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?
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)
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. https://aafa.org/allergies/types-of-allergies/food-allergies/
U.S. Department of Agriculture, FoodData Central. (2018). Sauce, fish, ready-to-serve. Retrieved from https://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 https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf
Can incorporating explosive strength training help develop power for athletes and sports enthusiasts who need to generate maximum energy quickly?
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. https://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. https://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
Can electrolyte chewing gum help physically active individuals, fitness enthusiasts, and athletes experiencing extreme heat and dehydration?
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 https://medlineplus.gov/fluidandelectrolytebalance.html
National Library of Medicine, MedlinePlus. (2023). Low blood sodium. Retrieved from https://medlineplus.gov/ency/article/000394.htm
National Library of Medicine MedlinePlus. (2023). Low blood potassium. Retrieved from https://medlineplus.gov/ency/article/000479.htm
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?
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 https://www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-works
American Diabetes Association. (2024). About diabetes: common terms. https://diabetes.org/about-diabetes/common-terms
Johns Hopkins Medicine. (2024). Liver: anatomy and functions. https://www.hopkinsmedicine.org/health/conditions-and-diseases/liver-anatomy-and-functions
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?
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:
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. https://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. https://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. https://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. https://doi.org/10.1177/0363546517697957
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?
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:
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:
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 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. https://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. https://doi.org/10.1007/s00167-018-5260-4
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?
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. https://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. https://doi.org/10.1589/jpts.30.411
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
