Individuals that go through severe low back pain caused by degeneration, herniated discs, vehicle, personal, work, and sports injuries, surgery, or spinal fusion is usually a last resort if non-invasive treatments fail to provide relief or not enough relief. Patients try to avoid spinal fusion because it can be an intense experience and requires a year-long recovery period. Unfortunately, individuals still experience discomfort and pain after surgery. Do individuals want to know what other treatment options are available, including chiropractic care?
Doctors will inform post-op patients of the risks involved with chiropractic therapy. However, chiropractic medicine can bring natural pain relief after surgery. Chiropractic treatment requires that an individual be adequately or fully healed before beginning a personalized treatment plan. At Injury Medical Chiropractic and Functional Medicine Clinic, we consult patients post-surgery about the effectiveness of rehabilitation spinal adjustments and physical therapy massage.
Wait Time After Surgery
Spinal fusion surgery involves removing the discs between two or more vertebrae and fusing the bones with metal screws and plates. The objective is to correct conditions like herniated discs and degenerative diseases by immobilizing the spine in that area. It can take at least three months for the vertebrae to fuse for a fully immobilized graft. Once the graft is complete, a few months of physical therapy are recommended to loosen/stretch and strengthen the muscles around the graft. Initial recovery combined with physical therapy typically takes a full year for a complete recovery.
It is during recovery where it can be difficult and for discomfort and pain to present. The reason is patients are recommended to avoid any twisting, bending, over-reaching motions, or the graft could break. This can make an individual take on awkward poses/postures, flexing and contracting muscles incorrectly, causing strain. The result is added discomfort and/or pain.
How Chiropractic Helps
Spinal fusion is not guaranteed to alleviate an individual’s back pain completely. But many do experience discomfort or pain post-surgery. This could be for a little while or longer, depending on their condition or injuries. Fortunately, chiropractic treatment can help bring pain relief through mobilization, manipulation, and massage techniques. Manipulations’ objective is to adjust and/or realign the bones of the spine and other areas of the body. Because of the intricacy of spinal manipulations, many who have undergone back or spinal fusion surgery are hesitant to seek chiropractic treatment. Discuss possible chiropractic care with your physician to determine if the surgical graft is strong enough to withstand spinal manipulations. If the graft is adequately/fully healed and your physician believes it can endure mild adjustments, reach out to a chiropractor to discuss a customized treatment plan.
Body Composition Testing
Poor Leg Skeletal Muscle Mass
The gluteal muscles or buttock muscles are the largest muscle group in the body. Individuals can start losing bone density by their 30s. This increases the risk of injury and further bone density loss. Bone density loss is a natural process, but the process can be accelerated for individuals with under-developed skeletal muscle mass. The health of muscles and bones are closely linked. Researchers found that individuals with less muscle mass than average for their height tended to have narrower and thinner bones. This resulted in limited lower bending strength.
Decreased muscle mass was shown to be linked to balance problems and increased risk of falls. There is a higher prevalence of sarcopenia or muscle wasting for patients with hip fractures and a reduction of leg muscle mass. The combination of:
Low muscle mass
Low bone density
Hip fractures
It can have lifelong consequences
References
Fernandez, Matthew et al. “Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 25,11 (2016): 3495-3512. doi:10.1007/s00586-015-4148-y
Keller, Glenda. “The effects of massage therapy after decompression and fusion surgery of the lumbar spine: a case study.” International journal of therapeutic massage & bodywork vol. 5,4 (2012): 3-8. doi:10.3822/ijtmb.v5i4.189
O’Shaughnessy, Julie et al. “Chiropractic management of patients post-disc arthroplasty: eight case reports.” Chiropractic & osteopathy vol. 18 7. 21 Apr. 2010, doi:10.1186/1746-1340-18-7
Perrucci, Rachel M, and Christopher M Coulis. “Chiropractic management of post-spinal cord stimulator spine pain: a case report.” Chiropractic & manual therapies vol. 25 5. 6 Feb. 2017, doi:10.1186/s12998-017-0136-0
Szulc, Pawel et al. “Low skeletal muscle mass is associated with poor structural parameters of bone and impaired balance in elderly men–the MINOS study.” Journal of bone and mineral research: The American Society for Bone and Mineral Research vol. 20,5 (2005): 721-9. doi:10.1359/JBMR.041230
Many doctors/surgeons rely on the widely adopted lumbar spinal fusion. However, experts have asserted that lumbar total disc replacement or TDR should be made available and increased for treating degenerative disc disease and other spinal conditions. Individuals interested in total disc replacement, the ability to have it done, and if insurance will pay? What to know about TDR and fusion before deciding and moving forward.
Total Disc Replacement
Spinal fusion has been the traditional approach for relieving lower back pain. In this procedure, a bone graft is inserted between two or more vertebrae. This eliminates movement that causes pain or could be dangerous to the individual. Total disc replacement demands more on a technical level than spinal fusion. However, the worn-out, injured, or damaged disc is fully replaced, even a completely degenerated disc, with a metal and/or plastic one. Benefits from lumbar TDR surgery include:
Shown to be a safe procedure with minimal complications
Significant improvement in health and quality of life
High rates of successful outcomes
Mobility is preserved
Who Needs Disc Replacement?
Low back problems affect more than a third of the population. This can come from:
Personal
Work
Sports
Automobile injuries
Aging
All are risk factors
Fusion or Total disc replacement
Fusion reduces and eliminates motion around the affected area which also changes with the spine’s mechanics. It can also place increased stress on the surrounding segments. However, the lack of motion is to eliminate the pain. Total disc replacement does increase mobility, but it can’t fully relieve the pain. It can relieve pain generated from the disc but not from other causes. TDR has been shown to:
Provides motion preservation
Reduces staying at the hospital
Provides long-term durability
Lower reoperation rates compared to fusion
Total disc replacement issues:
The procedure is more time-consuming
A lot of time making decisions
A lot of time preparing
An example could be the patient has a narrow disc space. Looking at the X-rays of the discs above and below, the surgeon has to make sure they choose the right size. Next, the narrow space needs to be mobilized back to a normal height that cannot be too high or too short. Finally, the surgeon has to make sure that the disc is anchored and fits properly.
Why Surgeons Still Choose Fusion?
Despite the benefits, there are reasons why surgeons still choose fusion.
There are strict rules as to when TDR can be used. This means insurers are prone only to approve fusion procedures.
The surgical technique is challenging. TDR surgery is a highly demanding procedure. As a result, many doctors specializing in fusion for 20 years or more can be reluctant to perform the procedure.
Complications and revision surgeries. Reoperations are sometimes necessary, but this happens in both fusion and TDR.
Individual Needs
Fortunately, most individuals with lower back problems never need total disc replacement. And those that do have severe pain/conditions are recommended to try non-invasive/surgical treatment. This ranges from:
Chiropractic
Physical therapy
Massage
Imaging and lab tests will be required. However, if an operation is necessary, ask questions about both procedures. For example, if a surgeon insists that fusion is the only option, ask why total disc replacement is not an option?
Body Composition Testing
Protein and Weight Loss
Protein is one of three basic macronutrients found in food. Proteins are made up of smaller units called amino acids. There are 22 amino acids, with 9 of these being essential. This means the body needs them, as the body cannot produce them. These essential amino acids can be obtained by eating protein-rich foods like:
Eggs
Meat
Fish
Vegetarian/vegan options include:
Nuts
Seeds
Beans
Tofu
Generally, all the essential amino acids cannot be obtained from just one food. Therefore it is recommended to eat a variety of animal and plant-based proteins. Protein is in almost every structure and function of the body.
Antibodies
These proteins fight off any infections, bacteria, etc.
Repair, maintenance, and structural
Proteins are the building blocks of the body’s muscles, bones, skin, and hair.
Hormones
Chemical messenger proteins are how cells and organs communicate. For example, Growth Hormone affects muscle gain and fat loss.
Enzymes
Not all proteins are enzymes; however, all enzymes are proteins. These proteins are catalysts or starters for chemical reactions in the body.
Transportation and storage
Some proteins carry molecules where they are needed. For example, hemoglobin or the red blood cells carry oxygen to cells, then transport carbon dioxide away.
Not getting enough protein in one’s diet can have serious consequences on the body’s health. Without enough protein, the muscles can begin to atrophy or waste away, taking Lean Body Mass, strength, and energy away as well.
The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. In addition, we provide copies of supporting research studies available to regulatory boards and the public upon request.
We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.
Salzmann, Stephan N et al. “Lumbar disc replacement surgery-successes and obstacles to widespread adoption.” Current reviews in musculoskeletal medicine vol. 10,2 (2017): 153-159. doi:10.1007/s12178-017-9397-4
“Comparison of Lumbar Total Disc Replacement With Surgical Spinal Fusion for the Treatment of Single-Level Degenerative Disc Disease: A Meta-Analysis of 5-Year Outcomes From Randomized Controlled Trials”, Zigler J, et al., Global Spine Journal, June 2018, PMC602295 www.ncbi.nlm.nih.gov/pmc/articles/PMC6022955/
Although it is not officially summer, the past few weeks sure feels like it. Especially for those with joint discomfort and pain. As the body ages, individuals may notice their joints have some mobility/flexibility issues in the summer heat. Again, the heat and humidity are the culprits. The hotter it is, the more the body is susceptible to inflammation and swelling. The more prone an individual’s body is to swelling, the more pain can present. Barometric pressure can also have some form of impact on joint health. The pressure changes can cause the joints to become more sensitive. When the pressure changes, individuals often speak of their joints feeling tighter combined with stiffness, leading to a cycle of swelling and pain.
Joint Anatomy
Whether it’s the hip, knee, elbow, or hand, all of the body’s joints have fluid in them. It is a gel-like substance known as synovial fluid. This is what lubricates the joints and keeps them functioning smoothly. However, the temperature and humidity levels can change the thickness of the fluid in the joints. This means that the synovial fluid can become inflamed with the weather changes. This is a symptom when the joints begin to feel like they cannot move and/or are becoming stiff. Joint inflammation can become more common and chronic as the body gets older.
Weather and the joints
The summer heat and humidity can affect the joint because:
The tendons, ligaments, and muscles expand in this type of weather
The heat can restrict individuals from moving around. Non-use stiffens the joints
Joints that have worn down cartilage could have exposed nerves that are reacting to the temperature changes
Humidity causes the body to lose water by sweating. This can reduce the fluid around the joints leading to stiffness, immobility, and pain.
However, not everyone has joint problems in the summer heat. Many have joint issues when it’s cold, damp, or raining. Other’s are at their best in cool, dry weather. It depends on an individual’s body and how their joints react when the temperature changes.
Maintaining joint health for the summer heat
When joint discomfort or pain presents in the summer, there are a few easy ways to gain relief.
Properly Hydrate the Body
Water and sports drinks maintain the fluid levels in the body, specifically, it keeps the joints moving. One way to hydrate the body can be achieved by eating healthy fruits and vegetables. Water-rich fruits and vegetables include:
Watermelon
Oranges
Strawberries
Tomatoes
Cucumbers
Spinach
Celery
Over-The-Counter pain ointments and creams
Arthritis and anti-inflammatory creams/ointments can ease joint pain by allowing more blood circulation in the affected areas.
Dressing for the heat
Wear loose, natural fiber, breathable clothing that allows the body to move freely while maintaining a cool temperature.
Relax in the air conditioning
Get into the air conditioning. The cool air can help reduce joint inflammation.
Get in the Water
Swimming or just wading through doing some light exercise in the water cools the body’s core. In addition, the buoyancy of the water relieves pressure on the joints.
Body Composition Testing
Body Water
The body is made up of as much as 2/3’s water. Even though much of the body is made up of water, the percentage of body composition changes based on functional needs. Essential functions of water include:
Water is the building block to almost every cell in the body
It regulates the body’s temperature through sweating and respiration
Carbohydrates and proteins for energy are transported via the water in the blood
Water assists in the removal of metabolic waste through urination
It is part of the shock-absorbing system that protects the brain and spinal cord
Water is part of the saliva and fluid that lubricates the joints
The amount of water in the body depends on various factors. This includes:
Age
Gender
Physical activity
It is referred to as Total Body Water or TBW.
TBW is constantly changing with gains and losses of fluid in healthy adults. The body can detect irregularities and compensate for losses and/or gains to make sure that the systems are balanced.
The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. In addition, we provide copies of supporting research studies available to regulatory boards and the public upon request.
We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.
Morton, Darren, and Robin Callister. “Exercise-related transient abdominal pain (ETAP).” Sports medicine (Auckland, N.Z.) vol. 45,1 (2015): 23-35. doi:10.1007/s40279-014-0245-z
Peeler, Jason et al. “Managing Knee Osteoarthritis: The Effects of Body Weight Supported Physical Activity on Joint Pain, Function, and Thigh Muscle Strength.” Clinical journal of sports medicine: official journal of the Canadian Academy of Sports Medicine vol. 25,6 (2015): 518-23. doi:10.1097/JSM.0000000000000173
Quick, D C. “Joint pain and weather. A critical review of the literature.” Minnesota medicine vol. 80,3 (1997): 25-9.
Timmermans, Erik J et al. “The Influence of Weather Conditions on Joint Pain in Older People with Osteoarthritis: Results from the European Project on OSteoArthritis.” The Journal of rheumatology vol. 42,10 (2015): 1885-92. doi:10.3899/jrheum.141594
A proper diagnosis goes a long way. Treatment and recovery can happen relatively quickly or broken up into parts, phases, and sessions, as part of a treatment and rehabilitation plan. This depends on the individual, their age, underlying conditions, and the severity of their injury/s. It is not uncommon to have a treatment schedule that could be weeks/months long. This can be tough on individuals with limited abilities and/or a slow progressive rehab to get back to normal. It is arduous, but to achieve optimal healing and health, it is expected.
Chiropractic medicine is no different. It’s non-invasive compared to surgery but not as immediate as medication/s. This places it in between. Recovery timelines can vary significantly based on the nature of the condition, the patient, their injury/s, and everything attached. Most chiropractic treatment and adjustment plans are scheduled according to the individual’s injury and/or condition. Every case is different, meaning that treatment could be a couple of sessions for an individual with mild sciatica to a few weeks or months for more severe injuries/conditions. Most want to know why chiropractors execute these plans over weeks and months.
The Body Needs To Get Used To The Adjustments
One reason for an extended adjustment schedule is to prevent adjustment shock. Adjustment shock often presents through soreness and tenderness, and there could be a feeling of soreness when sitting or standing or difficulty when trying to move with a normal range of motion. This happens when trying to heal the body too much and too fast. Trying to perform massive chiropractic adjustments without preparing the body could worsen and/or create further injury/s.
For example, correcting severe lordosis requires repositioning the spine’s curvature through properly planned out adjustment sessions. If a chiropractor tries to adjust/align the spine into place over a few days, this would be extremely uncomfortable and more than likely painful for the individual. Plus, there is a lack of musculoskeletal support from the rest of the body that is needed to make sure that the adjustments/changes take hold and are maintained. A chiropractor wants to avoid these issues to focus on getting the individual back to proper health.
Preparing The Body With A Solid Foundation
Chiropractic manipulations and adjustments need time to settle in, ensuring that they take hold and not shift back to the incorrect position. Spinal problems are not solved overnight. This means that the causes of misalignment will remain for a period as the treatment/adjustment process begins. A spaced-out schedule ensures that the adjustments are made accordingly to strengthen the spine through the process. This enables adjustments and the body to develop the necessary support system and prevent any negative re-shifting. As time goes on, the adjustments achieve total realignment, restoring the positive curvature that can be maintained.
Schedule Benefits
Finally, the step-by-step nature of a chiropractic adjustment schedule enables the treatment team to check the status of an adjustment plan. If radiological imaging shows changes, setbacks, or new issues arise, the treatment plan and schedule can be changed and adapted accordingly.
Body Composition Testing
Too Much Alcohol Can Slow Recovery From Tissue Injuries
Alcohol is often associated with celebrations, anniversaries, etc. But drinking too much can damage the immune system. Too much alcohol contributes to organ damage, specifically the liver. However, it is known to slow down recovery from tissue injuries, as well. Moderate drinking is defined as drinking up to 1 drink a day for women and up to 2 a day. Exceeding the recommended intake disrupts the immune pathways and impairs the body’s ability to fight off infections. Alcohol-related immune system damage has been associated with the development of certain types of cancer, including head and neck cancers among alcohol users. Before thinking that this is a problem that only affects chronic alcohol users, acute binge drinking can also severely impair the body’s immune system.
The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.
We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.
Holt, Kelly, et al. “The effects of a single session of chiropractic care on strength, cortical drive, and spinal excitability in stroke patients.” Scientific Reports vol. 9,1 2673. 25 Feb. 2019, doi:10.1038/s41598-019-39577-5
Iben, Axén, et al. “Chiropractic maintenance care – what’s new? A systematic review of the literature.” Chiropractic & manual therapies vol. 27 63. 21 Nov. 2019, doi:10.1186/s12998-019-0283-6
Mior, Silvano et al. “Chiropractic services in the active-duty military setting: a scoping review.” Chiropractic & manual therapies vol. 27 45. 15 Jul. 2019, doi:10.1186/s12998-019-0259-6
Pasala, Sumana et al. “Impact of Alcohol Abuse on the Adaptive Immune System.” Alcohol research: current reviews vol. 37,2 (2015): 185-97.
Muscle cramps are sudden and involuntary contractions of one or more of the body’s muscles. They often occur at night or at any moment stopped by a sudden Charley horse. These cramps can cause severe pain, making it impossible to move and use the affected muscle/s. They are usually brought on from:
Muscle cramps are common and can happen to anyone, but often occur to:
Indoor/outdoor physical work employees
Pregnant women
The elderly
Infants
Individuals that are overweight
Athletes
Cramping Up
Muscle cramps can be a symptom of a variety of medical issues. It is typically dehydration and muscle strain from overworking/exercising the muscles, but it can also be a sign of medical conditions like:
Poor circulation
Mineral depletion low levels of magnesium, calcium, potassium, and choline
Nerve disorders are rare cases, but a pinched nerve or spinal cord injury can cause nerve compression that can lead to cramping
Tight muscles, this comes from inactivity and not stretching the body causes the muscles to contract involuntarily
Hypothyroidism, a thyroid gland that is less active than normal can cause cramps
Liver disease
Muscle cramps can make daily activities difficult if not impossible to perform. They often happen at night affecting proper sleep. This can lead to:
Pain hangover
Grogginess
Fogginess
Cautious body behavior – as an individual wants to avoid pain and more cramping they begin to watch how they:
Step
Reach
Bend
Move
So as not to cause discomfort, pain, and further cramping, they develop awkward body positions that create more health problems from improper body posture.
Muscle cramps can happen to any muscle of the body. However, they present most often in the:
This is usually sudden, sharp pain. Individuals can also feel or see a lump of muscle tissue under the skin.
When to see a professional
They usually go away on their own not requiring medical care. However, seek medical attention if the cramps:
Are causing severe discomfort and pain
Severe swelling, redness, or changes in skin tone
Muscle weakness is present
They are occurring frequently
They do not improve with self-care
There is no connection with an obvious cause, like intense physical activity/exercise
Mineral Depletion
Choline is a nutrient that just as important but not as well known as B vitamins. Choline has a fundamental role in muscle physiology and low levels could be a cause/contributor of muscle cramping. Choline is well-known for its function as part of the neurotransmitter acetylcholine. This is a chemical messenger that transmits signals between nerve cells and muscles. Acetylcholine is the physiological link that tells the muscles to contract. This is where medications can interfere with the messaging system.
Most believe that muscle cramps are caused by magnesium deficiency. This is true, but magnesium is not the only nutrient that could present with muscle issues. Choline regulates intracellular calcium and muscle contraction. This is what helps bind calcium proteins to muscle receptors. Choline keeps minerals like calcium available to the muscles so they can use it instantly when they need to contract. For individuals with skeletal muscle issues, which can be muscle cramping, general soreness, or another type of issue, testing for choline status could be the key.
Prevention and Relief
Home self-care for prevention and relief includes:
Heat or ice application to the muscle/s and affected areas
Avoiding caffeine
Drink plenty of water before and during physical activities, indoor/outdoor work, exercise
The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.
Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico
References
American Osteopathic Association. Muscle Cramp. Accessed 12/10/2019.
Merck Manual. Muscle Cramps. Accessed 12/10/2019.
Miller, Timothy M, and Robert B Layzer. “Muscle cramps.” Muscle & nerve vol. 32,4 (2005): 431-42. doi:10.1002/mus.20341
Vitamin B12 and Shoulder Injuries. Most shoulder injuries involve the muscles, ligaments, and tendons. Individuals that perform repetitive arm motions/movements, constantly lift objects as part of their job, and athletes that use their arms repetitively have an increase in developing/experiencing shoulder injuries and problems. Shoulder injuries are commonly caused by physical activities that involve:
Excessive motions
Repetitive motions
Overhead motions
Sports like swimming, tennis, pitching, and weightlifting involve these repetitive arm/shoulder motions that contribute to shoulder injuries.
Injuries can also be brought on from everyday activities like washing/painting walls, hanging curtains/plants, and gardening.
Shoulder Injury Symptoms
If there is discomfort and/or pain in and around the shoulder here are a few ways to analyze the situation.
Does the shoulder feel like it could pop out or slide out of its socket?
Is there a lack of strength in the shoulder for normal daily activities?
If yes was an answer to any of these questions, individuals should consult an orthopedic surgeon and/or chiropractor for assistance in determining the problem and its severity.
Injury Categories
Individuals often underestimate the extent of an injury and usually just push/play through the discomfort and pain. This is how powerful the brain is as it ignores steady pain, weakness, or limitation of joint motion. Shoulder injuries and problems are grouped in the following categories.
Instability
This is when a shoulder joint moves/shifts or is forced out of its normal position. This is called instability and can result in dislocation of the joints in the shoulder. Individuals will experience pain when raising their arms. It can feel as if the shoulder is slipping out.
Impingement
Impingement is caused by excessive rubbing/friction of the muscles against the top part of the shoulder blade, known as the acromion. Impingement can happen during physical activities that require excessive overhead arm motion. Medical examination and care are recommended for inflammation, as it could eventually lead to a more serious injury.
Injuries
Bursitis
The bursa is the fluid-filled sacs that cushions the joints. These can become swollen and irritated from repetitive motions, falls, or other injuries. Individuals will notice the pain most when moving/rotating the shoulder.
Cartilage tear
The cartilage – the rubbery padding that goes around the rim of the shoulder joint can get damaged from repetitive motions, overextending, falls, or from intense force to the shoulder. With this type of injury individuals feel pain when reaching overhead, weakness, and/or catching, locking, and grinding feelings.
Rotator cuff tear
The rotator cuff consists of a group of muscles and tendons that hold the arm in place and allow for lifting the arm up and overhead. It can get damaged through overuse, falls, and regular wear and tear with age. Pain often presents at night, when lifting objects, and there could be a cracking sound when trying to move or rotate.
Frozen shoulder
This condition limits the joint’s movement. What happens is abnormal bands of tissue called adhesions build up in the joint and restrict movement. The shoulder can freeze up from not using it. This could be because pain or surgery causes an individual to use it less. This is when adhesions begin to build up.
Separation
This injury affects the joint where the collarbone and shoulder blade join. It is known as the acromioclavicular or AC joint. A fall or hard impact can tear the ligaments that hold it together. If the collarbone gets pushed out of place a bump forms/develops on top of the shoulder.
Fracture
A bone can break or crack from a vehicle accident, fall, or takes a hard hit. The most common fractures are to the clavicle – collarbone and the humerus – arm bone closest to the shoulder. This type of injury causes a great deal of pain and bruising. If the collarbone is broken, the shoulder can sag with the inability to lift the arm.
Vitamin B12
Rotator cuff injuries involve dysfunctional and/or damaged connective tissue. This could be from impaired collagen synthesisVitamin B12 helps combat inflammation and plays a significant role in collagen formation. Low vitamin B12 status can be directly linked to pro-inflammatory cytokines. This means that a lack of vitamin B12 increases inflammation.
Researchers followed a group of individuals to determine if their individual vitamin B12 levels correlated with an increased risk of a rotator cuff tear. To begin the study, levels of vitamin B12 were measured along with other nutrients that included:
Vitamin D
Zinc
Calcium
Magnesium
Folate
Homocysteine and blood sugar biomarkers, which are both associated with B12 metabolism were also measured. Homocysteine is a metabolite that builds up in the blood when specific nutrients, like B12, folate, or B6 become deficient. Elevated levels of homocysteine can be harmful and cause damage to blood vessels and brain tissue when not detoxified properly. In the study, the homocysteine levels did not differ between the groups, but vitamin B12 levels were significantly different.
The patients that were included were a healthy group that did not have any rotator cuff injury during the study.
The second group all experienced a rotator cuff tear that required surgery during the study.
With the various nutrients measured, only vitamin B12 and vitamin D showed differences. With the B12 and D being lower in the group that had the shoulder injury.
Specifically, the B12 levels in the healthy group were 627 pg/mL compared to 528 pg/mL in the injured group. This was a 16% decrease.
These subclinical deficiencies are usually missed with traditional serum testing which is why functional nutritional testing is clinically recommended.
Body Compositional Testing
Disclaimer
The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.
Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico
References
American Society for Surgery of the Hand: Shoulder Pain.
American Academy of Family Physicians: Shoulder Pain.
Knee Injuries, Surgeries, and Vitamin D Status. The knee joint is one of the largest and complex joints. It connects the thigh bone to the shinbone, which has a very important role in:
Supporting the body’s weight
Facilitating movement
Allowing the ability to bend the knee
Because of the complexity of the knee joint, it is highly susceptible to injuries. The most common injuries include tears in the:
Ligaments
Tendons
Cartilage
The kneecap itself can be fractured and/or dislocated.
Tears
Meniscal Tears
The meniscus is the cartilage between the knee joint that absorbs the impact/shock when running, playing sports, yard work, hiking, bicycling, etc. It cushions the joint and maintains stability.
Meniscus tears are common in sports that have a lot of jumping, starting/stopping quickly, changing direction suddenly, like volleyball, basketball, tennis, soccer, football. This is when the meniscus tears. Surgery can be required, depending on the severity/extent of the injury and tear.
Tendon Tears
The patellar tendon works with the knee muscles in the front of the thigh to straighten the leg. Tears in the patellar tendon are common among middle-aged individuals and those that participate in running or jumping sports.
A complete tear is considered a disabling injury that requires surgery for full functional recovery.
Fortunately, most tears are partial and require rest and chiropractic/physical therapy to heal.
Dislocation
Knee dislocations happen when the knee bones shift out of position. This can happen after a fall, car crash, or high-speed impact. It can also be caused by twisting the knee while the foot stays planted. Dislocations require relocation. However, sometimes a dislocated kneecap corrects itself and returns to the proper position. Other cases can require a mild sedative to allow a doctor to relocate the knee. Dislocations generally take around six weeks to fully heal.
Anterior Cruciate Ligament – ACL Injury
The anterior cruciate ligament or ACL is knee tissue that joins the upper and lower leg bones and maintains the knees’ stability. The ACL can be torn if the lower leg over-extends forward or if the leg gets twisted. ACL injuries are common knee injuries and account for around 40% of sports-related injuries. These injuries can range from a small tear in the ligament to a severe injury where the ligament tears completely or gets separated from the bone. Treatment depends on the severity of the injury. Depending on various factors including the severity of the tear, surgery could be required.
Knee Surgery
For most cases, surgery is done using arthroscopytechnology. This procedure uses small incisions to insert a camera and surgical instruments into the joint. Usually, two or three incisions are needed with recovery time being quicker than large incision surgery where the whole knee is opened. Minimally invasive arthroscopic surgery is preferred by sports medicine experts. With this procedure:
There is no need to cut the tendons or muscles
Bleeding is reduced
Small incisions decrease scarring
Recovery time is shorter
However, sometimes a large incision is required for complex surgical techniques. Common knee surgery procedures include:
Arthroscopy Surgery
This method allows the ability to see inside the knee joint. The procedure is often recommended for:
Diagnosis
Minor repairs to ligaments and/or tendons
Cartilage or bone that needs to be removed
Total Knee Replacement
A full knee replacement is known as arthroplasty. When the joint is damaged beyond repair from injury or disease, an implant is placed in the knee joint restoring function. A small amount of cartilage and bone from the shinbone and thigh bone gets removed for perfect placement of the new knee joint.
Revision Knee Replacement
Most knee replacements last around 15 – 20 years. For individuals that have knee replacement early, then a new operation for new implants could be required. Here, the surgeon removes the original prosthesis and replaces it with a new one.
Partial Knee Replacement
Some knee injuries do not require complete replacement. Here, only the worn-out portion of the joint is replaced. As an example, the cartilage that has been lost in an area of the knee can be repaired with a partial replacement.
Vitamin D Status
A study on athletes that underwent ACL surgery looked at their vitamin d status and how it affected their recovery.
The research concluded that vitamin D status had no effect on surgery outcomes.
However, those with the lowest vitamin D status had three times the failure rate than those with higher vitamin D
The average age of the individuals was around twenty-four and were healthy athletes.
Each of the patients in this study had their vitamin levels measured before the operation and were grouped based on their vitamin D status:
Group 1 vitamin D below 20 ng/mL – considered deficient
Group 2 vitamin D between 20-30 ng/mL – considered low but in a technical range
Group 3 vitamin D above 30 ng/mL – considered sufficient, but not optimal
All were followed for two years with their surgery recovery being measured with two systems.
The Lysholm score, which is a 100 point scoring system that looks at an individual’s knee functions that include:
Mechanical locking
Instability
Pain
Swelling
Stair climbing
Squatting
The WOMAC score is a scoring system that measures:
After 2 years, the Lysholm score and the WOMAC scores were similar.
However, there was a difference in the graft failure rate which was about 6% in group 1 with the lowest vitamin D and around 2% in groups 2 and 3. This shows that the lowest vitamin D status has three times the failure rate compared with those that had increased vitamin D levels. Vitamin D is a known anti-inflammatory with metabolic functions that are documented. Therefore, vitamin D does improve surgical success and recovery in healthy athletes.
Body Composition
Disclaimer
The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.
Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico
References
Brambilla, Lorenzo, et al. “Outcome of total hip and total knee arthroplasty and vitamin D homeostasis.” British medical bulletin vol. 135,1 (2020): 50-61. doi:10.1093/bmb/ldaa018
European Journal of Orthopedic Surgery and Traumatology, January 2021
Zhang, Hao et al. “Vitamin D Status and Patient Outcomes after Knee or Hip Surgery: A Meta-Analysis.” Annals of nutrition & metabolism vol. 73,2 (2018): 121-130. doi:10.1159/000490670
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine