other chronic conditions affecting the muscles. When trigger points affect the muscles in the lower torso, “Myofascial Pain and Dysfunction,” written by Dr. Janet Travell, M.D., pain associated with movement can cause tingling or electric sensations down to the lower extremities causing somato-visceral referred pain to the lower torso. Since the nerve roots from the spinal cord branch out to the various muscles and become irritated, causing referred pain to different areas of the lower extremities.

Trigger Point Therapy For The Abs- Video

Trigger Point Therapy - Treating the Abs

Have you been dealing with hip mobility issues? What about experiencing low back pain after being in a hunch position for an extended period? Or have you been experiencing problems in your pelvic region? Many of these issues are correlated with trigger points associated with the lower torso. Trigger points or myofascial pain syndrome are caused when the affected muscles have been overused or been through a traumatic event that causes referred pain to different body locations. The video explains where trigger points are located in the lower torso, especially in the abdomen and how to release them through palpations and massage. These techniques can help reduce the pain symptoms that affect the lower torso and manage myofascial pain from developing in the future.

Therapeutic Ways To Manage Trigger Points In The Lower Torso

Pain specialists like chiropractors and massage therapists will use various techniques to reduce the pain and alleviate the trigger points from the affected muscles. Many often go to a pain specialist who deals with trigger points through recommendations by their primary doctor. They will go through an examination process and explain to the pain specialist where the pain is located. Afterward, they will devise a treatment plan with the patient’s primary doctor, allowing them to follow a routine to prevent the pain from returning. Various techniques like stretching the abdominals, exercising, and resting can manage trigger points from returning to the affected muscles and even help bring muscle strength back to the body.

Conclusion

The lower torso consists of the hips, lower back, pelvis, and buttock region while protecting the body’s vital organs. The lower torso helps stabilize, the lower body extremities and supports the upper body’s weight. When normal issues like prolonged sitting or standing start to cause muscle strain to the lower torso region, it can develop trigger points to cause various problems to that region and cause mobility issues in the lower abdominal area. When the pain becomes unbearable, many individuals go to a pain specialist to help manage the trigger points from affecting the lower torso region and bring back mobility function to the lower extremities.

References

Akamatsu, Flavia Emi, et al. “Anatomical Basis of the Myofascial Trigger Points of the Gluteus Maximus Muscle.” BioMed Research International, Hindawi, 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5733974/.

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

Wade, Christian I, and Matthew J Streitz. “Anatomy, Abdomen and Pelvis, Abdomen – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 25 July 2022, https://www.ncbi.nlm.nih.gov/books/NBK553104/.

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Pregnancy Sciatica Chiropractic Clinic

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

Top view of a physiotherapist giving massages to the back of a pregnant woman lying on her side on a massage table at a health center. Concept of pregnant lumbar treatment.

The body experiences physical changes during pregnancy. As the baby grows, the body has to adjust, which can cause unfamiliar aches and pains. A common issue for pregnant women is sciatica symptoms or lumbar radiculopathy, which radiates discomfort sensations that travel down the lower spine, down the back of the thigh, and into the foot. Chiropractic care and massage therapy can realign the spine and hips, therapeutically massage circulation through the body, relieve symptoms, and restore function.

Table of Contents

Pregnancy Sciatica

The sciatic nerve is the largest in the body and the main nerve in the legs. In most cases, sciatica happens when this nerve gets compressed by bulging, slipped, or ruptured spinal discs, arthritis, or spinal stenosis.

Symptoms

Aches and pains that result from sciatica range from mild to severe sensations. Symptoms include:

Pain that travels from the pelvis down the back of the leg.
A burning sensation in the low back and buttocks.
Jolting pain that feels like an electric shock.
Numbness, muscle weakness, or tingling in one leg or foot.
Tingling sensation in one part of the body and pain in another.
Pain that worsens when coughing, sneezing or sitting for long periods.

Causes

Sciatica during pregnancy can be caused by:

Weight gain is going to pull the spine and muscles down.
Increased fluid retention can place added pressure on the nerve as it passes through the pelvis.
The expanding uterus can press down on the nerve in the lower part of the spine.
The growing belly and breasts shift the center of gravity forward and stretch the lordotic curve causing the muscles in the:
Buttocks and pelvis to tighten up and compress the sciatic nerve.
The baby’s head can rest directly on the nerve when settling into the proper birth position in the third trimester.
A herniated or slipped disc caused by the extra pressure of the growing uterus can be the cause, although this is less common.
Pregnancy also causes the body to release a hormone called relaxin, designed to relax the ligaments and prepare the pelvis for childbirth.
Loose ligaments can cause spinal compression and affect the sciatic nerve.

Sciatica will most likely occur during the third trimester when mother and baby are bulking up, but it can develop earlier, although this is less common. Most women experience symptoms on one side, though it can affect both legs. The condition can be constant or intermittent, depending on the amount of pressure placed on the nerve, and can remain for a few months after giving birth when the excess weight and fluid are gone.

Treatment Techniques

Simple home remedies and treatment to help ease the symptoms. These include:

Sleep on Your Side

Rest on the side of the body that does not present symptoms when lying down.
This takes the pressure off the compressed nerve.
Use a full-body pillow to support the hips and legs.

A Hot Shower, Heat, and Ice

Heat relaxes tight muscles and increases circulation.
Putting a cold pack on your lower back and rear pelvis can also help.

Consistent Movement

Consistent gentle movement that does not include too much bending or twisting is helpful to keep the musculoskeletal system active and limber.
Going for a light walk is recommended.
A prenatal yoga class can soothe muscles and the mind.
Low-impact activities like swimming can also be beneficial.

Prenatal Massage

Prenatal massage can reduce stress, improve blood circulation, and regulate hormones.

Chiropractic and Physical Therapy

Chiropractic is non-invasive and drug-free, making it a safe and gentle option for mom and baby.
A professional chiropractor can evaluate the condition.
Identify and remove interferences in the nervous system from the source.
Realign the bones.
Provide a personalized treatment plan to alleviate symptoms and stretches and strength-building exercises.

Sciatica In Pregnancy

References

American Pregnancy Association: “Prenatal Massage Therapy.

American Pregnancy Association: “Sciatic Nerve Pain During Pregnancy: Causes and Treatment.”

FRIEDMANN, E. “Narrowing of the spinal canal due to thickened lamina a cause of low-back pain and sciatica.” Clinical orthopedics vol. 21 (1961): 190-7.

Goldsmith, Laura T, and Gerson Weiss. “Relaxin in human pregnancy.” Annals of the New York Academy of Sciences vol. 1160 (2009): 130-5. doi:10.1111/j.1749-6632.2008.03800.x

KULOWSKI, J. “Unusual causes of low back pain and sciatica during pregnancy.” American journal of obstetrics and gynecology vol. 84 (1962): 627-30. doi:10.1016/0002-9378(62)90156-4

Trager, Robert J et al. “Ischial osteochondroma as an unusual source of pregnancy-related sciatic pain: a case report.” Chiropractic & manual therapies vol. 30,1 45. 17 Oct. 2022, doi:10.1186/s12998-022-00451-3

Experiencing Abdominal Pain? Could Be Trigger Points

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

Table of Contents

Introduction

When it comes to the torso is surrounded by various muscles that help protect the vital organs known as the gut system and help with stabilizing the spinal column in the body. The abdominal muscles are essential to maintaining good posture and core support for many individuals. When normal activities or chronic issues begin to affect the body, the abdominal muscles can also be affected and can cause referred pain all around the torso area. When the abdominal muscles are dealing with referred pain, it can develop into trigger points that mask other chronic conditions affecting the torso and the thoracolumbar region. Today’s article looks at the abdominal muscles and their function, how trigger points are affecting the abdomen, and how various treatments help manage trigger points associated with abdominal pain. We refer patients to certified providers who provide different techniques in abdominal pain therapies related to trigger points to aid many suffering from pain-like symptoms along the abdominal muscles along the torso. We encourage patients by referring them to our associated medical providers based on their examination when it is appropriate. We designate that education is a great solution to asking our providers profound and complex questions at the patient’s request. Dr. Alex Jimenez, D.C., notes this information as an educational service only. Disclaimer

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The Abdominal Muscles & Their Function

Do you have trouble moving around? Have you been dealing with muscle spasms along your abdomen? Does it hurt when you are sneezing, laughing, or coughing constantly? All these actions affecting your abdominal muscles might correlate with trigger points along the muscles and disrupt the torso area. The abdomen in the body has various muscles, a complex organ with many functions that contribute to a person’s quality of life. The abdominal muscles have many important parts, from supporting the trunk, allowing movement like twisting and turning, and holding the organs in the gut system in place through internal abdominal pressure regulation. The abdominal muscles have five main muscles that work together with the back muscles to keep body stability. They are:

Pyramidalis
Rectus Abdominus
External Obliques
Internal Obliques
Transversus Abdominis

Studies reveal that the abdominal muscles can help increase the stability of the lumbar region of the body from the vertebral columns by tending the thoracolumbar fascia and raising the intra-abdominal pressure. This allows the abdominal muscle to bend and flex in different positions without feeling pain. However, overusing the abdominal muscles can lead to unnecessary issues that can affect not only the torso but the surrounding muscles around the torso.

How Trigger Points Are Affecting The Abdomen

The book “Myofascial Pain and Dysfunction,” by Dr. Janet Travell, M.D., mentioned that abdominal symptoms are common and can cause diagnostic confusion for many people. Since the abdominal muscles can provide stability to the body’s trunk when a person overuses the abdominal muscles through various activities like quick and violent twisting of the mid-section, lifting heavy objects with the core instead of the legs, overdoing exercise regimes, or having a persistent cough, these various activities could potentially lead to the development of trigger points in the abdominal muscles causing pain in the abdomen and causing referred pain to the lower back. Studies reveal that trigger points along the abdominal muscles are developed through aggravating factors like prolonged sitting or standing can cause the abdominal muscles to become extremely tender and hyperirritable along the taut muscle bands. When trigger points affect the abdominal muscles, they can produce referred abdominal pain and visceral disorders (somato-visceral effects) that work closely together to mimic visceral diseases. This pertains to many individuals thinking something is wrong in their gut system, but their abdominal muscles are causing issues in their bodies.

Releasing Trigger Points In The Abdominal Muscles-Video

Have you been experiencing abdominal issues around your torso? Does it hurt when you laugh, cough, or sneeze? Do you feel muscle stiffness or tenderness along your abdominals? If you have been dealing with these symptoms throughout your life, you could be experiencing abdominal pain associated with trigger points in your torso. Abdominal pain is common for many individuals and can vary from gut issues or muscle issues that various factors can cause in the torso. Abdominal issues can even cause confusion to doctors when they are diagnosing the issues that are affecting their patients. When various actions cause pain to the abdominals, it can develop referred pain associated with trigger points. Trigger points develop when the muscle has been overused, creating tiny nodules in the taut band. Trigger points can be tricky to pinpoint but are treatable. The video above shows where the trigger points are located in the abdominal muscles and how to release them from the affected abdominal muscles to provide relief and reduce the mimic effects of visceral-somatic pain.

Managing Trigger Points Associated With Abdominal Pain Through Various Treatments

When abdominal pain affects the muscles, the symptoms can develop trigger points. When this happens, it can lead to confusion and often misdiagnosed. All is not lost; there are ways to manage trigger points associated with abdominal pain through various treatments. Studies reveal that various therapies like dry needling combined with palpations can reduce trigger points from causing more referred pain issues in the abdomen. Other ways to prevent trigger points from developing in the future are through exercises that can help strengthen the abdominal muscles. Exercises like abdominal breathing, pelvic tilts, sit-ups, and even laughter can help strengthen weak abdominal muscles and positively affect the body.

Conclusion

The torso has various muscles, known as abdominal muscles, that help protect the vital organs in the gut system, help stabilize the spinal column, and maintain good posture for many individuals. Various factors affecting the abdominal muscles can lead to a confusing diagnosis, as it could be an internal or external issue. When the abdominal muscles are affected by being overused through various activities, it can develop into trigger points in the muscles, causing visceral referred pain to the torso and cause muscle weakness. Luckily multiple treatments can help reduce the effects of trigger points associated with abdominal pain and can help strengthen the core of the body. This allows the individual to feel better and consider what not to do to their abdominals.

References

Balyan, Rohit, et al. “Abdominal Wall Myofascial Pain: Still an Unrecognized Clinical Entity.” The Korean Journal of Pain, The Korean Pain Society, Oct. 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5665744/.

Rajkannan, Pandurangan, and Rajagopalan Vijayaraghavan. “Dry Needling in Chronic Abdominal Wall Pain of Uncertain Origin.” Journal of Bodywork and Movement Therapies, U.S. National Library of Medicine, Jan. 2019, https://pubmed.ncbi.nlm.nih.gov/30691770/.

Seeras, Kevin, et al. “Anatomy, Abdomen and Pelvis, Anterolateral Abdominal Wall.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 25 July 2022, https://www.ncbi.nlm.nih.gov/books/NBK525975/.

Tesh, K M, et al. “The Abdominal Muscles and Vertebral Stability.” Spine, U.S. National Library of Medicine, June 1987, https://pubmed.ncbi.nlm.nih.gov/2957802/.

Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 1:Upper Half of Body. Williams & Wilkins, 1999.

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De-Stress Methods to Relieve Tension and Anxiety

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

physiotherapist and patient at the clinic's reception desk — physiotherapist and patient writing the form at the reception of the clinic

Stress and anxiety treatments can include a range of therapies, including talking therapy, meditation techniques, and medication. Chiropractic care, adjustments, and massage are also used as a treatment plan to de-stress. Whether diagnosed with an anxiety disorder or experiencing intense stress, chiropractic functional medicine can address the physical symptoms to rebalance the mind and body.

Table of Contents

De-Stress

Physical and mental health are connected. Stress and anxiety can cause tension, fatigue, headaches, and aches and pains. It can make sleeping and/or relaxing difficult, affecting mental and physical health. Signs of stress include:

Blood sugar level changes
Every day, or almost every day, tension headaches
Teeth grinding
Backaches
Muscle tension
Digestive problems
Skin irritation
Hair loss
Heart issues

The spine is the conduit for the sympathetic and parasympathetic nervous systems.

The sympathetic nervous system activates when the brain thinks sudden action or important stressful decisions must be taken.
The fight or flight response speeds up the heart rate and releases adrenaline.
The parasympathetic system deactivates the fight or flight response, calming the body into a more relaxed state.

Problems arise when the sympathetic nervous system is repeatedly activated, causing the fight-or-flight system to remain semi-active. This can happen during long commutes, traffic jams, loud music, deadlines, sports practice, rehearsals, etc. The parasympathetic nervous system never gets to activate and settle the mind and body. The result is constantly feeling stressed and agitated.

Chiropractic Care

Chiropractic care to de-stress decreases stress hormones and releases feel-good hormones like oxytocin, dopamine, and serotonin, which allow healing and help the body relax. Chiropractic adjustments let the brain know it’s time to activate the parasympathetic nervous system and ease down. Chiropractic helps by:

Relieving Muscle Tension

When the body is under stress, the muscles tense up, causing discomfort, aches, and pains.
The continued stress can lead to health issues, panic attacks, anxiety disorders, and depression.
Chiropractic relieves tension, restoring the body to its natural balance.

Restoring Body Function

When stress activates, it can cause body dysfunction.
Chiropractic can help effectively restore bodily functions.
Adjustments and massage rebalance blood circulation and energy flow, allowing clear nervous system transmission.

Lowering Blood Pressure

Chiropractic care has shown positive results in lowering blood pressure.

Improving Quality Sleep

Chiropractic care improves sleep patterns by correcting spinal misalignments.

Increasing Relaxation

Chiropractic adjustments can release and relax muscle activity, allowing the body to relax and de-stress completely.

The Impact of Stress

References

Jamison, J R. “Stress management: an exploratory study of chiropractic patients.” Journal of Manipulative and Physiological Therapeutics vol. 23,1 (2000): 32-6. doi:10.1016/s0161-4754(00)90111-8

Kültür, Turgut, et al. “Evaluation of the effect of chiropractic manipulative treatment on oxidative stress in sacroiliac joint dysfunction.” Turkish Journal of Physical Medicine and Rehabilitation vol. 66,2 176-183. 18 May. 2020, doi:10.5606/tftrd.2020.3301

Mariotti, Agnese. “The effects of chronic stress on health: new insights into the molecular mechanisms of brain-body communication.” Future science OA vol. 1,3 FSO23. 1 Nov. 2015, doi:10.4155/fso.15.21

https://www.nimh.nih.gov/health/publications/so-stressed-out-fact-sheet

Stefanaki, Charikleia, et al. “Chronic stress, and body composition disorders: implications for health and disease.” Hormones (Athens, Greece) vol. 17,1 (2018): 33-43. doi:10.1007/s42000-018-0023-7

Yaribeygi, Habib, et al. “The impact of stress on body function: A review.” EXCLI journal vol. 16 1057-1072. 21 Jul. 2017, doi:10.17179/excli2017-480

An Overview Of Lumbago

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

Table of Contents

Introduction

Many individuals don’t realize that the various muscles in their back help provide functionality to the body. The back muscles help move, bend, rotate, and help the individual stand up straight when they are out and about. The back muscles also help protect the cervical, thoracic, and lumbar sections of the spine and work together with the head, neck, shoulders, arms, and legs to provide mobility. When the body begins to wear down with age naturally, it can lead to back issues that can limit a person’s mobility, or normal activities can cause the back muscles to be overused and develop trigger points to invoke back pain or lumbago. Today’s article looks at the thoracolumbar paraspinal muscles in the back, how the lumbago is associated with trigger points, and treatments to relieve the lumbago in the thoracolumbar muscles. We refer patients to certified providers who provide different techniques in thoracic lumbar back pain therapies associated with trigger points to aid many suffering from pain-like symptoms along the thoracolumbar paraspinal muscles along the back, causing lumbago. We encourage patients by referring them to our associated medical providers based on their examination when it is appropriate. We designate that education is a great solution to asking our providers profound and complex questions at the patient’s request. Dr. Alex Jimenez, D.C., notes this information as an educational service only. Disclaimer

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The Thoracolumbar Paraspinal Muscles In The Back

Have you been finding it difficult to walk even for a short period? Do you feel aches and soreness when getting out of bed? Are you constantly in pain when bending over to pick up items from the ground? These various actions that you are doing incorporate the thoracolumbar paraspinal muscle in the back, and when issues affect these muscles, it can lead to lumbago associated with trigger points. The thoracolumbar paraspinal in the back is a group of muscles closely surrounded by the thoracolumbar spine, where the thoracic region ends, and the lumbar region begins. The thoracolumbar paraspinal muscles in the back have a casual relationship with the body as it requires contribution from the systems requiring movement. Studies reveal that the thoracolumbar paraspinal muscles are modulated through communication with the three sub-systems, which include:

The passive system: vertebrae, discs, and ligaments
The active system: muscles and tendons
The control system: central nervous system and nerves

Each system provides muscular activities when a person is bending down to pick up an object or doing simple movements. However, when the muscles become overused, it can lead to various issues affecting the back and surrounding muscles.

Lumbago Associated With Trigger Points

Studies reveal that paraspinal muscle integrity plays a very critical role when it comes to the maintenance of spinal alignment in the back. When the thoracolumbar paraspinal muscles become overused from normal activities, it can affect the back by causing back pain symptoms or lumbago associated with trigger points. In Dr. Travell, M.D.’s book “Myofascial Pain and Dysfunction,” trigger points may be activated due to sudden movements or sustained muscular contraction over time that leads to the development of lumbago. Atrophy issues in the paraspinal muscles can contribute to lumbago associated with trigger points that cause deep referred pain in the thoracolumbar regions of the back. Active trigger points in the deep muscle group of the thoracolumbar paraspinal can impair movement between the vertebrae during flexion or side bending.

An Overview Of Lumbago- Video

Back Pain (Backache / Lumbago) - Symptoms and Treatment Options

Lumbago or back pain is one of the most common issues that many individuals, from acute to chronic, depending on how severe the pain is inflicted on the back. Have you been feeling pain in your mid-lower back? Do you feel an electric shock when you run down your leg in a weird position? Or have you felt tenderness in the middle of your back? Experiencing these symptoms could indicate that the thoracolumbar paraspinal muscles are affected by trigger points associated with lumbago. The video explains what lumbago is, the symptoms, and various treatment options to relieve the pain and manage trigger points that are causing the thoracolumbar muscles issues in the back. Many individuals who suffer from lumbago don’t often realize that various factors can affect the surrounding muscles in the thoracolumbar region and mask other previous conditions from which they could suffer. Regarding managing lumbago associated with trigger points, various treatment options can help reduce the pain affecting the thoracolumbar paraspinal muscles while managing trigger points for progressing further in the back.

Treatments To Relieve Lumbago In The Thoracolumbar Muscles

Since lumbago or back pain is a common issue for many people, various treatments can reduce the pain-like symptoms in the thoracolumbar muscles and manage the associated trigger points. Some of the simplest treatments that many individuals can use are to correct how they are standing. Many individuals often lean on one side of their bodies which causes the thoracolumbar paraspinal muscles on the opposite sides to be overloaded. This causes spinal subluxation or misalignment to the thoracolumbar region. Another treatment that many people can incorporate into their daily lives is by going to a chiropractor for a spinal adjustment for the thoracolumbar spine. Studies reveal that chiropractic care combined with physical therapy can relieve the thoracolumbar back while reducing the pain symptoms associated with trigger points by loosening the stiff muscles and causing relief to the back.

Conclusion

The back has various muscles known as the thoracolumbar paraspinal muscles that allow movement and mobility to the body. The back muscles help protect the cervical, thoracic, and lumbar sections of the spine while working with the rest of the body’s components to keep the body stable. When natural aging or actions affect the back muscles, it can lead to various pain issues that can activate trigger points causing lumbago or back pain. Fortunately, some treatments can help alleviate back pain in the thoracolumbar paraspinal muscles while managing trigger points to bring back mobility to the back.

References

Bell, Daniel J. “Paraspinal Muscles: Radiology Reference Article.” Radiopaedia Blog RSS, Radiopaedia.org, 10 July 2021, https://radiopaedia.org/articles/paraspinal-muscles?lang=us.

du Rose, Alister, and Alan Breen. “Relationships between Paraspinal Muscle Activity and Lumbar Inter-Vertebral Range of Motion.” Healthcare (Basel, Switzerland), MDPI, 5 Jan. 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934538/.

He, Kevin, et al. “The Implications of Paraspinal Muscle Atrophy in Low Back Pain, Thoracolumbar Pathology, and Clinical Outcomes after Spine Surgery: A Review of the Literature.” Global Spine Journal, SAGE Publications, Aug. 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359686/.

Khodakarami, Nima. “Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation.” Healthcare (Basel, Switzerland), MDPI, 24 Feb. 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151187/.

Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 1:Upper Half of Body. Williams & Wilkins, 1999.

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The Digestive Process: Functional Medicine Sciatica Clinic

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

The body needs food for fuel, energy, growth, and repair. The digestive process breaks down food into a form the body can absorb and use for fuel. The broken-down food gets absorbed into the bloodstream from the small intestine, and the nutrients are carried to the cells throughout the body. Understanding how the organs work together to digest food can help with health goals and overall health.

Table of Contents

The Digestive Process

The organs of the digestive system are the following:

Mouth
Esophagus
Stomach
Pancreas
Liver
Gallbladder
Small intestine
Large intestine
Anus

The digestive process starts with the anticipation of eating, stimulating the glands in the mouth to produce saliva. The digestive system’s primary functions include:

Mixing food
Moving food through the digestive tract – peristalsis
The chemical breakdown of food into smaller absorbable components.

The digestive system converts food into its simplest forms, which include:

Glucose – sugars
Amino acids – protein
Fatty acids – fats

Proper digestion extracts nutrients from food and liquids to maintain health and function properly. Nutrients include:

Carbohydrates
Proteins
Fats
Vitamins
Minerals
Water

Mouth and Esophagus

The food is ground up by the teeth and moistened with saliva to swallow easily.
Saliva also has a special chemical enzyme that starts breaking down carbohydrates into sugars.
Muscular contractions of the esophagus massage the food into the stomach.

Stomach

The food passes through a small muscle ring into the stomach.
It gets mixed with gastric chemicals.
The stomach churns the food to break it down further.
The food is then squeezed into the first part of the small intestine, the duodenum.

Small Intestine

Once in the duodenum, the food mixes with more digestive enzymes from the pancreas and bile from the liver.
The food passes into the lower parts of the small intestine, called the jejunum and the ileum.
Nutrients are absorbed from the ileum, lined with millions of villi or thread-like fingers that facilitate the absorption.
Each villus is connected to a mesh of capillaries, which is how nutrients get absorbed into the bloodstream.

Pancreas

The pancreas is one of the largest glands.
It secretes digestive juices and a hormone called insulin.
Insulin helps regulate the amount of sugar in the blood.
Problems with insulin production can lead to conditions like diabetes.

Liver

The liver has several different roles that include:

Breaks down fats using bile stored in the gallbladder.
Processes proteins and carbohydrates.
Filters and processes impurities, medications, and toxins.
Generates glucose for short-term energy from compounds like lactate and amino acids.

Large Intestine

A large reservoir of microbes and healthy bacteria live in the large intestine and play an important role in healthy digestion.
Once the nutrients have been absorbed, the waste is passed into the large intestine or bowel.
Water is removed, and the waste gets stored in the rectum.
It is then passed out of the body through the anus.

Digestive System Health

Ways to keep the digestive system and the digestive process healthy include:

Drink More Water

Water helps the food flow more easily through the digestive system.
Low amounts of water/dehydration are common causes of constipation.

Add More Fiber

Fiber is beneficial to digestion and helps with regular bowel movements.
Incorporate both soluble and insoluble fiber.
Soluble fiber dissolves in water.
As soluble fiber dissolves, it creates a gel that can improve digestion.
Soluble fiber may reduce blood cholesterol and sugar.
It helps your body improve blood glucose control, which can aid in reducing your risk for diabetes.
Insoluble fiber does not dissolve in water.
Insoluble fiber attracts water into the stool, making it softer and easier to pass with less strain on the bowels.
Insoluble fiber can help promote bowel health and regularity and supports insulin sensitivity which can help reduce the risk of diabetes.

Balanced Nutrition

Eat fruit and vegetables daily.
Choose whole grains over processed grains.
Avoid processed foods in general.
Choose poultry and fish more than red meat and limit processed meats.
Cut down on sugar.

Eat Foods with Probiotics or Use Probiotic Supplements

Probiotics are healthy bacteria that help combat unhealthy bacteria in the gut.
They also generate healthy substances that nourish the gut.
Consume probiotics after taking antibiotics that often kill all the bacteria in the gut.

Eat Mindfully and Chew Food Slowly

Chewing food thoroughly helps to ensure the body has enough saliva for digestion.
Chewing food thoroughly also makes it easier for nutritional absorption.
Eating slowly gives the body time to digest thoroughly.
It also allows the body to send cues that it is full.

How The Digestive System Works

References

GREENGARD, H. “Digestive system.” Annual review of physiology vol. 9 (1947): 191-224. doi:10.1146/annurev.ph.09.030147.001203

Hoyle, T. “The digestive system: linking theory and practice.” British journal of nursing (Mark Allen Publishing) vol. 6,22 (1997): 1285-91. doi:10.12968/bjon.1997.6.22.1285

https://www.merckmanuals.com/home/digestive-disorders/biology-of-the-digestive-system/overview-of-the-digestive-system

https://www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-works

Martinsen, Tom C et al. “The Phylogeny and Biological Function of Gastric Juice-Microbiological Consequences of Removing Gastric Acid.” International journal of molecular sciences vol. 20,23 6031. 29 Nov. 2019, doi:10.3390/ijms20236031

Ramsay, Philip T, and Aaron Carr. “Gastric acid and digestive physiology.” The Surgical clinics of North America vol. 91,5 (2011): 977-82. doi:10.1016/j.suc.2011.06.010

Residual Backache On The Serratus Posterior Inferior

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

Table of Contents

Introduction

As the “backbone” of the body, the thoracic region of the back has various muscles that help support the ribcage and protect the heart and lungs from injuries. The thoracic spine’s main function is providing respiration and maintaining good posture. However, various habits can cause issues to the muscles in the thoracic spine, which leads to upper back pain and the development of trigger points. One of the thoracic muscles affected by trigger points is the serratus posterior inferior muscle. Today’s article looks at the serratus posterior inferior muscle, how trigger points affect the thoracic region of the back, and how to manage thoracic back pain associated with trigger points. We refer patients to certified providers who provide different techniques in thoracic back pain therapies associated with trigger points to aid many suffering from pain-like symptoms along the serratus posterior inferior muscle along the back. We encourage patients by referring them to our associated medical providers based on their examination when it is appropriate. We designate that education is a great solution to asking our providers profound and complex questions at the patient’s request. Dr. Alex Jimenez, D.C., notes this information as an educational service only. Disclaimer

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What Is The Serratus Posterior Inferior Muscle?

Have you felt aches and pain when bending down to pick something up? What about feeling tenderness near your lower back? Or have you experienced muscle stiffness when stretching? Many of these symptoms are associated with back pain that correlates to overusing the thoracic muscles, which includes the serratus inferior posterior muscles. The serratus posterior muscles (superior and inferior) are accessory breathing muscles as part of the extrinsic muscles. The serratus posterior inferior helps with the chest cavity’s expiration, while the superior help with inspiration. Some of the functionalities that the serratus posterior inferior provides are that in a bilateral action, the inferior works with the superior muscles to reduce the extension of the thoracic vertebrae.

In contrast, the unilateral action for the serratus posterior inferior muscle helps rotate the spine to the opposite sides. Studies reveal that based on the attachment of the serratus, the posterior inferior and superior are generally considered insignificant muscles. Since the serratus posterior muscles help aid respiration to the thoracic region, it can be succumbed to trigger points or myofascial pain syndrome that can affect the thoracic part of the back.

How Trigger Points Affect The Thoracic Region?

When the serratus posterior muscles in the thoracic region are affected by myofascial pain syndrome or trigger points, it correlates to the various activities the person has been doing that cause muscle strain along the serratus inferior posterior muscle. The book, “Myofascial Pain & Dysfunction” explains that when individuals feel a nagging ache in the lower thoracic region of the back, it correlates to residual backache associated with trigger points. Studies reveal that trigger points or myofascial pain syndrome are musculoskeletal pain disorder that affects one or multiple muscles in the body. Since back pain is common, trigger points can cause hyperirritability in the muscle’s taut band due to various factors that can cause strain on the affected muscle. When it comes to the serratus posterior inferior muscle developing active trigger points, it’s due to overload strain from combined movements like lifting, turning, and reaching for items that can also affect the surrounding muscles in the thoracic region of the back.

Trigger Point Of The Week: Serratus Posterior Inferior- Video

Serratus Posterior Inferior - Trigger Point of the Week

Have you been dealing with pain in your upper back in the thoracic region? Do you experience tenderness or soreness near your ribcage? Or have you felt a twinge of pain when turning your torso? Most of these symptoms are common signs that the thoracic region is affected by trigger points along the serratus posterior inferior muscle. The video explains where the serratus posterior inferior is located while pinpointing where the trigger points are located in the thoracic region of the back. Trigger points associated with thoracic back pain mimic other chronic conditions that can cause muscle tension and strain on the upper back. Studies reveal that latent and active trigger points affecting the upper thoracic area muscles can make many individuals feel more pain than they can tolerate. This can affect how a person functions and can make them feel inadequate. However, it is possible to incorporate a variety of treatments to reduce the pain and manage trigger points from progressing further in the thoracic region of the back.

Managing Thoracic Back Pain Associated With Trigger Points

Various treatments are available to reduce the pain affecting the thoracic region of the back and even manage trigger points associated with the serratus posterior inferior muscle. Many individuals often go to a chiropractor to relieve their back pain. Chiropractors utilize their hands and various techniques to manipulate the spine and can even pinpoint where the trigger points affect the multiple muscles in the thoracic region. Chiropractors even work with other pain specialists to devise a treatment procedure to reduce the symptoms while managing thoracic back pain associated with trigger points. Studies reveal that by when pain specialists like chiropractors begin identifying proper treatment strategies for managing thoracic back pain associated with trigger points, it might be able to reduce pain and improve function for many people dealing with thoracic back pain.

Conclusion

The thoracic region of the back has various muscles that help support the ribcage and protect vital organs, which include the heart and the lungs. One of the muscles in the thoracic region is the serratus posterior inferior muscle, an accessory breathing muscle that helps with the chest cavity expiration and helps reduce the extension of the thoracic vertebrae. When the inferior muscle becomes overused by various movements, it can develop trigger points along the inferior muscle, causing thoracic back pain. Trigger points along the serratus inferior posterior muscles can mimic other chronic conditions that can cause symptoms of muscle tension and strain on the upper back. Luckily, various treatments have been available to reduce pain symptoms and manage thoracic back pain associated with trigger points. These treatments can bring back mobility to the thoracic region of the back without the individual being in pain.

References

Chen, Chee Kean, and Abd Jalil Nizar. “Myofascial Pain Syndrome in Chronic Back Pain Patients.” The Korean Journal of Pain, The Korean Pain Society, June 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111556/.

Dor, Adi, et al. “Proximal Myofascial Pain in Patients with Distal Complex Regional Pain Syndrome of the Upper Limb.” Journal of Bodywork and Movement Therapies, U.S. National Library of Medicine, July 2019, https://pubmed.ncbi.nlm.nih.gov/31563368/.

Mitchell, Brittney, et al. “Anatomy, Back, Extrinsic Muscles.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 25 Aug. 2022, https://www.ncbi.nlm.nih.gov/books/NBK537216/.

Ortega-Santiago, Ricardo, et al. “Widespread Pressure Pain Sensitivity and Referred Pain from Trigger Points in Patients with Upper Thoracic Spine Pain.” Pain Medicine (Malden, Mass.), U.S. National Library of Medicine, 1 July 2019, https://pubmed.ncbi.nlm.nih.gov/30821833/.

Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 1:Upper Half of Body. Williams & Wilkins, 1999.

Vilensky , J A, et al. “Serratus Posterior Muscles: Anatomy, Clinical Relevance, and Function.” Clinical Anatomy (New York, N.Y.), U.S. National Library of Medicine, July 2001, https://pubmed.ncbi.nlm.nih.gov/11424195/.

Disclaimer

Herniated Disc Signs It Is Returning To Normal: Sciatica Clinic

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

Male doctor consults patient and shows the model of several spines in modern clinic — Doctor consults patient and shows the model of several spines in modern clinic. Healthcare concept

Herniated disc injuries and the time it takes to heal depend on the injury’s cause, the severity, and where it occurred along the spine. Symptoms can last a few days to months. Chiropractic treatment, massage therapy, and decompression realign the spine and return the disc to its correct position. Still, the herniated disc signs it is returning to normal can take time as the rest of the spine and body adjust to the realignment.

Table of Contents

Herniated Disc Signs It Is Returning To Normal

Most cases take a few weeks with healing time depending on health conditions, physical activity level, and age. However, in severe cases, a herniated disc can take up to several months to fully heal, but discomfort symptoms usually resolve sooner.

Expectations From a Healing Disc

Resting the spine and taking it easy after the injury is recommended.
Too much rest is not recommended as it can cause muscle stiffness.
While the herniated disc is healing, a primary doctor may prescribe anti-inflammatories or muscle relaxants to help ease discomfort.
A chiropractor and/or physical therapist can teach exercises and stretches to relieve pressure on nerves, loosen tight muscles, and improve circulation.

Signs The Herniated Disc Is Healing

Most herniated discs cause significant pain in the back and neck from the nervous system, causing some of the muscles of the low back or neck to spasm to protect the area from further damage.
Usually, the muscle spasms relax within the first days of the injury.
After spinal decompression, neurological symptoms like the sharp, shooting pain down a nerve in the arm or leg are the first symptoms to go away.
Then muscle weakness along the path of the nerve goes away.
Numbness in the extremities can linger around longer.

Length of Time

The wear and tear of adult spinal discs, combined with unhealthy posture habits, job occupation, previous injuries, etc., decrease blood circulation.
This is why it can take some time to heal completely, as the entire blood supply needs to reset to optimal circulation.
Nerve compression causing aches and pain sensations down the nerves can also take time.

Regular Activity

Returning to regular activities depends on the individual’s case and condition. It is essential not to overdo things that can cause excessive loading of the spine before the disc has fully healed, which increases the risk of re-herniation and other injuries.

Inactivity can slow the healing process and cause inflammation.
Patients are encouraged to return to activities that generate gentle motion to stimulate the stabilizing muscles to function properly and increase blood circulation to the injured area.
Individuals are recommended to:
Learn posture improvement when walking, sitting, standing, and sleeping.
Adjust sleep patterns.
Incorporate anti-inflammatory nutrition during the healing process.
Engage in light, gentle exercises.
Keep the body hydrated.
Avoid alcohol during the healing process.
This provides a mechanical and biological environment that eventually becomes a personalized exercise physical therapy program.

DOC Spinal Decompression

References

Díez Ulloa, Máximo Alberto. “Role of Microangiogenensis in Disc Herniation Healing.” Journal of investigative surgery: the official journal of the Academy of Surgical Research vol. 34,6 (2021): 685. doi:10.1080/08941939.2019.1682725

Factors that influence recovery: Mayo Clinic. February 8, 2022. “Herniated disk.” https://www.mayoclinic.org/diseases-conditions/herniated-disk/symptoms-causes/syc-20354095

Factors that influence recovery: NHS. March 22, 2021. “Slipped Disc.” https://www.nhs.uk/conditions/slipped-disc/

How to speed up healing time: American Academy of Orthopaedic Surgeons. January 2022. “Herniated Disk in the Lower Back” https://orthoinfo.aaos.org/en/diseases–conditions/herniated-disk-in-the-lower-back/

Keramat, Keramat Ullah, and Aisling Gaughran. “Safe physiotherapy interventions in large cervical disc herniations.” BMJ case reports vol. 2012 bcr2012006864. 18 Aug. 2012, doi:10.1136/bcr-2012-006864

Stoll, T et al. “Physiotherapie bei lumbaler Diskushernie” [Physiotherapy in lumbar disc herniation ]. Therapeutische Umschau. Revue therapeutique vol. 58,8 (2001): 487-92. doi:10.1024/0040-5930.58.8.487

Swartz, Karin R, and Gregory R Trost. “Recurrent lumbar disc herniation.” Neurosurgical focus vol. 15,3 E10. 15 Sep. 2003, doi:10.3171/foc.2003.15.3.10

Trigger Points Affecting The Serratus Anterior

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

Table of Contents

Introduction

The upper body works because it provides stability for the body and motor-sensory functions to the arms, neck, shoulders, and chest. The muscles surrounding each body section have different roles and outputs that have specific jobs for body functionality. For the chest body area, the various muscles are there to support the shoulders and arms while protecting the chest cavity and the internal organs inside. Some of the different chest muscles even support the internal organs and the rest of the muscles. One of those muscles is known as the serratus anterior muscle. Today’s article looks at this muscle, how trigger points affect the serratus anterior muscle, and various actions to manage trigger points along the serratus anterior. We refer patients to certified providers who provide different techniques in pain therapies associated with trigger points to aid many suffering from pain-like symptoms along the serratus anterior muscle along the ribcage. We encourage patients by referring them to our associated medical providers based on their examination when it is appropriate. We designate that education is a great solution to asking our providers profound and complex questions at the patient’s request. Dr. Alex Jimenez, D.C., notes this information as an educational service only. Disclaimer

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What Is The Serratus Anterior?

Have you been experiencing pain in your sides? Do you notice that your shoulders feel stiff when rotating backward? Or are you experiencing any cardiovascular disorders that are causing you pain? Pain can come in many forms and affect a person differently, as most of these symptoms are associated with trigger points affecting the serratus anterior muscle along the side of the ribs. The serratus anterior muscles work in the body because this muscle is located deep within the scapula (shoulder blades) and the pectoral muscles. Some of the functions that the serratus anterior provides are that it helps pull the shoulder blades forward around the thorax by allowing anteversion and protraction of the arms.

A great example is when a boxer is throwing a punch. This motor action is done with the long thoracic nerve. The long thoracic nerve originated from the C-5 and C-6 regions of the cervical spine and is the motor nerve for the serratus anterior muscle to allow an anterolateral motion for the shoulder blades that allows arm elevation. Another function of the serratus anterior is that it helps lift the ribs and provide assistance with respiration. The serratus anterior muscle also helps protect the side of the ribcage.

Trigger Points Affecting The Anterior Serratus Muscle

The serratus anterior muscle and the long thoracic nerve work hand-in-hand to provide motor function to the arms but can succumb to various injuries that can cause the development of trigger points or myofascial pain syndrome in the anterior serratus muscle. According to Dr. Travell, M.D.’s book, “Myofascial Pain & Dysfunction,” trigger points may be activated when the serratus anterior muscle has been overused and strained from excessive exercises like prolonged running, pushups, or heavy weight lifting or even extreme coughing from respiratory diseases. Other studies reveal that trigger points affecting the serratus anterior muscle can cause radiating pain along the anterior chest wall that can mimic radiculopathy and often be confused with chronic mechanical neck pain, instability in the glenohumeral, and even shoulder impingement syndrome. Trigger points are often difficult to diagnose due to the referred pain in the affected muscle. The various factors that contribute to the development of trigger points can be simple, like an overused muscle or even a slightly poor posture stance that can cause an imbalance in the body.

Trigger Point Release On The Serratus Anterior- Video

Trigger Point Release - Serratus Anterior

Have you been dealing with pain in the side of your ribs? What about experiencing stiffness or pain when throwing a punch? Do you feel any aches or soreness when adjusting your posture? These symptoms you are experiencing could contribute to the development of trigger points affecting the serratus anterior muscle. The serratus anterior covers the side of the ribcage and lies deep within the scapula and pectoral muscle. This muscle allows the motor function to the arms as it pulls the scapula forward around the thorax when someone throws a punch. However, when the muscle is overused, it can develop trigger points along the serratus anterior muscle and mimic chronic issues in the chest cavity. This causes referred pain to travel from the side of the ribs down to the hand, causing pain-like symptoms to the ring and pinky fingers. Fortunately, various treatments help manage trigger points in the serratus anterior muscle. The video above shows where the trigger points are located in the serratus anterior and how to release the trigger points from the affected muscle to relieve the pain and manage trigger points from returning to the muscle.

Various Actions To Manage Trigger Points Along The Serratus Anterior

When the serratus anterior is affected by trigger points, many people will often feel pain along their sides and complain about their chest hurting for an unknown reason. When this happens, they would be referred to a pain specialist like a chiropractor or a massage therapist to manage trigger points associated with the serratus anterior through various techniques. Studies reveal that techniques like intramuscular neural distribution of the serratus anterior muscle can help reduce the effects of trigger points in the affected muscle to reduce pain-like symptoms. Other methods like thoracic spinal manipulation, dry-needling, acupuncture, or stretching the muscle group can help loosen the stiff muscles and lower trigger points from forming. However, other actions that many people should consider are modifying or avoiding strenuous activities that can reactivate the serratus anterior muscle trigger points. Even when the person is sleeping, putting a pillow under to support the arm can prevent the scapula from falling forward.

Conclusion

The serratus anterior muscle is located at the side of the ribs and is deep within the scapula (the shoulder blades) and the poster muscles. The serratus anterior muscle works with the long thoracic nerve by providing motor function to the arms by allowing anterolateral motion. This allows the individual to throw a punch in a boxing match while lifting the ribs and assisting with respiration. When the serratus anterior muscle succumbs to injuries or has been overused, it can develop into trigger points and cause various issues affecting the body’s chest cavity. Trigger points are treatable through multiple therapies that can manage trigger points while reducing the pain effects rendered in the serratus anterior muscles. These therapies return mobility and motor function to the arms and the serratus anterior muscles.

References

Bautista, Alexander, et al. “Serratus Anterior Muscle Pain Syndrome: A Diagnostic Conundrum.” OUP Academic, Oxford University Press, 11 Feb. 2017, https://academic.oup.com/painmedicine/article/18/8/1600/2990174?login=false.

Long, Kirsten, and Forshing Lui. “Anatomy, Thorax, Long Thoracic Nerve.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 31 July 2021, https://www.ncbi.nlm.nih.gov/books/NBK535396/.

Lung, Kirsten, et al. “Anatomy, Thorax, Serratus Anterior Muscles – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 7 Oct. 2021, https://www.ncbi.nlm.nih.gov/books/NBK531457/.

Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 1:Upper Half of Body. Williams & Wilkins, 1999.

Yi, Kyu-Ho, et al. “Intramuscular Neural Distribution of the Serratus Anterior Muscle: Regarding Botulinum Neurotoxin Injection for Treating Myofascial Pain Syndrome.” Toxins, MDPI, 11 Apr. 2022, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9033065/.

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Neuropathy Therapeutic Massage Chiropractic Sciatica Clinic

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

Hospital Madrid_Property.jpg, Hospital Madrid_Javier David Dumitru.jpg, Hospital Madrid_Mariana Ramirez.jpg — Male physiotherapist giving feet massage to unrecognized woman lying in stretcher.

Neuropathy therapeutic massage is a system of structured palpations or movements of the body’s soft tissues. When the nerves don’t get enough oxygen and nutrients from blood circulation, symptoms like tenderness, tingling, numbness, and pain can present. The best way to move the blood is by massaging the circulation in and around the numb and sore areas and throughout the body. Many types of massage therapy are available for various health-related issues. This includes:

Pain alleviation and management
Injury rehabilitation and prevention
Stress alleviation
Anxiety and depression therapy
Immune system restoration
Increasing relaxation
Facilitating overall wellness

Table of Contents

Neuropathy Therapeutic Massage

Neuropathy therapeutic massage: The objective is to stimulate blood flow throughout the body. This is because the more muscles move, the better they can maintain blood circulation to nourish the nerves and the body, which is why physical activity/exercise/movement is encouraged. Benefits include:

De-stressing the nerves that are causing tingling, numbness, and burning.
The discomfort eases as the muscles are lengthened and loosened, releasing the tightness and pressure.
Endorphins (natural painkillers) are released, minimizing the pain.
Increase in circulation
Reduced spasms and cramping
Increased joint flexibility
Mobility restoration
Symptom relief
Decreased anxiety
Improved sleep quality
Increased energy levels
Improved concentration
Reduced fatigue

Massage Techniques

Massaging techniques include:

Kneading
Stroking
Gliding
Percussion
Vibration
Friction
Compression
Passive stretching
Active stretching

Effleurage

This can be firm or light soothing, stroking movements without dragging the skin, using the fingertips or the palms.

Petrissage

Lifting or picking up muscles and rolling the skin.

Tapotement

Striking with the side of the hand, usually with slightly flexed fingers, rhythmic finger movements, or short rapid movements with the sides of the hand.

These techniques may be applied with or without massage oils, topical ointments, salt or herbal preparations, hydromassage, thermal massage, or massage instruments/tools.

Massage Types

There are different types of massage, those that are for comfort and those for specific conditions or diseases. A few include:

Swedish Massage

Generally regarded as the most common form of massage, this technique involves a combination of five basic strokes and concentrates on the muscles and connective tissues.
Used to improve circulation, relaxation, pain relief, and overall maintenance and well-being.

Sports Massage

Sports massage therapies are used in preventative and therapeutic settings.
Athletes use the technique during warm-ups, training, and competition to treat and/or help in:
Injury prevention
Improved flexibility
Full range of motion
Improved performance
Helps to focus and mental clarity.

Reflexology

This technique uses a system of points on the hands, feet, and ears that correspond to or reflex other body areas.
Reflexologists apply appropriate pressure to these points to stimulate energy flow, to relieve pain or blockages throughout the body.
Reflexology is also used to ease stress and promote relaxation.

Aromatherapy

Various essential oils derived from plants, herbs, flowers, and roots have therapeutic qualities.
Aromatherapy involves essential oils to produce a certain effect; for example, lavender is used to induce calmness and relaxation.
When combined with body massage, aromatherapy can enrich the experience immensely.
A few drops can be added to massage cream or oil and applied to the skin.
Professional aromatherapists also blend oils to treat specific conditions.

Connective Tissue Massage

Connective tissue massage is similar to myofascial release in that it involves working with the fascia, or soft tissue, to relieve pain, tightness, and discomfort.
The theory of connective tissue massage is that tight, restricted body areas negatively affect other body areas.
Practitioners/therapists hook their fingers into the connective tissue and use pulling strokes to lengthen the tissues.
This releases tension, improves mobility and reduces stress.

Deep-Tissue Massage

Deep-tissue massage utilizes slow strokes, direct pressure, and/or friction across the grain of the muscles with the fingers, thumbs, and/or elbows.
Its purpose is to reach the fascia beneath the muscles going deep into the muscles and connective tissue to release aches and pains.
Therapists thoroughly understand the human body and have been trained to administer deep-tissue massage.
The technique is used in treating chronic pain, inflammation, and injury.

Geriatric Massage

Geriatric massage involves treating the elderly and addressing specific needs related to age, conditions, and illness.
The sessions are usually shorter and involve gentle techniques to facilitate pain relief, relaxation, and overall wellness.

Lymph Drainage Therapy

This technique involves the application of light, rhythmic strokes to alleviate various conditions related to the body’s lymph system.
The lymph system supports the immune system and is responsible for flushing toxins and draining fluid.
When lymph circulation slows down or stops, fluid can build up and cause physical problems like inflammation, edema, and neuropathies.
Therapists restore lymph flow by using a mapping system to assess problem areas, then apply gentle pressure using the fingers and hands to reactivate circulation.

Neuromuscular Therapy

Neuromuscular therapy is massage applied to specific muscles, often used to increase blood circulation, release muscle tension knots/trigger points, and/or release pain/pressure on nerves.
This therapy is also known as trigger-point therapy in that concentrated finger pressure is applied to specific points to alleviate muscular pain.

HealthCare

Neuropathy therapeutic massage is used in combination to enhance regular medical care. Let a doctor know when trying massage therapies, and follow any standard treatment plans. Some forms of massage can cause soreness the next day but should be combined with a sense of improvement and being healthier. If any part of the massage doesn’t feel right or is painful, let the therapist know immediately. Most serious issues come from too much pressure during the massage or sensitivity or allergy to massage oils. Massage therapy caution includes the following:

Vigorous massage should be avoided by individuals with bleeding disorders or low blood platelet counts and taking blood-thinning medications.
Massage therapy should not be done in areas with blood clots, fractures, healing wounds, skin infections, weakened bones from osteoporosis or cancer, or after recent surgery.
Cancer patients should discuss any concerns about massage therapy with their oncologist.
Pregnant women should consult their healthcare provider before using massage therapy.

Peripheral Neuropathy Recovery

References

American Massage Therapy Association defines massage therapy and basic massage therapy terms. www.amtamassage.org

Complementary and alternative methods: types of bodywork. Available at www.cancer.org

Gok Metin, Zehra, et al. “Aromatherapy Massage for Neuropathic Pain and Quality of Life in Diabetic Patients.” Journal of nursing scholarship: an official publication of Sigma Theta Tau International Honor Society of Nursing vol. 49,4 (2017): 379-388. doi:10.1111/jnu.12300

MassageTherapy.com. www.massagetherapy.com

National Institutes of Health, National Center for Complementary and Alternative Medicine

Samuels, Noah, and Eran Ben-Arye. “Integrative Approaches to Chemotherapy-Induced Peripheral Neuropathy.” Current oncology reports vol. 22,3 23. 11 Feb. 2020, doi:10.1007/s11912-020-0891-2

Sarısoy, Pınar, and Ozlem Ovayolu. “The Effect of Foot Massage on Peripheral Neuropathy-Related Pain and Sleep Quality in Patients With Non-Hodgkin’s Lymphoma.” Holistic nursing practice vol. 34,6 (2020): 345-355. doi:10.1097/HNP.0000000000000412

Thomas, Ewan, et al. “Peripheral Nerve Responses to Muscle Stretching: A Systematic Review.” Journal of sports science & medicine vol. 20,2 258-267. 8 Mar. 2021, doi:10.52082/jssm.2021.258

Zhang, Yong-Hui, et al. “Exercise for Neuropathic Pain: A Systematic Review and Expert Consensus.” Frontiers in medicine vol. 8 756940. 24 Nov. 2021, doi:10.3389/fmed.2021.756940

The Body’s Ability To Heal: Chiropractic Sciatica Clinic

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

Instructor helping recovery exercise for recovering patient — Experienced instructor helps a recovering patient perform recovery exercises on a special roller in a wellness center

The body’s ability to heal itself is quite remarkable. When injury or illness presents, the body’s systems activate to deal with the problem and restore itself to health. The spine’s bones protect the communication pathways of the spinal cord and nerve roots. If the nervous system suffers injury or is damaged in some way, causing impairment, it can cause malfunctioning of the tissues and organs throughout the body. Chiropractic care combined with functional medicine can restore and enhance the body’s self-healing abilities to optimal levels.

Table of Contents

The Body’s Ability To Heal Itself

A healthy body regenerates, fights infection, heals wounds, and repairs damage. The body is in a constant state of removing damage and producing new, healthy tissues.

Cells can heal themselves when they become unhealthy and replicate to replace injured or damaged cells.
The body produces new cells to heal the damage if a bone gets fractured or broken.
When the skin gets cut, the blood clots, stopping the bleeding, white blood cells remove the injured and dead cells, and new healthy cells repair the damaged tissue.
The immune system deals with viruses, bacteria, and toxins.
Natural destroyer cells recognize when the body’s cells have been invaded by a virus and destroy the infected cell.

Inflammation

Inflammation is the body’s reaction to an injury or infection, activating the immune system to restore the injured or infected area to health.

A fever is the body’s raising its temperature to levels that will kill viruses and bacteria.
The elevation in temperature also triggers certain cellular mechanisms which help the body fight the infection.

Stem Cells

The body heals and regenerates itself through stem cells.

Once the body is formed, embryonic stem cells disappear, and adult stem cells take over.
The adult stem cells divide, producing an identical stem cell and a healthy, mature cell of a specific type.
Each type of adult stem cell only can become certain types of tissue.
For example, Mesenchymal Stem Cells can regenerate bone, fat, muscle, and cartilage cells.
Neural Stem Cells help regenerate nerve tissue in the brain and spinal cord.
Epithelial Stem Cells regenerate skin.
Adult stem cells can reproduce for a long time but eventually stop reproducing as efficiently.

Nervous System

The nervous system assists the whole body in maintaining communication, using electrical and chemical impulses to send and receive messages. The system reacts to changes inside and outside the body. Infections, injuries, disorders, and conditions can cause imbalances causing communication problems that can lead to health issues. Common problems of the nervous system include:

Sciatica – Pressure on a nerve/s caused by a slipped, bulging, or herniated disc in the spine or arthritis of the spine and, sometimes, other factors.
Headaches
Dizziness
Neuralgia
Shingles – Infection of sensory nerves caused by the varicella-zoster virus.
Stroke – Lack of blood to part of the brain.
Parkinson’s disease – The death of neurons in a part of the brain called the midbrain. Symptoms include shaking and mobility problems.
Epilepsy – Abnormal electrical activity in the brain causing seizures.
Meningitis – Inflammation of the membrane covering the brain.
Multiple sclerosis – The myelin sheaths protecting the nerves of the central nervous system become damaged and deteriorates.

Chiropractic Care

Subluxations are misaligned or damaged joints that are not functioning correctly. These joints can place pressure on a nerve, which interferes with the normal nervous system function. Chiropractic care can realign, restore and maintain neuromusculoskeletal system health to reactivate the body’s natural healing abilities.

Cerebral Palsy Chiropractic Treatment

References

Haavik, Heidi, et al. “Effects of 12 Weeks of Chiropractic Care on Central Integration of Dual Somatosensory Input in Chronic Pain Patients: A Preliminary Study.” Journal of manipulative and physiological therapeutics vol. 40,3 (2017): 127-138. doi:10.1016/j.jmpt.2016.10.002

Lee, Courtney, et al. “Mind-body therapies for the self-management of chronic pain symptoms.” Pain medicine (Malden, Mass.) vol. 15 Suppl 1 (2014): S21-39. doi:10.1111/pme.12383

Maltese PE, Michelini S, Baronio M, Bertelli M. Molecular foundations of chiropractic therapy. Acta Biomed. 2019 Sep 30;90(10-S):93-102. doi: 10.23750/abm.v90i10-S.8768. PMID: 31577263; PMCID: PMC7233649.

McSwan, Joyce, et al. “Self-Healing: A Concept for Musculoskeletal Body Pain Management – Scientific Evidence and Mode of Action.” Journal of pain research vol. 14 2943-2958. 21 Sep. 2021, doi:10.2147/JPR.S321037

Navid, Muhammad Samran et al. “The effects of chiropractic spinal manipulation on central processing of tonic pain – a pilot study using standardized low-resolution brain electromagnetic tomography (sLORETA).” Scientific reports vol. 9,1 6925. 6 May. 2019, doi:10.1038/s41598-019-42984-3

It Could Be More Than Upper Back Pain

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

Table of Contents

Introduction

The upper back is part of the thoracic region of the spine, surrounded by various muscles that protect the thoracic joints and help assist with respiratory functionality for the lungs. The upper back muscles consist of the rhomboids and the trapezoid muscles that provide functionality to the scapula or shoulder blades. Other superficial muscles offer assistance to the thoracic spine. The serratus posterior muscle is one of the superficial muscles that helps the thoracic spine and, like all superficial muscles, can succumb to injuries that can lead to the development of overlapping referred pain symptoms known as trigger points. Today’s article focuses on the serratus posterior muscle function in the back, how trigger points are causing upper back pain, and various techniques to manage trigger points in the upper back. We refer patients to certified providers who are diverse in upper back pain therapies to aid many people suffering from myofascial pain syndrome or trigger points associated with the serratus posterior muscle along the upper back. We advised patients by referring them to our associated medical providers based on their examination when appropriate. We indicate that education is a great solution to asking our providers profound and complex questions at the patient’s request. Dr. Alex Jimenez, D.C., notes this information as an educational service only. Disclaimer

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The Serratus Posterior Muscle Function In The Back

Have you been dealing with constant upper back pain? Do you feel soreness at the base of your neck? Or are you having difficulty breathing? Most of the symptoms cause pain in the serratus posterior muscles that can lead to the development of myofascial pain syndrome or trigger points along the upper back. The serratus posterior has various roles in the upper back as it is not only part of the extrinsic muscles but also part of the accessory breathing muscle. The serratus posterior muscle helps with inspiration, which causes the chest cavity to expand as it is a superficial muscle attached to the ribs and is less commonly known. Studies show that the serratus posterior muscle is deep within the rhomboid muscles and is superficial. Even though this muscle is superficial when it has been overused through various activities, that can cause hypertrophy in the accessory respiratory muscles. Additional studies reveal that the serratus posterior superior muscle is considered clinically insignificant but has been impaired by myofascial pain syndrome or trigger points that can lead to upper back pain.

Trigger Points Causing Upper Back Pain

As stated earlier, the upper back is part of the thoracic region of the spine, and when various factors begin to affect the body, the back muscles tend to be involved. Studies reveal numerous sources of spinal pain in the thoracic spine. One is a myofascial pain syndrome affecting the serratus posterior muscles causing referred upper back pain. Myofascial pain syndrome or trigger points can be activated when the serratus posterior muscle is overloaded from thoracic respiratory issues like coughing due to pneumonia, asthma, or chronic emphysema. When respiratory problems affect the muscles in the thoracic region of the back, it leads to the development of trigger points, leading to overlapping issues like referred pain, motor dysfunction, and autonomic phenomena. According to Dr. Travell, M.D., in the upper back, trigger points can make the serratus posterior muscle cause overlapping risk profiles along the shoulder blades and have referred pain travel to the hands. This can make many individuals suffer from serious pain-like symptoms, causing them to be miserable.

Releasing Trigger Points Related Tension In The Upper Back-Video

Treatment of trigger point related tensions of the upper back

Have you been dealing with respiratory issues causing you to be hunched over constantly? Do you feel soreness or tenderness at the base of your neck? Or are you suffering from upper back pain? These symptoms are associated with trigger points that are affecting the serratus posterior muscles causing upper back pain. Trigger points, or myofascial pain syndrome, is a musculoskeletal disorder that causes tenderness along the affected muscle that causes referred pain to the surrounding muscles in the body. Trigger points associated with the serratus posterior muscles can cause referred pain in the upper back and mimic various chronic conditions. Trigger point pain is difficult to diagnose but can be manageable with treatment. The video above gives examples of how to treat trigger points to relieve tension in the upper back.

Various Techniques To Manage Trigger Points In The Upper Back

When it comes to upper back pain, many individuals will go to pain specialists like massage therapists or chiropractors to relieve any issues affecting the upper back. These pain specialists utilize various techniques like stretching, spinal manipulation, massages, and ischemic compression to alleviate pain and manage trigger points from forming further in the affected muscle. Pain specialists like massage therapists or chiropractors are excellent for locating pain-like symptoms associated with trigger points. Even though treatment can help manage symptoms associated with trigger points, many people can still incorporate these techniques, like deep breathing or correcting their posture, to prevent the upper back muscles from becoming strained and causing more issues than before.

Conclusion

The serratus posterior muscles have various roles in the upper back region of the body. These superficial muscles are extrinsic and accessory breathing muscles that help expand the chest cavity. When multiple issues affect the upper back muscles, like strenuous activities or respiratory problems, it can develop trigger points along the serratus posterior muscles and invoke pain-like symptoms to travel down to the hand, causing mobility issues. Thankfully, various techniques that pain specialists like chiropractors and massage therapists use can help manage trigger points from escalating and can bring upper back mobility to the body once again.

References

Altafulla, Juan J, et al. “An Unusual Back Muscle Identified Bilaterally: Case Report.” Cureus, Cureus, 15 June 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6093753/.

Briggs, Andrew M, et al. “Thoracic Spine Pain in the General Population: Prevalence, Incidence and Associated Factors in Children, Adolescents and Adults. A Systematic Review.” BMC Musculoskeletal Disorders, BioMed Central, 29 June 2009, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720379/.

Mitchell, Brittney, et al. “Anatomy, Back, Extrinsic Muscles.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 4 Aug. 2021, https://www.ncbi.nlm.nih.gov/books/NBK537216/.

Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 1:Upper Half of Body. Williams & Wilkins, 1999.

Vilensky, J A, et al. “Serratus Posterior Muscles: Anatomy, Clinical Relevance, and Function.” Clinical Anatomy (New York, N.Y.), U.S. National Library of Medicine, July 2001, https://pubmed.ncbi.nlm.nih.gov/11424195/.