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Scaphoid Fracture: Causes, Symptoms, and Treatments

Doctor at work in the hospital

Individuals who have fractured their scaphoid bone may experience pain and swelling in the wrist just below the thumb. Can immobilization with a cast and physical therapy help?

Scaphoid Fracture Treatment: Options and Outcomes

Scaphoid Fracture

A scaphoid fracture is a break in one of the wrist’s small or carpal bones. This type of fracture occurs most often after a fall onto an outstretched hand. Symptoms typically include swelling and pain in the wrist just below the base of the thumb. These fractures can be difficult to diagnose since they don’t always appear on an X-ray. If the X-ray is negative and the healthcare provider suspects a scaphoid fracture, an MRI may be necessary. Surgery may be required in more severe cases or when the injury is not healing correctly. (American Academy of Orthopaedic Surgeons, 2023)

A Break In The – Navicular Bone

The scaphoid is one of eight carpal bones in the wrist. It is located just below the thumb’s base and is shaped like a kidney bean. This bone can be identified by holding a thumbs-up position and feeling for the hollow between the two tendons below your thumb. The scaphoid is located at the base of the hollow. A break in the scaphoid bone most commonly occurs in the middle of the bone but can also happen at either end. A scaphoid fracture can be displaced or non-displaced (American Academy of Orthopaedic Surgeons, 2023)

Displaced Fracture

  • It is when the bone fragments have moved out of alignment.

Non-displaced Fracture

  • It is when the fragments are still in their normal location in the hand.

The scaphoid’s blood supply comes from a small vessel that enters the most distant part of the bone and flows back through the bone. Because of this one small blood supply, a fracture in the center can stop the circulation to the proximal portion of the bone. Because of this, scaphoid fractures need immediate diagnosis and treatment.

Symptoms

Pain or deep aching on the thumb-side of the wrist, typically after a fall on an outstretched arm, could be a scaphoid fracture. Other symptoms experienced include: (American Academy of Orthopaedic Surgeons, 2023)

  • Tenderness at the base of the hollow area.
  • Pain at the base of the hollow area.
  • Swelling in the wrist
  • Difficulty gripping objects

Pain can become worse from: (American Academy of Orthopaedic Surgeons, 2023)

  • Grasping
  • Pulling
  • Pushing
  • Pinching

Diagnosis

A healthcare provider will evaluate the hand for tenderness and pain in the hollow and/or the bone. If a break is suspected, they will order an X-ray. (Clementson M., Björkman A., & Thomsen N. O. B. 2020) Many patients are diagnosed with a wrist sprain when they have a fracture. Diagnosis can be difficult because the fracture often doesn’t appear on X-rays until weeks after the healing process starts. Physicians commonly treat a wrist injury as a scaphoid fracture initially and then repeat X-rays within two weeks. (American Academy of Orthopaedic Surgeons, 2023) If the injury doesn’t show on an X-ray, the provider may order an MRI, as these fractures can be easier to see on an MRI. An MRI can help ensure appropriate treatment immediately. (Wong S. B. S., & Peh W. C. G. 2019)

Treatment

If a wrist fracture is diagnosed, the wrist will be immobilized in a cast. However, a healthcare provider may also put the wrist in a cast if the X-ray is negative but they suspect a fracture. This will stabilize the injury until an MRI can be performed. With immobilization and follow-up treatment, scaphoid fractures often heal without surgery. Repeat X-rays are taken over several weeks or months so the provider can make sure the injury is healing correctly. If it is not healing correctly, surgery may be recommended. (Clementson M., Björkman A., & Thomsen N. O. B. 2020) If the fracture is displaced, healing correctly may be a challenge. In this case, a physician may recommend initial surgery to reposition the bones. (Clementson M., Björkman A., & Thomsen N. O. B. 2020) This type of surgery involves pinning the bone in place with screws.

Healing Time

Recovery

With the wrist in a cast, individuals will be instructed on activities to avoid placing even a small amount of strain (American Academy of Orthopaedic Surgeons, 2023)

  • Lifting
  • Pushing
  • Pulling objects that weigh more than one pound.
  • Sports activities
  • Throwing
  • Climbing
  • Using tools or machinery that vibrate.

Rehabilitation is an important part of healing because immobilization takes a long time. Wrist range-of-motion exercises can be started, followed by strengthening exercises for the wrist flexors and extensors. Supination, pronation, and grip exercises are also part of physical therapy.

Complications

Scaphoid fractures can lead to serious complications, especially when not properly treated. These include: (American Academy of Orthopaedic Surgeons, 2023) (Almigdad A. et al., 2024)

Nonunion

  • This describes a fracture that fails to heal.

Carpal Collapse

  • This is a form of degenerative arthritis.

Osteoarthritis

  • This condition causes degeneration of the cartilage in the joint.

Avascular Necrosis

  • This is when the blood supply to the bone is reduced or cut off, causing the bone to die.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.


Skateboarding Injury Treatment


References

American Academy of Orthopaedic Surgeons. (2023). Scaphoid fracture of the wrist. orthoinfo.aaos.org/en/diseases–conditions/scaphoid-fracture-of-the-wrist

Clementson, M., Björkman, A., & Thomsen, N. O. B. (2020). Acute scaphoid fractures: guidelines for diagnosis and treatment. EFORT open reviews, 5(2), 96–103. doi.org/10.1302/2058-5241.5.190025

Wong, S. B. S., & Peh, W. C. G. (2019). The role of magnetic resonance imaging in the evaluation of scaphoid fractures. Journal of Medical Radiation Sciences, 66(1), 3–4. doi.org/10.1002/jmrs.316

Almigdad, A., Al-Zoubi, A., Mustafa, A., Al-Qasaimeh, M., Azzam, E., Mestarihi, S., Khair, Y., & Almanasier, G. (2024). A review of scaphoid fracture, treatment outcomes, and consequences. International orthopaedics, 48(2), 529–536. doi.org/10.1007/s00264-023-06014-2

Cauda Equina: A Guide to Diagnosis and Treatment

Physical therapy with mechanical traction to relieve back pain and stiffness by gently stretching the spine, reducing pressure, and enhancing mobility for improved recovery.

Cauda equina syndrome/CES is a rare condition in which the nerves in the lower back are compressed. It can include sciatica as one of its symptoms. Individuals presenting with symptoms that could be CES are advised to see a healthcare provider as soon as possible, as delaying treatment can lead to permanent damage.

Cauda Equina: A Guide to Diagnosis and Treatment

Cauda Equina Syndrome

A cluster of nerve roots called the cauda equina, Latin for horse’s tail, sends and receives messages to the legs, bladder, and other body parts. Cauda equina syndrome is a rare condition in which nerve roots in the lower spinal cord are compressed. This compresses the nerves and disrupts motor and sensory function in the bladder and lower extremities. The most common cause is a ruptured or herniated disc in the lumbar area. This usually occurs when a severe disc herniation compresses the nerve bundle at the base of the spinal cord, causing significant neurological dysfunction like bladder/bowel issues and numbness in the saddle area. If found early, it is treated with surgery within 24 to 48 hours of symptom onset.

 

Initial Signs

Symptoms can occur acutely, in hours, or gradually over weeks or months. One of the first signs and most common symptoms is urinary retention, where the bladder fills, but there is no normal sensation or urge to urinate. (American Association of Neurological Surgeons, 2024) Other symptoms include: (Gardner A., Gardner E., & Morley T. 2011)

  • Severe low back pain
  • Sciatica
  • Pain, numbness, or weakness in one or both legs
  • Saddle anesthesia, which is numbness or other nerve sensations around the anus and the area that sits.
  • A loss of reflexes in the extremities
  • Sexual dysfunction that comes suddenly
  • Loss of bowel control
  • Overflow urination

There are two stages based on urinary symptoms (Fairbank J., & Mallen C. 2014)

CES-Incomplete CES-I

CES-Retention CES-R

  • Bladder control is completely lost.

Causes

The most common cause is a ruptured or herniated disc in the lumbar area. Other possible causes may include: (American Association of Neurological Surgeons, 2024)

Trauma or injury to the spine

  • that leads to fractures or dislocations (gunshots, falls, auto accidents)

Tumors or Infections

  • It can compress the cauda equina nerve bundle.

Spinal Stenosis

  • Narrowing of the spinal column can be either congenital or acquired.

Bone Spurs

Tuberculosis or Pott’s Paralysis

  • Pott’s paralysis is a neurological complication of tuberculosis (TB) of the spine.
  • TB is a bacterial infection that usually affects the lungs but can spread to the spine.

Iatrogenic Side Effects

  • Injuries or illnesses that result from medical or surgical treatment

Spinal Lesions or Malignant Tumors

  • A spinal lesion refers to any abnormal growth or damage within the spine.
  • It can include benign (noncancerous) and malignant (cancerous) tumors.
  • A malignant tumor is a cancerous growth within the spine; essentially, a malignant tumor is a type of spinal lesion with the potential to spread to other parts of the body.

Spinal Infection, Inflammation, Hemorrhage, or Fracture

  • A spinal infection refers to a bacterial, fungal, or viral infection that occurs within the bones of the spine (vertebrae) or the surrounding tissues, potentially causing pain, inflammation, and, in severe cases, neurological complications like weakness or paralysis;
  • Spinal inflammation is a general term for swelling or irritation within the spinal column.
  • Spinal hemorrhage” indicates bleeding within the spinal canal.
  • A spinal fracture refers to a break in one or more of the vertebrae in the spine.

Spinal Arteriovenous Malformations (AVMs)

  • A spinal arteriovenous malformation (AVM) is a rare condition in which the arteries and veins in the spinal cord tangle abnormally.
  • This can damage the spinal cord over time.

Complications from Lumbar Surgery

  • Lumbar surgery can have several complications, including infections, blood clots, nerve damage, and spinal fluid leaks.

Spinal Anesthesia

  • Spinal anesthesia is a regional anesthesia that blocks pain and sensation in the lower body.
  • It involves injecting a local anesthetic medication into the subarachnoid space surrounding the spinal cord.
  • The exact cause is not fully understood, but it can involve direct nerve root injury from the needle, inflammation caused by the anesthetic, or a spinal hematoma compressing the nerve roots.

Spinal Birth Defects

Diagnosis

Diagnosis requires a medical history of symptoms, general health, activity level, and a physical exam to assess strength, reflexes, sensation, stability, alignment, and motion. (​American Association of Neurological Surgeons, 2024) Testing includes:

Blood Tests

  • These test for infections.

MRI

Myelography

  • X-ray or computerized tomography (CT) imaging is enhanced by the injection of contrast material into the cerebrospinal fluid spaces, which can show displacement of the spinal cord or spinal nerves.

Specialized Nerve Testing

  • This could be nerve conduction velocity tests and testing electrical activity in muscles or electromyography.

Treatment

The extent of urinary problems can determine treatment protocols. A CES diagnosis is usually followed by emergency surgery within 24 to 48 hours to relieve compression of the nerves. Moving quickly is essential to prevent permanent complications such as nerve damage, incontinence, or leg paralysis. (American Association of Neurological Surgeons, 2024)

  • Depending on the cause, corticosteroids also may be prescribed to reduce swelling.
  • Antibiotics may be needed if an infection is responsible for CES.
  • For situations in which a tumor is the cause, surgery to remove it may be necessary, followed by chemotherapy and/or radiation.
  • The outcome with CES-I during surgery is generally favorable.
  • Those whose CES has deteriorated to CES-R tend to have a less favorable prognosis.

Post Surgery Therapy

After surgery, CES can be challenging to deal with. If bladder function has been impaired, recovery of control can take time.

  • It may be necessary to use a catheter or to wear disposable underwear. (American Association of Neurological Surgeons, 2024)
  • Frequent urinary infections are also a potential complication.
  • Loss of bladder or bowel control can be psychologically distressing, impacting social life, work, and relationships.
  • Sexual dysfunction can also occur, contributing to relationship difficulties or depression.

Therapy with a mental health professional may be recommended. When damage is permanent, it will be important to include family and friends in the adjustment to living with a chronic condition. Psychological counseling and/or a support group can be helpful. Other specialists who can help include: (American Academy of Orthopaedic Surgeons, 2024)

  • Occupational therapist
  • Physical therapist
  • Physiotherapist
  • Sex therapist
  • Social worker

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.


Disc Herniation


References

American Association of Neurological Surgeons. (2024). Cauda Equina Syndrome. www.aans.org/patients/conditions-treatments/cauda-equina-syndrome/

Gardner, A., Gardner, E., & Morley, T. (2011). Cauda equina syndrome: a review of the current clinical and medico-legal position. European Spine Journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 20(5), 690–697. doi.org/10.1007/s00586-010-1668-3

Fairbank, J., & Mallen, C. (2014). Cauda equina syndrome: implications for primary care. The British journal of general practice: the journal of the Royal College of General Practitioners, 64(619), 67–68. doi.org/10.3399/bjgp14X676988

American Academy of Orthopaedic Surgeons. (2024). Cauda equina syndrome. orthoinfo.aaos.org/en/diseases–conditions/cauda-equina-syndrome

Left Side Lower Back Pain: What You Need to Know

Spine problems, showing issue on model. Woman is on the consultation with doctor in clinic.

Should individuals experiencing lower left back pain see a healthcare provider if it lasts more than a few weeks?

Left Side Lower Back Pain: What You Need to Know

Left Side Lower Back Pain

Lower left back pain can impact your ability to go about your day. If left-side lower back pain lasts longer than a week, it is considered chronic back pain, which can severely impact one’s quality of life. This type of pain has various causes. Muscle or spine and nerve damage, including sciatica, can cause pain. Organs in the lower back, including the kidneys, can cause pain. Pregnancy-related changes, fibromyalgia, and other conditions can cause lower left-side back pain in females.

Causes

Back pain is common and affects almost everyone. (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023) Lower left back pain can have many causes, ranging from muscle and spine issues to organ infections. One way to help tell what’s causing the symptoms is to determine whether there is also sciatica, sharp or burning pain that radiates down one side of the body. It happens when the sciatic nerve gets compressed or irritated. Possible causes include (Penn Medicine, 2020)

Muscle Injury

  • A muscle injury from an accident or injury can be a cause that can appear with or without sciatica.
  • If this is the cause, you’ll notice that the pain improves with rest but worsens after you’ve sat for a long time or after getting up from sleep.
  • There may also be a limited range of motion, tenderness, or swelling.

Arthritis or Bone Conditions

  • Arthritis and bone issues, like osteoporosis, can also be a cause.
  • This can happen if the arthritis is in the left hip or the root cause is on the right side, but the body compensates by overusing muscles on the left side of the back.

Unhealthy Posture and Body Positioning

  • Unhealthy postures and body positioning can contribute to back pain and musculoskeletal problems.
  • To avoid straining the muscles, try sitting and standing straight and keeping all the joints at a 90-degree angle.
  • Move around every 20-30 minutes and stretch out.

Kidneys

  • The kidneys are located in the middle back.
  • Kidney infections or kidney stones could cause pain on the left side.
  • Other symptoms include pain when urinating, fever, and nausea.

Ulcerative Colitis

  • Ulcerative colitis, inflammation of the large intestine, can also cause lower left back pain in some cases.
  • If this is the cause, there may also be abdominal pain, cramping, nausea, and fatigue.

Uterine-Related Pain

  • Several conditions related to the uterus can cause back pain symptoms, including PMS, period cramps, endometriosis, and more.
  • Sometimes, these conditions cause pain on both sides, but some individuals may experience pain just on the left side.

Pregnancy

  • The weight gain, hormonal changes, and limited movement can also contribute to lower left back pain. (Cedars Sinai, 2024)

Spinal Disease

Sciatica

Some causes can also cause sciatica.

In many cases, over-the-counter anti-inflammatory medications can help with sciatica. If it persists, it is recommended to see your healthcare provider to find the root cause. The causes include: (Aguilar-Shea, A. L. et al., 2022)

Herniated disc

  • A disc that pops out of place can add pressure to the sciatic nerve.

Spinal Stenosis

  • Spinal stenosis, or spine narrowing, can also cause sciatic symptoms.

Spondylolisthesis

  • Occurs when vertebrae are out of alignment, leading to sciatic symptoms.

Pregnancy

  • Pregnancy-related growth and bodily changes oftentimes lead to sciatic nerve symptoms and sensations.

Muscle Spasms

  • Spasms like piriformis syndrome, a spasm of the muscle in the buttocks, can cause back pain.

Surgery

  • It’s normal to have back pain for up to six weeks after a back procedure.
  • However, if there is new or worsening lower left back pain after surgery, consult the healthcare provider. (Penn Medicine, 2017)

Describing Symptoms

Knowing how to describe your symptoms when seeing a healthcare provider is helpful. Answering these questions can help explain symptoms (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023)

  1. Have you had any accidents or injuries?
  2. Did the pain come on suddenly or gradually?
  3. Are you experiencing any limits to your range of motion?
  4. Do you have any numbness or tingling?
  5. What helps with the pain?
  6. What makes the pain worse?
  7. Do you have other symptoms, like a fever or trouble urinating?

Self Care

  • Self-care includes rest, ice, heat, and over-the-counter anti-inflammatory medications.
  • Non-steroidal anti-inflammatory drugs can help with pain.
  • Sleeping on a firm mattress and maintaining a healthy posture can help manage and improve symptoms. (See Q. Y., Tan J. B., & Kumar D. S. 2021)

Prescribed Treatment

  • Your healthcare provider may recommend massage, chiropractic care, and acupuncture treatments.
  • If pain can’t be managed at home, your healthcare provider may suggest prescription medications, including muscle relaxers.
  • These can allow the tissue to heal and reduce your pain as well.
  • If you have severe sciatica or vertebrae that have slipped out of place, the healthcare team might recommend a steroid injection into the lower left back to reduce pain by reducing inflammation.
  • In addition to prescription treatments, your healthcare provider might recommend physical therapy to retrain movements, build strength, and help prevent back pain.

Moving Around

It’s important not to move too much. Rest is important for healing, although don’t stop moving entirely. These tips can also help (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023)

  • Sleep on a firm mattress that will support your back.
  • Get a comfortable, ergonomic chair for your job.
  • If you work on your feet, learn to practice healthy posture and use shoes and insoles to facilitate and maintain correct posture.
  • Once you’ve healed, building your core strength may help avoid lower back pain in the future.

Injury Medical Chiropractic and Functional Medicine Clinic

Talk with a healthcare provider and request a referral to a specialist who can help with long-term management. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.


Lower Back Pain Chiropractor Treatment


References

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2023). Back pain. Retrieved from www.niams.nih.gov/health-topics/back-pain

Penn Medicine, B. T., MD. (2020). 4 reasons you may have back pain on only one side. Penn Medicine. www.pennmedicine.org/updates/blogs/musculoskeletal-and-rheumatology/2017/november/back-pain-on-one-side

Cedars Sinai. (2024). Back pain during pregnancy. www.cedars-sinai.org/health-library/diseases-and-conditions/b/back-pain-during-pregnancy.html

Aguilar-Shea, A. L., Gallardo-Mayo, C., Sanz-González, R., & Paredes, I. (2022). Sciatica. Management for family physicians. Journal of family medicine and primary care, 11(8), 4174–4179. doi.org/10.4103/jfmpc.jfmpc_1061_21

Penn Medicine, V. G., MD. (2017). Back pain that won’t go away—even with surgery. Penn Medicine. www.pennmedicine.org/updates/blogs/musculoskeletal-and-rheumatology/2017/november/back-pain-that-wont-go-away

See, Q. Y., Tan, J. B., & Kumar, D. S. (2021). Acute low back pain: diagnosis and management. Singapore Medical Journal, 62(6), 271–275. doi.org/10.11622/smedj.2021086

Peroneal Tendon Injuries: Types and Treatments

a physiotherapist performing an ultrasound on the ankle to check for injury

Are individuals with high foot arches or participating in sports involving repetitive ankle motion at risk for developing peroneal tendon injuries?

Peroneal Tendon Injuries: Types and Treatments

Peroneal Tendon Injuries

The peroneal tendons connect the muscles of the outer side of the lower leg to the foot. They may be acute—occurring suddenly—or chronic—developing over time. The basic types of peroneal tendon injuries are tendonitis, tears, and subluxation.

Anatomy and Function

The two major peroneal muscles (peroneus longus and peroneus brevis) are outside the lower leg, next to the calf muscles. The peroneal tendons run along the outer side of the ankle and attach to the foot, connecting these muscles to bone. They help stabilize the ankle joint, point the foot downward (plantarflexion), and turn the foot outward (eversion). In normal gait, the motion of the peroneal muscles is balanced by the muscles that invert the foot or rock the foot inward from the ankle.​ The two peroneal tendons sit one on top of the other right behind the fibula (the smaller lower leg bone). This closeness can contribute to problems with the peroneal tendons, as they rub together behind the ankle.

Tendonitis

The most common problem is inflammation or tendonitis. The tendons are usually inflamed just behind the fibula bone at the ankle joint. This part of the fibula is the bump on the outside of the ankle, and the peroneal tendons are located just behind that bony prominence. Tendonitis can either result from repetitive overuse or an acute injury. Common symptoms of tendonitis include:

  • Pain behind the ankle
  • Swelling over the peroneal tendons
  • Tenderness of the tendons
  • Pain usually worsens if the foot is pulled down and inwards, stretching the peroneal tendons.
  • X-rays of the ankle are taken.
  • MRI may show inflammation and fluid around the tendons. (Walt J. & Massey P. 2023)

Typical treatment of peroneal tendonitis is accomplished by:

Ice application

  • Applying ice to the area can help reduce swelling and control pain.

Rest

  • Resting is important to allow the tendon to heal.
  • A supportive device (walking boot or ankle brace) or crutches can help in severe cases.
  • Braces and boots provide support, reduce tendons’ stress, and allow rest and inflammation to subside.

Anti-inflammatory Medications

  • Motrin or Aleve are anti-inflammatory and can reduce the swelling around the tendon.

Physical Therapy

  • Physical therapy can help restore normal ankle joint mechanics, help with swelling and pain relief, and correct strength imbalances.

Cortisone Injections

  • Cortisone injections are low-risk if administered to the area around the tendon and not more often than every three months.
  • Ultrasound guidance can help ensure the medication is injected into the correct area. (Walt J. & Massey P. 2023)

Tendon Tears

Tears can occur and are more likely to happen in the peroneus brevis tendon. Tears are believed to be the result of two issues with the tendon. One is the blood supply. Tears of the peroneus brevis tendon almost always occur in the area where the blood supply and nutrition of the tendon are the poorest.

The second issue is the closeness between the two tendons, causing the peroneus brevis tendon to be wedged between the peroneus longus tendon and the bone. (Saxena A., & Bareither D. 2001) Tears of the peroneus brevis tendon are often treated with the same treatments for tendonitis. About half of the tears diagnosed by imaging are found to be asymptomatic. For individuals who don’t find lasting relief from symptoms, surgery may be necessary. Surgical options for peroneal tendon tears (Dombek M. F. et al., 2001)

Tendon Debridement and Repair

  • During a tendon debridement, the damaged tendon and the surrounding inflammatory tissue are removed.
  • The tear can be repaired, and the tendon can be tubularized to restore its normal shape.

Tenodesis

  • A tenodesis is a procedure where the damaged area of the tendon is sewn to the normal tendon.
  • In this case, the damaged segment of the peroneal tendon is removed, and the ends left behind are sewn to the adjacent remaining peroneal tendon.
  • Tenodesis is often recommended for tears involving more than 50% of the tendon. (Castilho R. S. et al., 2024)

Depending on the surgical procedure, Recovery after surgery can take several weeks of restricted weight-bearing and immobilization. Following immobilization, therapy can begin. Recovery is usually six to 12 weeks, depending on the surgery, but a full return to sports and activities may take several months. Risks of surgery include infection, stiffness, skin numbness near the incision, persistent swelling, and persistent pain.

Injury Medical Chiropractic and Functional Medicine Clinic

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


The Difference of Using Custom Foot Orthotics


References

Walt, J., & Massey, P. (2025). Peroneal Tendon Syndromes. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/31335074

Saxena, A., & Bareither, D. (2001). Magnetic resonance and cadaveric findings of the “watershed band” of the Achilles tendon. The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons, 40(3), 132–136. doi.org/10.1016/s1067-2516(01)80078-8

Dombek, M. F., Orsini, R., Mendicino, R. W., & Saltrick, K. (2001). Peroneus brevis tendon tears. Clinics in podiatric medicine and surgery, 18(3), 409–427.

Castilho, R. S., Magalhães, J. M. B., Veríssimo, B. P. M., Perisano, C., Greco, T., & Zambelli, R. (2024). Minimally Invasive Peroneal Tenodesis Assisted by Peroneal Tendoscopy: Technique and Preliminary Results. Medicina (Kaunas, Lithuania), 60(1), 104. doi.org/10.3390/medicina60010104

Managing Periodic Limb Movements of Sleep: Tips and Strategies

Physiotherapist or chiropractor doing manipulative spine treatment on mature patient.

For individuals experiencing periodic limb movements of sleep, can understanding how movements at night may relate to other sleep disorders help bring healthy sleep?

Managing Periodic Limb Movements of Sleep: Tips and Strategies

Periodic Limb Movements of Sleep

Periodic limb movements of sleep (PLMS) are involuntary, repetitive leg and sometimes arm movements during sleep. PLMS is one of the sleep disorders that may cause disruptive movement of the legs, like restless legs syndrome (RLS). It can lead to sleep disruption, insomnia, and daytime sleepiness.

Causes

The exact cause of PLMS is unknown, but it is thought to be related to:

  • Underlying medical conditions (e.g., restless legs syndrome, sleep apnea)
  • Nerve dysfunction
  • Neurochemical imbalances (e.g., dopamine, iron)

Symptoms

  • Repetitive leg and/or arm movements during sleep, typically lasting 0.5-5 seconds.
  • It may be accompanied by sensations of tingling, crawling, or pulling in the legs.
  • It can cause sleep disturbances, leading to daytime fatigue.

Type of Movements

Periodic limb movements during sleep (PLMS) consist of sudden jerking movements of the legs that occur involuntarily during sleep, which the affected individual may not realize is happening. It can be kicking, twitching, or extension of the legs.

  • Restless legs syndrome (RLS) symptoms are noted when awake.
  • PLMS occurs during sleep. (Walters A. S., & Rye D. B. 2009)
  • The movements associated often consist of flexion or extension at the ankle.
  • In some cases, this can also occur at the knee.
  • It may occur on one side or alternate back and forth between the left and right sides. (Cleveland Clinic, 2023)
  • It tends to increase with age and often but is not always accompanied by restless leg symptoms.

If PLMS causes daytime impairment, such as significant sleep disruption, excessive daytime sleepiness, and insomnia, it may be diagnosed as periodic limb movement disorder (PLMD). (Sleep Foundation, 2024)

Diagnosis

PLMS is diagnosed through a sleep study (polysomnography), which records brain waves, eye movements, muscle activity, and breathing patterns during sleep. As part of the study, superficial electrodes are placed on the legs and sometimes the arms to detect muscle contractions or movements.

  • In individuals with PLMS, repetitive movements at least four in a row may last from 1/2 second to 5 seconds.
  • The movements may be more significant if they are associated with arousal or awakenings from sleep.
  • They also may be deemed important if they become disruptive to a bed partner.
  • No further treatment may be necessary when noted in isolation on a sleep study without associated symptoms or impacts.
  • If another disorder cannot explain the movements, PLMS may be the likely diagnosis.
  • Again, if the movements lead to sleep disruption, insomnia, and excessive daytime sleepiness, it is called PLMD.
  • Isolated PLMS noted on a sleep study, without consequence, are insignificant and do not require treatment with medication.

Restless leg syndrome is diagnosed based on clinical criteria of having an uncomfortable feeling in the legs associated with an urge to move that occurs in the evening when lying down and is relieved by movement. (Stefani, A., & Högl, B. 2019)

Treatment

Treatment for PLMS depends on the underlying cause and severity of symptoms. Options include:

  • Medications (e.g., dopamine agonists, iron supplements)
  • Lifestyle changes (e.g., exercise, avoiding caffeine before bed)
  • Treating the underlying medical condition

In general, it is unnecessary to treat PLMS if the individual affected has no complaints of sleep disruption. Treatment can be considered if it causes:

  • Partial or total arousal from sleep
  • Contributes to insomnia
  • Undermines sleep quality
  • Also, if the movements are disruptive to a bed partner, getting them under control may be desirable.

Prescription medications can be effective in treating PLMS. (Cleveland Clinic, 2023) Many of the meds used to treat RLS can be helpful. These may include benzodiazepines (clonazepam), Mirapex (generic name pramipexole), and ropinirole. Movements may also occur with obstructive sleep apnea events, and then the treatment would target the breathing disorder.

Injury Medical Chiropractic and Functional Medicine Clinic

Individuals who struggle with sleep or other sleep disorders that impact their ability to get restful sleep should consult with their healthcare provider about getting an assessment and treatment to restore health. Individuals can recover and regain the benefits of quality rest through healthy sleep practices and lifestyle accommodations. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.


Revitalize and Rebuild with Chiropractic Care


References

Walters, A. S., & Rye, D. B. (2009). Review of the relationship of restless legs syndrome and periodic limb movements in sleep to hypertension, heart disease, and stroke. Sleep, 32(5), 589–597. doi.org/10.1093/sleep/32.5.589

Cleveland Clinic. (2023). Periodic limb movement disorder (PLMD). my.clevelandclinic.org/health/diseases/14177-periodic-limb-movements-of-sleep-plms

Sleep Foundation. (2024). Periodic Limb Movement Disorder What it is, what it feels like, its possible causes, and how it’s addressed. www.sleepfoundation.org/periodic-limb-movement-disorder

Stefani, A., & Högl, B. (2019). Diagnostic Criteria, Differential Diagnosis, and Treatment of Minor Motor Activity and Less Well-Known Movement Disorders of Sleep. Current treatment options in neurology, 21(1), 1. doi.org/10.1007/s11940-019-0543-8

How to Deal with Triceps Tendonitis: Causes and Solutions

Massage therapist treats injury of professional athlete male patient. Sports gun shock massages in medical office of gym. Percussion therapy for regeneration massage of athletic body. Physiotherapy

Triceps tendonitis can be frustrating, especially when you need to rest from normal activities. Can knowing the causes, symptoms, and diagnosis help individuals understand the treatment and prevention of the condition?

How to Deal with Triceps Tendonitis: Causes and Solutions

Triceps Tendonitis

Tendons are connective tissue that attach muscles to bones, enabling the joints to move. Triceps tendonitis is inflammation of the tendon at the back of the elbow. It is most often caused by overuse of the triceps muscles. The condition can cause pain, swelling, and loss of function. It’s common in jobs that require regular hammering, shoveling, and overhead reaching, as well as in weightlifters, gymnasts, and boxers.

Causes

The triceps muscle runs along the back of the upper arm and is attached to the point of the elbow by a tendon. This muscle straightens the elbow. Tendonitis develops from repeatedly straightening the elbow against resistance. This causes tiny tears in the tissue, which leads to inflammation. Triceps tendonitis commonly occurs from repetitive manual labor tasks or sports activities like throwing sports, gymnastics, or boxing. Exercises that target the triceps muscle can cause tendonitis to develop, including kickbacks, dips, push-ups, and bench presses. For this reason, triceps tendonitis is also known as weightlifter’s elbow. (Orthopedic & Spine Center, N.D.)

Symptoms

Inflammation leads to a series of chemical reactions in the area of the injury. There are five main symptoms of inflammation:

  • Redness
  • Warmth
  • Swelling
  • Pain
  • Loss of function

With triceps tendonitis, the pain and stiffness are felt at the back of the elbow. Weakness may also present when using the affected arm. Tendonitis usually causes more pain with movement than when resting. Pain can occur when straightening the elbow, which puts tension on the triceps, or bending the elbow, which stretches the tendon.

Diagnosis

A healthcare provider will ask questions and perform a physical exam to diagnose tendonitis. (Harvard Health Publishing, 2014) A healthcare provider will ask you to describe the pain and the activities that make it better or worse. The elbow will be assessed for movement issues, swelling, or deformities that could indicate a worse injury, like a tendon tear. A healthcare provider will order X-rays or other imaging, such as MRI, to assess for a bone fracture or more extensive damage to the tendon.

Treatment

Several types of treatments include self-care, physical therapy, and medications.

Self Care

Triceps tendonitis can be treated at home if symptoms are addressed early. These include:

Rest

  • Rest the triceps tendon by avoiding activities that cause pain for a few days.

Ice

  • Apply ice to the triceps tendon for 15 to 20 minutes, two to three times daily.
  • Massage the area with an ice cube for several minutes.

Range of Motion Exercises

  • Decrease stiffness in the elbow with gentle range of motion exercises.
  • Slowly bend and straighten the elbow in a pain-free range, 10 times.
  • Repeat several times per day.

Physical Therapy

Physical therapists use various therapies and tools when treating tendonitis, including (Prall J. & Ross M. 2019)

PT Modalities

  • Physical therapy modalities are used to decrease pain, inflammation, and stiffness.
  • Examples include ultrasound, electrical stimulation, and light therapy.

Manual Therapy

  • Manual techniques for tendonitis include soft tissue massage, friction massage, stretching, and joint mobilization.

Exercise

  • Stretching and strengthening exercises that target the triceps muscle and any other muscle weakness that might have contributed to the condition.

Activity Modification

  • A therapist will look at the activities that led to the tendonitis and ensure you use the correct form and proper body mechanics.
  • Sometimes, a physical therapist can make on-site changes in the work environment to help prevent further injury.

Medications

Medications that are used to treat the condition (Aurora Health Care, 2025)

NSAIDs

  • Nonsteroidal anti-inflammatory medications are often used to treat tendonitis.
  • Many are available over-the-counter, including Aleve, Bayer, and Advil.
  • These medications can also be prescribed in higher doses by a healthcare provider.

Pain-Relievers

  • Additional over-the-counter medications such as Tylenol can help decrease pain.

Oral Steroids

  • These medications might be prescribed for short-term use to decrease inflammation if over-the-counter medications are ineffective in treating symptoms.
  • Long-term use of oral steroids can cause more damage to the tendons. (Spoendlin J., Meier C., Jick S. S., & Meier C. R. 2015)

Corticosteroid Injections

  • Tendonitis is frequently treated with an injection of steroid medication to decrease inflammation.
  • However, having multiple injections in the same area can eventually cause tendons to weaken more. (NYU Langone Health, 2024)

Platelet-Rich Plasma

  • PRP is made by taking a small amount of blood and separating the platelets or cells that release growth factors to promote healing.
  • The liquid is then injected into the tendon.
  • PRP is controversial; some studies support its use, while others do not.
  • While PRP may show some promise, insurance may not cover PRP treatments because of the ambiguity in the clinical data.

Injury Medical Chiropractic and Functional Medicine Clinic

Prevention is key. Warming up before a workout, stretching, and using the proper form can help prevent triceps tendonitis. Temporarily halting activities to address symptoms can prevent more serious injury. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.


From Inflammation to Healing


References

Orthopedic & Spine Center. (N.D.). Triceps Tendonitis or Weightlifter’s Elbow. www.osc-ortho.com/resources/elbow-pain/triceps-tendonitis-or-weightlifters-elbow/

Harvard Health Publishing. (2014). Tendonitis. www.health.harvard.edu/diseases-and-conditions/tendonitis

Prall, J., & Ross, M. (2019). The management of work-related musculoskeletal injuries in an occupational health setting: the role of the physical therapist. Journal of Exercise Rehabilitation, 15(2), 193–199. doi.org/10.12965/jer.1836636.318

Aurora Health Care. (2025). Tendonitis symptoms & treatment. www.aurorahealthcare.org/services/orthopedics/conditions/tendonitis

Spoendlin, J., Meier, C., Jick, S. S., & Meier, C. R. (2015). Oral and inhaled glucocorticoid use and risk of Achilles or biceps tendon rupture: a population-based case-control study. Annals of Medicine, 47(6), 492–498. doi.org/10.3109/07853890.2015.1074272

NYU Langone Health. (2024). Therapeutic injections for bursitis & tendinitis in adults. nyulangone.org/conditions/bursitis-tendinitis/treatments/therapeutic-injections-for-bursitis-tendinitis

The Surprising Health Benefits of Parsley Tea

Positive and smiling young couple spending free time together at home while sitting at table with smartphone and pot of hot brew

Can drinking parsley tea help improve overall health?

The Surprising Health Benefits of Parsley Tea

Parsley Tea

Parsley is commonly used as a garnish and to increase flavor in dishes. Some use parsley leaves instead of salt in their food to reduce their sodium intake. It is widely available in grocery stores and can be grown at home. Parsley tea is an herbal tea. Surprisingly, parsley tea benefits health, but not all of this is supported by scientific evidence. There are different kinds of parsley:

  • Curly leaf (Petroselinum crispum)
  • Flat leaf (Petroselinum neapolitanum) or Italian parsley.
  • Parsley is high in vitamins A, B, C, E, and K.
  • Parsley also provides fiber, iron, copper, calcium, and potassium.

The kind used in tea is up to you, based on flavor preferences.

Benefits

Parsley is believed to have various benefits, some of which are derived from consuming parsley tea. For example, parsley is used to freshen breath; however, adding sugar reduces dental benefits. Many women also suggest that parsley helps to ease menstrual cramps, and others say that consuming parsley or tea helps them eliminate excess water weight. However, further research is needed to support its benefits that include: (Ganea M. et al., 2024)

  • Asthma
  • Cough
  • Digestive problems
  • Menstrual problems
  • Fluid retention and swelling (edema)
  • Urinary tract infections
  • Kidney stones
  • Cracked or chapped skin
  • Bruises
  • Insect bites
  • Liver disorders
  • Tumors

Preparation

The quickest way to enjoy parsley tea is to use a parsley tea bag. Brands are available online and in health food stores. Parsley tea bags are manufactured using dried leaves, which can be stored in a cool, dry place and last much longer than fresh parsley. The herb is inexpensive, and making parsley tea at home is also cheap and easy.

Choose Parsley

  • Flat or curly.
  • Remove the leaves from the stems.
  • Gather about 1/8-1/4 cups of leaves for each cup of tea.
  • Place the leaves at the bottom of your cup or in a tea infuser.
  • Note: you can also use a French press to make parsley tea.
  • To do so, place the loose leaves at the bottom of the French press.

Heat Water

  • Once boiling, fill the cup or press with hot water.

Allow the Leaves to Steep

  • For about four minutes.
  • Steep longer if you prefer a stronger cup.
  • If you are new to parsley tea, start with a weaker cup and gradually increase the strength as you get used to the taste.

Remove the Parsley Leaves

  • With a spoon, remove the infuser and discard the leaves.
  • If you use a press, place the plunger on top and slowly press down to separate the leaves from the tea.
  • Flavor your tea with lemon or a little sugar (optional).

Side Effects

The FDA generally recognizes parsley as safe (GRAS). However, consuming large amounts—more than you would typically consume in amounts commonly found in food—can be dangerous. Having a cup of tea daily is not considered a large amount, but if you make tea with parsley oil or ground parsley seeds, your intake could be much higher than normal. Individuals who consume too much parsley may experience anemia and liver or kidney problems. (Alyami F. A., & Rabah D. M. 2011) Individuals who have diabetes, fluid retention, high blood pressure, or kidney disease should talk to their doctor to see if consuming parsley is safe for them, as it may cause side effects that can worsen their condition. Patients who undergo surgery are advised to avoid parsley in the two weeks before their procedure.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic focuses on and treats injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers use an integrated approach to create customized care plans for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, electroacupuncture, and various medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, nutritionists, and health coaches to provide the most effective clinical treatments.


Optimizing Your Wellness


References

Ganea, M., Vicaș, L. G., Gligor, O., Sarac, I., Onisan, E., Nagy, C., Moisa, C., & Ghitea, T. C. (2024). Exploring the Therapeutic Efficacy of Parsley (Petroselinum crispum Mill.) as a Functional Food: Implications in Immunological Tolerability, Reduction of Muscle Cramps, and Treatment of Dermatitis. Molecules (Basel, Switzerland), 29(3), 608. doi.org/10.3390/molecules29030608

Alyami, F. A., & Rabah, D. M. (2011). Effect of drinking parsley leaf tea on urinary composition and urinary stones’ risk factors. Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 22(3), 511–514.

What is the Push-Pull Workout Method? A Complete Guide

Full body of male instructor supporting man doing exercise with elastic resistance band during fitness training with class in spacious studio

Can a push-pull workout routine be an option for individuals who want focused training on specific muscle groups and balanced muscle development throughout the body?

What is the Push-Pull Workout Method? A Complete Guide

Push-Pull Strength Training

A “push-pull” workout is a training style in which you split your exercise routine into separate days dedicated to “push” exercises (targeting muscles like the chest, shoulders, and triceps) and “pull” exercises (targeting muscles like the back and biceps). This allows focused training on each muscle group by isolating their primary movement patterns—pushing away from the body or pulling towards it. The workout often accompanies a separate leg day to complete the full-body workout. This routine comes from bodybuilding. Bodybuilders use this method to maximize their workouts and rest periods. By splitting their workouts into push exercises one day and pull exercises another, they can work out more often without overtraining. (Castanheira R. P. M. et al., 2017)

Upper Body Push Exercises

These exercises involve all the movements that push the weights away from your body. These exercises typically focus on the quads, outer thighs, chest, shoulders, and triceps. (Collins P. 2009)

Pushups

  • Push-ups are a versatile bodyweight exercise that engages multiple muscle groups, including the chest, shoulders, triceps, and core.

Chest Presses

  • Chest presses are exercises that target the pectoral muscles (chest muscles).
  • They can be performed with various equipment and techniques, providing a comprehensive workout for the chest.

Chest Flies

  • Chest flies are a weightlifting exercise that targets the pectoral muscles (chest muscles).
  • They are performed by lying on a bench and extending the arms outward with weights in each hand.
  • The weights are then lowered in an arc motion until they are slightly below chest level before being raised back to the starting position.

Overhead Presses

  • An overhead press is a weight-training exercise that involves pushing a weight above your head.
  • Also known as a shoulder, military, or strict press.

Lateral Raises

  • Lateral raises are an isolation exercise that targets the lateral deltoid muscle on the shoulder’s side.
  • They raise the arms laterally (out to the sides) while slightly bending at the elbows.

Bent Arm Lateral Raises

  • A bent-over lateral raise is a weightlifting exercise that strengthens the rear deltoids, the muscles on the back of the shoulders.
  • It also works other upper and lower body muscles, including the trapezius, rhomboids, triceps, hamstrings, and lower back.

Front Raises

  • Front raises are a weight training exercise that targets the shoulder muscles.
  • They can also help build strength and stability in the upper body.

Dips

  • Dips are an upper-body exercise that uses your body weight to strengthen your triceps and chest.

Triceps Extensions

  • Triceps extensions are resistance exercises that target the triceps muscles in the back of the upper arm.
  • They involve extending the arms at the elbows while keeping the shoulders stationary.

Skull Crushers

  • Skull crushers are a weightlifting exercise that targets the triceps muscles in the upper arms.
  • They are performed by lying on a bench or floor, holding a weight (such as a dumbbell or barbell) overhead, and then lowering it towards the forehead while keeping the elbows slightly bent.
  • This exercise helps to strengthen and build muscle mass in the triceps.

Upper Body Pull Exercises

Pull exercises are movements where you are pulling the weight toward your body. These exercises primarily use the biceps, hamstrings, glutes, and back muscles. A routine set up in which you do a push routine one day and a pull routine the next without working the same muscles two days in a row.

Barbell Rows

  • Often referred to as a “bent-over row” due to the hinged position of your body during the movement.
  • A barbell row is a weightlifting exercise in which you bend over at the hips, grasp a barbell with an overhand grip, and pull the weight toward your stomach.
  • This exercise primarily targets the upper back muscles, including the latissimus dorsi, while also engaging the core and posterior chain muscles.

One Arm Rows

  • A variation of the bent-over row, a one-arm row, also known as a single-arm dumbbell row, is an upper-body exercise that targets the back muscles using a dumbbell and a bench.

Double arm rows

  • A “double arm row” is a rowing exercise in which you simultaneously pull a weight toward your body using both arms, typically with a barbell or dumbbell.
  • This exercise engages your upper back muscles, including the latissimus dorsi, trapezius, and rhomboids.
  • To effectively target the back muscles, you maintain a bent-over position. Essentially, it’s the opposite movement of a chest press, but you use both arms simultaneously.

Barbell High Rows

  • A barbell high row, also known as a wide row, is an exercise that uses a barbell to work the upper and mid back muscles.

Dumbell Pullovers

  • Dumbbell pullovers are a weightlifting exercise that targets the chest, back, and shoulder muscles.

Seated Rows with Resistance Bands

  • A “seated row with bands” is an exercise where you sit on the ground, loop a resistance band around your feet, and then pull the handles towards your chest, mimicking a rowing motion.
  • By squeezing the shoulder blades together, this motion primarily targets the upper back muscles, including the latissimus dorsi and rhomboids.
  • You are essentially performing a seated row movement using the tension of a resistance band instead of weights.

Lat Pulls with Resistance Band

  • Lat pulls with a resistance band are a back exercise that strengthens the latissimus dorsi muscles and can improve posture.

Back extensions

  • Back extensions are an exercise that strengthens and isolates the lower back muscles, also known as the erector spinae.

Seated Alternating Rows

  • A seated alternating row is an exercise that targets the upper back, biceps, and lats.
  • It can be performed using a resistance machine or with a band.

Renegade Rows

  • A renegade row is a full-body exercise that combines a plank with a dumbbell row.
  • It’s an advanced exercise that targets the upper body, back, shoulders, and core.

Biceps Curls

  • A bicep curl involves bending the arm at the elbow towards the body, strengthening the biceps, the large muscles in the front of the upper arm.

Home Equipment

Resistance bands and a quality pair of adjustable dumbbells are recommended for home training. These don’t take up much space and can be used for most upper-body exercises. To set up a more dedicated space for workouts, add a weight bench or a full home gym to increase your push-pull training options.

Benefits

Push-pull workouts are great for anybody, whether you’re a bodybuilder or just someone lifting weights to be strong and fit. This routine is usually spread out over three days of training, allowing for shorter workouts. These can help you stay committed despite a busy schedule and are easier than longer, total-body workouts. These exercises can also be done with a cable pulley system or resistance bands.

  1. Day 1 might be a push upper body workout.
  2. Day 2 might be a lower-body workout.
  3. Day 3 might be the pull upper body workout.

First, push-pull workouts allow you to work your muscles without overstressing them. (Castanheira R. P. M. et al., 2017) Second, although they are more frequent, push-pull workouts are shorter, so you can do more because your other muscles are resting. Third, push-pull routines are more interesting and contain more variety, as they can be done in various ways.

Alternating Workouts

Trainers recommend changing workouts every 6-12 weeks to avoid hitting a plateau, which can delay weight loss (American Council on Exercise, 2001). For example, you could do a push-pull routine for a few weeks and then switch to a different training method, pyramid training. Then, return to total body workouts, which you can do up to 3 non-consecutive days a week. Circuit training may be an option because the quick workouts allow you to get your cardio in simultaneously. (Haltom R. W. et al., 1999) With so many different training methods, there’s no need to do the same workouts repeatedly.

Injury Medical Chiropractic and Functional Medicine Clinic

For those who are easily bored with weight training and prefer a variety of exercises, this can be a refreshing way to stay focused and avoid burnout. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.


Transform Your Body


References

Castanheira, R. P. M., Ferreira-Junior, J. B., Celes, R. S., Rocha-Junior, V. A., Cadore, E. L., Izquierdo, M., & Bottaro, M. (2017). Effects of Synergist vs. NonSynergist Split Resistance Training Routines on Acute Neuromuscular Performance in Resistance-Trained Men. Journal of strength and conditioning research, 31(12), 3482–3488. doi.org/10.1519/JSC.0000000000001762

Collins, P. (2009). Functional Fitness. Germany: Meyer & Meyer Sport, Limited.

American Council on Exercise. (2001). Weight Loss Plateaus and Pitfalls. ACE. contentcdn.eacefitness.com/assets/education-resources/lifestyle/fitfacts/pdfs/fitfacts/itemid_69.pdf

Haltom, R. W., Kraemer, R. R., Sloan, R. A., Hebert, E. P., Frank, K., & Tryniecki, J. L. (1999). Circuit weight training and its effects on excess postexercise oxygen consumption. Medicine and science in sports and exercise, 31(11), 1613–1618. doi.org/10.1097/00005768-199911000-00018

Understanding Rotator Cuff Tears: Causes and Treatments

You made a lot of progress today.

Could older individuals who do not have symptoms of shoulder pain or loss of shoulder and arm function have a rotator cuff tear?

Understanding Rotator Cuff Tears: Causes and Treatments

Rotator Cuff Tear Physical Therapy

A rotator cuff tear is a common injury to the four muscles and tendons surrounding and stabilizing the shoulder joint. Studies have shown that (Geary M. B., & Elfar J. C. 2015)

  • 30% of those under the age of 70
  • 70% of those over age 80 have a rotator cuff tear.

Physical therapy is often recommended as a first-line initial treatment for rotator cuff pain. In most cases, a rotator cuff tear will not need surgical treatment. Determining when surgery is necessary depends on several factors a patient can discuss with their healthcare provider.

Causes

  • Overuse and repetitive motions
  • Trauma (e.g., falls, collisions)
  • Age-related degeneration

Symptoms

  • Shoulder pain, especially with overhead or rotational movements
  • Weakness and difficulty raising the arm
  • Clicking or grinding sounds in the shoulder
  • Limited range of motion

Treatment

The goal of physical therapy for a rotator cuff tear is not necessarily to heal the torn tendon but to relieve pain and improve strength by reducing inflammation and restoring shoulder joint mechanics. This is achieved through physical therapy, ice application, anti-inflammatory treatments like medications, and cortisone injections.

Physical Therapy

The goal of physical therapy is to improve the function of the muscles that surround the shoulder. Physical therapy targets the smaller muscles around the shoulder that are commonly neglected. By strengthening these muscles, the treatment can help compensate for damaged tendons and improve the mechanics of the shoulder joint. A chiropractic physical therapy team will develop a personalized exercise program. Generally, rehabilitation will start with gentle range of motion exercises that can be accomplished using the arms to lift a mobility stick/wand overhead.

Shoulder Pulleys

  • These improve shoulder range of motion and flexibility.

Isometric Exercises

  • These exercises are for the rotator cuff muscles and may then be started.
  • This exercise can improve the contracting of the muscles around the shoulder and offer more support to the shoulder joint.

Scapular Stabilization Exercises

  • These can also be done to improve the muscles surrounding the shoulder blade’s function.
  • This can help improve how the shoulder joint, arm, and scapulae move together when using the arm.

Advanced Strengthening

  • Advanced exercises can be done with a dumbbell or resistance band.

Consult your healthcare provider or physical therapist before starting these or any other exercises for a rotator cuff tear. Doing exercises correctly prevents further pain, injury, or shoulder problems. Specific, focused exercises can help expedite and regain normal shoulder function.

Injury Medical Chiropractic and Functional Medicine Clinic

The prognosis for rotator cuff tears depends on the severity of the tear and the individual’s overall health. With proper treatment, most people can regain the full function of their shoulders. However, some may experience ongoing pain or limitations in severe cases. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.


Shoulder Pain Chiropractic Treatment


References

Geary, M. B., & Elfar, J. C. (2015). Rotator Cuff Tears in the Elderly Patients. Geriatric orthopaedic surgery & rehabilitation, 6(3), 220–224. doi.org/10.1177/2151458515583895

Discover the Deliciousness of Rice Noodles

Dried white rice noodles. Raw pasta. Uncooked noodles on plate.

Can incorporating rice noodles be a healthy alternative to traditional pasta for individuals looking to change their normal routine?

Discover the Deliciousness of Rice Noodles

Rice Noodles

Several alternatives are available to replace wheat-based pasta, including:

  • Black beans
  • Chickpeas
  • Edamame
  • Lentils
  • Rice

Like gluten-free pasta, rice noodles are made with rice flour instead of semolina wheat. Different types of rice, such as brown and white, can be used to make rice noodles. The ingredients are typically rice flour, water, and tapioca starch for texture. Compared with wheat pasta, rice noodles have a mild flavor and texture.

Nutrition

Rice noodle calories and nutrition information is for 1 cup of cooked noodles. (U.S. Department of Agriculture, 2020)

  • Calories – 187
  • Fat – 0.4 grams
  • Carbohydrates – 41.8 grams
  • Protein – 3.1 grams
  • Fiber – 1.75 grams
  • Sugar – 0.05 grams
  • Sodium – 438 milligrams

Carbohydrates

Regular spaghetti noodles are made with semolina, which comes from durum wheat. Rice noodles are a healthy source of complex carbohydrates, with 41.8g of carbohydrates per serving. Individuals who follow a low-carb diet or track their carb intake should consider portion sizes when enjoying rice noodle dishes.

Fats

Rice noodles contain less than 1g of fat per serving. However, the fat content of meals may vary depending on the other ingredients, sauces, and toppings. Foods high in fat, such as vegetable oils, nuts, seeds, avocados, fish, and eggs, will increase the total fat.

Protein

Rice noodles have 3.1g of protein per serving. Although they are not a significant source of protein, they can be paired with other protein sources, such as meat, fish, or tofu, to make high-protein meals.

Vitamins and Minerals

Rice noodles contain small amounts of:

  • Calcium
  • Iron
  • Magnesium
  • Zinc

Health Benefits

The noodles are an alternative to regular pasta, which can be a healthful addition to a well-balanced diet and make for a great gluten-free pasta alternative.

Energy Levels

  • Because they are predominantly made of carbohydrate calories, they are beneficial for increasing and sustaining energy levels.

Gluten-Free Alternative

  • Rice noodles are especially beneficial for individuals who follow a gluten-free diet.
  • Individuals with celiac disease and non-celiac gluten sensitivity should read rice noodle packaging carefully to ensure it is gluten-free.
  • The noodles are also suitable for vegan, vegetarian, low-fat, and low-calorie diets.

Allergies

The noodles are inherently gluten-free because the main ingredient is rice flour. However, individuals with gluten intolerance should ensure no cross-contamination occurs with other non-gluten-free ingredients. Individuals with dietary allergies should check the label to see if cross-contamination may have occurred during processing or if a rice noodle product contains added allergens. Rice noodles are also free of other common allergens, including dairy, soy, eggs, fish, nuts, and wheat.

Preparation

They are cooked by boiling them in water, which rehydrates them. Once cooked, they can be used like regular pasta noodles. They are commonly used in stir-fries and Italian pasta dishes and can be used as substitutes for wheat, egg, and ramen noodles. If a recipe calls for any noodles, use rice noodles instead to change up the texture and flavor.

Storage and Safety

The noodles should be stored in a cool, dry place like the pantry. They come in vacuum-sealed packaging or boxes, so they do not need refrigeration until cooked.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic focuses on and treats injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers use an integrated approach to create customized care plans for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, electroacupuncture, and various medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, nutritionists, and health coaches to provide the most effective clinical treatments.


Atherosclerosis: The Joint Pain Connection


References

U.S. Department of Agriculture, FoodData Central. (2020). Rice Noodles, cooked. Retrieved from fdc.nal.usda.gov/food-details/1101528/nutrients

Standing Lower Back Flexion Exercises for Pain Relief

Human spine model in hands. Young woman is in the gym with training equipment.

Could incorporating standing lumbar flexion exercise into a daily routine help decrease pain and improve overall spinal mobility for individuals with low back pain?

Standing Lower Back Flexion Exercises for Pain Relief

Standing Lower Back Flexion Exercise

A chiropractic physical therapy team visit can help determine which exercises are best for an individual’s injury or condition and teach them what to stop doing if they have low back pain. Exercise and proper posture can decrease discomfort and improve mobility for individuals with low back pain. (Suh, J. H. et al., 2019) Sometimes, exercises that bend backward are recommended, while other times, flexion or forward bending movements are the best way to manage lower back pain. Many find the standing Williams lumbar flexion exercises maneuver helpful for low back pain. (Amila A, Syapitri H, Sembiring E. 2021)

Benefits

Individuals with certain diagnoses may benefit from spinal flexion. These diagnoses include:

Be sure to speak with a healthcare provider to understand the diagnosis and low back symptoms, and work with a physical therapist to be sure that forward flexion of the spine is the correct exercise for your back.

When To Avoid Lumbar Flexion

Some should avoid excessive forward bending, which could cause further damage or injury to the spine. Reasons to avoid flexion include:

Before starting this or any other exercise program for your spine, check with a healthcare provider or physical therapist.

How to Perform

Gradually progressing with other gentle lumbar flexion exercises before full-standing lumbar flexion is recommended. These include performing a week or two of lumbar flexion lying down, followed by a couple weeks of lumbar flexion seated. Once these exercises are easy to perform and pain-free, progress with lumbar flexion standing postures.​To perform, follow these steps:

  • Stand with your feet shoulder-width apart.
  • Slowly bend forward by sliding your hands down the front of your thighs.
  • Reach down as far as possible and let your lower back bend forward.
  • Grab your ankles and gently pull into more forward flexion to increase the backstretch.
  • Hold the end position for a second or two, then slowly return to the starting position.

As you exercise, be sure to monitor changes in symptoms. Pain worsening in the back or traveling down your leg indicates that you should stop the exercise (Spine-health, 2017). If the pain decreases in your leg or centralizes to your back, continue the exercise. Standing lumbar flexion can be repeated for 10 repetitions a couple of times daily. It can help decrease low back or leg pain symptoms and stretch tight hamstrings and back muscles. (Montefiore Pediatric Orthopedic and Scoliosis Center, 2003)

Injury Medical Chiropractic and Functional Medicine Clinic

Exercise can also prevent future lower back problems. Standing back flexion, postural correction, regular physical activity, and exercise are tools for keeping the spine healthy. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.


What Causes Disc Herniation?


References

Suh, J. H., Kim, H., Jung, G. P., Ko, J. Y., & Ryu, J. S. (2019). The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial. Medicine, 98(26), e16173. doi.org/10.1097/MD.0000000000016173

Amila A, Syapitri H, Sembiring E. (2021). The effect of William Flexion Exercise on reducing pain intensity for elderly with low back pain. Int J Nurs Health Serv., 4(1), 28-36. doi.org/https://doi.org/10.35654/ijnhs.v4i1.374

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

Sfeir, J. G., Drake, M. T., Sonawane, V. J., & Sinaki, M. (2018). Vertebral compression fractures associated with yoga: a case series. European journal of physical and rehabilitation medicine, 54(6), 947–951. doi.org/10.23736/S1973-9087.18.05034-7

Howell E. R. (2012). Conservative management of a 31 year old male with left sided low back and leg pain: a case report. The Journal of the Canadian Chiropractic Association, 56(3), 225–232.

Spine-health. (2017). Exercise with lower back pain: Should you work through the pain? Spine-health
Knowledge from Veritas. www.spine-health.com/blog/exercising-lower-back-pain-should-you-work-through-pain

Montefiore Pediatric Orthopedic and Scoliosis Center. Center, M. P. O. a. S. (2003). Low Back Strain. www.cham.org/File%20Library/Global%20Navigation/Expertise%20And%20Programs/Pediatric%20Expertise/Orthopedics/Monte-LOW-BACK-STRAIN-WITH-EXERCISES.pdf

Sparkling Water: A Healthy Drink with Surprising Benefits

Glass of water with a bottle on table

Can individuals add sparkling water to their diet to help lower blood sugar and aid with weight loss?

Sparkling Water: A Healthy Drink with Surprising Benefits

Sparkling Water

Sparkling water is generally considered a healthy drink with health benefits. It is refreshing, increases hydration, improves digestion, and may even help with weight loss (Takahashi A. 2025) (University of Chicago Medicine, 2023). This is nothing new. A previous study suggested that carbonated water makes the body feel full. The carbonation in sparkling water can trick the stomach into feeling fuller, potentially reducing overall calorie intake by curbing snacking between meals, which could prevent overeating and weight gain. (Wakisaka S. et al., 2012) However, a new report suggests carbonated water may help with weight loss by enhancing glucose/sugar uptake and metabolism. (Takahashi A. 2025) But further research is needed.

Lower Blood Sugar Levels

The report compared the effects of carbonated water to hemodialysis, a treatment that filters blood for individuals with kidney failure. (Takahashi A. 2025) Hemodialysis turns the blood alkaline, enhancing glucose absorption and metabolism. (EurekAlert, 2025)

Researchers assume that the carbon dioxide (CO2) absorbed after drinking sparkling water and the CO2 supplied during hemodialysis behave similarly. Carbonated water may consume glucose in the blood near the stomach, temporarily lowering blood sugar levels. However, the researchers suggested that follow-up continuous glucose monitoring (CGM) studies to measure blood sugar levels before and after drinking carbonated water would be necessary to validate the effect.

This does not mean that after drinking sparkling water, there will be major changes to an individual’s weight. Something metabolically is probably happening, but it’s still barely being discovered. The impact of CO2 in carbonated water is not a standalone solution for weight loss. (Takahashi A. 2025)

Adding To A Diet

If sparkling water can help manage blood glucose, it could also affect how the body stores fat. Over time, high blood sugar levels can overwhelm the body, and excess sugar becomes stored as body fat instead of being stored properly for energy use, causing weight gain. (Centers for Disease Control and Prevention, 2024) But for the most part, according to the research, the carbon dioxide in sparkling water may help to prevent this by stimulating glycolysis, or the process the body uses to break down glucose for energy and keep blood sugar levels low. (National Cancer Institute, N.D) (Takahashi A. 2025) Further research is needed to confirm and understand how sparkling water can proficiently and effectively work for weight loss.

Carbonated water alone is unlikely to contribute to significant weight loss. However, sparkling water can be a useful tool for weight loss as part of a healthy lifestyle (Takahashi A. 2025). A balanced diet and regular exercise are still essential for effective weight management.

Weight Gain

Some researchers have questioned whether sparkling water can lead to weight gain. A study on rats and humans found a link between drinking carbonated water and increased levels of the hunger-stimulating hormone ghrelin. (Eweis D. S., Abed F., & Stiban J. 2017) This could lead to increased appetite and higher calorie consumption, but more research is needed, as sleep, physical activity levels and hydration also impact hormones.

Individuals interested in including carbonated water in a balanced diet should check the labels for the caloric content, added sugars, and sugar alcohols, like xylitol or erythritol, which can cause gas or bloating. It is ideal if the label says water and carbonation; the fewer ingredients, the better.

Injury Medical Chiropractic and Functional Medicine Clinic

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


Chiropractic Care and Metabolism: The Hidden Link


References

Takahashi A. (2025). Can carbonated water support weight loss? BMJ Nutr Prev Health. doi.org/10.1136/bmjnph-2024-001108

University of Chicago Medicine. (2023). Is sparkling water good for you? What about hard seltzer? www.uchicagomedicine.org/forefront/health-and-wellness-articles/is-carbonated-water-good-for-you

Wakisaka, S., Nagai, H., Mura, E., Matsumoto, T., Moritani, T., & Nagai, N. (2012). The effects of carbonated water upon gastric and cardiac activities and fullness in healthy young women. Journal of nutritional science and vitaminology, 58(5), 333–338. doi.org/10.3177/jnsv.58.333

EurekAlert. (2025). Fizzy water might aid weight loss by boosting glucose uptake and metabolism. BMJ Nutrition Prevention & Health. doi.org/10.1136/bmjnph-2024-001108

Centers for Disease Control and Prevention. (2024). About insulin resistance and type 2 diabetes. Retrieved from www.cdc.gov/diabetes/about/insulin-resistance-type-2-diabetes.html

National Cancer Institute. (N.D.). Glycolysis. Retrieved from www.cancer.gov/publications/dictionaries/cancer-terms/def/glycolysis

Eweis, D. S., Abed, F., & Stiban, J. (2017). Carbon dioxide in carbonated beverages induces ghrelin release and increased food consumption in male rats: Implications on the onset of obesity. Obesity research & clinical practice, 11(5), 534–543. doi.org/10.1016/j.orcp.2017.02.001

Headaches and Neck Pain: The Connection and Finding Relief

Medium close up of upset woman suffering from pain in cervical spine while professional doctor examining this area

Could individuals who are having headaches with neck pain need emergency treatment or need to get started with sustained physical therapy?

Headaches and Neck Pain: The Connection and Finding Relief

Headaches and Neck Pain

Headaches and neck pain are two very common symptoms. They often occur together and signal common health issues, including fatigue, sinus headaches, and migraines. The combination can also occur due to serious health issues such as a concussion or meningitis. Causes of headaches with neck pain range from various causes, such as not getting enough sleep, having the neck in an awkward position, or having a hangover, to life-threatening issues like fluid buildup in the brain. It is recommended that individuals see a healthcare provider as soon as possible to rule out any life-threatening issues. Discuss the symptoms of neck pain with headache, what can cause these symptoms, and discuss treatment and prevention.

Symptoms

Symptoms are similar to what they feel like when they occur alone. Headache can present as:

  • A feeling of fullness in the head
  • Head soreness
  • Sharp head pain
  • Throbbing head pain
  • Pounding head pain

Neck pain can present as:

  • Pain in the back of the neck
  • Pain and/or aching of the upper back and/or shoulders

Associated Symptoms

Additional symptoms are common. Symptoms associated with headaches and neck pain include:

  • Neck stiffness
  • Trouble concentrating
  • Exhaustion or sleepiness
  • Aching throughout the body
  • Nausea
  • Dizziness
  • Vertigo – feeling like the room is spinning.
  • Photophobia – discomfort when looking at bright lights.
  • A feeling of numbness or tingling down the arm

Generally, associated symptoms suggest a more severe cause and can help a healthcare provider make a diagnosis.

Emergency Help

New symptoms of headache or neck pain can indicate a serious condition. If you develop these symptoms together, get prompt medical attention.

Causes

There are a variety of medical conditions that can cause headaches and neck pain. Both of these conditions are caused by irritation of sensory nerve fibers. Sometimes, head or neck pain can spread to other areas because the sensory nerves of these structures are so close together. (Côté P. et al., 2019) Additionally, a medical condition like an infection can affect the other due to proximity. Causes of headaches with neck pain include:

Headaches

  • Sinus headaches, tension headaches, and cervicogenic headaches are usually associated with head pain, but they can also involve neck pain. (Côté P. et al., 2019)

Migraine

  • Migraines are commonly associated with headaches and often cause neck pain as well.
  • In addition, they can cause nausea and body aches.

Fatigue

  • Being tired commonly leads to temporary headaches and neck pain until thorough rest is achieved.

Alcohol Consumption and/or a Hangover

  • For many, drinking can trigger a headache.
  • This is a common migraine trigger, but it can also trigger headaches for those who don’t have migraines.

Muscle Strain

  • Prolonged or recurrent positions that strain the neck muscles, like lifting or sitting at a desk, can cause aching or pain that involves both the head and neck. (Houle M. et al., 2021)

Injuries

  • Trauma such as whiplash or falling can cause soreness in the head and neck.
  • Bruises or other injuries may be present.
  • Severe injuries can cause damage to the skull, brain, spine, spinal nerves, or spinal cord.

Concussion

  • A concussion often causes trouble concentrating, persistent headaches, and neck pain.
  • Usually, these symptoms improve within a few weeks after a mild concussion.

Meningitis

  • Inflammation or infection of the lining around the brain and spinal cord causes pain or tenderness in the head, back, and neck.
  • Neck stiffness and fever are commonly associated symptoms.

Pinched Nerve

  • Arthritis is a common cause of pressure on spinal nerves.
  • A pinched nerve in the upper spine can cause pain in the head and neck and tingling down the arm.

Herniated Disc

  • Degenerative arthritis or trauma can cause a spinal disc to press on a nerve and possibly on the spinal cord.
  • This may cause loss of sensation or weakness of the arm.

Subarachnoid Hemorrhage

  • This is a serious condition caused by bleeding of a blood vessel in the brain.
  • Irritation and inflammation can cause severe head and neck pain, possibly with seizures and loss of consciousness.

Hydrocephalus

  • Fluid can accumulate around the brain, causing pain-inducing pressure.
  • Causes include obstruction of cerebrospinal fluid flow due to brain tumors, brain infections, or congenital malformations. (Langner S. et al., 2017)

Increased Intracranial Pressure

  • Pressure on the brain and the brain’s blood vessels can cause pain.
  • Causes of pressure within the skull include hydrocephalus, head trauma, brain tumors, or swelling from a stroke.
  • Severe cases can cause lethargy or loss of consciousness.

Brain or Spine cancer

  • Cancer of the brain or within the spine can cause pain affecting the head and neck, often with other symptoms, like loss of vision.

Treatment

Talk to a healthcare provider about the following treatments. Treating headaches with neck pain includes methods that address symptoms and methods that treat the underlying cause. The medications used for headaches with neck pain often reduce both symptoms, but this depends on the cause. Treatments that can relieve both headaches and neck pain when they occur together include:

  • Getting proper sleep to alleviate fatigue.
  • Rest and rehabilitation after a concussion or another injury.
  • Physical therapy to keep muscles flexible and relaxed.
  • Non-surgical decompression and traction to decompress the spine.
  • Pain medication to relieve pain after minor trauma.
  • Migraine medication or sinus headache treatment (Petersen S. M., Jull G. A., & Learman K. E. 2019)
  • Fluids for meningitis treatment and antibiotics for bacterial meningitis.
  • Surgical procedures for a tumor or subarachnoid hemorrhage.
  • A surgical procedure to relieve hydrocephalus.

Headache Treatment

You can do a few things to relieve your headaches, and although they won’t directly take away your neck pain, your headache relief might also decrease your neck pain. These include:

  • Avoiding loud noises
  • Cranial massage
  • Applying gentle cranial pressure
  • Avoiding bright lights as much as possible
  • Using specialized migraine sunglasses

Neck Pain Treatment

Some treatments that can specifically treat neck pain include:

  • Exercise, stretching, and physical therapy (Côté P. et al., 2019)
  • Ice or heat
  • Muscle relaxants
  • Anti-inflammatory injections

Injury Medical Chiropractic and Functional Medicine Clinic

Knowing whether a serious problem is causing headaches and neck pain can be difficult. The more dangerous conditions don’t necessarily cause more severe pain. This is why getting medical attention is crucial if you have these symptoms together. If you frequently have both headaches and neck pain, it can have a substantial impact on your quality of life. There are ways to manage the symptoms, including preventative measures such as physical therapy, exercises, and avoiding triggers. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.


Tension Headaches


References

Côté, P., Yu, H., Shearer, H. M., Randhawa, K., Wong, J. J., Mior, S., Ameis, A., Carroll, L. J., Nordin, M., Varatharajan, S., Sutton, D., Southerst, D., Jacobs, C., Stupar, M., Taylor-Vaisey, A., Gross, D. P., Brison, R. J., Paulden, M., Ammendolia, C., Cassidy, J. D., … Lacerte, M. (2019). Non-pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration. European journal of pain (London, England), 23(6), 1051–1070. doi.org/10.1002/ejp.1374

Houle, M., Lessard, A., Marineau-Bélanger, É., Lardon, A., Marchand, A. A., Descarreaux, M., & Abboud, J. (2021). Factors associated with headache and neck pain among telecommuters – a five days follow-up. BMC Public Health, 21(1), 1086. doi.org/10.1186/s12889-021-11144-6

Langner, S., Fleck, S., Baldauf, J., Mensel, B., Kühn, J. P., & Kirsch, M. (2017). Diagnosis and Differential Diagnosis of Hydrocephalus in Adults. Diagnostik und Differenzialdiagnostik des Hydrozephalus beim Erwachsenen. RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin, 189(8), 728–739. doi.org/10.1055/s-0043-108550

Petersen, S. M., Jull, G. A., & Learman, K. E. (2019). Self-reported sinus headaches are associated with neck pain and cervical musculoskeletal dysfunction: a preliminary observational case-control study. The Journal of manual & manipulative therapy, 27(4), 245–252. doi.org/10.1080/10669817.2019.1572987

The Hidden Gems: Uncovering the Beneficial Properties of the Coconut

Can coconut be a healthier alternative food option for individuals trying to improve their health and wellness?

The Coconut

Located in the tropical regions around the world, especially in Southeast Asia, the Pacific islands, sunny coastal states in the U.S., and India, the coconut (Cocos nucifera L.) is a monoecious perennial palm that has many uses for people who are looking for alternatives in their dietary needs. Known as the “tree of life,” the coconut has numerous utilities that people can incorporate from food, medicine, and household products. (Beveridge et al., 2022) The outer coconut husk is used in household items, while the coconut fruit is used for food and medicinal purposes, from antibacterial and antioxidant to containing microminerals and nutrients. (DebMandal & Mandal, 2011) This tropical fruit can be used in baked goods, skin products, and food dishes and can help restore the body’s electrolytes. We associate with certified medical providers who inform our patients of the importance of incorporating healthy foods like coconut into a healthy diet. While asking important questions to our associated medical providers, we advise patients to integrate small changes into their daily dietary intake to feel good. Dr. Alex Jimenez, D.C., envisions this information as an academic service. Disclaimer.

 

Nutritional Facts

With coconut being a versatile fruit, it has many nutritional benefits. It is classified as a medium-chaired saturated fat absorbed by the body differently and can help reduce LDL-Cs (low-density lipoproteins, reduce cardiovascular diseases, and improve cognitive function. (Hewlings, 2020) When it comes to the nutritional facts of eating one piece of coconut is about:

  • 1 piece of coconut: 45g
  • Calories: 159
  • Total Fats: 15g
    • Saturated fat: 13g
  • Cholesterol: 0mg
  • Sodium: 9mg
  • Potassium: 160mg
  • Total Carbohydrate: 7g
    • Dietary fibers: 4.1
    • Sugar: 2.8g
  • Protein: 1.5g

Coconuts are high in saturated fats and medium-chain fatty, so they can cross the blood-brain barrier and be absorbed, transported, and utilized for energy production for the body. They can also provide beneficial properties to the gut microbiome. (Fan et al., 2022) At the same time, if people drink the water from the coconut, its nutritional facts include:

  • 1 cup of coconut water: 240g
  • Calories: 45
  • Total Fats: 0.5g
    • Saturated fat: 0.4g
  • Cholesterol: 0mg
  • Sodium: 252mg
  • Potassium: 600mg
  • Total Carbohydrate: 9g
    • Dietary fiber: 2.6g
    • Sugar: 6g
  • Protein: 1.7g

 


Food As Medicine- Video

"Fighting Cardiovascular Disease and Metabolic Syndrome" | El Paso, Tx (2023)

The Health Benefits Of The Coconut

With the coconut tree being “the tree of life,” the fruit has many beneficial properties for health and wellness. For instance, using coconut oil for cooking has many advantages, such as being resistant to oxidation and polymerization due to its high saturated fatty acid content, being consumed at low levels, and reducing cardiovascular diseases. (Schwingshackl & Schlesinger, 2023) At the same time, when people start to use coconut oil for part of their cooking, they will notice that their body weight decreases. (Duarte et al., 2022). Below are other beneficial properties when people start incorporating coconut into their diet.

 

Replenish Electrolytes

Many people starting to work out or are physically active can utilize coconut water to replace sports drinks to replenish their electrolytes. When a person is exercising and sweating profusely, water and sodium levels are depleted, thus compromising the cardiovascular system’s ability to maintain a person’s exercise performance. (O’Brien et al., 2023) Hence, drinking coconut water can help rehydrate the body and replenish those electrolytes. At the same time, incorporating a bit of citrus fruit can provide extra health benefits and enhance the flavor of coconut water.

 

Reduces Blood Sugar

Coconuts can also help lower blood sugar levels, and for diabetic individuals, it can help reduce their blood glucose to healthy levels, regulate their carbohydrate metabolism, and improve their antioxidant capacity to reduce any comorbidities associated with diabetes. (Dai et al., 2021) Additionally, many diabetic individuals can substitute regular sugar with coconut sugar as it has a high nutritional value and a low glycemic index that can be beneficial to moderate glucose absorption. (Saraiva et al., 2023)

 

Adding Coconut To Your Diet

Many people can incorporate coconut into their diet by eating the fruit, drinking the coconut water, and utilizing it for smoothies and baked goods. By adding coconut to a healthy diet, many people can get their healthy fats in moderation, their electrolytes replenished, and enjoy eating clean, healthy foods. Making small changes by incorporating foods that have antioxidants into a healthy diet can help many people eat healthier and have more energy. At the same time, when people incorporate physical activity with their diet, they will begin to notice small positive changes in themselves and their bodies, thus leading happy, healthier lives.

 


References

Beveridge, F. C., Kalaipandian, S., Yang, C., & Adkins, S. W. (2022). Fruit Biology of Coconut (Cocos nucifera L.). Plants (Basel), 11(23). doi.org/10.3390/plants11233293

Dai, Y., Peng, L., Zhang, X., Wu, Q., Yao, J., Xing, Q., Zheng, Y., Huang, X., Chen, S., & Xie, Q. (2021). Effects of coconut water on blood sugar and retina of rats with diabetes. PeerJ, 9, e10667. doi.org/10.7717/peerj.10667

DebMandal, M., & Mandal, S. (2011). Coconut (Cocos nucifera L.: Arecaceae): in health promotion and disease prevention. Asian Pac J Trop Med, 4(3), 241-247. doi.org/10.1016/S1995-7645(11)60078-3

Duarte, A. C., Spiazzi, B. F., Zingano, C. P., Merello, E. N., Wayerbacher, L. F., Teixeira, P. P., Farenzena, L. P., de Araujo, C., Amazarray, C. R., Colpani, V., & Gerchman, F. (2022). The effects of coconut oil on the cardiometabolic profile: a systematic review and meta-analysis of randomized clinical trials. Lipids Health Dis, 21(1), 83. doi.org/10.1186/s12944-022-01685-z

Fan, L., Zhu, X., Sun, S., Yu, C., Huang, X., Ness, R., Dugan, L. L., Shu, L., Seidner, D. L., Murff, H. J., Fodor, A. A., Azcarate-Peril, M. A., Shrubsole, M. J., & Dai, Q. (2022). Ca:Mg ratio, medium-chain fatty acids, and the gut microbiome. Clin Nutr, 41(11), 2490-2499. doi.org/10.1016/j.clnu.2022.08.031

Hewlings, S. (2020). Coconuts and Health: Different Chain Lengths of Saturated Fats Require Different Consideration. J Cardiovasc Dev Dis, 7(4). doi.org/10.3390/jcdd7040059

O’Brien, B. J., Bell, L. R., Hennessy, D., Denham, J., & Paton, C. D. (2023). Coconut Water: A Sports Drink Alternative? Sports (Basel), 11(9). doi.org/10.3390/sports11090183

Saraiva, A., Carrascosa, C., Ramos, F., Raheem, D., Lopes, M., & Raposo, A. (2023). Coconut Sugar: Chemical Analysis and Nutritional Profile; Health Impacts; Safety and Quality Control; Food Industry Applications. Int J Environ Res Public Health, 20(4). doi.org/10.3390/ijerph20043671

Schwingshackl, L., & Schlesinger, S. (2023). Coconut Oil and Cardiovascular Disease Risk. Curr Atheroscler Rep, 25(5), 231-236. doi.org/10.1007/s11883-023-01098-y

 

Disclaimer

Alcoholic Peripheral Neuropathy: Nerve Damage from Consumption

An Asian man has tingling and numbness in his hand which causes beriberi.

Excessive alcohol consumption: what is alcoholic peripheral neuropathy?

Alcoholic Peripheral Neuropathy: Nerve Damage from Consumption

Alcoholic Peripheral Neuropathy

Alcoholic peripheral neuropathy (ALN) is a condition that damages the nerves in the body due to chronic alcohol consumption. It can cause sensory, motor, and autonomic dysfunction, which can lead to disability. This damage prevents the nerves from communicating information. Most symptoms generally start as mild but typically worsen over time as the neuropathy progresses. The most common symptoms are: (National Library of Medicine, 2023)

  • Numbness or tingling sensation in the extremities
  • Pain or a burning sensation in the extremities
  • Difficulty walking
  • Difficulty urinating
  • Difficulty talking or swallowing

Affected nerves include the peripheral and autonomic nerves, which help regulate internal body functions. Around 46% of chronic alcohol users will eventually develop the condition. (Julian T., Glascow N., Syeed R., & Zis P. 2019)

Causes

The exact cause of alcoholic neuropathy is unclear. But it is directly related to heavy and long-term alcohol consumption. (Julian T., Glascow N., Syeed R., & Zis P. 2019) It is believed overconsumption of alcohol can directly harm and hinder the nerves’ ability to communicate information. Unhealthy nutritional habits are often associated with it as well. Research shows that decreased thiamine/B vitamin plays a role, while others suggest an overall dietary deficiency may play a role. (Julian T., Glascow N., Syeed R., & Zis P. 2019) However, alcoholic neuropathy can also occur without the presence of malnutrition. (Julian T., Glascow N., Syeed R., & Zis P. 2019)

Neuropathy Development and Progression

Alcoholic peripheral neuropathy develops depending on many factors, including the amount of daily/nightly alcohol consumed, age and overall health, nutritional intake, and other individual factors. In most cases, the neuropathy takes several years or decades to develop, depending on the amount of alcohol consumed.

Symptoms

Symptoms are usually related to nerve dysfunction and include: (National Library of Medicine, 2023)

  • A tingling or pins-and-needles sensation in the extremities.
  • Numbness of the extremities, most commonly in the legs or feet. (Julian T., Glascow N., Syeed R., & Zis P. 2019)
  • Pain or burning sensation in the arms, legs, or feet.
  • Symptoms that occur in the arms and legs typically affect both sides.
  • Cramps, aches, or weakness of the muscles.
  • Constipation or diarrhea.
  • Nausea and vomiting.
  • Difficulty urinating or incontinence.
  • Difficulty walking.
  • Difficulty talking or swallowing.
  • Heat intolerance.
  • Erection difficulties.

Most symptoms begin as mild and usually worsen over time as the neuropathy progresses. Alcoholic neuropathy affects individuals who consume excessive amounts of alcohol over a long time. (Julian T., Glascow N., Syeed R., & Zis P. 2019)

Diagnosis

Symptoms can vary significantly so that a diagnosis may take time. It usually involves a combination of the following (National Institute of Neurological Disorders and Stroke, 2024)

Medical History

  • Healthcare providers will collect data involving past medical history and all current symptoms.

Physical Exam

  • This exam looks at other medical conditions contributing to symptoms, like diabetes or high blood pressure.

Neurological Exam

  • This is a noninvasive exam to determine the location and extent of neurological damage.
  • Healthcare providers may ask patients several questions and have them complete a series of small movements to check neurological function.

Blood and Urine Tests

  • These tests can detect diabetes, liver and kidney problems, infections, vitamin deficiencies, and other conditions that can cause neuropathic conditions.

Chronic alcohol use can also affect how the body stores and uses vitamins necessary for healthy nerve function. Vitamin levels that a healthcare provider may check include: (National Library of Medicine, 2023)

  • Vitamin A
  • Biotin
  • Folic acid
  • Niacin, or vitamin B3
  • Pyridoxine, or vitamin B6
  • Pantothenic acid

Liver Disease

Individuals with chronic liver disease often have neuropathy. The severity and stage are associated with a higher incidence of neuropathy. (Pasha MB, Ather MM, Tanveer MA, et al. 2019)

Treatment

Alcoholic neuropathy is not reversible, even when quitting drinking. However, individuals with the condition can make healthy changes to minimize symptoms and receive help for chronic alcohol use. The first step is stopping alcohol consumption. (Chopra K., & Tiwari V. 2012) Talk to a healthcare provider about what options are available. Treatment can include:

  • In-patient or outpatient rehab
  • Therapy
  • Medication
  • Social support from groups like Alcoholics Anonymous

A combination of treatments will likely be utilized. Other treatment options involve symptom management and preventing further injuries and may include:

  • Physical therapy
  • Keeping the head elevated while sleeping.
  • Orthopedic splints to maintain limb function and positioning.
  • Wearing compression stockings.
  • Adding vitamins and supplements.
  • Eating extra salt for those without hypertension
  • Medications to reduce pain and discomfort.
  • Intermittent catheterization or manual expression of urine for those with difficulty urinating.

Individuals with neuropathy may have reduced sensitivity in the arms and legs. If this occurs, additional steps need to be taken to prevent other injuries, that include (National Library of Medicine, 2023)

  • Wear special footwear to prevent foot injuries.
  • Checking feet daily for wounds.
  • Prevent burns by ensuring that bath and shower water is not too hot.

Injury Medical Chiropractic and Functional Medicine Clinic

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


Peripheral Neuropathy Myths and Facts


References

National Library of Medicine. (2023). Alcoholic neuropathy. Retrieved from medlineplus.gov/ency/article/000714.htm

Julian, T., Glascow, N., Syeed, R., & Zis, P. (2019). Alcohol-related peripheral neuropathy: a systematic review and meta-analysis. Journal of Neurology, 266(12), 2907–2919. doi.org/10.1007/s00415-018-9123-1

National Institute of Neurological Disorders and Stroke. (2024). Peripheral neuropathy. Retrieved from www.ninds.nih.gov/health-information/disorders/peripheral-neuropathy

Pasha MB, A. M., Tanveer MA, et al. (2019). Frequency of peripheral neuropathy in chronic liver disease. Med Forum Monthly, 30(8), 23-26. medicalforummonthly.com/index.php/mfm/article/view/3761

Chopra, K., & Tiwari, V. (2012). Alcoholic neuropathy: possible mechanisms and future treatment possibilities. British journal of clinical pharmacology, 73(3), 348–362. doi.org/10.1111/j.1365-2125.2011.04111.x