An axillary nerve injury can cause pain, weakness, and shoulder mobility loss. Can physical therapy help restore and maintain shoulder joint flexibility?
Axillary Nerve
The axillary nerve, or the circumflex nerve, is a peripheral nerve that runs through the shoulder and supports movement and sensation in the upper limbs. It originates in the neck at the brachial plexus, a network of nerves that extends from the neck and upper torso to the shoulders and arms. Its primary purpose is to supply nerve function to the shoulder joint and three muscles in the arm and also innervates some skin in the region.
Anatomy
Except for the cranial nerves, all the body’s nerves branch off from the spinal cord, emerge from between vertebrae and continue to branch off as they travel to various muscles and other structures. The axillary nerve is named after the axilla, the medical name for the armpit. Individuals have two, one on each side. After leaving the spinal column, the axillary nerve runs behind the axillary artery and continues to the shoulder blade’s lower edge of the subscapularis muscle. It winds back and travels down the arm along the posterior humeral circumflex artery, which then passes through the quadrangular space (a small area of the shoulder blade just above the armpit where there is a gap in the muscles that allows nerves and blood vessels to pass through to the arm before it divides into terminal branches, which are:
Anterior Division
Supplies motor innervation to the deltoid’s anterior and middle heads, allowing the arm to abduct or move away from the body.
It winds around the neck of the humerus/funny bone, goes beneath the deltoid muscle, and then connects to the forward edge of the deltoid.
A few small cutaneous branches serve the skin in that area.
Posterior Division
Innervates the teres minor muscles and the lower part of the deltoid.
It enters the deep fascia and becomes the superior lateral cutaneous nerve.
It then wraps around the lower edge of the deltoid, connects to the skin over the lower two-thirds of the muscle, and covers the long head of the triceps brachii.
Articular Branch
Comes from the trunk of the axillary nerve and enters the glenohumeral joint, which is in the shoulder, below the subscapularis muscle.
Anatomical Variations
In a case report, healthcare providers noted an incidence of the nerve branching directly off the upper trunk of the brachial plexus rather than the posterior cord. (Subasinghe S. K. and Goonewardene S. 2016) In this case, it innervated the subscapularis muscle, latissimus dorsi, and the deltoid and teres minor muscles and also had a communicating branch to the posterior cord. Another case documented multiple abnormalities in the course of the axillary nerve in an individual with pain and severely limited shoulder mobility. (Pizzo R. A. et al., 2019) During reverse shoulder arthroplasty, the surgeon discovered that the axillary nerve ran beside the coracoid process instead of underneath and stayed close to the subscapularis muscle instead of traveling through the quadrangular space. The case noted earlier reports of axillary nerves not running through the quadrangular space. In those cases, the nerve pierced the subscapularis muscle or split into branches before reaching the quadrangular space.
Function
The axillary nerve functions as a motor nerve that controls movement and a sensory nerve that controls sensations like touch or temperature.
Motor
As a motor nerve, the axillary nerve innervates three muscles in the arm and includes:
Deltoid
Allows flexing of the shoulder joint and rotating the shoulder inward.
Long Head of the Triceps
It runs down the back of the outer arm, allowing straightening, pulling the upper arm toward the body, or extending it backward.
The radial nerve can also innervate this muscle.
Teres Minor
One of the rotator cuff muscles starts outside the shoulder and runs diagonally along the bottom edge of the shoulder blade.
It works with other muscles to allow for the external rotation of the shoulder joint.
Sensory
In its sensory role, the nerve carries information to the brain from the following:
Glenohumeral joint or the ball-and-socket joint in the shoulder.
The skin on the lower two-thirds of the deltoid muscle through the superior lateral cutaneous branch.
Injuries and Conditions
Problems with the axillary nerve can be caused by injuries anywhere along the arm and shoulder and by disease. Common injuries include:
Dislocations
Of the shoulder joint, which can cause axillary nerve palsy.
Fracture
Of the surgical neck of the humerus.
Compression
This stems from walking with crutches, also known as crutch palsy.
Direct Trauma
This can be from an impact sports, work, automobile accident, collision, or laceration.
Added Pressure
This can be from wearing a cast or splint.
Surgical Accidental Injury
An injury or damage can come from shoulder surgery, especially arthroscopic surgery on the inferior glenoid and capsule.
Quadrangular Space Syndrome
This is where the axillary nerve is compressed where it passes through that space, which is most common in athletes who perform frequent overhead motions)
Nerve Root Damage
Between the fifth and sixth cervical vertebrae, where the nerve emerges from the spinal cord, which can be caused by traction, compression, spinal disc prolapse, or a bulging disc.
Systemic Neurological Disorders
Example – multiple sclerosis
Erb’s Palsy
A condition often is the result of a birth injury called shoulder dystocia, in which a baby’s shoulder/s becomes stuck during childbirth.
Axillary Nerve Palsy
Damage can result in a type of peripheral neuropathy that can cause weakness in the deltoid and teres minor muscles.
This can result in losing the ability to lift the arm away from the body and weakness in various shoulder movements.
If the damage is severe enough, it can cause paralysis of the deltoid and other minor muscles, resulting in flat shoulder deformity, in which individuals cannot lay their shoulders flat when lying down.
Axillary nerve damage also can lead to a change, reduction, or loss of sensation in a small part of the arm just below the shoulder.
Nerve Injury Statistics
Three times more common in men than women.
It may be present in as many as 65% of shoulder injuries.
The risk of injury due to dislocation is significantly increased after age 50.
Tests
If a healthcare provider suspects a problem with axillary nerve function, they’ll test the shoulder’s range of motion and skin sensitivity. A difference in the range of motion between the shoulders can indicate a nerve injury. Individuals may be sent for electromyography and a nerve conduction study to verify nerve palsy. In some cases, an MRI and/or X-rays may be ordered, especially if the cause of possible nerve damage is unknown.
Rehabilitation
Depending on the severity and cause of the injury, non-surgical treatments may be recommended, with surgery as a last resort. Non-surgical treatment can include some combination of immobilization, rest, ice, physical therapy, and anti-inflammatory meds. Physical treatment typically lasts about six weeks and focuses on strengthening and stimulating the muscles to prevent joint stiffness, which can impair long-term function.
Surgery
If conservative treatments don’t work, surgery may be recommended, especially if several months have passed without improvement. Surgical outcomes are generally better if surgery is performed within six months of the injury, and regardless of the time frame, the prognosis is considered positive in about 90% of cases. Surgical procedures performed for axillary nerve dysfunction or injury include:
Neurolysis
This procedure involves targeted damage/degeneration of nerve fibers, interrupts the nerve signals, and eliminates pain while the damaged area heals.
Neurorrhaphy
This procedure stitches a severed nerve back together.
Nerve Grafting
Grafting involves transplanting a portion of another nerve, usually the sural nerve, to reconnect severed nerves.
This helps, especially when the damaged portion is too large to be repaired by neurorrhaphy.
It allows a pathway for signals and encourages the regrowth of nerve axons.
Neurotization or Nerve Transfer
Similar to grafting but used when the nerve is too damaged to heal.
This procedure involves transplanting a healthy but less important nerve, or a portion of a nerve, to replace the damaged one and restore function.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Shoulder Pain Chiropractic Treatment
References
Subasinghe, S. K., & Goonewardene, S. (2016). A Rare Variation of the Axillary Nerve Formed as Direct Branch of the Upper Trunk. Journal of clinical and diagnostic research : JCDR, 10(8), ND01–ND2. doi.org/10.7860/JCDR/2016/20048.8255
Pizzo, R. A., Lynch, J., Adams, D. M., Yoon, R. S., & Liporace, F. A. (2019). Unusual anatomic variant of the axillary nerve challenging the deltopectoral approach to the shoulder: a case report. Patient safety in surgery, 13, 9. doi.org/10.1186/s13037-019-0189-1
The vastus lateralis is a muscle on the outside part of the thigh. Injuries to the muscle include strains, tendinitis, femoral nerve compression, and others. Can rehabilitation like heat and ice, massage, and strength and mobility exercises help individuals return to normal activities and function?
Vastus Lateralis Muscle
The vastus lateralis is the largest of the four quadriceps muscles on the thigh’s outer portion. The vastus lateralis helps extend the knee joint and maintain the knee position when walking or running. The vastus lateralis functions to work with the other quad muscles to help extend the knee joint.
Anatomy
Most muscles are attached to bone points of attachment, called the origin and insertion points. The vastus lateralis origin and insertion points are as follows (Vieira, EPL. 2017)
Origin
The origin is on the upper inter-trochanteric line of the femur or thigh bone.
It also arises from the base of the greater trochanter and the linea aspera, the supracondylar ridge, and the lateral intermuscular septum.
Insertion
From its origin, the muscle courses down the lateral thigh and inserts as part of the lateral quadriceps tendon on the tibial tubercle, an elevated portion of the upper shin.
The muscle is a large, flat structure with different attachments and a flat aponeurosis or sheath of connective tissue on the outer thigh.
The femoral nerve from lower back levels two, three, and four controls or innervates the muscle.
Blood supply to the muscle goes through the lateral circumflex femoral artery of the upper thigh.
Function
The muscle works with the other quadriceps muscles to extend or straighten the knee. The quads are responsible for functional activities like walking, running, climbing stairs, and getting up from a seated position. The vastus lateralis and the iliotibial band, which courses down the lateral thigh next to this muscle, form the lateral wall of the thigh. The vastus lateralis is on the opposite side of the vastus medialis muscle on the inner portion of the thigh. These muscles work together to maintain the appropriate position of the patella/kneecap in the femoral groove of the thigh bone. Malfunctioning these muscles properly can lead to knee pain from patellofemoral stress syndrome. (American Academy of Orthopaedic Surgeons, 2024)
Conditions
Many different injuries and conditions can affect the vastus lateralis and quad muscles, especially in athletes or active individuals. These injuries can cause vastus lateralis pain and other problems. (Timothy J. Von Fange, 2024) Some of the injuries and conditions include:
Patellofemoral Stress Syndrome – PFSS
This occurs when the kneecap tracks improperly in the femoral groove of the knee joint.
This leads to pain and difficulty when walking and running.
Vastus Lateralis Strain
A sudden force on the thigh can cause the quad muscle to be strained.
If the vastus lateralis suffers a pull injury, individuals may have pain, muscle swelling, thigh bruising, and walking difficulties.
Patellar Tendinitis
Irritation of the quad tendon that courses over the kneecap can cause patellar tendinitis.
Femoral Nerve Compression Weakness
The femoral nerve may become pinched or irritated from a herniated disc, lumbar stenosis, or arthritis.
Pain, numbness, tingling, or weakness in the thigh may result.
Iliotibial Band Friction Syndrome
Tight or weak muscles can irritate the IT band, and the vastus lateralis muscle can be affected.
Injury Rehabilitation
Injury to the vastus lateralis or quad muscles can cause pain, swelling of the thigh, or limited walking ability. Various treatments are available to help expedite recovery. A primary healthcare provider may recommend working with a physical therapy team. Self-care techniques can include:
Heat and Ice
Ice may be applied to the lateral thigh the first few days after injury to control pain and decrease swelling and inflammation.
Ice should be applied for 10 to 15 minutes.
Individuals may switch to heat two to three days after to promote circulation and improve tissue mobility.
Heat should be applied for 10 to 15 minutes.
Massage
Massage can help decrease pain and promote circulation.
Massage techniques can improve tissue mobility before stretching to help improve quadriceps motion.
Exercises and Stretching
A physical therapy team will prescribe certain exercises and stretches to help regain strength and range of motion. After an injury, quad stretching can improve the mobility and function of the muscle group.
Prone Towel Quad Stretch
Lie on your stomach and place a towel or strap around the ankle.
Bend the knee up, and gently pull on the towel to bend the knee fully.
A pulling sensation should be felt in the front of the thigh.
Hold the stretch for 30 seconds and release.
Repeat three times.
Half-kneeling Quad and Hip Flexor Stretch
Kneel on one knee.
Slowly move forward until a stretch is felt in the front of the hip and thigh.
Hold this position for 30 seconds.
Relax back to the starting position.
Repeat three times.
Back Exercises
If femoral nerve irritation coming from the lower back is causing thigh pain or weakness, exercises to release the nerve may be helpful and can include:
Prone press-ups
Supine lumbar flexion
Lumbar side glides
The exercises are designed to relieve pressure on the lumbar nerve, and postural correction exercises may be performed to maintain decompression.
Strengthening
Weakness to the vastus laterals and quads may be causing injury, and strengthening exercises may be prescribed during rehabilitation and can include:
Hip-strengthening exercises
Straight leg raises
Leg extension exercises
Lunges
Squats
Strengthening exercises should be done two to four times weekly with appropriate rest between sessions.
Balance exercises and sport-specific plyometric training may be recommended to ensure the quad functions normally.
Most quadriceps and vastus lateralis muscle injuries heal within six to eight weeks.
Recovery may be shorter or longer depending on the nature of the injury.
Injury Medical Chiropractic and Functional Medicine Clinic
By understanding the anatomy and function of the vastus lateralis muscle, a healthcare provider can help individuals understand their specific injury and develop a treatment program to rehabilitate the muscle properly. At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for you and strive to develop fitness and better the body through research methods and total wellness programs. These natural programs use the body’s ability to achieve improvement goals, and athletes can condition themselves to excel in their sport through proper fitness and nutrition. Our providers use an integrated approach to create personalized programs, often including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.
Ramírez-delaCruz, M., Bravo-Sánchez, A., Esteban-García, P., Jiménez, F., & Abián-Vicén, J. (2022). Effects of Plyometric Training on Lower Body Muscle Architecture, Tendon Structure, Stiffness, and Physical Performance: A Systematic Review and Meta-analysis. Sports medicine – open, 8(1), 40. doi.org/10.1186/s40798-022-00431-0
Can beginner workouts help individuals who want to improve their health by helping them lose weight and improve their quality of life?
Beginner Workouts
Individuals new to exercise do not need to go through intense workout sessions to gain the benefits of physical activity. Basic exercises and beginner workouts that can be done at home or outdoors, whichever is better or more convenient, are recommended when starting a fitness regimen to lose weight and improve overall health.
Health Benefits
Basic exercise sessions are the building blocks of a fitness program. They encourage habits that lead to significant weight loss and lifelong weight management skills. Here are a few workouts considered easy because they don’t require gym equipment, their intensity can be adjusted to match an individual’s physical activity level, and some can be done from a chair or bed for those who have trouble standing for long periods. Exercising offers immediate benefits, including increasing brain health and improving mood and long-term effects like decreased disease risk. (Centers for Disease Control and Prevention, 2024)
Easy Exercises
For individuals who are completely new to exercise, low-intensity activity sessions can help burn more calories so long as they don’t compensate for the hunger that the physical activity creates by eating more. Combining diet with exercise is essential if weight loss is the goal. This can involve learning to eat lean protein, fruit, and vegetables and watching portion sizes. Studies of low-intensity exercise show the body burns fat when performing basic exercise and physical activities. (Lee D. et al., 2021) Another study looked at the effect of beginner workouts on cortisol levels. Cortisol is a hormone associated with abdominal weight gain when levels stay elevated for long periods. The study found that low-intensity exercise decreased circulating cortisol levels. (Gerber M. et al., 2020) Beginner exercises to lose weight also help individuals (Vina J. et al., 2012)
Increase self-confidence
Decrease stress levels
Improve sleep
Establish healthy habits
Burn calories to stimulate weight loss and sustain weight management.
Develop strong muscles
Basic exercise remains a core component of fitness programs for many. This includes individuals with type 2 diabetes, metabolic syndrome, and cardiovascular disease. (Apostolopoulos V. et al., 2014)
Easy Workouts
Types of beginner workouts include:
Bodyweight training
Chair workouts
Dancing workouts
Online workouts
Shadowboxing
Stairclimbing
Aqua jogging
Biking
Walking
Gardening and yard work
At-Home
Set short-term goals to complete three workouts during the first week, then gradually add workout days until you can perform some form of physical activity on most days. The type of exercise chosen is less important than the consistency of the program.
Bodyweight Training
No special gym equipment is needed to burn calories and build stronger muscles.
Take 10 to 15 minutes for five incline push-ups against a surface that allows the body to be at an incline, such as a countertop, bathroom sink, etc.
Five chair squats
Five walking lunges or stationary lunges, holding on to a countertop for support.
Repeat the sequence two to three times.
Chair Workout
Individuals who are uncomfortable standing for long periods use a sturdy chair and complete 10 to 15 minutes of movement with a seated workout several times weekly.
Dancing
Put on music and dance for 15 to 30 minutes.
No choreography is necessary.
The important thing is to move to the music.
Online Workouts
Many online workouts are free, and most offer easy workouts for beginners.
Shadowboxing
Shadowboxing is easy, with no equipment required, and it helps to decrease stress.
Stairclimbing
Take 10 minutes to walk up and down a flight of steps.
Those who don’t have a staircase available can use a step or platform.
Outdoors
Exercising outside provides extra perks. There are stress-relieving benefits to breathing fresh air and enjoying the outdoors.
Aqua Jogging
Try pool running or aqua jogging for those with joint pain when walking for long periods.
Floatation devices keep the upper body afloat.
Once in the water, walk without letting your feet touch the bottom of the pool.
If no floatation device is available, individuals can walk in the water with their feet on the pool floor.
Biking
Take a leisurely spin around the neighborhood
Ride on a continuous path or track requiring 20 to 30 minutes of pedaling.
Walking
A 30-minute walk workout can be counted as daily exercise.
Walk slowly for five minutes.
Pick up the pace for 20 minutes
Cool down and walk slowly for five minutes.
Gardening or Yard Work
Spending time in the garden or yard is a great way to work muscles and burn calories.
Digging, weeding, raking, and mowing are all recommended activities that count as exercise for beginners.
Injury Medical Chiropractic and Functional Medicine Clinic
Remember, as a beginner, the point is to get the body moving, establish a workout routine, and gradually build confidence to increase exercise enjoyment and health benefits. Workouts for beginners, especially those who still need to maintain an exercise program, are designed to develop life-long habits of well-being. At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for you and strive to develop fitness and better the body through research methods and total wellness programs. These natural programs use the body’s ability to achieve improvement goals, and athletes can condition themselves to excel in their sport through proper fitness and nutrition. Our providers use an integrated approach to create personalized programs, often including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.
Lee, D., Son, J. Y., Ju, H. M., Won, J. H., Park, S. B., & Yang, W. H. (2021). Effects of Individualized Low-Intensity Exercise and Its Duration on Recovery Ability in Adults. Healthcare (Basel, Switzerland), 9(3), 249. doi.org/10.3390/healthcare9030249
Gerber, M., Imboden, C., Beck, J., Brand, S., Colledge, F., Eckert, A., Holsboer-Trachsler, E., Pühse, U., & Hatzinger, M. (2020). Effects of Aerobic Exercise on Cortisol Stress Reactivity in Response to the Trier Social Stress Test in Inpatients with Major Depressive Disorders: A Randomized Controlled Trial. Journal of clinical medicine, 9(5), 1419. doi.org/10.3390/jcm9051419
Vina, J., Sanchis-Gomar, F., Martinez-Bello, V., & Gomez-Cabrera, M. C. (2012). Exercise acts as a drug; the pharmacological benefits of exercise. British journal of pharmacology, 167(1), 1–12. doi.org/10.1111/j.1476-5381.2012.01970.x
Apostolopoulos, V., Borkoles, E., Polman, R., & Stojanovska, L. (2014). Physical and immunological aspects of exercise in chronic diseases. Immunotherapy, 6(10), 1145–1157. doi.org/10.2217/imt.14.76
Individuals experiencing persistent pain, weakness, numbness, and tingling in the back could be suffering from nerve root encroachment. Could surgery ease nerve compression and improve symptoms for persistent and severe cases?
Surgical Decompression
The pain, weakness, numbness, and tingling associated with nerve root encroachment are usually first treated with non-surgical therapies that include:
Anti-inflammatory medications
Physical therapy
This can be enough to address the irritation of the spinal nerve root. But when cases become severe, surgical decompression may be recommended and necessary. It can be done in a couple of different ways.
Causes and Symptoms
Vertebrae are bones in the spine. Small openings called foramina allow a spinal nerve root to pass through on each side of the vertebra. When nerve root encroachment is present, the spinal nerve root gets compressed, pinched, and trapped, which can cause peripheral symptoms such as numbness, tingling, pain, or weakness to develop. Nerve root encroachment is typically caused by normal aging degenerative wear and tear changes in the vertebrae. (Choi Y. K. 2019) These degenerative changes can include:
Facet joint hypertrophy
Ligament and bone hypertrophy
Disc disorders
Formation of bone spurs or osteophytes.
If these degenerative changes progress, they can encroach and compress a nerve root, leading to peripheral symptoms. (Choi Y. K. 2019)
When Surgery Is Recommended
When symptoms occur, initial treatment will involve:
Physical therapy
Chiropractic realignment
Massage therapies
Rest
Lifestyle adjustments
Nonsteroidal anti-inflammatories – NSAIDs
Corticosteroid injections into the spine
If conservative therapies don’t fully heal or improve symptoms or there are neurological problems like difficulty with balance or walking, then surgery may be recommended. Severe pain that limits normal function is an indication for surgery, and rapidly progressive weakness of the arms and/or legs or signs of cauda equina syndrome are indications for emergency surgery.
Surgery Options
Different types of spinal surgery may be performed. A neurosurgeon will decide the best procedure for each patient based on their case, age, medical conditions, and other factors. Specific spinal surgical decompression depends on what is causing the nerve compression. In most cases, it involves removing bone or tissue to relieve nerve pressure or provide support to stabilize the joint. The most common types of surgical decompression include: (Mayo Clinic Health System, 2022)
Maintain the stability and alignment of the spine.
Improve the stability and alignment of the spine.
Anterior Surgery
The anterior approach to surgery means that the spine is accessed through the anterior/front of the spine. In this surgery, one or more discs and bone spurs may be removed through an incision in the front of the neck. (American Association of Neurological Surgeons, 2024) For example, an anterior cervical discectomy may alleviate pressure on one or more nerve roots in the neck. With an anterior lumbar interbody fusion, a surgeon removes a degenerative disc in the lower spinal area by going through a patient’s lower abdomen. (American Association of Neurological Surgeons, 2024) After the disc is removed, a structural device, usually made of bone, fills the space where it once was. This device encourages bone healing and helps the vertebrae’s bodies fuse.
Posterior Surgery
Posterior surgery means the spine is accessed through the posterior/back of the spine. An example is removing a thickened ligament, bone spur, or disc material in the neck. To do this, a small incision in the back of the neck may be made to remove part of the back of the vertebrae called the lamina. This is called a posterior cervical laminectomy. (American Association of Neurological Surgeons, 2024) A posterior lumbar interbody fusion removes a degenerative disc by going through the back. (American Association of Neurological Surgeons, 2024) Like the anterior approach, a structural device often contains bone to fill the space where the disc once was to fuse the bones.
Potential Risks
As with any surgery, it’s important that the individual and their healthcare provider carefully discuss the benefits and risks. Spinal surgical decompression includes: (Proietti L. et al., 2013)
Bleeding
Blood clots
Surgical site infection
Urinary tract infection
Lung infection
Intestinal blockage
There are also specific risks to the area of the spine being operated on and how it is surgically approached. For example, a cervical anterior procedure may injure the esophagus, trachea, or carotid artery. Likewise, damage to the C5 nerve root/C5 palsy can occur from cervical spinal decompressive surgery. This complication causes weakness, numbness, and pain in the shoulders. (Thompson S. E. et al., 2017) The spinal cord may also be injured during surgery and result in paralysis, although this is rare. (American Association of Neurological Surgeons, 2024)
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
The Non-Surgical Solution
References
Choi Y. K. (2019). Lumbar foraminal neuropathy: an update on non-surgical management. The Korean journal of pain, 32(3), 147–159. doi.org/10.3344/kjp.2019.32.3.147
Proietti, L., Scaramuzzo, L., Schiro’, G. R., Sessa, S., & Logroscino, C. A. (2013). Complications in lumbar spine surgery: A retrospective analysis. Indian journal of orthopaedics, 47(4), 340–345. doi.org/10.4103/0019-5413.114909
Thompson, S. E., Smith, Z. A., Hsu, W. K., Nassr, A., Mroz, T. E., Fish, D. E., Wang, J. C., Fehlings, M. G., Tannoury, C. A., Tannoury, T., Tortolani, P. J., Traynelis, V. C., Gokaslan, Z., Hilibrand, A. S., Isaacs, R. E., Mummaneni, P. V., Chou, D., Qureshi, S. A., Cho, S. K., Baird, E. O., … Riew, K. D. (2017). C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases. Global spine journal, 7(1 Suppl), 64S–70S. doi.org/10.1177/2192568216688189
Can individuals maintain proper hydration levels in their bodies to prevent spinal pain and other musculoskeletal conditions?
Introduction
When making small changes to better their health and wellness, many understand that eating nutritional foods, exercising, and finding ways to reduce the pain and stress that environmental factors have affected the body. However, there is also another crucial component to a person’s health and wellness, and that is staying hydrated. Many individuals sometimes don’t realize that the human body contains about 60% of the water, which helps every vital organ, muscle, tissue, and vertebra in the body to function. However, many individuals who do not consume enough water due to a stressful event, exercising, or just wanting to drink sugary drinks will feel pain and discomfort in their bodies. This can range from mild headaches to back pain. Today’s article focuses on what spinal pain correlates with the back, why staying hydrated can reduce spinal pain and ways to stay hydrated. We talk with certified associated medical providers who inform our patients to maintain proper hydration to reduce the chances of spinal pain affecting their bodies. While asking their associated medical provider intricate questions, we advise patients to incorporate daily hydration levels as part of their routine to reduce the chances of spinal pain from returning. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.
Spinal Pain Is Correlated With The Back
Do you feel constant aches or pains after a stressful day? Do you feel like chugging gallons of water but still feel thirsty? Or have you been noticing that you have been dealing with limited mobility that has been causing you pain and discomfort in your lower back? These pain-like scenarios are multifactorial and can correlate with spinal pain affecting the back. Now, many people wonder why spinal pain is associated with back pain. The spine is crucial in allowing the individual to be upright and move around during daily activities. The spinal vertebrae discs are between the bones, which would enable shock absorption when a person twists, bends, or flexes so the bones don’t rub together. However, when the body ages, the spine does, too, which causes the intervertebral disc to gradually fall and change the dynamics of the affected spine segments. (Kos et al., 2019) To that point, when the intervertebral disc becomes compressed due to degeneration, it can lead to the development of back pain.
Since low back pain is a multifactorial musculoskeletal condition, many individuals often develop low back pain from numerous environmental risk factors like physical labor, excessive sitting or standing, poor dieting, andphysical inactivity, which can cause individuals to have a loss of sensation, reduced reflexes, limited range of movements and tenderness can affect a person’s gait and posture. (Kabeer et al., 2023) When the spinal discs are being compressed, the water inside the disc becomes dehydrated and is linked to lower back pain. (Cheung et al., 2023) When the spinal discs are dehydrated in the spine due to improper hydration, it can lead to immobility, cause the disc to degenerate, and cause spinal structural defects that cause the surrounding muscles and tissues to have biomechanical instability and inflammation. (Hauser et al., 2022) When the body starts dehydrating, it retrieves water from the spine and other parts to sustain life and keep the vital organs functioning.
Eating Right To Feel Better- Video
Why Staying Hydrated Can Reduce Spinal Pain
Proper hydration is key to reducing the chances of spinal pain. By staying hydrated with plain, pure water, individuals can stay focused, remove toxins from the body, aid in weight reduction, and reduce muscle and low back pain. (Nsiah-Asamoah & Buxton, 2021) Drinking at least 64 ounces of water a day can rehydrate the body and prevent future issues that can cause pain.Proper hydration allows the body to maintain cell activity and regulate body temperature, reducing the chances of pain affecting the body.
Ways to Stay Hydrated
There are ways to stay hydrated and allow the body to have proper hydration levels. Incorporating hydrating fruits and vegetables can help aid in proper hydration as these fruits and vegetables contain about 90% water and the essential nutrients. Additionally, when individuals try to get their hydration levels back up, they are encouraged to drink more fluids as they prefer, especially if they feel unwell. This is to ensure that the body is hydrated enough so that individuals can receive subcutaneous or intravenous fluid supplements combined with regular fluid intake. (Li et al., 2023) Another way many individuals can stay hydrated is to combine non-surgical treatments like chiropractic care and spinal decompression to help realign and lengthen the spine to reduce unwanted pressure on the spinal discs and rehydrate them. The combination of non-surgical treatments and drinking plenty of hydrating fluids can help many individuals dealing with back pain associated with the spine as they start to make small changes to their routine and can live a life pain-free.
References
Cheung, S. T. Y., Cheung, P. W. H., & Cheung, J. P. Y. (2023). Why Are Some Intervertebral Discs More Prone to Degeneration?: Insights Into Isolated Thoracic “Dysgeneration”. Spine (Phila Pa 1976), 48(12), E177-E187. doi.org/10.1097/BRS.0000000000004632
Hauser, R. A., Matias, D., Woznica, D., Rawlings, B., & Woldin, B. A. (2022). Lumbar instability as an etiology of low back pain and its treatment by prolotherapy: A review. J Back Musculoskelet Rehabil, 35(4), 701-712. doi.org/10.3233/BMR-210097
Kabeer, A. S., Osmani, H. T., Patel, J., Robinson, P., & Ahmed, N. (2023). The adult with low back pain: causes, diagnosis, imaging features and management. Br J Hosp Med (Lond), 84(10), 1-9. doi.org/10.12968/hmed.2023.0063
Kos, N., Gradisnik, L., & Velnar, T. (2019). A Brief Review of the Degenerative Intervertebral Disc Disease. Med Arch, 73(6), 421-424. doi.org/10.5455/medarh.2019.73.421-424
Li, S., Xiao, X., & Zhang, X. (2023). Hydration Status in Older Adults: Current Knowledge and Future Challenges. Nutrients, 15(11). doi.org/10.3390/nu15112609
Nsiah-Asamoah, C. N. A., & Buxton, D. N. B. (2021). Hydration and water intake practices of commercial long-distance drivers in Ghana: what do they know and why does it matter? Heliyon, 7(3), e06512. doi.org/10.1016/j.heliyon.2021.e06512
Does an individual’s ideal daily intake of vegetables depend on age, sex, and activity level?
Daily Serving of Vegetables
Vegetables are vital to a healthy diet. Every type offers various nutrients in a unique combination of vitamins, minerals, and phytochemicals. Plus, they are low in fat and calories and packed with fiber. The U.S. Department of Agriculture and other health organizations recommend eating a variety for optimal health. An age guide recommends the number of cups of vegetables that babies and older adults should consume daily. The U.S. Centers for Disease Control and Prevention reports that very few individuals meet the vegetable consumption guidelines, putting them at risk for chronic diseases like diabetes and heart disease. (U.S. Centers for Disease Control and Prevention, 2017)
What Is a Serving?
Current Dietary Guidelines recommend 2 1/2 cups of vegetables or nine servings daily. However, the amount varies by age. Serving sizes are also based on the type of vegetable. Overall, individuals are recommended to consume a variety each day. For most vegetables, a serving equals the amount that will fill one measuring cup. However, a serving of raw leafy greens like spinach and lettuce is two cups (U. S. Department of Agriculture, 2020), and eight ounces of vegetable juice also counts as one cup serving. For those who don’t have a measuring cup or kitchen scale, here are some one-cup equivalents for certain vegetables.
One large tomato
One medium potato
One large ear of corn
One large sweet pepper
One large sweet potato
Two medium carrots
Five or six broccoli florets
Another way is to use tablespoons—one cup contains around 16 tablespoons, which can be used when calculating servings for babies, toddlers, and young children.
Babies
Most babies are ready to eat solid foods between four and six months. There’s no ideal order, so starting with vegetables is fine. Starting babies with foods like peas, carrots, and squash could help encourage a preference for these foods that will carry on into adulthood, as babies tend to gravitate toward sweet flavors and may only want applesauce and pears, which could lead to not wanting to eat vegetables. It is recommended to start with a few teaspoons at a time. Eventually, they will eat about three or four tablespoons of baby food, like cereal or purees, a few times a day, which can fill about half a cup.
Toddlers 2-3
Toddlers age two to three should consume one cup of vegetables each day. If that sounds like a lot, remember that one cup can be spread throughout the day—it doesn’t have to be finished in a single meal. It also means one cup of various vegetables, not just one type. For example, some baby carrots during breakfast, steamed broccoli for lunch, and roasted sweet potatoes with dinner. Each serving can include four tablespoons that will become one serving. And if the only vegetable the toddler will eat is corn, that’s okay. There are also ways to disguise vegetables so they will eat them, like spinach or kale, which can disappear into a fruit smoothie. Children under five can choke on uncooked fruits and vegetables, so make sure whatever form is safe.
Young Children 4-8
Boys and girls in this age group should eat one and a half cups of vegetables daily. Regarding preparation, it’s fine to eat raw and cooked veggies. However, four-year-olds are still at risk of choking on raw vegetables. Cut carrots, bell peppers, and other vegetables into pieces no larger than a half-inch long so they won’t get stuck in their throat if inadvertently swallowed without chewing properly. And steamed, baked, and roasted vegetables are the healthiest.
Tweens 9-13
During the tween years, nutritional needs vary slightly based on sex. The recommended daily amount for girls is at least two cups. For boys, the recommendation is at least two and a half cups. Tweens of either gender who are especially active benefit from eating more than the suggested minimum. Research shows that boys eat fewer vegetables and fruits than girls. (Bere E. et al., 2008) Offer as much variety of vegetables and ways to prepare to find the ones they enjoy most.
Teens 14-18
Teenage girls should eat at least two and a half cups of vegetables daily, and boys eat at least three cups. Active teens who get 30 minutes of exercise daily may need more. However, it can be harder to monitor their vegetable intake as kids get older and spend more time eating away from home. In all family meals, try to include a variety of healthy prepared vegetables like:
Raw in salads
Steamed
Roasted
Baked as a side dish
Folded into omelets
Added to soups and stews
Layered on pizzas
Make it easy for teenagers to have vegetables between meals. Pre-cut carrots, celery, and bell peppers can be kept front and center in the fridge alongside hummus or guacamole for dipping.
Young Adults 19-30
The recommended daily amount of vegetables for individuals ages 19 to 30 is the same as for teens: at least three cups daily for men and at least two and a half cups for women. Those who exercise should include more. If a busy lifestyle makes getting all the vegetables needed difficult, take advantage of options like smoothies, including vegetables, pre-tossed salads, and prepped-for-cooking vegetables at the store. They may be more expensive, but if the time saved makes it easier to eat vegetables, it may be worth it, and eventually, individuals will learn how to prepare their own. Kitchen gadgets, like a smoothie blender, can help with faster preparations.
Adults 31-50
As with young adults, the amount of vegetables should be at least two and a half cups daily for women, three cups for men, and more for those who work out or are physically active.
Older Adults 51-Up
Because the body’s metabolism slows down, individuals 51 and older are advised to cut calories to prevent weight gain. This also applies to calories from vegetables. Women 51 and older should consume around two cups of vegetables daily, and men should consume around two and a half cups. Active older adults should continue to factor in the amount of physical activity with vegetable intake. Individuals should talk to their doctor or see a nutritionist if they want more specific guidance on what to include in their diet.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic providers use an integrated approach to create personalized care plans for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and sports 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.
Bere, E., Brug, J., & Klepp, K. I. (2008). Why do boys eat less fruit and vegetables than girls?. Public health nutrition, 11(3), 321–325. doi.org/10.1017/S1368980007000729
For individuals with chronic pain conditions, what are the risks of developing peptic ulcers?
NSAIDs and Peptic Ulcers
A peptic ulcer is a sore in the lining of the stomach or duodenum, the first area of the small intestine. The most common symptom is a burning stomach pain that may come and go for several days or weeks. Other symptoms include:
Feeling full
Feeling bloated
Belching
Heartburn
Nausea
Stress and spicy foods can worsen ulcers but do not cause them.
A peptic ulcer is a sore that occurs in the mucosal lining of the stomach, small intestine, or esophagus. It is caused by stomach acids or other digestive juices damaging the stomach or duodenum lining. When the ulcer is in the stomach, it might also be called a gastric ulcer. The acid can create a painful open sore that may bleed. The most common cause of a peptic ulcer is a type of bacteria called Helicobacter pylori (H. pylori). A second, less common cause of peptic ulcers is the use of non-steroidal anti-inflammatory medications or NSAIDs like aspirin, ibuprofen, and naproxen. (Fashner J. & Gitu A. C. 2015) Using over-the-counter NSAIDs for the occasional headache or achy back won’t cause a peptic ulcer. Rather, peptic ulcer disease is something that can occur with longer-term use, especially at high doses, such as for chronic pain associated with arthritis or other inflammatory conditions. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022)
NSAIDs and Ulcer Development
NSAIDs can cause ulcers because they can interfere with the stomach’s ability to protect itself from gastric acids as they slow the production of protective mucus in the stomach and change its structure. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022) While these acids are vital to the digestive process, they can compromise the stomach’s protective barriers. The stomach has three protections against gastric acid:
Foveolar cells that line the stomach produce a protective mucus.
Bicarbonate is produced by the foveolar cells, which help neutralize stomach acid.
Blood circulation aids in repairing and renewing cells in the stomach’s mucosal layer.
Specific lipids called prostaglandins, which the body makes, affect pain receptors. NSAIDs work to reduce pain by blocking enzymes involved in the production of certain prostaglandins. Prostaglandins also protect the stomach’s mucosal layer, which can be broken when depleted. Suppressing the body’s natural defenses against gastric acids can lead to inflammation in the stomach lining. Over time, this can cause a capillary blood vessel to rupture, causing bleeding and the development of an open, ulcerative sore. (Bjarnason I. et al., 2018)
Symptoms
A peptic ulcer may cause symptoms in the digestive tract, but some individuals may have no symptoms. The most common symptom is upper abdominal pain, which can feel dull or burning. The pain can range in severity, with some experiencing mild discomfort and others having severe pain. Most of the time, the pain will occur after a meal, but it might also happen at night for some. It could go on from a few minutes to a few hours. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022) Other symptoms are less common but can include:
Bloating
Burping
Gas
Nausea
Vomiting
Loss of appetite
Weight loss
Feeling sick in the stomach.
Feeling full after even a small meal.
In rare cases, individuals with peptic ulcers may see blood in their stool or have black stools because blood is present. Blood coming from one or more peptic ulcers could also be visible in vomit. Call a healthcare provider right away if there is blood in stool or vomit, as this can be a sign of excessive bleeding or other serious problems. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022)
Diagnosis
When peptic ulcer symptoms occur, a healthcare provider may order several tests to determine the cause. For individuals who are receiving NSAIDs for chronic pain, a healthcare provider may already have a high suspicion that the medication is the cause or is contributing to peptic ulcer disease. Because infection with H. pylori is the most common cause, it is normally ruled out through a breath, blood, or stool test. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022) Tests to look for ulcers inside the upper digestive tract can include:
Upper GI Series
Patients drink a barium substance to help the internal organs appear on imaging.
A series of X-rays are taken.
Upper Endoscopy
A flexible tube with a camera is used to look inside the esophagus, the stomach, and the duodenum.
All NSAIDs have the potential to cause indigestion, gastric bleeding, and ulcers. However, some individuals are more susceptible to developing peptic ulcer disease than others. Peptic ulcers caused by NSAIDs are more likely to occur in individuals who: (National Institute of Diabetes and Digestive and Kidney Diseases, 2022)
Are 70 or older
Have a history of ulcers
Take corticosteroids
Take high-dose NSAIDs
Take NSAIDs regularly for a long time
Take more than two types of NSAIDs
Use aspirin daily, including low-dose aspirin, for cardioprotective purposes.
Take blood thinners
Drink alcohol regularly
Smoke
Studies suggest that 25% of those who use NSAIDs long-term will develop an ulcer, but only a small percentage will go on to develop serious complications. (Lanza F. L. et al., 2009)
Treatment
NSAID-induced ulcers usually heal once the NSAID is stopped. Certain treatments may be recommended to expedite the healing process depending on the severity of the peptic ulcer. In severe cases, surgery may be recommended to repair the damage.
Medications
A healthcare provider may recommend taking one or more medications. Over-the-counter options may include:
Antacids help neutralize stomach acid.
A proton pump inhibitor or PPI, such as omeprazole, lowers acid levels in the stomach. (Begg M. et al., 2023)
The bigger problem for individuals is how to manage pain when the medications are discontinued. For individuals with chronic pain, this may require the help of a physical therapy team, including a pain management healthcare provider. Certain medications called COX inhibitors could be used to control pain for some. COX inhibitors have been shown to work for pain relief and are associated with fewer digestive side effects than other types of NSAIDs. These meds have also been shown to have cardiovascular side effects, however, so it’s usually recommended they be used at the lowest dosage. (Scarpignato C. et al., 2015)
Lifestyle Adjustments
Lifestyle adjustments may be recommended to heal peptic ulcers, including:
Avoiding foods that worsen symptoms.
Avoiding caffeine
Avoiding alcohol
Quitting smoking
Surgery
In some cases, surgery may be recommended, but this is more often the case when there are complications as a result of the ulcer, such as:
Avoiding long-term and high-dose use of NSAIDs or not using these medications can help protect and prevent peptic ulcers. For individuals who have to take an NSAID due to a condition they are trying to manage, a healthcare provider may prescribe one of the meds used to treat peptic ulcers to prevent them from occurring. Some believe that spicy food and stress cause ulcers, but that has been discredited. (Cleveland Clinic, 2022) Most individuals who take NSAIDs will not experience peptic ulcer disease. (Drini M. 2017) However, those who have chronic pain and who are receiving high doses should be aware of the potential.
Injury Medical Chiropractic and Functional Medicine Clinic
Individuals who have any concerns about the use of NSAIDs and how the digestive system will be affected should ask a healthcare provider if there are ways to prevent ulcers and if those measures should be implemented while receiving high doses of NSAIDs. Left untreated, ulcers can lead to complications, which is why it is important to get a diagnosis and receive treatment. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign naturally.
Root Causes of Gut Dysfunction
References
Fashner, J., & Gitu, A. C. (2015). Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection. American family physician, 91(4), 236–242.
Bjarnason, I., Scarpignato, C., Holmgren, E., Olszewski, M., Rainsford, K. D., & Lanas, A. (2018). Mechanisms of Damage to the Gastrointestinal Tract From Nonsteroidal Anti-Inflammatory Drugs. Gastroenterology, 154(3), 500–514. doi.org/10.1053/j.gastro.2017.10.049
Lanza, F. L., Chan, F. K., Quigley, E. M., & Practice Parameters Committee of the American College of Gastroenterology (2009). Guidelines for prevention of NSAID-related ulcer complications. The American journal of gastroenterology, 104(3), 728–738. doi.org/10.1038/ajg.2009.115
Begg, M., Tarhuni, M., N Fotso, M., Gonzalez, N. A., Sanivarapu, R. R., Osman, U., Latha Kumar, A., Sadagopan, A., Mahmoud, A., & Khan, S. (2023). Comparing the Safety and Efficacy of Proton Pump Inhibitors and Histamine-2 Receptor Antagonists in the Management of Patients With Peptic Ulcer Disease: A Systematic Review. Cureus, 15(8), e44341. doi.org/10.7759/cureus.44341
Scarpignato, C., Lanas, A., Blandizzi, C., Lems, W. F., Hermann, M., Hunt, R. H., & International NSAID Consensus Group (2015). Safe prescribing of non-steroidal anti-inflammatory drugs in patients with osteoarthritis–an expert consensus addressing benefits as well as gastrointestinal and cardiovascular risks. BMC medicine, 13, 55. doi.org/10.1186/s12916-015-0285-8
Lee, C. W., & Sarosi, G. A., Jr (2011). Emergency ulcer surgery. The Surgical clinics of North America, 91(5), 1001–1013. doi.org/10.1016/j.suc.2011.06.008
Drini M. (2017). Peptic ulcer disease and non-steroidal anti-inflammatory drugs. Australian prescriber, 40(3), 91–93. doi.org/10.18773/austprescr.2017.037
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