Exploring Antalgic Gait: Causes and Solutions

By

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Mature woman exercising on physical therapy in rehab center — Stroke female patient learning how to walk with walking stick while therapist next to her helping in rehabilitation room

Individuals walking with a limp that results in pain could have an antalgic gait, an abnormal walking pattern commonly seen in emergency clinics and primary care offices. Can recognizing the symptoms help healthcare providers develop an effective treatment for the underlying cause?

Table of Contents

Antalgic Gait

Limping and having an antalgic gait usually indicate a larger issue within the leg or lower back. It is the most common type of abnormal gait. There are various causes of antalgic gait, including acute injuries and gradually progressing medical conditions. The most common causes include osteoarthritis in one of the leg’s joints, lumbar radiculopathy, or an injury to a ligament or tendon. Paying attention to when the limping occurs, and any accompanying symptoms can help determine its origins.

Walking

When limping, the stance phase during walking is shorter than the swing phase. To compensate for the imbalance, individuals may widen their legs apart to provide a support base. In severe cases, an individual may swing their leg irregularly or take several side steps.

Causes and Symptoms

Antalgic gait can be caused by pain in any part of the lower extremity. Limping when walking may be a primary concern but is rarely the only complaint. Other associated symptoms may also be present, depending on the cause. These include:

Limited range of motion
Joint stiffness
Muscular weakness
Numbness and tingling
Pain
Swelling
Leg instability or buckling
Clicking or popping

Common Causes include:

Hip, knee, and/or Foot problems

When the hip, knee, ankle, or foot joints are injured or have some issue, walking can be painful and lead to a limp.

Sprains, Strains, or Soft-tissue Injuries

Sprains, strains, and soft-tissue injuries can result from acute injury or chronic, repetitive activities over time. (Pirker W. and Katzenschlager R. 2017) Sprains affect the body’s ligaments, while strains impact muscle tendons. However, sprains and strains occur when the impacted structure is overstretched or partially torn. The damage can lead to pain and antalgic gait. An injury to several other soft-tissue structures, including a bursa or fluid-filled sacs that reduce friction, meniscus, or fat pad, can also lead to limping. Symptoms typically include swelling, pain, and limited range of motion. More severe injuries can also make the leg feel unstable and cause it to give way when walking. Sometimes, bruising can also occur in the area of the injury. (American Academy of Orthopaedic Surgeons, 2020)

Osteoarthritis

Osteoarthritis occurs when the smooth, articular cartilage that lines the ends of bones begins to thin and deteriorate. This can alter the normal movement of a joint and lead to pain. Osteoarthritis symptoms gradually progress, affect individuals over 50, and worsen after periods of sedentary activity (Arthritis Foundation, Osteoarthritis, N.D.) Typically, it results in pain, stiffness, clicking, and occasionally swelling in the affected joint. These symptoms are usually worse in the morning and at the end of a long activity day. Moving around and warming the joint improves osteoarthritis symptoms. (Arthritis Foundation, Osteoarthritis, N.D.)

Lower Back Radiculopathy

Lumbar radiculopathy is when the nerve roots branching off the spine’s lower region become compressed or inflamed. This can occur because of disc issues like bulging, degeneration, herniation, bone spurring, or, rarely, a growth or tumor. (Johns Hopkins Medicine, 2024) Because these nerves control movement, sensation, and strength in the legs and feet, irritation in one can lead to limping. (Yokogawa N. et al., 2015) The antalgic gait from this condition frequently comes on suddenly and is commonly accompanied by back pain symptoms. This can include shooting pain and paresthesia in the leg. Depending on which nerve is involved, individuals may also experience muscular weakness in certain areas of the lower extremity. Sometimes, the affected leg feels like it will buckle while standing or walking. (Johns Hopkins Medicine, 2024)

Other causes include:

Broken bones
Tumors
Infections
Blood clots
Vascular issues

Treatment

Treatment for antalgic gait depends on the underlying cause but can include:

Rest, ice, and elevation are important for injuries. Individuals can control their initial symptoms by icing, elevating the leg, and resting from irritating activities.
Activity modifications
Antibiotics for infections
Pain relievers
Anti-inflammatories
Physical therapy is also frequently initiated to strengthen the core and alleviate walking symptoms.
Chiropractic realignment
Non-surgical decompression
Acupuncture
A corticosteroid injection or joint replacement surgery may prove necessary in more advanced cases. (Arthritis Foundation, Osteoarthritis, N.D.)
A spinal injection or surgery can reduce the pressure on the nerve root if conservative interventions fail to improve antalgic gait patterns. (Johns Hopkins Medicine, 2024)
Crutches, canes, walkers, or assistive devices can reduce pressure traveling through an affected joint and improve overall walking quality. A study found that using a cane for two months helped reduce pain and improve function in individuals with knee osteoarthritis. (Fang M. A. et al., 2015)

Injury Medical Chiropractic and Functional Medicine Clinic

Though it can be tempting to ignore the limp and push through it, discussing the condition with a healthcare provider is important. A thorough medical exam and diagnostic tests, such as X-ray, MRI, or EMG, can help determine the underlying causes of a limp, help discover the cause of the problem, and help improve the quality of walking. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. Using an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility and help individuals return to normal activities. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers if other treatments are needed.

Chiropractic and Integrative Healthcare

References

Pirker, W., & Katzenschlager, R. (2017). Gait disorders in adults and the elderly : A clinical guide. Wiener klinische Wochenschrift, 129(3-4), 81–95. doi.org/10.1007/s00508-016-1096-4

Arthritis Foundation. (N.D.). Osteoarthritis. www.arthritis.org/diseases/osteoarthritis

American Academy of Orthopaedic Surgeons. (2020). Sprains, strains, and other soft-tissue injuries. orthoinfo.aaos.org/en/diseases–conditions/sprains-strains-and-other-soft-tissue-injuries/

Johns Hopkins Medicine. (2024). Radiculopathy. www.hopkinsmedicine.org/health/conditions-and-diseases/radiculopathy

Yokogawa, N., Toribatake, Y., Murakami, H., Hayashi, H., Yoneyama, T., Watanabe, T., & Tsuchiya, H. (2015). Differences in Gait Characteristics of Patients with Lumbar Spinal Canal Stenosis (L4 Radiculopathy) and Those with Osteoarthritis of the Hip. PloS one, 10(4), e0124745. doi.org/10.1371/journal.pone.0124745

Fang, M. A., Heiney, C., Yentes, J. M., Harada, N. D., Masih, S., & Perell-Gerson, K. L. (2015). Effects of contralateral versus ipsilateral cane use on gait in people with knee osteoarthritis. PM & R : the journal of injury, function, and rehabilitation, 7(4), 400–406. doi.org/10.1016/j.pmrj.2014.09.018

White Rice: An Essential Fuel for Athletes and Bodybuilders

By

Dr. Alex Jimenez

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Closeup shot of cooked rice on a wooden plate with some parsley leaves and wooden chopsticks — A closeup shot of cooked rice on a wooden plate with some parsley leaves and wooden chopsticks

Can eating white rice as a primary carbohydrate source provide quick energy and glycogen replenishment for athletes and bodybuilders who require high volumes of carbohydrates for fuel and muscle recovery?

Table of Contents

Sports Nutrition White Rice

Athletes and bodybuilders often eat white rice to restore mass amounts of glycogen after an intense workout, race, or game. Brown rice is nutritious and recommended for overall health, but athletes and bodybuilders incorporate further nutritional guidelines for added fuel and performance. White rice is a starchy grain used by more than half the world’s population because of its versatility, availability, and ability to adapt to various flavors and seasonings. Its chewiness and soft texture add substance to and complement many meals.

Bodybuilders

Athletes and bodybuilders need macronutrients to fuel extreme training and replenish depleted glycogen stores. Carbohydrate-rich foods like white rice are high on the glycemic index (a score for how foods affect blood sugar and insulin levels) and provide a readily available source of carbohydrates for muscle glycogen synthesis. (Thomas, D. E. et al., 1991) White rice is considered excellent sports nutrition for athletes. (Melin, A. et al., 2016) Although white rice is considered less nutritious than brown rice, athletes and weightlifters consume it as part of their specifically developed nutrition plans. One of the most popular meals is a bowl of white rice combined with grilled chicken breast, providing lean protein. Endurance runners often load up on carbohydrates like white rice before marathons. Strenuous workouts deplete sugar/glycogen in the muscles. Eating the right carbohydrates is important to replenish those stores. Knowing how to improve carbohydrate availability during prolonged exercise is essential for athletes. (Burke, L. M. et al., 2011)

Fuel and Muscle Recovery

The high glycemic value of white rice provides quick fuel for hard workouts and expedites muscle recovery. It does not have the negative effects of potential gastrointestinal issues, allergy symptoms, or blocking the ability to absorb micronutrients. Brown rice contains phytic acid(located in the grain’s bran), an antinutrient that binds to essential minerals like iron, zinc, calcium, and magnesium and prevents the body from absorbing them. The milling process to change brown rice to white removes the phytate. Research is ongoing on degrading phytic acid in brown rice and whole grains, and some studies have found antioxidant benefits in phytate. This could increase the amount of carbohydrates that are safe for athletes. (Liang, J. et al., 2008)

Safe Carbohydrate

Athletes and bodybuilders with food sensitivity may have issues eating whole grains, as brown rice has more fiber. Extreme exercise requires a surplus of carbohydrates. For prolonged exercise lasting more than two hours, athletes should consume 60 grams per hour of carbohydrates. White rice is considered safe to consume before exercise as it is easy on the stomach and has been shown to meet sports nutrition recommendations.

Workouts

Rice contains more carbohydrates than potatoes for the same serving size. Parboiled, converted, and instant white rice can be eaten pre- and post-workout meals, ensuring the body is thoroughly fueled for training, competition, and recovery. However, white rice may not be the best option for sedentary individuals.

Brown Rice

Brown rice is healthier for bodybuilders who train less than four days per week or have a metabolic disease.
Brown rice is a nutrient-dense food recommended for everyday active individuals who can tolerate whole grains and is a rich source of fiber and nutrients essential for a well-balanced healthy diet.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized programs. We focus on what works for you to enhance fitness and improve the body through research methods and total wellness programs. These programs strive to achieve improvement goals, and athletes can condition themselves to excel through proper fitness and nutrition. Our providers use Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. An integrated approach improves flexibility, mobility, and agility. If further training or treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, trainers, medical researchers, and rehabilitation providers.

Sports Nutrition and Dietitian

References

Thomas, D. E., Brotherhood, J. R., & Brand, J. C. (1991). Carbohydrate feeding before exercise: effect of glycemic index. International journal of sports medicine, 12(2), 180–186. doi.org/10.1055/s-2007-1024664

Melin, A., Tornberg, Å. B., Skouby, S., Møller, S. S., Faber, J., Sundgot-Borgen, J., & Sjödin, A. (2016). Low-energy density and high fiber intake are dietary concerns in female endurance athletes. Scandinavian journal of medicine & science in sports, 26(9), 1060–1071. doi.org/10.1111/sms.12516

Burke, L. M., Hawley, J. A., Wong, S. H., & Jeukendrup, A. E. (2011). Carbohydrates for training and competition. Journal of sports sciences, 29 Suppl 1, S17–S27. doi.org/10.1080/02640414.2011.585473

Liang, J., Han, B. Z., Nout, M. J., & Hamer, R. J. (2008). Effects of soaking, germination and fermentation on phytic acid, total and in vitro soluble zinc in brown rice. Food chemistry, 110(4), 821–828. doi.org/10.1016/j.foodchem.2008.02.064

Hamstring Pain behind the Knee: Symptoms and Solutions

By

Dr. Alex Jimenez

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brunette physiotherapist stretching leg of man training in rehabilitation center

Individuals dealing with symptoms like sudden pain, weakness, and tenderness in the back of the knee could have a hamstring injury. Can knowing the symptoms and performing self-care help bring relief?

Hamstring Pain Behind The Knee

The hamstrings consist of three long muscles that run down the back of the thigh, cross over the back of the knee, and connect to bones in that area. A hamstring injury, such as a strain or tear, tendonitis, or biceps femoris tendinopathy, can cause pain in the back of the knee, difficulty bending the knee, swelling, and bruising. A hamstring strain occurs when the muscle is stretched too far or torn completely. This can happen from sudden, forceful movements or overstretching. Hamstring tendonitis develops over time, usually after a sudden increase in activity, when the hamstring tissue cannot recover from too much loading. Pain is often felt after physical activity and exercise and, in severe cases, during the activity or throughout the day. Biceps femoris tendinopathy can also cause pain in the back of the knee. Strains, tendonitis, bursitis, and muscle tears are all possible explanations for a hamstring injury that leads to pain behind the knee. Discussing pain symptoms with a healthcare provider is recommended, especially if it occurs suddenly during physical activity or exercise. They can help identify the exact cause and offer guidance for rehabilitation, including physical therapy referrals.

Causes and Triggers

Individuals may experience hamstring pain behind the knee when the muscles in that area are overworked, inflamed, or injured, such as from activities like running, walking, dancing, soccer, or basketball. Possible types of injuries and their causes.

Tendonitis

The hamstring tendons connect behind the knee.
When the tendons become inflamed due to overuse, they can lead to swelling and pain that worsen with activity. (National Library of Medicine, 2017) (American Academy of Orthopaedic Surgeons, 2020)

Strain or Tear

A muscle strain occurs when the muscle is stretched too much, and the fibers tear.
A hamstring strain is also called a pulled hamstring. (American Academy of Orthopaedic Surgeons, 2021)

Bursitis

This is inflammation of tiny fluid-filled sacs that help cushion joints during movement.
Inflammation from bursitis can affect the nerves within the hamstring, resulting in pain. (American Academy of Orthopaedic Surgeons, 2020)

Pes anserine

This is a specific type of bursitis which affects the knee tendons. (American Academy of Orthopaedic Surgeons, 2021)

Muscle Overload

A primary cause of muscle strain occurs when the muscle is stretched too far or has to handle a sudden force like sprinting or kicking. (American Academy of Orthopaedic Surgeons, 2021)

Severe Cases

Most causes of pain behind the knee are easily treatable at home with self-care and rest. However, it can be more severe, signaling a blood clot, infection, torn muscle or tendon/ligament. Hamstring knee pain may be serious if any of the following is experienced (American Academy of Orthopaedic Surgeons, 2021)

Sudden pain during physical activity, often during a full stride.
Feeling a pop or sharp pain that causes falling or limping.
Pain that worsens over time and prevents or hinders walking or exercising as normal.

If pain is severe and does not improve with rest and anti-inflammatory medications, evaluation by a healthcare professional is necessary.

Assesses Hamstring Pain

A healthcare provider will ask about symptoms and injury, including what happened when the pain began. They will perform a physical examination, which may include pressing on the back of the thigh to look for swelling, bruising, tenderness, or bunched-up muscles. (American Academy of Orthopaedic Surgeons, 2021) The healthcare provider will ask the patient to perform specific resisted movements, such as the manual muscle test, and measure the range of motion. Diagnostic testing includes an X-ray or MRI to determine the degree of the injury and which soft tissues or bones may be involved.

Self-Care

The first line of treating hamstring knee pain is the RICE protocol, which includes: (Mount Siani, 2024)

Rest

Stop any activity that causes symptoms and pain.
A healthcare provider may recommend crutches or a knee scooter in severe cases.

Ice

Apply cold packs to the swollen or painful area for 20 minutes throughout the day.

Compression

A knee brace, wrap, or bandage that applies gentle pressure to the injured area can help reduce and prevent swelling.

Elevation

Lifting the leg higher than the heart will help reduce swelling and blood accumulation.
Individuals may need to lie on a bed or sofa and elevate their legs with pillows.

Individuals can use at-home pain relievers like acetaminophen or NSAIDs like ibuprofen or naproxen. Over time, and depending on the severity of the injury, a healthcare provider will advise on gentle hamstring stretches and how to ease back into physical activity.

Professional Therapy and Surgical Treatments

Depending on the severity of the condition, a healthcare provider may recommend additional interventions, that include (American Academy of Orthopaedic Surgeons, 2021)

Immobilization

A healthcare provider will advise immobilizing the knee to help with muscle healing, which could involve wearing a knee brace or using crutches.

Physical therapy

A healthcare provider may refer the patient to a physical therapist, who will perform a personalized evaluation and prescribe targeted exercises to heal the injury and regain strength, flexibility, and movement.

Surgery

Tendon avulsion injuries are when the hamstring tendon completely tears away from the bone, and surgery is required to reattach the tendon.

Platelet-rich plasma – PRP

Platelet-rich plasma has become an additional treatment for hamstring muscle strain or tendonitis. (Seow D. et al., 2021)
The treatment involves injecting a solution from the patient’s blood into the muscle to heal the injury.

Recovery

Predicting how long a hamstring injury takes to heal and how long the pain will linger depends on the type, location, and severity. The most severe type is the hamstring coming unattached around the knee. This surgical repair and rehabilitation take at least three months before returning to sports and exercise (American Academy of Orthopaedic Surgeons, 2021). Lesser injuries like tendonitis or a mild strain can take less time to heal. However, it’s essential to avoid reinjuring the area so the condition does not become chronic. This includes: (American Academy of Orthopaedic Surgeons, 2021)

Stretching to encourage and maintain flexibility.
Fixing muscle imbalances between the quadriceps and hamstring.
Endurance and conditioning.
Avoiding overuse.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. We focus on what works for you and use an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility, relieving pain and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers. Our providers use Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.

Chiropractic Care for Leg Instability

References

National Library of Medicine. (2017). Tendinitis Also called: Tendonitis. Retrieved from medlineplus.gov/tendinitis.html

American Academy of Orthopaedic Surgeons. OrthoInfo. (2020). Sprains, strains, and other soft tissue injuries. orthoinfo.aaos.org/en/diseases–conditions/sprains-strains-and-other-soft-tissue-injuries/

American Academy of Orthopaedic Surgeons. OrthoInfo. (2021). Hamstring muscle injuries. orthoinfo.aaos.org/en/diseases–conditions/hamstring-muscle-injuries/

American Academy of Orthopaedic Surgeons. OrthoInfo. (2021). Pes aserine (knee tendon) bursitis. orthoinfo.aaos.org/en/diseases–conditions/pes-anserine-knee-tendon-bursitis/

Mount Siani. (2024). Hamstring strain – aftercare. www.mountsinai.org/health-library/selfcare-instructions/hamstring-strain-aftercare

Seow, D., Shimozono, Y., Tengku Yusof, T. N. B., Yasui, Y., Massey, A., & Kennedy, J. G. (2021). Platelet-Rich Plasma Injection for the Treatment of Hamstring Injuries: A Systematic Review and Meta-analysis With Best-Worst Case Analysis. The American journal of sports medicine, 49(2), 529–537. doi.org/10.1177/0363546520916729

Adjusting Your Work Office Chair to Alleviate Back and Hip Pain

By

Dr. Alex Jimenez

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This Tension Is Tiring Me Out — An attractive business woman suffering from back pain while working on computer in a modern office.

Individuals who sit in an office chair for a long period naturally tend to slouch over or slouch down into the chair. This posture can overstretch the spinal ligaments, strain the discs and surrounding structures in the spine, and contribute to or worsen back pain. Can the right office chair settings help relieve and prevent future injuries?

Table of Contents

Work Office Chair

Sitting in an office chair for prolonged periods can cause lower back pain or worsen an existing back problem. The main reason behind this is that sitting is a static posture that increases stress in the back, shoulders, arms, and legs, putting pressure on the back muscles and spinal discs. Over time, incorrect sitting posture can damage the spinal structures. Most office chair customers base their decisions on availability, color, style, and price. However, it’s recommended that individuals learn about fitting seating equipment to their height, frame, or any condition, such as back or hip pain. The controls on or under the armrests and at the bottom of the chair seat, including the levers, paddles, and knobs, are there for a reason. Here are some recommendations for adjusting their work office chair to decrease back and hip pain.

Height Adjustment

The chair’s height affects the quadriceps, psoas, and hamstring muscles, which are important in posture-related back pain. Height adjustment is the primary way to change the angle of the hip joint while sitting. This angle affects the position of the pelvis and the degree of curve in the lower back, which can alter the spine’s normal alignment. (De Carvalho D. et al., 2017) Adjusting the chair’s height can provide a reference for other chair and workstation adjustments.

Back Angle

The hip angle is how close (increased hip flexion) or how far away (less hip flexion) the trunk is to the top of the thigh when sitting. Adjusting chair height can control the angle of the hip joint. When adjusting the height, adjust the degree of flexion at the hip joint to ensure ideal alignment for the individual body frame. A recent study measured the load that sitting has on simulated spinal discs. Researchers concluded that pressure on the spine can be relieved with a more open angle between the trunk and the thigh, that is, the hip joint angle. (Rohlmann A. et al., 2011) The backrest, seat tilt, and lumbar support features help maintain a pain-free back and relieve pressure and tension in the lower back and should be utilized.

Seat Depth

A kitchen chair, for example, may have no back supports or armrests to assist with posture and angle. (Holzgreve F. et al., 2022) When sitting, the individual’s back should be against the back of the work office chair for the best support and a healthy posture. Individuals will want to check and see how concave the seat surface is. If there is a prominent curve, this will cause the back to be rounded when sitting, which can become uncomfortable and lead to back pain. A chair with built-in support or a pillow can help adjust the depth. This means that chair size matters, as different people will need seats of varying depths to match their musculoskeletal structure.

Seat Height

Another way to understand the hip joint angle is to compare the height of the knees to the height of the hips. This is usually the easiest way to assess whether the chair height is right while adjusting. When the seat is right, the feet will be flat on the floor. The feet should reach the floor without causing pressure on the back of the thighs. Individuals with dangling feet, which may be because of their height, should place a footrest or thick book under them. The knees should be approximately level with or lower than the hips. In this case, the level is a 90-degree angle between the hip and trunk, which is stress-free on the hips and back.

Risks

Chair Too High

For individuals who can’t reach their feet to the floor, the chair is probably too high. The Occupational Safety and Health Administration (OSHA) says this is potentially hazardous because it can lead to scooting forward and forgoing the backrest’s support (United States Department of Labor, N.D.) Sitting like this is considered an awkward posture and a risk factor for work-related musculoskeletal disorders (MSD). Musculoskeletal disorders and symptoms caused by awkward sitting posture include muscle fatigue, swelling, pain, numbness, or decreased circulation. (Ng, P. K., Jee, K. S. and Lim, S. Y. 2016)

Chair Too Low

If the knees are higher than the hips, the chair is probably too low, causing extreme flexion in the hip joints. Most individuals’ backs can’t handle this well because their hip muscles are not flexible enough. If sitting with knees higher than hips, the position can cause lower back pain.

Taking Breaks

No matter how comfortable a work office chair is, prolonged static posture is unhealthy for the spine and is a common contributor to back problems and muscle strain. Remember to stand, stretch, and walk for at least a minute or two every half hour to prevent the back from staying in one position for a long period. A quick stretch or minimal movement, like a quick walk, will help. A longer walk will help even more, promoting blood circulation to supply nutrients to all the spinal structures.
Moving and stretching regularly throughout the day will help keep the joints, ligaments, muscles, and tendons loose and promote comfort, relaxation, and the ability to focus productively.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. An integrated approach to treating injuries and chronic pain syndromes improves flexibility, mobility, and agility, relieving pain and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers.

Low Back Pain: Impact and Chiropractic Solutions

References

De Carvalho, D., Grondin, D., & Callaghan, J. (2017). The impact of office chair features on lumbar lordosis, intervertebral joint and sacral tilt angles: a radiographic assessment. Ergonomics, 60(10), 1393–1404. doi.org/10.1080/00140139.2016.1265670

Rohlmann, A., Zander, T., Graichen, F., Dreischarf, M., & Bergmann, G. (2011). Measured loads on a vertebral body replacement during sitting. The spine journal : official journal of the North American Spine Society, 11(9), 870–875. doi.org/10.1016/j.spinee.2011.06.017

Holzgreve, F., Maurer-Grubinger, C., Fraeulin, L., Bausch, J., Groneberg, D. A., & Ohlendorf, D. (2022). Home office versus ergonomic workstation – is the ergonomic risk increased when working at the dining table? An inertial motion capture based pilot study. BMC musculoskeletal disorders, 23(1), 745. doi.org/10.1186/s12891-022-05704-z

United States Department of Labor. (N.D.). Computer workstations eTool. Retrieved from www.osha.gov/etools/computer-workstations

Ng, P. K., Jee, K. S. & Lim, S. Y. (2016). Development of Ergonomics Guidelines for Improved Sitting Postures in the Classroom among Malaysian University Students. American Journal of Applied Sciences, 13(8), 907-912. doi.org/10.3844/ajassp.2016.907.912

The Importance of Stability Running Shoes for Pronation Control

By

Dr. Alex Jimenez

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male and female runners running urban race together

Could stability running shoes help correct foot pronation for runners, athletes, and physically active individuals who tend to have foot pronation issues?

Table of Contents

Stability Running Shoes

Stability is having firm, steady balance in the feet and ankles. Individuals with flat feet or feet that tend to pronate or turn inward can seriously compromise their running stability, potentially increasing their risk of injury and making running uncomfortable. Stability running shoes can help because they stabilize the feet and ankles that roll inward. They combine the right alignment, arch support, and cushioning, and this specialty footwear helps hold the feet and ankles steady and can help maintain a straight gait.

Pronation

Pronation occurs when the foot and/or ankle roll inward when running or walking. It’s a common issue, typically caused by pushing off the ground with a big toe and a second toe. Arches can be excessively strained when pronation or overpronation occurs, resulting in ankle or shin pain. Eventually, overpronation can even cause the feet to flatten. Many runners find that the instability of an inward-rolling foot makes them more prone to strained muscles or falls. However, a study determined that foot pronation was not associated with increased injury risk in novice runners wearing non-specialty shoes. (Nielsen R. O. et al., 2014) However, another study found that foot pronation contributed to joint loading or increased stress on the joints of the lower limbs after long-distance running. (Mei Q. et al., 2019) This extra stress could be a factor in the development of osteoarthritis.

Supination

In contrast to pronation, some runners experience the opposite problem of supination. Supination occurs when the ankle or foot rolls outward from the center, which can cause pain or injury as it increases the likelihood of ankle rolls or sprains.

Features

Stability running shoes with the right features can help stabilize the feet and ankles for safer, more efficient running. This could make a major difference in how individuals feel after a run. For example, those with weak ankles should look for ankle support shoes with motion control, arch support, and grippy traction. Stabilizing shoes offer the following structural supports.

Arch Support

The foot is less likely to turn inward with a firm, high arch support.

Midsole Cushioning

Like arch support, cushioning the entire mid-section of the foot helps hold it steady.
For example, in walking shoes for flat feet, extra supportive cushioning in the midfoot helps prevent further arch collapse.
Stability running shoes may advertise having bars, rails, or medial posts to help maintain balance and reduce pronation.

Heel Cups and Heel Counters

A deep heel cup sits under the heel, correctly aligning the foot and ankle.
Heel counters are hard plastic inserts that reinforce the back of a running shoe, increasing overall support and holding the foot in place.

Wider Base

A wider platform underneath the foot is another key to preventing the inward rolling of overpronation.
It’s a common feature of walking shoes for seniors that provide stability for balance issues.

Choose the Right Shoes

Selecting the best shoe for pronation issues does not have to be complex. At many athletic stores, customers start with an in-store gait, foot shape, and running style assessment. Overpronators should look for a shoe with at least some of the features listed, such as arch support, cushioning, heel cups, counters, or a wide base. For narrow or wide feet, seek out shoes made specifically for these issues. In any running shoe, comfort is the number one priority. The feet should feel firmly supported with no pinching, and the toe shoes should have plenty of wiggle room and be able to lace up without hassle.

Benefits

Stability running shoes may also improve performance. A well-cushioned, well-fitting stability shoe can enhance running comfort, making workouts more enjoyable. When running without pain, individuals are more likely to continue running long-term. A stability shoe that prevents overpronation can improve form, allowing faster and more efficient running. A study in the Journal of Orthopaedic and Sports Physical Therapy explored the potential of motion-control shoes, which are somewhat more stabilizing than stability shoes regarding running injuries. The authors concluded that these shoes may reduce the risk of injuries related to overpronation. (Willems T. M. et al., 2021) Another study compared stability shoes to neutral and motion-control shoes in female runners with various degrees of foot pronation. Those who ran in stability shoes missed the fewest days of training, an indicator that they experienced fewer injuries, but those who wore stability shoes reported more pain while running than those who wore neutral shoes. (Ryan M. B. et al., 2011)

Conclusion

Stability running shoes might be the solution for jogging pain and injuries. The only way to find out is to try them for yourself. Look for footwear with sturdy arch support, plenty of cushioning in the midsole, heel support, and a wide sole. At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for you and strive to create fitness and better the body through research methods and total wellness programs. These programs use the body’s ability to achieve improvement goals, and athletes can condition themselves to excel through proper fitness and nutrition. Our providers use an integrated approach to create personalized programs, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.

Correct Foot Pronation

References

Nielsen, R. O., Buist, I., Parner, E. T., Nohr, E. A., Sørensen, H., Lind, M., & Rasmussen, S. (2014). Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study. British journal of sports medicine, 48(6), 440–447. doi.org/10.1136/bjsports-2013-092202

Mei, Q., Gu, Y., Xiang, L., Baker, J. S., & Fernandez, J. (2019). Foot Pronation Contributes to Altered Lower Extremity Loading After Long Distance Running. Frontiers in physiology, 10, 573. doi.org/10.3389/fphys.2019.00573

Willems, T. M., Ley, C., Goetghebeur, E., Theisen, D., & Malisoux, L. (2021). Motion-Control Shoes Reduce the Risk of Pronation-Related Pathologies in Recreational Runners: A Secondary Analysis of a Randomized Controlled Trial. The Journal of orthopaedic and sports physical therapy, 51(3), 135–143. doi.org/10.2519/jospt.2021.9710

Ryan, M. B., Valiant, G. A., McDonald, K., & Taunton, J. E. (2011). The effect of three different levels of footwear stability on pain outcomes in women runners: a randomised control trial. British journal of sports medicine, 45(9), 715–721. doi.org/10.1136/bjsm.2009.069849

Improve Physical and Emotional Health with a Hatha Yoga Class

By

Dr. Alex Jimenez

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For individuals dealing with stress, back and neck pain, and wanting to improve overall health, can trying a Hatha yoga class help?

Hatha Yoga Class

A yoga class is great for moms, athletes, or anyone interested in low-impact exercise. Today, many practice yoga for its mind and body, health and wellness benefits. Research shows that hatha yoga helps to reduce stress, relieve back and arthritis pain, support healthy habits, and improve emotional health. (National Center for Complementary and Integrative Health, 2023) Hatha classes stretch, unwind, and release tension, providing a healthy outlet for hectic lifestyles.

What Is It?

In Sanskrit, Hatha translates to force. Hatha yoga focuses on posture and breathing techniques to channel energy. Classes last 45 to 90 minutes and consist of breathing, poses, and meditation.

Benefits

Dozens of peer-reviewed studies have been analyzed, and evidence has been found to suggest that yoga may benefit the following conditions. (National Center for Complementary and Integrative Health, 2023)

Anxiety and Depression

Yoga can help relieve everyday anxiety and depressive symptoms.
However, it may not be effective for clinically diagnosed mental health conditions.
The reviews and published studies on yoga did not find conclusive evidence to support its effectiveness in managing anxiety disorder, depression, or PTSD.

Arthritis and Fibromyalgia

According to the NCCIH, there is limited evidence to support yoga’s benefits for osteoarthritis, rheumatoid arthritis, and fibromyalgia.

Back Pain

The American College of Physicians recommends yoga as a non-pharmacological back pain treatment. (Qaseem A. et al., 2017)
A review of studies found that yoga improves low-back pain and function with both short-term and intermediate-term benefits, and its effects are similar to those of other types of exercise. (Skelly A. C. et al., 2020)

Balance

According to 11 out of 15 reviewed studies, yoga helps to improve balance in generally healthy individuals.

Emotional Health

Yoga has a positive impact on mental health. Ten out of 14 studies reviewed showed benefits in improving resilience or general mental well-being.

Menopause

Yoga can relieve physical and psychological symptoms of menopause, including hot flashes, according to the review of 1,300 study participants.

Mindfulness

In a survey of 1,820 young adults, participants attributed increased mindfulness, motivation to participate in other forms of activity, and eating healthier. (Watts A. W. et al., 2018)

Multiple Sclerosis

The NCCIH reports showed that yoga had short-term benefits on mood and fatigue in individuals with multiple sclerosis.
However, it did not affect muscle function, cognitive function, or quality of life.

Neck Pain

A 2019 meta-analysis, including ten studies and a total of 686 subjects, found that yoga can reduce neck pain intensity and disability pain while also improving the range of motion. (Li Y. et al., 2019)

Sleep

Several studies have found yoga can improve sleep quality and duration.
Populations found to experience sleep benefits include cancer patients, older adults, individuals with arthritis, pregnant women, and women experiencing menopause symptoms.

Stress Management

Yoga improved physical or psychological stress-related measures in 12 of 17 studies reviewed.

What to Expect

There are several different styles of yoga to choose from. Classes labeled yoga are likely the Hatha variety. Hatha is a gentle style that focuses on static poses and is great for beginners. However, it can still be physically and mentally challenging. Practitioners should wear athletic clothes and sports bras for maximum comfort and ease of movement. Each class varies depending on the instructor, but most last between 45 and 90 minutes.

Class Breakdown

Classes typically start with a gentle warm-up, advance to more physical poses, and end with a short meditation.

Breathing

Most Hatha classes start with a period of focus on breathing.
As you perform the poses, the instructor will continue to remind everyone to focus on breathing and may suggest different breathing exercises.

Poses

Yoga poses, also called postures or asanas, are a series of movements that help improve balance, flexibility, and strength.
Poses range in difficulty from laying flat on the floor to physically challenging positions.
If, during a class, a pose is too difficult, the instructor can provide a modified posture.

Meditation

Most classes end with a short period of meditation.

If you go into a Hatha class and it feels too slow or inactive, there are faster-paced, more athletic yoga classes, including flow, vinyasa, or power yoga classes. See if it’s more your speed.

Injury Medical Chiropractic Clinic

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

Home Exercises for Pain Relief

References

National Center for Complementary and Integrative Health. (2023). Yoga: What you need to know. Retrieved from www.nccih.nih.gov/health/yoga-what-you-need-to-know#hed11

Qaseem, A., Wilt, T. J., McLean, R. M., Forciea, M. A., Clinical Guidelines Committee of the American College of Physicians, Denberg, T. D., Barry, M. J., Boyd, C., Chow, R. D., Fitterman, N., Harris, R. P., Humphrey, L. L., & Vijan, S. (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine, 166(7), 514–530. doi.org/10.7326/M16-2367

Skelly, A. C., Chou, R., Dettori, J. R., Turner, J. A., Friedly, J. L., Rundell, S. D., Fu, R., Brodt, E. D., Wasson, N., Kantner, S., & Ferguson, A. J. R. (2020). Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Agency for Healthcare Research and Quality (US).

Watts, A. W., Rydell, S. A., Eisenberg, M. E., Laska, M. N., & Neumark-Sztainer, D. (2018). Yoga’s potential for promoting healthy eating and physical activity behaviors among young adults: a mixed-methods study. The international journal of behavioral nutrition and physical activity, 15(1), 42. doi.org/10.1186/s12966-018-0674-4

Li, Y., Li, S., Jiang, J., & Yuan, S. (2019). Effects of yoga on patients with chronic nonspecific neck pain: A PRISMA systematic review and meta-analysis. Medicine, 98(8), e14649. doi.org/10.1097/MD.0000000000014649

Managing Extensor Tendonitis: Tips and Remedies

By

Dr. Alex Jimenez

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Woman exercising with dumbbells during rehabilitation — Young woman exercising with dumbbells together with therapist during rehabilitation

Individuals with inflammation, pain, and swelling on the tops of their feet or hands could be experiencing extensor tendonitis. What treatment options are available?

Table of Contents

Extensor Tendonitis

These tendons attach to muscles that straighten the fingers and lift the toes and the top of the foot. Extensor tendonitis is characterized by inflammation of the tendons on the tops of the hands and feet. It often results from overuse of the muscles and from wearing tight shoes. Symptoms tend to worsen with activity and improve with rest. The condition does not usually require surgery; treatments include medications, home remedies/activity modification, and physical therapy.

Types

Tendonitis can develop in any tendon of the extensor muscles. These tendons are long, thin bands of tissue that can be felt on the tops of the hands and feet. The structures attach to muscles on one end and bones of the fingers and toes on the other. The extensor tendons in the hands include: (American Society for Surgery of the Hand, 2024)

The extensor digitorum communis straightens the index, middle, ring, and small fingers.
The extensor digiti minimi straightens the small finger.
The extensor indicis proprius straightens the index finger.
The extensor pollicis longus and extensor pollicis brevis muscles move the thumb into the thumb-up position.

Extensor tendons on the top of the foot attach to: (American Society for Surgery of the Hand, 2024)

The extensor digitorum longus and extensor digitorum brevis muscles lift the second, third, fourth, and fifth toes.
The extensor hallucis longus lifts the big toe.

Tendonitis vs Tendinopathy

Chronic tendon pain can lead to a condition known as tendinopathy.
Tendonitis results from inflammation.
Tendinopathy is the degeneration/micro-tearing of a tendon that occurs with long-term overuse.
Knowing which condition you are dealing with is important because it requires different treatments.

Symptoms

The primary symptom is pain in the affected tendon/s. Individuals may also experience swelling, and the skin can become red or warm to the touch. Extensor tendonitis can cause pain when using the affected muscles, moving the hand or foot in the opposite direction, and stretching the tendons. Usually, the pain worsens when using the affected muscles and improves with rest.

Causes

Extensor tendonitis in the hands usually results from overuse, which causes inflammation. However, it can also result from trauma, such as falling on the hand or an injury during physical or sports activities. Common activities include: (Hanson Z. C., and Lourie G. M. 2022)

Manual labor work
Typing
Computer mouse use
Weightlifting
Gymnastics
Playing a musical instrument

Extensor tendonitis in the foot can also result from overuse activities like running, especially uphill. However, it can also occur from wearing overly tight or tightly laced shoes for physical activities like running or dancing. Less common causes include: (Arthritis Foundation, N.D.)

Medical conditions like diabetes or arthritis
Medication side effects
Infection
Joint deformities

Treatment

Extensor tendonitis usually improves with conservative treatment, which includes self-care, activity modification, physical therapy, and medication.

Medications

Individuals can treat inflammation with non-steroidal anti-inflammatory drugs NSAIDs like:

Ibuprofen
Naproxen
Aspirin
Acetaminophen can help reduce pain.
In some cases, individuals may need prescription anti-inflammatory medications like corticosteroids or pain relievers for short-term use.

Self-Care and Activity Adjustments

Self-care includes:

Rest and avoid any activities that increase pain symptoms. If you can’t avoid them completely, take frequent breaks to allow the muscles to relax.
Apply ice to the hand or foot several times daily for up to 20 minutes.
Compression wraps should be applied on the foot or hand using an elastic bandage or soft splint to help support the injured tendons and reduce swelling.
Elevate the hand or foot if swollen above the heart level when resting.

Activity Adjustments

Modifying activities can help address the underlying cause/s.
Hand extensor tendonitis can develop from poor positioning.
Setting up an ergonomic workstation can help.
Consult a coach or trainer if the tendonitis is related to sports or exercise.
Individuals might need to adjust their technique or training schedule to decrease pressure on the tendons.

Physical Therapy

Physical therapy is an effective treatment. A therapy team can help determine the condition’s underlying cause and provide a personalized treatment program. Interventions can include:

Pain-reducing treatments like ultrasound, electrical stimulation, electroacupuncture, and laser therapy.
Manual therapy
Massage therapies
Targeted exercise programs
Prescription of orthotics like a hand splint or shoe inserts.

Surgery

Surgery is not necessary unless the tendon is torn. (Bronner S., Ojofeitimi S., and Rose D. 2008) (American Society for Surgery of the Hand, 2014) Recovery after surgical repair requires physical therapy treatment following specific protocols based on the patient’s case.

Prognosis

Extensor tendonitis can take weeks or even months to fully heal. Early diagnosis and determining the condition’s underlying cause rather than just treating symptoms are recommended for a faster and optimal recovery. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility, relieving pain, and helping individuals return to normal activities. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers if other treatments are needed.

Move Better, Live Better, with Chiropractic

References

American Society for Surgery of the Hand. (2024). Tendons. www.assh.org/handcare/safety/tendons#Finger%20Extensor

Hanson, Z. C., & Lourie, G. M. (2022). Middorsal Wrist Pain in the High-Level Athlete: Causes, Treatment, and Early Return to Play. Orthopaedic journal of sports medicine, 10(4), 23259671221088610. doi.org/10.1177/23259671221088610

Arthritis Foundation. Foundation, A. (N.D.). Tendinitis. www.arthritis.org/diseases/tendinitis

Bronner, S., Ojofeitimi, S., & Rose, D. (2008). Repair and rehabilitation of extensor hallucis longus and brevis tendon lacerations in a professional dancer. The Journal of orthopaedic and sports physical therapy, 38(6), 362–370. doi.org/10.2519/jospt.2008.2749

American Society for Surgery of the Hand. (2014). Extensor tendon injury. www.assh.org/handcare/condition/extensor-tendon-injury#:~:text=The%20tendon%20may%20take%20eight%20to%20twelve%20weeks,may%20include%20stitches%20%28for%20cuts%20in%20the%20tendon%29.

Discover the Versatility of Fish Sauce and Substitutes

By

Dr. Alex Jimenez

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Woman pouring soy sauce into small bowl — Woman pouring couple of tea spoons of soy sauce into small bowl when making dipping sauce for snack plate

Individuals who are vegan, vegetarian, or allergic to fish may want to avoid fish sauce and foods made with it. What are fish-free sauce substitutes?

Table of Contents

Fish Sauce Substitutes

Fish sauce is a liquid ingredient that adds a salty fish flavor to recipes. It is made by coating fish, like anchovies, in salt and letting them ferment in large barrels. The result is bottled fish sauce. Commonly associated with Asian cooking, fish sauce adds flavor to recipes like noodles, stir-fries, and more. The sauce is described as having an earthy, umami flavor. Because the sauce has a unique flavor that is difficult to replicate, removing it altogether is an option for those who do not consume fish products or do not have this ingredient readily available. There are fish sauce substitutes that are vegan—and vegetarian-friendly.

Options

Fish and fish products can be part of a balanced diet and a nutritious source of omega fatty acids. However, fish sauce can be substituted for those who follow a meat-free meal plan, have seafood allergies, or do not have fish sauce available. Omitting some or all animal products from one’s diet is not as easy as avoiding fish. Individuals must also check ingredient labels for animal-based ingredients and byproducts. According to the Asthma and Allergy Foundation of America, fish and shellfish are among the most common food allergies in the U.S. (Asthma and Allergy Foundation of America, 2022)

Nutrition

Nutrition information for one tablespoon or 18 grams of fish sauce. (U.S. Department of Agriculture, 2018)

Calories – 6.3
Fat – 0 grams
Sodium – 1,410 milligrams
Carbohydrates – 0.66 grams
Fiber – 0 grams
Sugars – 0.66 grams
Protein – 0.91 grams

Fish sauce is usually added in small amounts so that it is not a significant source of calories, protein, fat, or carbohydrates. However, it does contain 1,410 milligrams of sodium. Guidelines recommend 2,300 milligrams of sodium per day for adults, and the recommended serving size of sauce contains around 61%. (U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2020)

Substitutes

Fish sauce substitutes typically replace the salty, savory flavors and help deepen the taste of recipes by adding salty and umami flavors. The vegan and vegetarian-friendly alternatives do not provide the fish flavor.

Soy Sauce

Soy sauce is a liquid condiment made with fermented ingredients. It replicates the salty flavor, and although it can be high in sodium, it yields a similar nutritional profile. Soy sauce can be substituted at a 1:1 ratio. Adding minced fish, such as anchovies or sardines, is optional to satisfy the fish flavor.

Tamari

Tamari is a gluten-free Japanese-style soy sauce that can naturally substitute fish sauce and be used in equal amounts.

Worcestershire Sauce

Worcestershire sauce can substitute the fish sauce flavor and saltiness. It is a condiment that deepens the flavor of dishes like steaks, stews, sauces, marinades, etc. Though it is not a traditional ingredient in Asian cooking, it can be used in recipes like noodles, dumplings, marinated meat, and salads. It is lower in sodium, so it may be preferred for a low-sodium meal plan. It can be used at a 1:1 ratio.

Hoisin Sauce

Hoisin sauce is made from fermented soybeans. It has the fermented aspect of fish sauce and the salty flavors of soy sauce, with a slightly sweet flavor. Compared to American-style barbecue sauce, it is thick and usually used as a glaze or dipping sauce. To substitute, mix hoisin sauce with soy sauce at a 1:1 ratio to offset the sweetness of hoisin sauce. Use the mixture to replace the fish sauce in equal amounts.

Oyster Sauce

Oyster sauce is a fish product with the closest flavor profile to fish sauce. It has a thicker consistency, offers a salty fish flavor, and can be used at a 1:1 ratio.

Integrative and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment plans through an integrated approach to restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and integrated 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, trainers, and health coaches to provide the most effective clinical treatments.

Body Signals Decoded

References

Asthma and Allergy Foundation of America. (2022). Food allergies. Allergies. aafa.org/allergies/types-of-allergies/food-allergies/

U.S. Department of Agriculture, FoodData Central. (2018). Sauce, fish, ready-to-serve. Retrieved from fdc.nal.usda.gov/fdc-app.html#/food-details/174531/nutrients

U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2020). Dietary Guidelines for Americans, 2020-2025. Retrieved from www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf

Take Athletic Abilities to the Next Level: Explosive Strength Training

By

Dr. Alex Jimenez

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Young fit woman doing fitness exercises at gym — Shot of female athlete jumping on wood box during sport training in fitness center

Can incorporating explosive strength training help develop power for athletes and sports enthusiasts who need to generate maximum energy quickly?

Table of Contents

Explosive Training

Explosive strength training exercises help develop power and athletic abilities by challenging the nervous and muscular systems. The focus is on the number of sets, repetitions, and rest periods to maximize gains. Explosive exercises typically use fewer repetitions 3–6 and more sets 3–5 to allow for maximum power output. Adequate rest periods, 2–3 minutes, are allotted between sets to prevent fatigue and reduce the risk of injury. Explosive training combines strength and speed to increase an individual’s power output and can be helpful for various sports, including track and field, court sports, cycling, and football.

Exercises

Explosive strength training uses large muscle movements that can include:

Squats
Power cleans
Weighted or unweighted vertical jumps
Heavy ball throws
Hill sprinting

Smaller muscle exercises can also build power, but results may be limited. These can include:

Bench presses
Pushups

Sample Exercises

Training exercises to develop power include:

Sprints
Agility drills
Weighted step ups
Overhead walking lunges
Plyometrics
Squats

Explosive training exercises should be selected to match individual fitness and sports goals. Exercise choices should simulate the movement patterns specific to the sport. Explosive training is unlikely to lead to injury if you train slowly, listen to your body for signs and symptoms of injury, and work with a qualified professional. Some evidence suggests that regularly engaging in explosive strength training can decrease the risk of injury.

Explosive strength exercises are movements that require an athlete to produce maximum or near-maximum output in a short time.
Explosive training aims to build enough power to ultimately move heavy weights quickly.
It is recommended to start with light weights and use slow, controlled movements.
The amount of weight used during a workout and the speed at which they are lifted should be increased over several weeks and training sessions.

Benefits

Research supports that explosive speed and strength exercise builds power but is more effective when combined with other training. For example, in a study, researchers showed that a mixed maximal and explosive strength training program was more effective than traditional approaches like circuit training in increasing overall fitness and adaptive processes that are helpful when increasing training loads, such as runners training for a marathon. (Taipale, R. S. et al., 2014) Other reports suggest that to maximize strength, power, and speed, a combination of heavy and light explosive exercise provides optimal results compared to training only in one style. (Baker D. 2003) The first training phase should focus on increasing maximum strength and building a solid foundation to maximize power output or movement speed. The second phase is devoted to power and speed training. (DeWeese B. H. et al., 2015)

Programs

The first five weeks of a 12-week training program to increase power and speed may consist primarily of heavy strength training. The next six weeks would consist of heavy and high-power explosive exercise training, and the final week would be high-power movements. Individuals are recommended to work with a coach or personal trainer specializing in this type of training when developing a program. A qualified professional can choose sport-specific exercises that will help improve performance. Correct form is essential for safety. A professional trainer can observe alignment throughout each exercise and provide adjustments and tips for safety and efficiency.

Injury Medical Chiropractic

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

Chiropractic Sport Rehabilitation

References

Taipale, R. S., Mikkola, J., Salo, T., Hokka, L., Vesterinen, V., Kraemer, W. J., Nummela, A., & Häkkinen, K. (2014). Mixed maximal and explosive strength training in recreational endurance runners. Journal of strength and conditioning research, 28(3), 689–699. doi.org/10.1519/JSC.0b013e3182a16d73

Baker D. (2003). Acute effect of alternating heavy and light resistances on power output during upper-body complex power training. Journal of strength and conditioning research, 17(3), 493–497. doi.org/10.1519/1533-4287(2003)017<0493:aeoaha>2.0.co;2

DeWeese, B. H., Hornsby, G., Stone, M., & Stone, M. H. (2015). The training process: Planning for strength–power training in track and field. Part 2: Practical and applied aspects. Journal of Sport and Health Science, 4(4), 318–324. doi:10.1016/j.jshs.2015.07.002

Exploring Electrolyte Chewing Gum: What You Need to Know

By

Dr. Alex Jimenez

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Orange slice, a handful of bubblegums and a pack of gum tablets on a colorful background. High quality photo

Can electrolyte chewing gum help physically active individuals, fitness enthusiasts, and athletes experiencing extreme heat and dehydration?

Table of Contents

Electrolyte Chewing Gum

Electrolyte powder mix and drinks have been marketed as efficient and time-saving for fast-paced lives. Now, electrolytes are in chewing gum form. These gums work by activating salivary glands and making the mouth water. Manufacturers claim the gum’s sour taste makes the mouth water, quenches thirst, and replenishes some electrolytes. Some brands don’t list the percentages or amounts of ingredients, making determining each gum’s electrolyte content difficult. However, electrolyte chewing gum is designed to eliminate feelings of thirst and is not meant to hydrate the body. This can be dangerous because it gives the individual a false sense of hydration. When the thirst mechanism is impaired, an individual may not drink enough fluids, leading to dehydration. The Food and Drug Administration has not studied the effectiveness of electrolyte gum.

Signs The Body Is Not Getting Enough Electrolytes

Electrolyte deficiency can result from insufficient fluids or excessive sweating (National Library of Medicine, 2024). Signs that the body is not getting enough electrolytes can vary because the body needs each electrolyte for specific functions. The symptoms can range from neurological symptoms such as headaches and seizures in the case of low sodium to muscle cramps and weakness when there are low potassium levels. (National Library of Medicine, 2023) (National Library of Medicine, 2023) However, individuals can still have electrolyte imbalances even if they do not have symptoms. This is why proper hydration and intake of electrolytes through water and food are important.

Ingredients

The ingredients listed on electrolyte chewing gum include:

Sugar
Gum base
Corn syrup
Citric acid
Glycerin
Natural flavors
Soy lecithin
Artificial sweeteners
Artificial color
Electrolytes in sodium citrate and potassium citrate

However, gum brands fail to include the percentages of the ingredients, making it hard to figure out the actual electrolyte content. The amount can determine their effectiveness. Given their size, estimates point to very little electrolyte content, possibly around 10 milligrams of sodium per piece, which is insufficient to hydrate the body.

Rehydrating the Body

Food and fluids are reliable sources of electrolytes that the body can absorb. Sources include:

Fruits like bananas and oranges contain potassium and magnesium.
Vegetables also contain potassium and magnesium.
Dairy for calcium.

Electrolyte supplements are generally unnecessary if you eat a balanced diet. However, these products could be useful during exercise, especially for their sodium content (National Library of Medicine, 2024). When exposed to the heat, consider a rehydration solution like sports drinks or making your own. The presence of sugar increases the absorption of sodium by the intestine. Sugar in electrolyte solutions does not add calories; it helps the intestine absorb the sodium faster and holds water in the bloodstream, helping maintain blood pressure. While chewing a piece of electrolyte gum might make it easy to get balanced electrolytes, it is not enough to replenish the body. Individuals who need more electrolytes should talk to their healthcare provider about the best way to meet their body’s needs. They may recommend drinks or powders specially formulated to provide an electrolyte boost.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop highly effective treatment plans through an integrated approach for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and integrated 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.

Balancing Body and Metabolism

References

National Library of Medicine, MedlinePlus. (2024). Fluid and electrolyte balance. Retrieved from medlineplus.gov/fluidandelectrolytebalance.html

National Library of Medicine, MedlinePlus. (2023). Low blood sodium. Retrieved from medlineplus.gov/ency/article/000394.htm

National Library of Medicine MedlinePlus. (2023). Low blood potassium. Retrieved from medlineplus.gov/ency/article/000479.htm

Understanding the Role of Supportive Digestive Organs

By

Dr. Alex Jimenez

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Woman holding illustration. Professional medical worker in white coat is in the office.

For individuals looking to improve their gut health, can learning about the supportive digestive organs help with how digestion works and how it can be affected by inflammatory bowel disease/IBD?

Table of Contents

Supportive Digestive Organs

Most people are familiar with food movement from the mouth through the esophagus, stomach, small intestine, and large intestine. However, digestion begins in the mouth with the formation of saliva, and the supportive digestive organs provide the necessary fluids to digest food and used by the body. The digestive tract runs from the mouth to the anus in one long, continuous tube. Several supportive digestive organs assist digestion but are not considered part of the digestive tract, including the salivary glands, pancreas, liver, and gallbladder.

Salivary Glands

The salivary glands produce saliva passed through ducts and into the mouth. Saliva is a clear liquid containing various substances important for digestion and the beginning of the food breakdown process (National Institute of Diabetes and Digestive and Kidney Diseases, 2017). Saliva is important to digestion because it aids chewing, contains antibodies, and helps keep the mouth clean. Infections, mumps, obstructions, Sjogren’s syndrome, and cancer are diseases and conditions that can affect the salivary glands.

Pancreas

Behind the stomach is the pancreas, which is important to digestion because it is where digestive enzymes and hormones are produced. Digestive enzymes help break down food (National Institute of Diabetes and Digestive and Kidney Diseases, 2017). The pancreas also creates Insulin, a hormone that helps balance blood sugar levels. Individuals with Type 1 diabetes are unable to make insulin and need insulin shots to balance sugar levels. Individuals with Type 2 diabetes also need insulin because their body is either resistant to insulin or their pancreas does not respond correctly. (American Diabetes Association, 2024) Glucagon is another hormone produced in the pancreas to raise blood sugar when the levels are very low. For individuals who have diabetes, glucagon can increase blood sugar levels too high. Insulin and glucagon work together to regulate blood sugar. (American Diabetes Association, 2024) Some diseases and conditions affecting the pancreas include pancreatitis, cancer, and cystic fibrosis.

Liver

The liver is one of the largest organs. Its functions include creating bile, storing nutrients and glycogen, converting toxins into harmless substances, and/or enabling their removal. Bile is passed through ducts that run from the liver to the duodenum of the small intestine. Blood circulates through the digestive tract and liver, where vitamins and nutrients are processed and stored (Johns Hopkins Medicine, 2024). The liver is also the body’s detox organ, helping remove byproducts produced by alcohol and medications. The liver also helps break down old or damaged blood cells and produces substances to help with blood clotting. (Johns Hopkins Medicine, 2024) Diseases and conditions of the liver include cirrhosis, hepatitis, hemochromatosis, and cancer.

Gallbladder

The gallbladder is a much smaller organ located just under the liver. This supportive digestive organ stores bile after it is made in the liver. After eating, the small intestine releases a special hormone called cholecystokinin, which prompts the gallbladder to send bile through ducts and into the small intestine. Once in the small intestine, the bile breaks down the fat from the food. Conditions that can affect the gallbladder include gallstones. Surgery to remove the gallbladder, known as a cholecystectomy, is common. Some individuals may initially need to make adjustments to their diet after surgery. (Johns Hopkins Medicine, 2024)

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop highly effective treatment plans through an integrated approach for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and integrated 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.

Healthy Diet and Chiropractic

References

National Institute of Diabetes and Digestive and Kidney Diseases. Dis (2017). Your digestive system & how it works. Retrieved from www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-works

American Diabetes Association. (2024). About diabetes: common terms. diabetes.org/about-diabetes/common-terms

Johns Hopkins Medicine. (2024). Liver: anatomy and functions. www.hopkinsmedicine.org/health/conditions-and-diseases/liver-anatomy-and-functions

Johns Hopkins Medicine. (2024). Cholecystectomy. www.hopkinsmedicine.org/health/treatment-tests-and-therapies/cholecystectomy

Plantaris Muscle Tear: Symptoms, Diagnosis, and Recovery

By

Dr. Alex Jimenez

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Calf Sports Massage Therapy — Physiotherapist massaging male patient with injured calf. Sports injury treatment.

Individuals who engage in sports and physical activities that involve lunging forward while running or jumping can sustain a plantaris muscle injury. Can understanding the anatomy of the back of the leg and the symptoms help diagnose and treat plantar muscle injuries?

Table of Contents

Plantaris Muscle

The plantaris muscle is a long, narrow muscle in the calf that runs along the back of the leg. It’s part of the Triceps Surae, a group of muscles in the calf that, along with the gastrocnemius and soleus muscles, makes up the bulk of the back of the leg. It is located in the superficial posterior compartment of the leg. Strains or tears of the plantaris muscle at the back of the leg can cause pain and swelling, similar to a calf strain or Achilles tendon tear. Individuals may feel immediate pain, cramping, and other symptoms.

Anatomy

The gastrocnemius and soleus muscles are the major muscles, with the soleus located deeper in the leg. Together, they form the Achilles tendon, which blends into a tendon in the back of the heel and attaches to the heel bone/calcaneus. When the calf muscles contract, they point the foot downward, propelling the body forward when walking, running, and sprinting. The plantaris muscle and tendon sit more or less in the center of the calf, between the two heads of the gastrocnemius. Around 7% to 20% of the population are born without plantaris muscles. There are variations, such as having a double- or triple-headed plantaris muscle. (Olewnik Ł. et al., 2020) However, individuals that do not have the muscle or have a variation have not been shown to affect long-term or short-term mobility.

Symptoms

Plantaris muscle ruptures are the most common injury and occur often during running or jumping. (Spang C. et al., 2016) Many who sustain this injury are athletes who have to lunge forward. Common symptoms include:

Sudden onset pain behind the calf.
Swelling of the calf muscle.
Muscle knots or myofascial trigger points of the calf muscle.
Swelling and bruising in the back of the calf area.
Cramping in the calf muscle.
Spasm sensations of the calf muscle.
Symptoms of a plantaris muscle strain are less severe, with the common signs being tightness and pain during and after physical activity.

Diagnosis

Plantaris muscle tears differ from Achilles tendon tears because the foot can be pointed downward following the rupture, whereas an Achilles tear cannot. Plantaris ruptures can also be confused with a blood clot in the large veins of the calf, called deep vein thrombosis/DVT. (Rohilla S. et al., 2013) Tests like MRI or ultrasound can be performed to confirm or exclude a plantaris rupture. Both can be useful for verifying whether the injury is a strain or tear and identifying other possible causes of calf pain.

Treatment

Treatment is typically non-surgical. While the injuries can cause pain and disability, the symptoms almost always resolve with conservative treatments and therapies. Rest, ice, compression, and elevation are the first line used and may be all that is needed for a muscle strain. Short-term use of NSAIDs may be recommended for a strain or tear to reduce pain and inflammation. (Morelli K. M. et al., 2018) If the pain is profound or there is a tear, patients may require short-term immobilization or the use of a crutch for the pain to subside. With the assistance of a physical therapist, sports chiropractor, and athletic trainer, gradual increases in mobility and strength can be obtained. Symptoms usually gradually resolve over several weeks. Full recovery may take up to eight weeks, depending on the severity of the injury.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop customized treatment programs through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility, relieving pain, and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Control Foot Motion with Custom Orthotics

References

Olewnik, Ł., Zielinska, N., Karauda, P., Tubbs, R. S., & Polguj, M. (2020). A three-headed plantaris muscle: evidence that the plantaris is not a vestigial muscle?. Surgical and radiologic anatomy : SRA, 42(10), 1189–1193. doi.org/10.1007/s00276-020-02478-8

Spang, C., Alfredson, H., Docking, S. I., Masci, L., & Andersson, G. (2016). The plantaris tendon: a narrative review focusing on anatomical features and clinical importance. The bone & joint journal, 98-B(10), 1312–1319. doi.org/10.1302/0301-620X.98B10.37939

Rohilla, S., Jain, N., & Yadav, R. (2013). Plantaris rupture: why is it important?. BMJ case reports, 2013, bcr2012007840. doi.org/10.1136/bcr-2012-007840

Morelli, K. M., Brown, L. B., & Warren, G. L. (2018). Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. The American journal of sports medicine, 46(1), 224–233. doi.org/10.1177/0363546517697957

Managing Posterolateral Corner Injuries: Treatment and Recovery

By

Dr. Alex Jimenez

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Physiotherapist examining his patients knee in clinic

Individuals who have sustained trauma to the knee area from work, physical activity, or a motor vehicle collision can experience significant pain and mobility impairment. Can physical therapy help heal and strengthen the PLC?

Table of Contents

Posterolateral Corner Knee Injury

The posterolateral corner, or PLC, comprises muscles, tendons, and ligaments in the back of the knee that help support and stabilize the outside region. The primary role of the PLC is to prevent the knee from excessive amounts of rotation or bowing/turning outward. (Chahla J. et al., 2016) Posterolateral corner injuries can cause significant pain and can dramatically impact an individual’s ability to walk, work, or maintain independence. Treatment options will depend on the severity of the injury.

The Posterolateral Corner

The posterolateral corner comprises multiple structures that support and stabilize the outside of the knee. The structures are subdivided into primary and secondary stabilizers. The primary group includes:

Lateral collateral ligament- LCL
Popliteofibular ligament – PFL
Popliteus tendon

The secondary stabilizers include:

The lateral capsule of the knee.
Coronary ligament.
Fabellofibular ligament.
Lateral gastrocneumius tendon.
The long head of the biceps femoris.
Iliotibial/IT band (Chahla J. et al., 2016)

The primary role is to prevent the knee from excessively turning outward, so the grouping provides secondary assistance in preventing the lower leg bone/tibia from shifting forward or backward on the thighbone/femur. Occasionally, one or several posterolateral corner structures can be sprained, strained, or torn.

How Injury Occurs

An injury occurs when a direct blow to the inner portion of the front of the knee causes the leg to bow outward. A posterolateral corner injury may also be sustained without contact, for example, if the knee hyperextends or buckles away from the other leg into a varus/bow leg position. Because the knee usually moves during a PLC, concurrent sprains or tears to the anterior cruciate ligament/ACL or posterior cruciate ligament/PCL are also common. (Chahla J. et al., 2016) Other situations that can also cause PLC injuries include automobile crashes and falls from elevated surfaces. (Shon O. J. et al., 2017) When this type of trauma causes a posterolateral corner injury, bone fractures are also common.

Symptoms

Depending on the severity of the injury, multiple symptoms may be present, including:

Difficulty walking or climbing stairs due to instability. (Shon O. J. et al., 2017)
Numbness or tingling in the lower leg.
Pain, swelling, bruising, and hardening in the knee and surrounding area.
Outward bowing position of the affected knee when standing.
Foot drop presents on the injured side. (Chahla J. et al., 2016)

For individuals who suspect that they have sustained a PLC injury or have any of the symptoms listed, it is critical to be seen by an orthopedic specialist or emergency room physician. A healthcare provider will properly evaluate the leg and develop the appropriate treatment.

Diagnosis

Diagnosis begins with a comprehensive examination. In addition to looking for the symptoms noted, a healthcare provider will move the legs in different directions to assess for any instability. The dial test may be performed, which involves having the patient lie on their stomach while the healthcare professional assesses the side-to-side rotation in the leg to check for excessive motion. (Shon O. J. et al., 2017) Imaging is frequently ordered to determine which anatomical structures are affected more accurately. X-rays can help rule out concurrent fractures and check for excessive laxity in the knee area. MRIs are also useful for visualizing the various tendons and ligaments, helping the healthcare provider look closely at any sprains or tears that may have occurred. However, MRIs may be less accurate in diagnosing PLC injuries after 12 weeks, so they should be obtained as soon as possible. Based on this evaluation, the injury may be classified using the following system (Shon O. J. et al., 2017)

Grade 1

0 to 5 degrees of rotational or varus/bowing instability.
Incompletely torn posterolateral corner.

Grade 2

6 to 10 degrees of rotational or varus/bowing instability.
Incompletely torn posterolateral corner.

Grade 3

Eleven or more degrees of rotational or varus/bowing instability.
Completely torn posterolateral corner.

Treatment

The care received after a posterolateral corner injury can vary depending on the structures involved and the overall severity.

Nonsurgical

Nonsurgical treatment is typically reserved for isolated grade 1 or 2 PLC injuries. (Shon O. J. et al., 2017) Depending on which structures are affected, a stabilizing brace may be worn, and crutches are often needed to decrease the strain on the knee. Physical therapy is also commonly prescribed and focuses on the following goals:

Gradually reducing crutch use.
Improving balance and stability.
Improving walking patterns.
Regaining the range of motion in the knee.
Strengthening the leg muscles.
Gradually reintroducing specific movements like running and jumping.

Surgery

Non-surgical treatment tends not to work with grade 3 injuries. If surgery is not performed, individuals may also suffer from chronic knee instability or develop long-term osteoarthritis. (Chahla J. et al., 2019) Surgical treatment is often recommended for grade 3 injuries. The damaged primary stabilizers are surgically reconstructed using a graft from another body region. Surgical repairs may also be performed on any secondary stabilizers to improve stability. (Chahla J. et al., 2019) Any other ligament injuries, such as ACL, PCL, or concurrent fractures, will also be addressed. Following the procedure, individuals immobilize their knee with a brace and do not place weight on the affected leg to protect the surgical area. Depending on the surgeon’s recommendations, this can last six weeks or more. Physical therapy is also initiated after a surgical procedure. Though rehabilitation progresses slowly, the goals are often the same as when treating milder PLC injuries. Returning to work, sports, and/or physical activity after surgery may take six months of therapy or more. (Shon O. J. et al., 2017)

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment program through an integrated approach to treat injuries and chronic pain syndromes, improve flexibility, mobility, and agility, relieve pain, and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Knee Injury Rehabilitation

References

Chahla, J., Moatshe, G., Dean, C. S., & LaPrade, R. F. (2016). Posterolateral Corner of the Knee: Current Concepts. The archives of bone and joint surgery, 4(2), 97–103.

Shon, O. J., Park, J. W., & Kim, B. J. (2017). Current Concepts of Posterolateral Corner Injuries of the Knee. Knee surgery & related research, 29(4), 256–268. doi.org/10.5792/ksrr.16.029

Chahla, J., Murray, I. R., Robinson, J., Lagae, K., Margheritini, F., Fritsch, B., Leyes, M., Barenius, B., Pujol, N., Engebretsen, L., Lind, M., Cohen, M., Maestu, R., Getgood, A., Ferrer, G., Villascusa, S., Uchida, S., Levy, B. A., Von Bormann, R., Brown, C., … Gelber, P. E. (2019). Posterolateral corner of the knee: an expert consensus statement on diagnosis, classification, treatment, and rehabilitation. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 27(8), 2520–2529. doi.org/10.1007/s00167-018-5260-4

Levator Scapulae Muscles: A Key Player in Shoulder Blade Mobility

By

Dr. Alex Jimenez

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Male chiropractor works with a patient in a rehabilitation center, he gives him a massage

The levator scapulae muscles could be overstretched for individuals experiencing upper back, shoulder, and neck pain. Can physical therapies help relieve pain and retrain the muscles to function properly?

Table of Contents

Levator Scapulae Muscles

The levator scapulae muscles stretch along the spine across the upper back and neck. They originate from the cervical vertebrae C1 to C4 and attach to the inside top edge of the scapula. (Chotai P. N. et al., 2015) They elevate the shoulder blades, tilt the head, and work with other muscles to stabilize the spine and influence neck motion and upper back posture. The shoulder blade/scapula is the flat, triangular-shaped bone that sits on top of the upper part of the rib cage. Where the levator scapulae attaches, the muscles raise the shoulder blade, a movement called elevation, and indirectly rotates the scapula’s bottom tip downward towards the spine. These shoulder blade movements are part of the shoulder joint’s larger flexion and abduction movements.

Flexion occurs when moving the arm forward and up, and abduction occurs when moving the arm out to the side.
The levator scapulae muscles contract during flexion and/or abduction,
The muscles also contract when moving the neck in side bending, lateral flexion, rotation, or twisting.

Symptoms

Neck and shoulder pain are common problems for office workers, truck drivers, and others who sit most of the day for their jobs. It can worsen when there is no spinal support for maintaining correct alignment. Poorly designed work chairs may contribute to chronic muscle tension and spasms, plus they may contribute to muscle weakness. One of the primary functions of the levator scapulae muscles is to keep the shoulder blade in a position that supports a vertical alignment of the head and to prevent forward head posture. (Yoo W. G. 2018)

However, the shoulder blade is an extremely movable bone. Maintaining stability and correct neck posture is not easy. The levator scapulae muscles may not be strong enough to keep the shoulder blade where it’s supposed to be for healthy posture, and instead, they become overstretched. When muscles are overstretched, they often become taut to try to maintain some form of stability. It can feel like muscle tension because the muscles shorten, but there is a difference. The situation can worsen if one slouches, has no lumbar support, and/or the desk or steering wheel is too high or too low, which may force the shoulder blade upward or downward.

Pain Relief

The levator scapulae muscles are two of several shoulder muscles that may contribute when neck pain presents. This is why a qualified, licensed health professional should diagnose any pain or dysfunction in the area. Physical therapy can help get the body back on track. (Yoo W. G. 2018) Treatment may consist of restoring muscle strength and flexibility in the shoulder, neck, and upper back muscles and developing better posture habits. Physical therapy exercises, particularly those that address upper back posture, can help reduce the stress placed on the levator scapulae muscles and can help decrease kyphosis, often a precursor to forward head posture. Stretching, strengthening, and posture lessons will help relieve pain and increase the physical functioning of the upper body. Other tips for avoiding and relieving muscle pain include:

Stretching regularly by gently rotating the neck and shoulders.
Applying heat to promote relaxation.
Regular massage therapy.
Adjusting chairs and/or monitor height to align with a straight line of sight.
Not carrying heavy bags, especially on one shoulder.
Avoiding side sleeping without proper head support.

Injury Medical Chiropractic Clinic

Visiting a chiropractic and physical therapy team can help treat injuries and chronic pain syndromes, relieve pain, resolve musculoskeletal issues, and prevent future symptoms. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized care program for each patient through an integrated approach to help return to normal and optimal function. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

The Natural Way to Heal: Non-Surgical Chiropractic Care for Pain Relief

References

Chotai, P. N., Loukas, M., & Tubbs, R. S. (2015). Unusual origin of the levator scapulae muscle from mastoid process. Surgical and radiologic anatomy : SRA, 37(10), 1277–1281. doi.org/10.1007/s00276-015-1508-6

Yoo W. G. (2018). Effects of thoracic posture correction exercises on scapular position. Journal of physical therapy science, 30(3), 411–412. doi.org/10.1589/jpts.30.411

A Complete Guide to Managing Piriformis Syndrome

By

Dr. Alex Jimenez

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Chiropractor working on young woman spine while female patient lies on massage table

For individuals experiencing piriformis syndrome. Can knowing the causes and what it feels like help in diagnosis and treatment?

Table of Contents

Managing Piriformis Syndrome

Piriformis syndrome is where spasms occur in the piriformis muscle located in the buttocks. These muscle spasms can cause pain and numbness in the buttocks and the back of the leg. (Cedars Sinai, 2022)

What Is It?

Piriformis syndrome is an irritation of the sciatic nerve from the piriformis muscle. Although the piriformis muscle is small compared to other muscles around the hip and thigh, it supports the hip joint’s external rotation or turning out. The sciatic nerve supplies the lower extremities with motor and sensory functions. The piriformis tendon and sciatic nerve cross each other behind the hip joint in the deep buttock. Both are about one centimeter in diameter. The piriformis muscle spasms can irritate the sciatic nerve, causing sciatica symptoms. (Cedars Sinai, 2022)

Triggers

A piriformis syndrome diagnosis means the piriformis tendon binds or spasms around the sciatic nerve, causing irritation and symptoms. Many doctors and specialists support the theory that when the piriformis muscle and its tendon tighten, this can cause compression and pinch the nerve. This can decrease blood circulation and irritate the nerve due to pressure. (Cass S. P. 2015) Many doctors also believe that piriformis syndrome occurs from anatomic variation of the muscle and tendon. It is thought this muscle-tendon variation irritates the nerve in some, leading to sciatica symptoms.

How It Feels

Common signs and symptoms experienced include (Cass S. P. 2015)

Pain in the buttocks.
Pain behind the hip.
Electric shock pains traveling down the back of the lower extremity.
Numbness in the lower extremity.
Tenderness with pressure that often causes pain when sitting.
Some develop symptoms abruptly, while others gradually increase in symptoms in the back of their thighs.

Most who are diagnosed with piriformis syndrome are generally active individuals who experience increasing difficulty with certain types of physical activity.

Testing

There are no specific tests that accurately diagnose piriformis syndrome. Doctors will order tests, including MRI and nerve conduction studies. Because it can be difficult to diagnose, there are likely many misdiagnosis cases. This means that some with the condition don’t have a piriformis diagnosis. In addition, some with vague hip pain may receive this diagnosis even if they don’t have the condition. (Cass S. P. 2015) An injection is often administered into the piriformis muscle when the diagnosis is uncertain. (Jankovic D. et al., 2013) Performing an injection can help determine the specific location of the discomfort. When an injection is given into the piriformis muscle or tendon, it is administered by ultrasound guidance to ensure the needle delivers medication to the correct location. (Bardowski E. A., and Byrd J. W. T. 2019)

Differential Diagnosis

Some other conditions with buttock pain can have similar symptoms. Other causes can include:

Radiculopathy/Sciatica
Herniated discs
Hip bursitis
Spinal stenosis

The diagnosis of piriformis syndrome is given when these diagnoses are eliminated as possible causes of pain.

Treatment

Managing piriformis syndrome is quite general, and it is often difficult to recover from. Common treatment and management suggestions include the following. (Jankovic D. et al., 2013)

Rest

Avoiding activities that cause symptoms for at least a few weeks.

Physical Therapy

Focuses on stretching and strengthening the hip rotator muscles.

Anti-inflammatory Medication

To decrease inflammation around the tendon.

Deep Massage

Used to relax the piriformis muscle and help release the compressed nerve.

Cortisone Injections

It can help decrease inflammation and swelling.

Botulinum Toxin Injection

It can paralyze the piriformis muscle to reduce pain and discomfort.

In severe cases, surgery can be performed to loosen the piriformis tendon, known as a piriformis release (Cass S. P. 2015). This surgical procedure is recommended when conservative treatments have been tried for at least six months and other causes of pain have been evaluated and ruled out. Recovery takes several months.

The goal of managing piriformis syndrome is to improve the range of motion and flexibility around the hip and diminish inflammation around the sciatic nerve. Working with a professional chiropractic team can help relieve pain, return individuals to normal function, and expedite healing. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a customized treatment program through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.

Piriformis Syndrome Treatment Chiropractor

References

Cedars Sinai. Sinai, C. (2022). Piriformis syndrome. www.cedars-sinai.org/health-library/diseases-and-conditions/p/piriformis-syndrome.html

Cass S. P. (2015). Piriformis syndrome: a cause of nondiscogenic sciatica. Current sports medicine reports, 14(1), 41–44. doi.org/10.1249/JSR.0000000000000110

Jankovic, D., Peng, P., & van Zundert, A. (2013). Brief review: piriformis syndrome: etiology, diagnosis, and management. Canadian journal of anaesthesia = Journal canadien d’anesthesie, 60(10), 1003–1012. doi.org/10.1007/s12630-013-0009-5

Bardowski, E. A., & Byrd, J. W. T. (2019). Piriformis Injection: An Ultrasound-Guided Technique. Arthroscopy techniques, 8(12), e1457–e1461. doi.org/10.1016/j.eats.2019.07.033