The Role of Pudendal Nerve in Chronic Pelvic Pain

Couple riding road bicycles outside and wearing helmets and sung — Athletic couple riding road bicycles outside. Healthy lifestyle and fun concept. Fit couple riding in the nature while wearing sports clothing, protective helmets and sunglasses.

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

Table of Contents

Pudendal Neuropathy

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

Causes

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

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

Symptoms

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

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

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

Cyclist’s Syndrome

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

Cyclist’s Syndrome Prevention

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

Rest

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

Seat

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

Bike Fitting

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

Shorts

Wear padded bike shorts.

Treatments

A healthcare provider may use a combination of treatments.

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

Pregnancy and Sciatica

References

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

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

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

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

How Laser Spine Surgery Can Help Relieve Chronic Pain

Dr. Alex Jimenez

Handsome Caucasian male doctor and an African senior man interacting with each other in clinic

For individuals who have exhausted all other treatment options for low back pain and nerve root compression, can laser spine surgery help alleviate nerve compression and provide long-lasting pain relief?

Table of Contents

Laser Spine Surgery

Laser spine surgery is a minimally invasive surgical procedure that uses a laser to cut through and remove spinal structures that are compressing nerves and causing intense pain. The minimally invasive procedure often results in less pain, tissue damage, and faster recovery than more extensive surgeries.

How It Works

Minimally invasive procedures result in less scarring and damage to surrounding structures, often reducing pain symptoms and a shorter recovery time. (Stern, J. 2009) Small incisions are made to access spinal column structures. With open-back surgery, a large incision is made down the back to access the spine. The surgery differs from other surgeries in that a laser beam, rather than other surgical instruments, is used to cut structures in the spine. However, the initial incision through the skin is made with a surgical scalpel. Laser is an acronym for Light Amplification Stimulated by Emission of Radiation. A laser can generate intense heat to cut through soft tissues, especially those with a high water content, like spinal column discs. (Stern, J. 2009) For many spine surgeries, the laser cannot be used to cut through bone as it generates instant sparks that can damage surrounding structures. Rather, laser spine surgery is primarily used to perform a discectomy, which is a surgical technique that removes a portion of a bulging or herniated disc that is pushing against the surrounding nerve roots, causing nerve compression and sciatic pain. (Stern, J. 2009)

Surgical Risks

Laser spine surgery may help resolve the cause of nerve root compression, but there is an increased risk of damage to nearby structures. Associated risks include: (Brouwer, P. A. et al., 2015)

Infection
Bleeding
Blood clots
Remaining symptoms
Returning symptoms
Further nerve damage
Damage to the membrane around the spinal cord.
Need for additional surgery

A laser beam is not precise like other surgical tools and requires practiced mastery and control to avoid damage to the spinal cord and nerve roots. (Stern, J. 2009) Because lasers cannot cut through bone, other surgical instruments are often used around corners and at different angles because they are more efficient and allow greater accuracy. (Atlantic Brain and Spine, 2022)

Purpose

Laser spine surgery is performed to remove structures that are causing nerve root compression. Nerve root compression is associated with the following conditions (Cleveland Clinic. 2018)

Bulging discs
Herniated discs
Sciatica
Spinal stenosis
Spinal cord tumors

Nerve roots that are injured or damaged and constantly send chronic pain signals can be ablated with laser surgery, known as nerve ablation. The laser burns and destroys the nerve fibers. (Stern, J. 2009) Because laser spine surgery is limited in treating certain spinal disorders, most minimally invasive spine procedures do not use a laser. (Atlantic Brain and Spine. 2022)

Preparation

The surgical team will provide more detailed instructions on what to do in the days and hours before surgery. To promote optimal healing and a smooth recovery, it is recommended that the patient stay active, eat a healthy diet, and stop smoking prior to the operation. Individuals may need to stop taking certain medications to prevent excess bleeding or interaction with anesthesia during the operation. Inform the healthcare provider about all prescriptions, over-the-counter drugs, and supplements being taken.

Laser spine surgery is an outpatient procedure at a hospital or outpatient surgical center. The patient will likely go home on the same day of the operation. (Cleveland Clinic. 2018) Patients cannot drive to or from the hospital before or after their surgery, so arrange for family or friends to provide transportation. Minimizing stress and prioritizing healthy mental and emotional well-being is important to lowering inflammation and aiding recovery. The healthier the patient goes into surgery, the easier the recovery and rehabilitation will be.

Expectations

The surgery will be decided by the patient and healthcare provider and scheduled at a hospital or outpatient surgical center. Arrange for a friend or family member to drive to the surgery and home.

Before Surgery

The patient will be taken to a pre-operative room and asked to change into a gown.
The patient will undergo a brief physical examination and answer questions about medical history.
The patient lies on a hospital bed, and a nurse inserts an IV to deliver medication and fluids.
The surgical team will use the hospital bed to transport the patient in and out of the operating room.
The surgical team will assist the patient in getting onto the operating table, and the patient will be administered anesthesia.
The patient may receive general anesthesia, which will cause the patient to sleep for the surgery, or regional anesthesia, injected into the spine to numb the affected area. (Cleveland Clinic. 2018)
The surgical team will sterilize the skin where the incision will be made.
An antiseptic solution will be used to kill bacteria and prevent the risk of infection.
Once sanitized, the body will be covered with sterilized linens to keep the surgical site clean.

During Surgery

For a discectomy, the surgeon will make a small incision less than one inch in length with a scalpel along the spine to access the nerve roots.
A surgical tool called an endoscope is a camera inserted into the incision to view the spine. (Brouwer, P. A. et al., 2015)
Once the problematic disc portion causing the compression is located, the laser is inserted to cut through it.
The cut disc portion is removed, and the incision site is sutured.

After Surgery

After surgery, the patient is brought to a recovery room, where vital signs are monitored as the effects of the anesthesia wear off.
Once stabilized, the patient can usually go home one or two hours after the operation.
The surgeon will determine when the individual is clear to resume driving.

Recovery

Following a discectomy, the individual can return to work within a few days to a few weeks, depending on the severity, but it can take up to three months to return to normal activities. Length of recovery can range from two to four weeks or less to resume a sedentary job or eight to 12 weeks for a more physically demanding job that requires heavy lifting. (University of Wisconsin School of Medicine and Public Health, 2021) During the first two weeks, the patient will be given restrictions to facilitate the spine’s healing until it becomes more stable. Restrictions can include: (University of Wisconsin School of Medicine and Public Health, 2021)

No bending, twisting, or lifting.
No strenuous physical activity, including exercise, housework, yard work, and sex.
No alcohol in the initial stage of recovery or while taking narcotic pain medications.
No driving or operating a motor vehicle until discussed with the surgeon.

The healthcare provider may recommend physical therapy to relax, strengthen, and maintain musculoskeletal health. Physical therapy may be two to three times weekly for four to six weeks.

Process

Optimal recovery recommendations include:

Getting enough sleep, at least seven to eight hours.
Maintaining a positive attitude and learning how to cope and manage stress.
Maintaining body hydration.
Following the exercise program as prescribed by the physical therapist.
Practicing healthy posture with sitting, standing, walking, and sleeping.
Staying active and limiting the amount of time spent sitting. Try to get up and walk every one to two hours during the day to stay active and prevent blood clots. Gradually increase the amount of time or distance as recovery progresses.
Do not push to do too much too soon. Overexertion can increase pain and delay recovery.
Learning correct lifting techniques to utilize the core and leg muscles to prevent increased pressure on the spine.

Discuss treatment options for managing symptoms with a healthcare provider or specialist to determine if laser spine surgery is appropriate. Injury Medical Chiropractic and Functional Medicine Clinic care plans and clinical services are specialized and focused on injuries and the complete recovery process. Dr. Jimenez has teamed with the top surgeons, clinical specialists, medical researchers, therapists, trainers, and premiere rehabilitation providers. We focus on restoring normal body functions after trauma and soft tissue injuries using Specialized Chiropractic Protocols, Wellness Programs, Functional and integrative Nutrition, Agility and mobility Fitness Training, and Rehabilitation Systems for all ages. Our areas of practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols.

The Non-Surgical Approach

References

Stern, J. SpineLine. (2009). Lasers in Spine Surgery: A Review. Current Concepts, 17-23. www.spine.org/Portals/0/assets/downloads/KnowYourBack/LaserSurgery.pdf

Brouwer, P. A., Brand, R., van den Akker-van Marle, M. E., Jacobs, W. C., Schenk, B., van den Berg-Huijsmans, A. A., Koes, B. W., van Buchem, M. A., Arts, M. P., & Peul, W. C. (2015). Percutaneous laser disc decompression versus conventional microdiscectomy in sciatica: a randomized controlled trial. The spine journal : official journal of the North American Spine Society, 15(5), 857–865. doi.org/10.1016/j.spinee.2015.01.020

Atlantic Brain and Spine. (2022). The Truth About Laser Spine Surgery [2022 Update]. Atlantic Brain and Spine Blog. www.brainspinesurgery.com/blog/the-truth-about-laser-spine-surgery-2022-update?rq=Laser%20Spine%20Surgery

Cleveland Clinic. (2018). Can Laser Spine Surgery Fix Your Back Pain? health.clevelandclinic.org/can-laser-spine-surgery-fix-your-back-pain/

University of Wisconsin School of Medicine and Public Health. (2021). Home Care Instructions after Lumbar Laminectomy, Decompression or Discectomy Surgery. patient.uwhealth.org/healthfacts/4466

Unveiling the Mystery of Back Mice: Causes and Solutions

Dr. Alex Jimenez

Individuals may discover a lump, bump, or nodule under the skin around their lower back, hips, and sacrum that can cause pain by compressing nerves and damaging the fascia. Can knowing the conditions linked to them and their symptoms help healthcare providers determine a correct diagnosis and develop an effective treatment plan for experiencing?

Table of Contents

Painful Bumps, Nodules Around Low Back, Hips, and Sacrum

Painful masses in and around the hips, the sacrum, and the lower back are lumps of fat or lipomas, fibrous tissue, or other types of nodules that move when pressed on. Some healthcare providers and chiropractors, in particular, use the non-medical term back mice (In 1937, the term was used to describe lumps associated with episacroiliac lipoma) to describe the bumps. Some healthcare professionals argue against calling the masses mice because it is not specific and could lead to misdiagnoses or incorrect treatment.

Most show up in the lower back and hip area.
In some cases, they protrude or herniate through the lumbodorsal fascia or the network of connective tissue that covers the deep muscles of the lower and middle back.
Other lumps can develop in the tissue under the skin.

Today, many conditions are associated with back mice lumps, including:

Iliac crest pain syndrome
Multifidus triangle syndrome
Lumbar fascial fat herniation
Lumbosacral (sacrum) fat herniation
Episacral lipoma

Related Conditions

Iliac Crest Pain Syndrome

Also known as iliolumbar syndrome, iliac crest pain syndrome develops when a tear in the ligament occurs.
The ligament band connects the fourth and fifth lumbar vertebrae with the ilium on the same side. (Dąbrowski, K. Ciszek, B. 2023)
Causes include:
Tearing the ligament from repeated bending and twisting.
Trauma or fracture of the ilium bone caused by a fall or vehicle collision accident.

Multifidus Triangle Syndrome

Multifidus triangle syndrome develops when the multifidus muscles along the spine weaken and diminish function or ability.
These muscles can atrophy, and intramuscular fatty tissue can replace the muscle.
Atrophied muscles decrease the spine’s stability and can cause lower back pain. (Seyedhoseinpoor, T. et al., 2022)

Lumbar Facial Fat Herniation

The lumbodorsal fascia is a thin fibrous membrane covering the back’s deep muscles.
Lumbar fascial fat herniation is a painful mass of fat that protrudes or herniates through the membrane, gets trapped and inflamed, and causes pain.
The causes of this type of herniation are currently unknown.

Lumbosacral (Sacrum) Fat Herniation

Lumbosacral describes where the lumbar spine meets the sacrum.
Lumbosacral fat herniation is a painful mass like lumbar facial herniation in a different location around the sacrum.
The causes of this type of herniation are currently unknown.

Episacral Lipoma

Episacral lipoma is a small painful nodule under the skin that primarily develops over the top outer edges of the pelvic bone. These lumps occur when a portion of the dorsal fat pad protrudes through a tear in the thoracodorsal fascia, the connective tissue that helps hold the back muscles in place. (Erdem, H. R. et al., 2013) A healthcare provider may refer an individual to an orthopedist or orthopedic surgeon for this lipoma. An individual may also find pain relief from a massage therapist familiar with the condition. (Erdem, H. R. et al., 2013)

Symptoms

Back lumps can often be seen under the skin. They are typically tender to the touch and can make sitting in a chair or lying on the back difficult, as they often appear on the hip bones and sacroiliac region. (Bicket, M. C. et al., 2016) The nodules may:

Be firm or tight.
Have an elastic feel.
Move under the skin when pressed.
Cause intense, severe pain.
The pain results from pressure on the lump, which compresses the nerves.
Damage to the underlying fascia can also cause pain symptoms.

Diagnosis

Some individuals do not realize they have nodules or lumps until pressure is applied. Chiropractors and massage therapists often find them during treatments but do not diagnose the abnormal fatty growth. The chiropractor or massage therapist will refer the patient to a qualified dermatologist or medical professional who can perform imaging studies and a biopsy. Determining what the lumps are can be challenging because they are non-specific. Healthcare providers sometimes diagnose the nodules by injecting them with a local anesthetic. (Bicket, M. C. et al., 2016)

Differential Diagnosis

The fatty deposits can be any number of things, and the same applies to the sources of nerve pain. A healthcare provider may further diagnose by ruling out other causes, which can include:

Sebaceous Cysts

A benign, fluid-filled capsule between the layers of skin.

Subcutaneous Abscess

A collection of pus beneath the skin.
Usually painful.
It can become inflamed.

Sciatica

Radiating nerve pain down one or both legs that is caused by a herniated disc, bone spur, or spasming muscles in the lower back.

Liposarcoma

Malignant tumors can sometimes appear as fatty growths in the muscles.
Liposarcoma is typically diagnosed by biopsy, where some tissue is removed from the nodule and examined for cancer cells. (Johns Hopkins Medicine. 2024)
An MRI or CT scan may also be performed to determine the exact location of the nodule.
Painful lipomas are also associated with fibromyalgia.

Treatment

Back nodules are usually benign, so there’s no reason to remove them unless they’re causing pain or mobility problems (American Academy of Orthopedic Surgeons: OrthoInfo. 2023). However, they should be examined to make sure they are not cancerous. Treatment usually involves injected anesthetics, such as lidocaine or corticosteroids, as well as over-the-counter pain relievers like NSAIDs.

Surgery

If pain is severe, surgical removal may be recommended. This involves cutting out the mass and repairing the fascia for lasting relief. However, removal may not be recommended if there are many nodules, as some individuals can have hundreds. Liposuction may be effective if the lumps are smaller, more extensive, and comprise more fluid. (American Family Physician. 2002) Complications of surgical removal can include:

Scarring
Bruising
Uneven skin texture
Infection

Complementary and Alternative Treatment

Complimentary and Alternative Medicine treatments like acupuncture, dry needling, and spinal manipulation can help. Many chiropractors believe back nodules can be successfully treated with complementary and alternative therapies. A common approach uses acupuncture and spinal manipulation in combination. A case study reported that anesthetic injections followed by dry needling, like acupuncture, improved pain relief. (Bicket, M. C. et al., 2016)

Injury Medical Chiropractic and Functional Medicine Clinic specializes in progressive therapies and functional rehabilitation procedures focused on restoring normal body functions after trauma and soft tissue injuries and the complete recovery process. Our areas of practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols. If the individual requires other treatment, they will be referred to a clinic or physician best suited for their condition, as Dr. Jimenez has teamed with the top surgeons, clinical specialists, medical researchers, therapists, trainers, and premiere rehabilitation providers.

Beyond the Surface

References

Dąbrowski, K., & Ciszek, B. (2023). Anatomy and morphology of iliolumbar ligament. Surgical and radiologic anatomy : SRA, 45(2), 169–173. doi.org/10.1007/s00276-022-03070-y

Seyedhoseinpoor, T., Taghipour, M., Dadgoo, M., Sanjari, M. A., Takamjani, I. E., Kazemnejad, A., Khoshamooz, Y., & Hides, J. (2022). Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis. The spine journal : official journal of the North American Spine Society, 22(4), 660–676. doi.org/10.1016/j.spinee.2021.10.018

Erdem, H. R., Nacır, B., Özeri, Z., & Karagöz, A. (2013). Episakral lipoma: Bel ağrısının tedavi edilebilir bir nedeni [Episacral lipoma: a treatable cause of low back pain]. Agri : Agri (Algoloji) Dernegi’nin Yayin organidir = The journal of the Turkish Society of Algology, 25(2), 83–86. doi.org/10.5505/agri.2013.63626

Bicket, M. C., Simmons, C., & Zheng, Y. (2016). The Best-Laid Plans of “Back Mice” and Men: A Case Report and Literature Review of Episacroiliac Lipoma. Pain physician, 19(3), 181–188.

Johns Hopkins Medicine. (2024). Liposarcoma. www.hopkinsmedicine.org/health/conditions-and-diseases/sarcoma/liposarcoma

American Academy of Orthopedic Surgeons: OrthoInfo. (2023). Lipoma. orthoinfo.aaos.org/en/diseases–conditions/lipoma

American Family Physician. (2002). Lipoma excision. American Family Physician, 65(5), 901-905. www.aafp.org/pubs/afp/issues/2002/0301/p901.html

A Comprehensive Guide to Spinal Nerve Roots and Their Functions

Dr. Alex Jimenez

Middle aged male doctor pointing on human spine model with a pen and explaining patient his problem in medical clinic. Spinal healthcare and back pain treatment concept. Selective focus, copy space.

When sciatica or other radiating nerve pain presents, can learning to distinguish between nerve pain and different types of pain help individuals recognize when spinal nerve roots are irritated or compressed or more serious problems that require medical attention?

Table of Contents

Spinal Nerve Roots and Dermatomes

Spinal conditions such as herniated discs and stenosis can lead to radiating pain that travels down one arm or leg. Other symptoms include weakness, numbness, and/or shooting or burning electrical sensations. The medical term for pinched nerve symptoms is radiculopathy (National Institutes of Health: National Institute of Neurological Disorders and Stroke. 2020). Dermatomes could contribute to irritation in the spinal cord, where the nerve roots cause symptoms in the back and limbs.

Anatomy

The spinal cord has 31 segments.

Each segment has nerve roots on the right and left that supply motor and sensory functions to the limbs.
The anterior and posterior communicating branches combine to form the spinal nerves that exit the vertebral canal.
The 31 spine segments result in 31 spinal nerves.
Each one transmits sensory nerve input from a specific skin region on that side and area of the body.
These regions are called dermatomes.
Except for the first cervical spinal nerve, dermatomes exist for each spinal nerve.
The spinal nerves and their associated dermatomes form a network all over the body.

Dermatomes Purpose

Dermatomes are the body/skin areas with sensory input assigned to individual spinal nerves. Each nerve root has an associated dermatome, and various branches supply each dermatome off that single nerve root. Dermatomes are pathways through which sensational information in the skin transmits signals to and from the central nervous system. Sensations that are physically felt, like pressure and temperature, get transmitted to the central nervous system. When a spinal nerve root becomes compressed or irritated, usually because it comes into contact with another structure, it results in radiculopathy. (National Institutes of Health: National Institute of Neurological Disorders and Stroke. 2020).

Radiculopathy

Radiculopathy describes symptoms caused by a pinched nerve along the spine. Symptoms and sensations depend on where the nerve is pinched and the extent of the compression.

Cervical

This is a syndrome of pain and/or sensorimotor deficiencies when nerve roots in the neck are compressed.
It often presents with pain that goes down one arm.
Individuals may also experience electrical sensations like pins and needles, shocks, and burning sensations, as well as motor symptoms like weakness and numbness.

Lumbar

This radiculopathy results from compression, inflammation, or injury to a spinal nerve in the lower back.
Sensations of pain, numbness, tingling, electrical or burning sensations, and motor symptoms like weakness traveling down one leg are common.

Diagnosis

Part of a radiculopathy physical examination is testing the dermatomes for sensation. The practitioner will use specific manual tests to determine the spinal level from which the symptoms originate. Manual exams are often accompanied by diagnostic imaging tests like MRI, which can show abnormalities in the spinal nerve root. A complete physical examination will determine if the spinal nerve root is the source of the symptoms.

Treating Underlying Causes

Many back disorders can be treated with conservative therapies to provide effective pain relief. For a herniated disk, for example, individuals may be recommended to rest and take a nonsteroidal anti-inflammatory medication. Acupuncture, physical therapy, chiropractic, non-surgical traction, or decompression therapies may also be prescribed. For severe pain, individuals may be offered an epidural steroid injection that can provide pain relief by reducing inflammation. (American Academy of Orthopaedic Surgeons: OrthoInfo. 2022) For spinal stenosis, a provider may first focus on physical therapy to improve overall fitness, strengthen the abdominals and back muscles, and preserve motion in the spine. Pain-relieving medications, including NSAIDs and corticosteroid injections, can reduce inflammation and relieve pain. (American College of Rheumatology. 2023) Physical therapists provide various therapies to decrease symptoms, including manual and mechanical decompression and traction. Surgery may be recommended for cases of radiculopathy that don’t respond to conservative treatments.

Injury Medical Chiropractic and Functional Medicine Clinic care plans and clinical services are specialized and focused on injuries and the complete recovery process. Our areas of practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols. We focus on restoring normal body functions after trauma and soft tissue injuries using Specialized Chiropractic Protocols, Wellness Programs, Functional and integrative Nutrition, Agility, and mobility Fitness Training, and Rehabilitation Systems for all ages. If the individual requires other treatment, they will be referred to a clinic or physician best suited for their condition. Dr. Jimenez has teamed with the top surgeons, clinical specialists, medical researchers, therapists, trainers, and premiere rehabilitation providers to bring El Paso, the top clinical treatments, to our community.

Reclaim Your Mobility: Chiropractic Care For Sciatica Recovery

References

National Institutes of Health: National Institute of Neurological Disorders and Stroke. (2020). Low back pain fact sheet. Retrieved from www.ninds.nih.gov/sites/default/files/migrate-documents/low_back_pain_20-ns-5161_march_2020_508c.pdf

American Academy of Orthopaedic Surgeons: OrthoInfo. (2022). Herniated disk in the lower back. orthoinfo.aaos.org/en/diseases–conditions/herniated-disk-in-the-lower-back/

American College of Rheumatology. (2023). Spinal stenosis. rheumatology.org/patients/spinal-stenosis

Treating Cervicogenic Migraine Headaches with Physical Therapy

Dr. Alex Jimenez

Low-spirited patient complaining of neck pain to doctor — Upset female seated at desk before neurologist touching side of neck with hand during medical consultation

For individuals who suffer from migraine headaches, can incorporating physical therapy help decrease pain, improve mobility, and manage future attacks?

Table of Contents

Migraine Physical Therapy

Cervicogenic migraine headaches can cause pain, limited motion, or confusing symptoms like dizziness or nausea. They may originate from the neck or cervical spine and be called cervicogenic headaches. A chiropractic physical therapy team can assess the spine and offer treatments that help improve mobility and decrease pain. Individuals may benefit from working with a migraine physical therapy team to perform treatments for specific conditions, quickly and safely relieving pain and returning to their previous level of activity.

Cervical Spine Anatomy

The neck is comprised of seven stacked cervical vertebrae. The cervical vertebrae protect the spinal cord and allow the neck to move through:

Flexion
Extension
Rotation
Side bending

The upper cervical vertebrae help support the skull. There are joints on either side of the cervical level. One connects to the back of the skull and allows motion. This suboccipital area is home to several muscles that support and move the head, with nerves that travel from the neck through the suboccipital area into the head. The nerves and muscles in this area may be a source of neck pain and/or headaches.

Symptoms

Sudden motions can trigger symptoms of cervicogenic migraine, or they may come on during sustained neck postures. (Page P. 2011) The symptoms are often dull and non-throbbing and may last several hours to days. Symptoms of cervicogenic migraine headache may include:

Pain on both sides of the back of the head.
Pain in the back of the head that radiates to one shoulder.
Pain on one side of the upper neck that radiates to the temple, forehead, or eye.
Pain in one side of the face or cheek.
Reduced range of motion in the neck.
Sensitivity to light or sound
Nausea
Dizziness or vertigo

Diagnosis

Tools a physician may use may include:

X-ray
MRI
CT scan
Physical examination includes neck range of motion and palpation of the neck and skull.
Diagnostic nerve blocks and injections.
Neck imaging studies may also show:
Lesion
Bulging or herniated disc
Disc degeneration
Arthritic changes

Cervicogenic headache diagnosis is usually made with one-sided, non-throbbing headache pain and a loss of neck range of motion. (Headache Classification Committee of the International Headache Society. 2013) A healthcare provider may refer the individual to physical therapy to treat cervicogenic headaches once diagnosed. (Rana M. V. 2013)

Physical Therapy

When first visiting a physical therapist, they will go through medical history and conditions, and questions will be asked about the onset of pain, symptom behavior, medications, and diagnostic studies. The therapist will also ask about previous treatments and review medical and surgical history. Components of the evaluation may include:

Palpation of the neck and skull
Measures of neck range of motion
Strength measurements
Postural assessment

Once the evaluation is completed, the therapist will work with the individual to develop a personalized treatment program and rehabilitation goals. Various treatments are available.

Exercise

Exercises to improve neck motion and decrease pressure on cervical nerves may be prescribed and may include. (Park, S. K. et al., 2017)

Cervical rotation
Cervical flexion
Cervical side bending
Cervical retraction

The therapist will train the individual to move slowly and steadily and avoid sudden or jerky movements.

Postural Correction

If forward head posture is present, the upper cervical spine and the suboccipital area could compress the nerves that travel up the back of the skull. Correcting posture may be an effective strategy for treatment and can include:

Performing targeted postural exercises.
Utilizing a supportive neck pillow for sleep.
Using a lumbar support when sitting.
Kinesiology taping may help increase tactile awareness of back and neck position and improve overall postural awareness.

Heat/Ice

Heat or ice may be applied to the neck and skull to help decrease pain and inflammation.
Heat can help relax tight muscles and improve circulation and may be used before performing neck stretches.

Massage

If tight muscles are limiting neck motion and causing head pain, a massage can help improve mobility.
A special technique called suboccipital release loosens the muscles that attach the skull to the neck for improved motion and decreased nerve irritation.

Manual and Mechanical Traction

Part of the migraine physical therapy plan may involve mechanical or manual traction to decompress the neck’s discs and joints, improve motion in the neck, and decrease pain.
Joint mobilizations may be used to improve neck motion and manage pain. (Paquin, J. P. 2021)

Electrical Stimulation

Electrical stimulation, like electro-acupuncture or transcutaneous neuromuscular electrical stimulation, may be used on the neck muscles to decrease pain and improve headache symptoms.

Therapy Duration

Most migraine physical therapy sessions for cervicogenic headaches last about four to six weeks. Individuals may experience relief within a few days of starting therapy, or symptoms may come and go in different phases for weeks. Some experience continued migraine headache pain for months after starting treatment and use techniques they learned to help control symptoms.

Injury Medical Chiropractic and Functional Medicine Clinic specializes in progressive therapies and functional rehabilitation procedures focused on restoring normal body functions after trauma and soft tissue injuries. We use Specialized Chiropractic Protocols, Wellness Programs, Functional and integrative Nutrition, Agility and mobility Fitness Training, and Rehabilitation Systems for all ages. Our natural programs use the body’s ability to achieve specific measured goals. We have teamed up with the city’s premier doctors, therapists, and trainers to provide high-quality treatments that empower our patients to maintain the healthiest way of living and live a functional life with more energy, a positive attitude, better sleep, and less pain.

Chiropractic Care For Migraines

References

Page P. (2011). Cervicogenic headaches: an evidence-led approach to clinical management. International journal of sports physical therapy, 6(3), 254–266.

Headache Classification Committee of the International Headache Society (IHS) (2013). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia : an international journal of headache, 33(9), 629–808. doi.org/10.1177/0333102413485658

Rana M. V. (2013). Managing and treating headache of cervicogenic origin. The Medical clinics of North America, 97(2), 267–280. doi.org/10.1016/j.mcna.2012.11.003

Park, S. K., Yang, D. J., Kim, J. H., Kang, D. H., Park, S. H., & Yoon, J. H. (2017). Effects of cervical stretching and cranio-cervical flexion exercises on cervical muscle characteristics and posture of patients with cervicogenic headache. Journal of physical therapy science, 29(10), 1836–1840. doi.org/10.1589/jpts.29.1836

Paquin, J. P., Tousignant-Laflamme, Y., & Dumas, J. P. (2021). Effects of SNAG mobilization combined with a self-SNAG home-exercise for the treatment of cervicogenic headache: a pilot study. The Journal of manual & manipulative therapy, 29(4), 244–254. doi.org/10.1080/10669817.2020.1864960

Understanding the Nutritional Differences: Fresh Fruit vs Dried Fruit

Dr. Alex Jimenez

Dried fruits, healthy and delicious — Dried fruits - best start of day with yogurt - bananas apricots, papaya, crenberries, bio quality.

Can knowing the serving size help lower sugar and calories for individuals who enjoy eating dried fruits?

Table of Contents

Dried Fruits

Dried fruits, like cranberries, dates, raisins, and prunes, are great because they last a long time and are healthy sources of fiber, minerals, and vitamins. However, dried fruits contain more sugar and calories per serving because they lose volume when dehydrated, allowing more to be consumed. This is why the serving size matters to ensure one does not overeat.

Serving Size

Fruits are dried in dehydrators or left in the sun to dehydrate naturally. They are ready once most of the water has disappeared. The loss of water decreases their physical size, which allows individuals to eat more, increasing sugar and calorie intake. For example, around 30 grapes fit in a single measuring cup, but 250 raisins can fill one cup once dehydrated. Nutritional information for fresh and dried fruit.

One cup of grapes has around 15 grams of sugar. (FoodData Central. U.S. Department of Agriculture. 2018)
One cup of raisins has 116 grams of sugar. (FoodData Central. U.S. Department of Agriculture. 2017)
Calories
One cup of grapes has about 104 calories.
One cup of raisins has over 480 calories.

Sugar

Ten grapes have 34 calories and about 7.5 grams of sugar. (FoodData Central. U.S. Department of Agriculture. 2018)
Thirty raisins have 47 calories and under 10 grams of sugar.
Grapes’ natural sugar content varies, so different types can be subject to nutritional value assessments.
Some fruits, like cranberries, can be very tart, so sugar or fruit juices are added during drying.

Ways to Use

Fresh fruit may be higher in certain vitamins, but mineral and fiber content are retained during drying. Dried fruits are versatile and can be made part of a healthy, balanced diet that can include:

Trail Mix

Mix dried fruits, nuts, and seeds.
Monitor portion size.

Oatmeal

Lightly sweeten oatmeal with a small serving of dried fruits for a hearty and healthy breakfast.

Salads

Toss dark, leafy greens, fresh apple slices, dried cranberries or raisins, and cheeses.

Main Course

Use dried fruit as an ingredient in savory entrees.

Protein Bar Substitutes

Raisins, dried blueberries, apple chips, and dried apricots are convenient and last longer than fresh fruit, making them perfect when protein bars are unavailable.

At Injury Medical Chiropractic and Functional Medicine Clinic, our areas of practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols. We focus on what works for you to achieve improvement goals and create an improved body through research methods and total wellness programs.

Functional Medicine’s Influence Beyond Joints

References

FoodData Central. U.S. Department of Agriculture. (2017). Raisins. Retrieved from fdc.nal.usda.gov/fdc-app.html#/food-details/530717/nutrients

FoodData Central. U.S. Department of Agriculture. (2018). Grapes, American type (slip skin), raw. Retrieved from fdc.nal.usda.gov/fdc-app.html#/food-details/174682/nutrients

FoodData Central. U.S. Department of Agriculture. (2018). Grapes, red or green (European type, such as Thompson seedles), raw. Retrieved from fdc.nal.usda.gov/fdc-app.html#/food-details/174683/nutrients

Choosing the Right Size and Firmness of an Exercise Stability Ball

Dr. Alex Jimenez

time-to-get-the-ball-rolling-portrait-of-a-handso-2023-11-27-05-13-08-utc_02 — Time to get the ball rolling. Portrait of a handsome man standing with an exercise ball

For individuals wanting to improve core stability, can using the right size exercise or stability ball help improve workouts and achieve goals?

Table of Contents

Exercise Stability Ball

An exercise ball, stability ball, or Swiss ball is a piece of fitness equipment used in gyms, Pilates and yoga studios, and HIIT classes. (American Council on Exercise. 2014) It is inflated with air to supplement bodyweight workouts or improve posture and balance. It can also be used as a chair. They add a core stability challenge to almost any exercise (American Council on Exercise, N.D.) Getting the appropriate exercise ball size and firmness for your body and purpose will ensure an optimal workout.

Size

The exercise ball size should be proportional to individual height.
Individuals should be able to sit on the ball with their legs at a 90-degree angle or slightly more, but not less.
The thighs should be parallel to the ground or angled slightly down.
With the feet flat on the floor and the spine straight, not leaning forward, backward, or sideways, the knees should be even with or slightly lower than the hips.

Here is the American Council on Exercise guide when choosing. (American Council on Exercise. 2001)

Height – Ball Size

Under 4’6”/137 cm – 30 cm/12 inches
4’6” – 5’0”/137-152 cm – 45 cm/18 inches
5’1”-5’7”/155-170 cm – 55 cm/22 inches
5’8”-6’2”/173-188 cm – 65 cm/26 inches
Over 6’2”/188 cm – 75 cm/30 inches

Getting the right exercise ball for weight is also important. Individuals who are heavy for their height may need a larger ball to keep the knees and legs at the correct angle. It is recommended to check the weight rating of the ball, its durability, and its high burst resistance before buying.

Inflation

Individuals want a little give on the ball’s surface for exercise. When sitting on the exercise stability ball, body weight should create a little seat and provide more stability. More importantly, it allows sitting evenly on the ball, which is essential for exercising with proper spinal alignment. (Rafael F. Escamilla et al., 2016) Inflation is a matter of preference, but the more inflated the ball is, the more difficult it will be to balance the body, whether sitting or in other positions. It is recommended not to over-inflate the ball at the risk of bursting. The ball may require reinflation occasionally, so many are sold with a small pump for this purpose.

Exercises and Stretches

Exercise balls are highly versatile, inexpensive, and easy-to-use workout tools. They are beneficial for improving core strength and stability. Ways to be used include:

Active sitting in place of a chair.
Stretching on the ball.
Balance and stability exercises.
Pilates or yoga.
Strength workout.
Target exercises for core activation and strengthening.

At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for you and strive to create fitness and better the body through research methods and total wellness programs. These natural programs use the body’s ability to achieve improvement goals and athletes can condition themselves to excel in their sport through proper fitness and nutrition. Our providers use an integrated approach to create personalized programs, often including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.

Home Exercises For Pain Relief

References

American Council on Exercise. Sabrena Jo. (2014). Core-strengthening Stability Ball Workout. ACE Fitness® & Healthy Lifestyle Blog. www.acefitness.org/resources/pros/expert-articles/5123/core-strengthening-stability-ball-workout/

American Council on Exercise. (N.D.). Exercise Database & Library. Featured Exercises from ACE. Stability Ball. Healthy Living Blog. www.acefitness.org/resources/everyone/exercise-library/equipment/stability-ball/

American Council on Exercise. (2001). Strengthen your abdominals with stability balls. Healthy Living Blog. acewebcontent.azureedge.net/assets/education-resources/lifestyle/fitfacts/pdfs/fitfacts/itemid_129.pdf

Escamilla, R. F., Lewis, C., Pecson, A., Imamura, R., & Andrews, J. R. (2016). Muscle Activation Among Supine, Prone, and Side Position Exercises With and Without a Swiss Ball. Sports health, 8(4), 372–379. doi.org/10.1177/1941738116653931

How Footwear Affects Back Pain

Dr. Alex Jimenez

Physical therapist assessing lower extremity muscle strength in patient — Man lying in supine position on examination bed while physiotherapist applying downward pressure on his lower leg

Footwear can cause lower back pain and problems for some individuals. Can understanding the connection between footwear and back problems help individuals find the right shoes to maintain back health and relieve pain?

Table of Contents

Footwear Back Pain

The back provides the strength for physical activities. Back pain affects daily life and can have various causes. Unhealthy posture, walking, twisting, turning, bending, and reaching can contribute to back problems that result in pain. According to the CDC, 39% of adults report living with back pain (Centers for Disease Control and Prevention, 2019). Improper footwear can also contribute to back pain. Selecting footwear carefully can help bring pain relief and help maintain spinal health. Individuals can enjoy less pain and manage symptoms by choosing shoes that maintain spinal alignment and protect the feet from blunt impact.

Understanding the Back Pain-Footwear Connection

Improper footwear could be the cause of lower back pain. What impacts the bones at the bottom of the neuromusculoskeletal system radiates upward and affects the spine and back muscles. What footwear is used travels upward, impacting gait, posture, spinal alignment, and more. When back problems originate from the feet, these are biomechanical issues. Biomechanics means how the bones, joints, and muscles work together and how changes in external forces impact the body.

Movement

When the feet impact the ground, they are the first extremities to absorb shock for the rest of the body. Individuals will start to walk differently if they have a problem or change in their feet. Wearing shoes with improper support can increase the wear and tear on the muscles and joints, leading to awkward and unnatural movement. For example, consider the difference between standing on tiptoes in high heels and the natural flat-footed state. Well-cushioned shoes help absorb impact and lessen pain sensations. The pressures on each of the joints shift balance, which causes instability problems with less pressure on some and more on others. This creates an imbalance that leads to pain and joint conditions.

Posture

Maintaining a healthy posture is another factor in preventing or alleviating back pain. With the right footwear, the body can maintain a healthier stance and the right curvature throughout the spine, and it helps distribute the weight evenly. This results in decreased stress on ligaments, muscles, and joints. (Harvard Health Publishing. 2014) It’s recommended to see an orthopedist to get to the root of an individual’s condition. For some, a herniated disc, sciatica, automobile collision, fall, unhealthy ergonomics, or a combination, as well as other underlying issues, may be contributing to their back pain.

Shoe Types and Their Impact on The Back

How various shoes impact posture, potentially causing or relieving back pain.

High Heels

High heels can definitely contribute to back pain. They change body posture, causing a domino effect on the spine. The body’s weight is shifted to increase pressure on the balls of the feet, and the spine’s alignment becomes altered. High heels also affect how the ankles, knees, and hips move when walking, balance, and how the back muscles operate, all of which can worsen back pain.

Flat Shoes

Flat shoes may not be the best choice for spinal health. If they lack arch support, they can cause the foot to roll inward, known as pronation. This can contribute to misalignment, which can strain the knees, hips, and lower back. However, they can be a decent choice if they provide arch support. When wearing flat shoes with healthy support, the weight is distributed evenly on the feet and the spine. This helps maintain correct posture, which can help prevent and/or alleviate back pain.

Sneakers, Tennis, and Athletic Shoes

Sneakers, tennis, and athletic shoes can relieve back pain with thorough cushioning and support. Choosing the right ones involves determining the activity that will be done in them. There are tennis, running, basketball, pickleball, skating shoes, and more. Research what features will be needed for the sport or activity. This could include:

Heel cups
Insole cushioning
Wide base
Other features to meet individual foot needs.

It is recommended that athletic shoes be changed every 300 to 500 miles of walking or running or with any signs of unevenness when placed on a flat surface, as worn-out soles and degraded materials can increase the risk of injury and back pain. (American Academy of Podiatric Sports Medicine, 2024). If a certain pair puts the legs, hips, or ankles into an unnatural position or impedes regular movement, it may be time to replace them.

Choosing the Right Shoes

The ideal solution for choosing shoe wear is to get a gait analysis and a review of how you walk and run. Various healthcare professionals may offer this service to tailor each individual’s search for the right shoes for back pain. In gait analysis, individuals are asked to run and walk, sometimes on camera, while a professional notes physical tendencies, like when the foot hits the ground and whether it rolls inward or outward. This provides data on affected posture, movement, pain levels, how much arch support is needed, and what type to wear to help prevent back pain. Once the analysis is complete, it will guide you on what to look for, such as what level of arch support, heel height, or material is best for you.

Injury Medical Chiropractic and Functional Medicine Clinic specializes in progressive, cutting-edge therapies and functional rehabilitation procedures focused on clinical physiology, total health, practical strength training, and complete conditioning. We focus on restoring normal body functions after trauma and soft tissue injuries. We use Specialized Chiropractic Protocols, Wellness Programs, Functional and integrative Nutrition, Agility and mobility Fitness Training, and Rehabilitation Systems for all ages. Our programs are natural and use the body’s ability to achieve specific measured goals rather than introducing harmful chemicals, controversial hormone replacement, unwanted surgeries, or addictive drugs. We have teamed up with the city’s premier doctors, therapists, and trainers to provide high-quality treatments that empower our patients to maintain the healthiest way of living and live a functional life with more energy, a positive attitude, better sleep, and less pain.

Benefits of Using Custom Foot Orthotics

References

Centers for Disease Control and Prevention. (2019). Back, lower limb, and upper limb pain among U.S. adults, 2019. Retrieved from www.cdc.gov/nchs/products/databriefs/db415.htm

Harvard Health Publishing. (2014). Posture and back health. Harvard Health Education. www.health.harvard.edu/pain/posture-and-back-health

American Academy of Podiatric Sports Medicine. Ayne Furman, D. F., AAPSM. (2024). How do I know when it is time to replace my athletic shoes?

Fueling Your Body with Glycogen: A Complete Guide

Dr. Alex Jimenez

Fitness women, laughing and eating fruit on training, weight loss exercise and workout break by Can.

For individuals who are getting into exercise, fitness, and physical activity, can knowing how glycogen works help in workout recovery?

Table of Contents

Glycogen

When the body needs energy, it draws on its glycogen stores. Low-carbohydrate, ketogenic diets and intense exercise deplete glycogen stores, causing the body to metabolize fat for energy. Glycogen is supplied through carbohydrates in an individual’s diet and is used to power the brain, physical activity, and other bodily functions. The molecules made from glucose are mainly stored in the liver and muscles. What is eaten, how often, and the activity level influence how the body stores and uses glycogen. Restoring glycogen after physical activity or working out is a vital part of the recovery process. The body can quickly mobilize glycogen from these storage sites when it needs fuel. Eating enough carbohydrates to reach health goals and activity levels is essential for success.

What Is It

It is the body’s stored form of glucose or sugar.
It is stored in the liver and muscles.
It is the body’s primary and preferred energy source.
It comes from carbohydrates in foods and drinks.
It is made from several connected glucose molecules.

Production and Storage

Most carbohydrates eaten are converted to glucose, which becomes the body’s main energy source. However, when the body doesn’t need fueling, the glucose molecules become linked chains of eight to 12 glucose units, forming a glycogen molecule.

Process Triggers

Eating a carbohydrate-containing meal will raise blood glucose levels in response.
Increasing glucose signals the pancreas to produce insulin, a hormone that helps the body’s cells take up glucose from the bloodstream for energy or storage.
Insulin activation causes the liver and muscle cells to produce an enzyme called glycogen synthase, which links glucose chains together.
With enough glucose and insulin, glycogen molecules can be delivered to the liver, muscles, and fat cells for storage.

Since most glycogen is found in the muscles and liver, the amount stored in these cells varies depending on activity level, how much energy is burned at rest, and the foods eaten. The muscles primarily use glycogen stored in the muscles, while glycogen stored in the liver is distributed throughout the body, mainly to the brain and spinal cord.

Body Usage

The body converts glucose to glycogen through a process called glycogenesis. During this process, various enzymes help the body break down glycogen in glycogenolysis so the body can use it. The blood has a set amount of glucose ready to go at any given time. The insulin levels also drop when the level begins to decline, either from not eating or burning glucose during exercise. When this happens, an enzyme known as glycogen phosphorylase starts breaking the glycogen down to supply the body with glucose. Glucose from liver glycogen becomes the body’s primary energy. Short bursts of energy use glycogen, whether during sprints or heavy lifting. (Bob Murray, Christine Rosenbloom, 2018) A carbohydrate-rich pre-workout drink can provide energy to exercise longer and recover quicker. Individuals should eat a post-workout snack with a balanced amount of carbohydrates to replenish glycogen stores. The brain also uses glucose for energy, with 20 to 25% of glycogen going toward powering the brain. (Manu S. Goyal, Marcus E. Raichle, 2018) Mental sluggishness or brain fog can develop when not enough carbohydrates are consumed. When glycogen stores are depleted through exercise or insufficient carbs, the body can feel fatigued and sluggish and perhaps experience mood and sleep disturbances. (Hugh S. Winwood-Smith, Craig E. Franklin 2, Craig R. White, 2017)

Diet

What foods are eaten and how much physical activity an individual does also influence glycogen production. The effects can be acute if one follows a low-carb diet, where carbohydrates, the primary source of glucose synthesis, are suddenly restricted.

Fatigue and Brain Fog

When first starting a low-carb diet, the body’s glycogen stores can be severely depleted and individuals may experience symptoms like fatigue and brain fog. (Kristen E. D’Anci et al., 2009)
The symptoms begin to subside once the body adjusts and renews its glycogen stores.

Water Weight

Any amount of weight loss can have the same effect on glycogen stores.
Initially, individuals may experience a rapid drop in weight.
Over time, weight may plateau and possibly increase.

The phenomenon is partly due to glycogen composition, which is also water. Rapid glycogen depletion at the onset of the diet triggers the loss of water weight. Over time, glycogen stores are renewed, and the water weight returns. When this happens, weight loss can stall or plateau. Fat loss can continue despite the short-term plateau effect.

Exercise

If undertaking a strenuous exercise routine, there are strategies to help avoid decreased performance that may be helpful:

Carbo-loading

Some athletes consume excessive amounts of carbohydrates before working out or competing.
Extra carbohydrates provide plenty of fuel.
The method has fallen out of favor as it can lead to excess water weight and digestive issues.

Glucose Gels

Energy gels containing glycogen can be consumed before or as needed during an event to increase blood glucose levels.
For example, energy chews are effective supplements for runners to help increase performance during extended runs.

Low-Carb Ketogenic Diet

Eating a diet high in fat and low in carbohydrates can put the body in a keto-adaptative state.
In this state, the body begins to access stored fat for energy and relies less on glucose for fuel.

At Injury Medical Chiropractic and Functional Medicine Clinic, our providers use an integrated approach to create personalized care plans for each individual, often including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Our goal is to restore health and function to the body.

Sports Nutrition and Sports Dietician

References

Murray, B., & Rosenbloom, C. (2018). Fundamentals of glycogen metabolism for coaches and athletes. Nutrition reviews, 76(4), 243–259. doi.org/10.1093/nutrit/nuy001

Goyal, M. S., & Raichle, M. E. (2018). Glucose Requirements of the Developing Human Brain. Journal of pediatric gastroenterology and nutrition, 66 Suppl 3(Suppl 3), S46–S49. doi.org/10.1097/MPG.0000000000001875

Winwood-Smith, H. S., Franklin, C. E., & White, C. R. (2017). Low-carbohydrate diet induces metabolic depression: a possible mechanism to conserve glycogen. American journal of physiology. Regulatory, integrative and comparative physiology, 313(4), R347–R356. doi.org/10.1152/ajpregu.00067.2017

D’Anci, K. E., Watts, K. L., Kanarek, R. B., & Taylor, H. A. (2009). Low-carbohydrate weight-loss diets. Effects on cognition and mood. Appetite, 52(1), 96–103. doi.org/10.1016/j.appet.2008.08.009

How to Keep Your Intervertebral Discs Healthy and Strong

Dr. Alex Jimenez

For individuals who are dealing with back pain and problems, could knowing how to improve and maintain intervertebral disc health help alleviate symptoms?

Table of Contents

Intervertebral Disc Health

The spinal column comprises 24 movable bones and 33 bones called vertebrae. The vertebral bones are stacked on top of each other. The intervertebral disc is the cushioning substance between the adjacent bones. (Dartmouth. 2008)

Bones

The vertebral bones are small and round in an area called the vertebral body. In the back is a bony ring from which protrusions extend and arches and pathways are formed. Each structure has one or more purposes and includes: (Waxenbaum JA, Reddy V, Williams C, et al., 2023)

Stabilizing the spine.
Providing a space for the connective tissue and back muscles to attach.
Providing a tunnel for the spinal cord to pass through cleanly.
Providing a space where nerves exit and branch out to all areas of the body.

Structure

The intervertebral disc is the cushioning that sits between the vertebrae. The design of the spine allows it to move in various directions:

Flexion or bending
Extension or arching
Tilting and rotation or twisting.

Powerful forces act upon and influence the spinal column to produce these movements. The intervertebral disc absorbs shock during movement and protects the vertebrae and spinal cord from injury and/or trauma.

Ability

On the outside, strong woven fiber tissues form an area called the annulus fibrosis. The annulus fibrosis contains and protects the softer gel substance in the center, the nucleus pulposus. (Y.S. Nosikova et al., 2012) The nucleus pulposis provides shock absorption, flexibility, and pliability, especially under pressure during spinal movement.

Mechanics

The nucleus pulposus is a soft gel substance located in the center of the disc that allows elasticity and flexibility under stress forces to absorb compression. (Nedresky D, Reddy V, Singh G. 2024) The swivel action alters the tilt and rotation of the vertebra above and below, buffering the effects of spinal motion. The discs swivel in response to the direction the spine moves. The nucleus pulposus is made mostly of water, which moves in and out through small pores, acting as byways between the vertebra and disc bone. Body positions that load the spine, like sitting and standing, push the water out of the disc. Lying down on the back or in a supine position facilitates water restoration into the disc. As the body ages, the discs lose water/dehydrate, leading to disc degeneration. The intervertebral disc has no blood supply, which means that for a disc to receive necessary nutrition and for waste removal, it must rely on water circulation to stay healthy.

Care

Some ways of maintaining intervertebral disc health include:

Paying attention to posture.
Changing positions frequently throughout the day.
Exercising and moving around.
Applying correct body mechanics to physical activities.
Sleeping on a supportive mattress.
Drinking plenty of water.
Eating healthy.
Maintaining a healthy weight.
Drinking alcohol in moderation.
Quitting smoking.

At Injury Medical Chiropractic and Functional Medicine Clinic, we treat injuries and chronic pain syndromes by improving an individual’s ability through flexibility, mobility, and agility programs tailored for all age groups and disabilities. Our chiropractic team, care plans, and clinical services are specialized and focused on injuries and the complete recovery process. Our areas of practice include Wellness & Nutrition, Acupuncture, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols. If other treatment is needed, individuals will be referred to a clinic or physician best suited to their injury, condition, and/or ailment.

Beyond the Surface: Understanding the Effects of Personal Injury

References

Dartmouth Ronan O’Rahilly, MD. (2008). Basic Human Anatomy. Chapter 39: The vertebral column. In D. Rand Swenson, MD, PhD (Ed.), BASIC HUMAN ANATOMY A Regional Study of Human Structure. W.B. Saunders. humananatomy.host.dartmouth.edu/BHA/public_html/part_7/chapter_39.html

Waxenbaum, J. A., Reddy, V., Williams, C., & Futterman, B. (2024). Anatomy, Back, Lumbar Vertebrae. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/29083618

Nosikova, Y. S., Santerre, J. P., Grynpas, M., Gibson, G., & Kandel, R. A. (2012). Characterization of the annulus fibrosus-vertebral body interface: identification of new structural features. Journal of anatomy, 221(6), 577–589. doi.org/10.1111/j.1469-7580.2012.01537.x

Nedresky D, Reddy V, Singh G. (2024). Anatomy, Back, Nucleus Pulposus. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/30570994

Food Poisoning and Gut Health: What You Need to Know

Dr. Alex Jimenez

Man is showing illustration. Conception of dieting. Professional medical worker in white coat is in the office.

Can knowing which foods to eat help individuals recovering from food poisoning restore gut health?

Table of Contents

Food Poisoning and Restoring Gut Health

Food poisoning can be life-threatening. Fortunately, most cases are mild and short-lived and last only a few hours to a few days (Centers for Disease Control and Prevention, 2024). But even mild cases can wreak havoc on the gut, causing nausea, vomiting, and diarrhea. Researchers have found that bacterial infections, like food poisoning, can cause changes in gut bacteria. (Clara Belzer et al., 2014) Eating foods that promote gut healing after food poisoning may help the body recover and feel better faster.

Foods to Eat

After food poisoning symptoms have resolved, one may feel that returning to the usual diet is fine. However, the gut has endured quite an experience, and even though acute symptoms have subsided, individuals may still benefit from foods and drinks that are easier on the stomach. Recommended foods and beverages after food poisoning include: (National Institute of Diabetes and Digestive and Kidney Diseases. 2019)

Gatorade
Pedialyte
Water
Herbal tea
Chicken broth
Jello
Applesauce
Crackers
Toast
Rice
Oatmeal
Bananas
Potatoes

Hydration after food poisoning is crucial. Individuals should add other nutritious and hydrating foods, like chicken noodle soup, which helps because of its nutrients and fluid content. The diarrhea and vomiting that accompany the illness can leave the body severely dehydrated. Rehydrating beverages help the body replace lost electrolytes and sodium. Once the body is rehydrated and can hold down bland foods, slowly introduce foods from a regular diet. When resuming the usual diet after rehydration, eating small meals frequently, every three to four hours, is recommended instead of eating a large breakfast, lunch, and dinner meal daily. (Andi L. Shane et al., 2017) When choosing Gatorade or Pedialyte, remember that Gatorade is a sports-rehydrating drink with more sugar, which could irritate an inflamed stomach. Pedialyte is designed for rehydrating during and after illness and has less sugar, making it a better option. (Ronald J Maughan et al., 2016)

When Food Poisoning Is Active Foods To Avoid

During food poisoning, individuals typically do not feel like eating at all. However, to avoid worsening the illness, Individuals are recommended to avoid the following while actively ill (Ohio State University. 2019)

Caffeinated drinks and alcohol can further dehydrate.
Greasy foods and high-fiber foods are hard to digest.
Foods and beverages high in sugar can cause the body to produce high glucose levels and weaken the immune system. (Navid Shomali et al., 2021)

Recovery Time and Resuming Regular Diet

Food poisoning doesn’t last long, and most uncomplicated cases are resolved within a few hours or days. (Centers for Disease Control and Prevention, 2024) Symptoms depend on the type of bacteria. Individuals may become ill within minutes of consuming contaminated food up to two weeks later. For example, Staphylococcus aureus bacteria generally cause symptoms almost immediately. On the other hand, listeria may take up to a couple of weeks to cause symptoms. (Centers for Disease Control and Prevention, 2024) Individuals can resume their usual diet once symptoms are gone, the body is thoroughly hydrated and can hold down bland foods. (Andi L. Shane et al., 2017)

Learning About Food Substitutions

References

Centers for Disease Control and Prevention. (2024). Food poisoning symptoms. Retrieved from www.cdc.gov/foodsafety/symptoms.html

Belzer, C., Gerber, G. K., Roeselers, G., Delaney, M., DuBois, A., Liu, Q., Belavusava, V., Yeliseyev, V., Houseman, A., Onderdonk, A., Cavanaugh, C., & Bry, L. (2014). Dynamics of the microbiota in response to host infection. PloS one, 9(7), e95534. doi.org/10.1371/journal.pone.0095534

National Institute of Diabetes and Digestive and Kidney Diseases. (2019). Eating, diet, & nutrition for food poisoning. Retrieved from www.niddk.nih.gov/health-information/digestive-diseases/food-poisoning/eating-diet-nutrition

Shane, A. L., Mody, R. K., Crump, J. A., Tarr, P. I., Steiner, T. S., Kotloff, K., Langley, J. M., Wanke, C., Warren, C. A., Cheng, A. C., Cantey, J., & Pickering, L. K. (2017). 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 65(12), e45–e80. doi.org/10.1093/cid/cix669

Maughan, R. J., Watson, P., Cordery, P. A., Walsh, N. P., Oliver, S. J., Dolci, A., Rodriguez-Sanchez, N., & Galloway, S. D. (2016). A randomized trial to assess the potential of different beverages to affect hydration status: development of a beverage hydration index. The American journal of clinical nutrition, 103(3), 717–723. doi.org/10.3945/ajcn.115.114769

Ohio State University. Kacie Vavrek, M., RD, CSSD Ohio State University. (2019). Foods to avoid when you have the flu. health.osu.edu/wellness/exercise-and-nutrition/foods-to-avoid-with-flu

Shomali, N., Mahmoudi, J., Mahmoodpoor, A., Zamiri, R. E., Akbari, M., Xu, H., & Shotorbani, S. S. (2021). Harmful effects of high amounts of glucose on the immune system: An updated review. Biotechnology and applied biochemistry, 68(2), 404–410. doi.org/10.1002/bab.1938

Rinninella, E., Raoul, P., Cintoni, M., Franceschi, F., Miggiano, G. A. D., Gasbarrini, A., & Mele, M. C. (2019). What is the Healthy Gut Microbiota Composition? A Changing Ecosystem across Age, Environment, Diet, and Diseases. Microorganisms, 7(1), 14. doi.org/10.3390/microorganisms7010014

Mosby, C. A., Bhar, S., Phillips, M. B., Edelmann, M. J., & Jones, M. K. (2022). Interaction with mammalian enteric viruses alters outer membrane vesicle production and content by commensal bacteria. Journal of extracellular vesicles, 11(1), e12172. doi.org/10.1002/jev2.12172

Davani-Davari, D., Negahdaripour, M., Karimzadeh, I., Seifan, M., Mohkam, M., Masoumi, S. J., Berenjian, A., & Ghasemi, Y. (2019). Prebiotics: Definition, Types, Sources, Mechanisms, and Clinical Applications. Foods (Basel, Switzerland), 8(3), 92. doi.org/10.3390/foods8030092

Harvard Medical School. (2023). How to get more probiotics. www.health.harvard.edu/staying-healthy/how-to-get-more-probiotics

National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Treatment of viral gastroenteritis. Retrieved from www.niddk.nih.gov/health-information/digestive-diseases/viral-gastroenteritis/treatment

Recovering from a Dislocated Hip: What You Need to Know

Dr. Alex Jimenez

Experienced physiotherapist working with female patient in rehabilitation center, woman in comfortable training suit

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

Table of Contents

Dislocated Hip

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

What Is It?

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

Hip Anatomy

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

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

Posterior Hip Dislocation

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

Anterior Hip Dislocation

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

Hip Subluxation

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

Symptoms

Symptoms can include:

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

Causes

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

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

Developmental Dislocation of the Hip

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

Treatment

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

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

Surgery

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

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

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

Recovery

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

Chiropractic Solutions for Osteoarthritis

References

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

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

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

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

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

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

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

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

Acupressure: Activating Acupoints for Holistic Health and Wellness

Dr. Alex Jimenez

Shot of a young female doctor giving a patient advice during a consultation.

Can incorporating acupressure provide effective relief and benefits for individuals looking to try natural treatments for common health ailments?

Table of Contents

Acupressure

Acupressure is a type of complementary medicine that is rising in popularity due to its simplicity and accessibility. It can assist in treating various diseases and conditions. (Piyush Mehta et al., 2016) Anyone can learn it, and no special equipment is required. It is an effective and safe therapeutic option with no known side effects. (Youngmi Cho et al., 2021) It is a cost-effective intervention similar to acupuncture. (Lukas Israel et al., 2021)

What Is It?

The concept of acupressure activates acupoints or pressure points across meridians or channels connected to various organs to balance energy and promote health. Practitioners believe that the quality or state of a person’s energy determines their health. (Piyush Mehta et al., 2016) Acupressure is the stimulation of acupoints using either the fingers or a tool. Massage techniques like Amma, Shiatsu, Tui Na, and Thai massage incorporate acupressure in their treatments and follow the same energy channels as acupuncture.

The Way It Works

Acupressure works similarly to acupuncture. The Gate Control Theory theorizes that pleasure impulses reach the brain four times faster than pain impulses. Continuous pleasurable impulses close the neural gates and block slower messages, like pain. According to this theory, acupressure improves the pain perception threshold. (Piyush Mehta et al., 2016) Stimulating acupoints activates functional responses, like releasing hormones. These hormones serve various functions, physical, like regulating organ function, and mental, like regulating emotions, and releasing them can help improve health and well-being. (Piyush Mehta et al., 2016)

Acupressure is a simple and effective intervention that can be self or professionally administered.
Acupoints are activated in the elbows, fingers, feet, knuckles, palms, or thumbs.
Though acupressure doesn’t require specialized tools, they are available for convenience.
Some practitioners used Bian stones to activate acupoints.
Modern tools can assist with activating acupoints. (Piyush Mehta et al., 2016)
Pressing the acupoints is adequate, and inaccuracies are unlikely to cause harm or injury. (Youngmi Cho et al., 2021)

Some of the tools available include: (Piyush Mehta et al., 2016)

Spinal device
Gloves
Device for fingers
Pen
Ring
Footwear
Footboard
Device for ear
Clamps

Benefits

Acupressure is often used alongside modern medicine, as it treats common or coexisting symptoms, such as anxiety or stress. Some of the conditions for which acupressure may be effective include.

Stress and Fatigue Reduction

Stress and fatigue are common but often arise alongside other ailments or conditions if persistent or severe, anxiety and fatigue can significantly affect quality of life by reducing an individual’s ability to participate in daily activities. In a study looking at shift work nurses who experience stress and fatigue from the intensity of their work, acupressure significantly reduced their symptoms. (Youngmi Cho et al., 2021) In studies with breast cancer survivors, acupressure was also used to decrease fatigue levels and was shown to be an effective and low-cost option for managing persistent fatigue alongside standard care for breast cancer. (Suzanna Maria Zick et al., 2018) (Suzanna M Zick et al., 2016)

Can Help With Anxiety and Depression

Depression and anxiety can be part of a disorder or exist on their own. Acupressure may help alleviate some of the anxiety and depression that arise as part of a condition or ailment. In the shift work nurses study, acupressure helped decrease anxiety levels. (Youngmi Cho et al., 2021) In other studies, acupressure reduced anxiety scores and improved depressive symptoms in individuals with mild to moderate symptoms. (Elizabeth Monson et al., 2019) (Jingxia Lin et al., 2022) (Suzanna Maria Zick et al., 2018)

Pain Reduction

Individuals experience physical pain for a variety of reasons. Pain can come from temporary sports injuries, work, sudden awkward movements, and/or chronic illness. Acupressure can effectively reduce pain as a complementary therapy. (Elizabeth Monson et al., 2019) In a study, athletes who had a musculoskeletal sports injury reported decreased pain intensity after three minutes of acupressure therapy. (Aleksandra K Mącznik et al., 2017) In another study, breast cancer survivors showed significant improvements with acupressure. (Suzanna Maria Zick et al., 2018)

Nausea Relief

Nausea and vomiting are conditions that are common for those who are pregnant or undergoing chemotherapy. It also can be a medication side effect or arise with migraine or indigestion. There is evidence that acupressure may be effective in alleviating symptoms. Some researchers believe a particular type of acupressure known as auricular acupressure is the most effective for treating chemotherapy-induced nausea and vomiting alongside standard treatment. (Jing-Yu Tan et al., 2022) However, further research is needed to determine whether this is a viable, ongoing option for treating nausea and vomiting. (Heather Greenlee et al., 2017)

Sleep Better

Acupressure can be an effective and low-cost option for managing breast cancer symptoms. One study found relaxing acupressure techniques improved sleep quality and quality of life in breast cancer survivors. Additionally, researchers note that relaxing acupressure is more effective for improving sleep and quality of life than stimulating acupressure. (Suzanna M Zick et al., 2016)

Allergy Reduction

Allergic rhinitis is inflammation caused by an allergic reaction. Previous trials have found that acupressure could improve overall health by reducing seasonal allergic rhinitis symptoms and the need for allergy medication. (Lukas Israel et al., 2021) Researchers also noted that individuals are likely to adhere to self-applied acupressure therapy as a form of self-massage. (Lukas Israel et al., 2021)

Always consult a healthcare provider before starting acupressure treatments, especially if you have any pre-existing health conditions. At Injury Medical Chiropractic and Functional Medicine Clinic, we treat injuries and chronic pain syndromes by developing personalized treatment plans and specialized clinical services focused on injuries and the complete recovery process. Flexibility, mobility, and agility programs are tailored for all age groups and disabilities. If other treatment is needed, individuals will be referred to a clinic or physician best suited to their injury, condition, and/or ailment.

Enhance Performance with Functional Foot Orthotics

References

Mehta, P., Dhapte, V., Kadam, S., & Dhapte, V. (2016). Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments. Journal of traditional and complementary medicine, 7(2), 251–263. doi.org/10.1016/j.jtcme.2016.06.004

Cho, Y., Joo, J. M., Kim, S., & Sok, S. (2021). Effects of Meridian Acupressure on Stress, Fatigue, Anxiety, and Self-Efficacy of Shiftwork Nurses in South Korea. International journal of environmental research and public health, 18(8), 4199. doi.org/10.3390/ijerph18084199

Israel, L., Rotter, G., Förster-Ruhrmann, U., Hummelsberger, J., Nögel, R., Michalsen, A., Tissen-Diabaté, T., Binting, S., Reinhold, T., Ortiz, M., & Brinkhaus, B. (2021). Acupressure in patients with seasonal allergic rhinitis: a randomized controlled exploratory trial. Chinese medicine, 16(1), 137. doi.org/10.1186/s13020-021-00536-w

Zick, S. M., Sen, A., Hassett, A. L., Schrepf, A., Wyatt, G. K., Murphy, S. L., Arnedt, J. T., & Harris, R. E. (2018). Impact of Self-Acupressure on Co-Occurring Symptoms in Cancer Survivors. JNCI cancer spectrum, 2(4), pky064. doi.org/10.1093/jncics/pky064

Zick, S. M., Sen, A., Wyatt, G. K., Murphy, S. L., Arnedt, J. T., & Harris, R. E. (2016). Investigation of 2 Types of Self-administered Acupressure for Persistent Cancer-Related Fatigue in Breast Cancer Survivors: A Randomized Clinical Trial. JAMA oncology, 2(11), 1470–1476. doi.org/10.1001/jamaoncol.2016.1867

Monson, E., Arney, D., Benham, B., Bird, R., Elias, E., Linden, K., McCord, K., Miller, C., Miller, T., Ritter, L., & Waggy, D. (2019). Beyond Pills: Acupressure Impact on Self-Rated Pain and Anxiety Scores. Journal of alternative and complementary medicine (New York, N.Y.), 25(5), 517–521. doi.org/10.1089/acm.2018.0422

Lin, J., Chen, T., He, J., Chung, R. C., Ma, H., & Tsang, H. (2022). Impacts of acupressure treatment on depression: A systematic review and meta-analysis. World journal of psychiatry, 12(1), 169–186. doi.org/10.5498/wjp.v12.i1.169

Mącznik, A. K., Schneiders, A. G., Athens, J., & Sullivan, S. J. (2017). Does Acupressure Hit the Mark? A Three-Arm Randomized Placebo-Controlled Trial of Acupressure for Pain and Anxiety Relief in Athletes With Acute Musculoskeletal Sports Injuries. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 27(4), 338–343. doi.org/10.1097/JSM.0000000000000378

Tan, J. Y., Molassiotis, A., Suen, L. K. P., Liu, J., Wang, T., & Huang, H. R. (2022). Effects of auricular acupressure on chemotherapy-induced nausea and vomiting in breast cancer patients: a preliminary randomized controlled trial. BMC complementary medicine and therapies, 22(1), 87. doi.org/10.1186/s12906-022-03543-y

Greenlee, H., DuPont-Reyes, M. J., Balneaves, L. G., Carlson, L. E., Cohen, M. R., Deng, G., Johnson, J. A., Mumber, M., Seely, D., Zick, S. M., Boyce, L. M., & Tripathy, D. (2017). Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: a cancer journal for clinicians, 67(3), 194–232. doi.org/10.3322/caac.21397

Ho, K. K., Kwok, A. W., Chau, W. W., Xia, S. M., Wang, Y. L., & Cheng, J. C. (2021). A randomized controlled trial on the effect of focal thermal therapy at acupressure points treating osteoarthritis of the knee. Journal of orthopaedic surgery and research, 16(1), 282. doi.org/10.1186/s13018-021-02398-2

Periscapular Bursitis: A Comprehensive Guide for Recovery

Dr. Alex Jimenez

Doctor making medical examination on patient shoulder in clinic while he feeling pain

For individuals experiencing shoulder and upper back pain, could periscapular bursitis be a possible cause?

Table of Contents

Periscapular Bursitis

The scapula/shoulder blade is a bone that shifts position with upper body and shoulder movement. The scapula motion is critical to the normal function of the shoulder and the spine. When abnormal or sudden shoulder movements occur, inflammation and pain symptoms can develop. (Augustine H. Conduah et al., 2010)

Normal Scapula Function

The scapula is a triangular bone on the upper back outside the rib cage. Its outer or lateral side contains the shoulder joint socket /glenoid, while the rest of the bone serves as attachment points for the different shoulder and back muscles. The scapula shifts on the rib cage when moving the arm forward and back. This movement is called scapulothoracic motion and is critical to the normal function of the upper extremity and the shoulder joint. When the scapula does not glide in a coordinated motion, the function of the torso and shoulder joints can become stiff and painful. (J. E. Kuhn et al., 1998)

Scapular Bursa

A bursa is a fluid-filled sac that allows smooth, gliding motion between structures, body tissues, bones, and tendons. Bursae are found throughout the body, including those in front of the kneecap, outside the hip, and at the shoulder joint. When a bursa becomes inflamed and irritated, normal movements can become painful. There are bursae around the scapula in the upper back. Two of these bursa sacs are between the bones and the serratus anterior muscle that controls scapular movement on the chest wall. One bursa sac is located on the upper corner of the scapula, close to the spine at the base of the neck, and the other is at the bottom corner of the scapula, close to the mid-back. Either or both bursa sacs can be affected by periscapular bursitis. There are other bursae around the scapula and the surrounding tendons, but the two corner sacs tend to be the primary bursae that develop periscapular bursitis.

Inflammation

When these bursae become inflamed and irritated, swollen, and thickened, the condition known as bursitis results. When bursitis occurs near the scapula, muscle, and shoulder blade movements can lead to discomfort and pain. The most common symptoms of periscapular bursitis include:

Snapping with movement
Grinding sensations or crepitus
Pain
Tenderness directly over the bursa (Augustine H. Conduah et al., 2010)
Abnormal scapular sensations and movements

An examination of the scapula may display abnormal movements of the shoulder blade. This can lead to winging, where the shoulder blade is not held correctly to the rib cage and protrudes abnormally. Individuals with winging of the scapula typically have abnormal shoulder joint mechanics because the shoulder’s positioning is altered.

Causes

The causes of periscapular bursitis can be varied. The most common is overuse syndrome, where a specific activity is causing irritation to the bursa. These can include:

Sports-related activities that result from repetitive use.
Work-related activities that result from repetitive use.
Traumatic injuries that cause inflammation or irritation to the bursa.

Some conditions can cause abnormal anatomy or bone protuberances, irritating the bursa. One condition is a benign bone growth known as an osteochondroma. (Antônio Marcelo Gonçalves de Souza and Rosalvo Zósimo Bispo Júnior 2014) These growths can project off the scapula, leading to irritation and inflammation.

Treatment

Treatment of periscapular bursitis begins with conservative therapies. Invasive treatments are rarely needed to correct the problem. Treatment can include:

Rest

The first step is to rest the irritated bursa and settle the inflammation.
This can take a few weeks and can be accomplished by modifying physical, sports, or work-related activities.

Ice

Ice is useful for reducing inflammation and controlling pain.
Knowing how to ice an injury properly can help manage the pain and swelling.

Physical Therapy

Physical therapy can alleviate the symptoms of inflammation through various exercises and stretches.
The therapy can improve scapular mechanics so the injury does not become ongoing and recurrent.
Abnormal movement of the scapula on the rib cage can not only lead to the development of bursitis, but if these abnormal mechanics are not addressed, the problem may recur.

Anti-Inflammatory Medications

Non-steroidal anti-inflammatory medications are used to control the inflammation in the short term. (Augustine H. Conduah et al., 2010)
The medications can help block the inflammatory response.
Before taking any medication, individuals should confirm with their healthcare provider that it is safe.

Cortisone Injections

Successful treatment with a cortisone shot is a sign that surgery will be more effective for individuals who may need surgery.
Cortisone injections can be very helpful in delivering a powerful anti-inflammatory dose directly to the site of inflammation. (Augustine H. Conduah et al., 2010)
Cortisone injections should be limited in terms of how many injections are offered to an individual, but in limited doses can be very helpful.
However, cortisone shots should only be performed once the diagnosis is confirmed.

Surgery

Surgery is seldom necessary but can be effective in individuals who are unable to find relief with conservative treatments.
Surgery is often used for individuals with abnormal scapular anatomy, like bone growths or tumors.

Scapular Winging in Depth

References

Conduah, A. H., Baker, C. L., 3rd, & Baker, C. L., Jr (2010). Clinical management of scapulothoracic bursitis and the snapping scapula. Sports health, 2(2), 147–155. doi.org/10.1177/1941738109338359

Kuhn, J. E., Plancher, K. D., & Hawkins, R. J. (1998). Symptomatic scapulothoracic crepitus and bursitis. The Journal of the American Academy of Orthopaedic Surgeons, 6(5), 267–273. doi.org/10.5435/00124635-199809000-00001

de Souza, A. M., & Bispo Júnior, R. Z. (2014). Osteochondroma: ignore or investigate?. Revista brasileira de ortopedia, 49(6), 555–564. doi.org/10.1016/j.rboe.2013.10.002

Preventing Wrist Injuries: The Role of Wrist Protection

Dr. Alex Jimenez

hand powerlifter hold bar barbell before bench press powerlifting competition, power sports games

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

Table of Contents

Wrist Protection

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

Wrist Strength

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

Side to side
Up and down
Rotate

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

Protecting the Wrists

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

Increase Mobility

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

Warm-Up

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

Strengthening Exercises

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

Wraps

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

Preventing Overuse Injuries

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

Proper Form

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

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

Fitness Health

References

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

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

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

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

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