What type of concussion tests are there to help establish the extent of head injuries and help assess improvement during recovery?
Concussion Tests
A concussion is a temporary change in brain function that occurs from a traumatic brain injury or TBI. It can cause problems with thinking and mood and can take weeks to years to heal. Concussion tests are done after a suspected head injury and are also used after diagnosis to assess healing progress. They are noninvasive tests that measure brain functions. Several tests vary in how they are given and what they measure.
Tests
A mild or moderate traumatic brain injury can cause damage to the brain that is not detectable with brain imaging tests. However, the damage can cause serious symptoms, including headaches, emotional changes, difficulty concentrating, and memory problems. (Haider M. N. et al., 2021) The effects of a concussion can be hard to describe, but concussion testing can help identify and quantify these changes. For individuals who don’t have time to heal or experience further brain injuries while recovering, the effects can be prolonged and worsen. This is one reason why concussion testing is vital to get a diagnosis and follow medical recommendations to avoid further injury to the brain. Diagnosis can help set goals, adjust, and assess how the effects improve over time. With improvement, individuals can participate in rehabilitation and follow their doctor’s instructions for gradually returning to work, school, and other activities.
Measurements
Concussion tests can measure subtle aspects of brain function, like visual or auditory perception and response speed (Joyce A. S. et al., 2015). The damage sustained can impair these abilities, like slow decision-making. A traumatic brain injury can be associated with serious injuries, like a skull fracture, swelling, bruise, or bleeding in the brain. These injuries can be detected with imaging tests and often require surgery or other interventions. Brain damage from bleeding or swelling would cause focal neurological symptoms and signs, including partial vision loss, numbness, and weakness. Individuals can have a concussion along with detectable brain injuries or in the absence of detectable brain injuries.
Types of Tests
There are several types of concussion tests. Individuals may have one or more of these, depending on the standard test that is used in their school, sports league, or by their doctor. These can include:
Online Checklists
Several different online checklists are available for concussion screening.
These tests may include questions about symptoms and are often used as self-tests but are not intended to replace an evaluation by a medical professional.
Baseline and Post-Injury Tests
Many schools and sports leagues conduct preseason skill measurements, including memory tests or tests of speed and accuracy, either in an interview form or with computer testing.
Individuals might be asked to retake the test that is used as a comparison if they have experienced a traumatic brain injury.
Standardized Assessment of Concussion – SAC
This five-minute test can be done on the sidelines after a sports injury or later.
It evaluates orientation, immediate memory, neurologic function, concentration, and delayed recall. (Kaufman M. W. et al., 2021)
King-Devick Concussion Test
This two-minute test can be performed on the sidelines after a sports injury or later to assess language, eye movement, and attention. (Krause D. A. et al., 2022)
Post-Concussion Symptom Scale
This test includes 22 questions involving neurocognitive factors, including difficulty concentrating or remembering, physical symptoms like headaches and dizziness, and emotional symptoms like sadness or irritability. (Langevin P. et al., 2022)
Sport Concussion Assessment Tool – SCAT
This test includes an on-field assessment noting concussion symptoms, memory assessment using Maddocks questions (a short list of specific questions), Glasgow Coma Scale (GCS), and cervical spine assessment.
An off-field assessment involves the evaluation of cognitive, neurological, balance, and delayed recall. (Kaufman M. W. et al., 2021)
Buffalo Concussion Physical Examination – BCPE
A modified physical examination that assesses neck tenderness and range of motion, head, jaw, and face abnormalities, eye movements examination, and coordination. (Haider M. N. et al., 2021)
After a concussion, individuals will also have a physical examination, including a full neurological examination, in a doctor’s office.
Results
A doctor will diagnose based on symptoms, physical examination, and concussion test results. For example, for individuals who have broken several bones and are taking powerful pain medications, concussion test results can be abnormal even if they did not experience a concussion. The results of concussion testing can be compared with results before the head injury. Often, baseline testing is required for participation in certain sports leagues at professional and amateur levels. A low score can indicate that head injury has impaired brain function. Sometimes, testing can be done within a few hours of the head trauma and then again a few days later. Responses of individuals who did not have measurements taken before a head injury can be compared with the average results of people their age.
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.
Lumbar Spine Injuries in Sports: Chiropractic Healing
References
Haider, M. N., Cunningham, A., Darling, S., Suffoletto, H. N., Freitas, M. S., Jain, R. K., Willer, B., & Leddy, J. J. (2021). Derivation of the Buffalo Concussion Physical Examination risk of delayed recovery (RDR) score to identify children at risk for persistent postconcussive symptoms. British journal of sports medicine, 55(24), 1427–1433. doi.org/10.1136/bjsports-2020-103690
Joyce, A. S., Labella, C. R., Carl, R. L., Lai, J. S., & Zelko, F. A. (2015). The Postconcussion Symptom Scale: utility of a three-factor structure. Medicine and science in sports and exercise, 47(6), 1119–1123. doi.org/10.1249/MSS.0000000000000534
Kaufman, M. W., Su, C. A., Trivedi, N. N., Lee, M. K., Nelson, G. B., Cupp, S. A., & Voos, J. E. (2021). The Current Status of Concussion Assessment Scales: A Critical Analysis Review. JBJS reviews, 9(6), e20.00108. doi.org/10.2106/JBJS.RVW.20.00108
Krause, D. A., Hollman, J. H., Breuer, L. T., & Stuart, M. J. (2022). Validity Indices of the King-Devick Concussion Test in Hockey Players. Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine, 32(3), e313–e315. doi.org/10.1097/JSM.0000000000000938
Langevin, P., Frémont, P., Fait, P., & Roy, J. S. (2022). Responsiveness of the Post-Concussion Symptom Scale to Monitor Clinical Recovery After Concussion or Mild Traumatic Brain Injury. Orthopaedic journal of sports medicine, 10(10), 23259671221127049. doi.org/10.1177/23259671221127049
Elbow pain from lifting is a common symptom among individuals who lift weights, heavy objects, children, grocery bags, etc. Depending on the underlying cause, can conservative treatments relieve and heal elbow pain?
Elbow Pain Caused By Lifting
Elbow pain from lifting can result from weight training, repetitive daily tasks, or job duties like lifting small children or heavy objects. Pain can manifest at the sides or the front of the elbow. Most minor injury cases can be treated with ice, rest, and medications at home. However, pain after lifting can also be a sign of a serious injury, such as a tendon rupture/tear.
Minor Pain From Lifting
Lifting puts pressure on the tendons connecting the wrist and upper arm to the bones in the elbow joint. Minor elbow pain can occur from temporary inflammation in any of these structures after lifting an object. Tendonitis occurs when a tendon becomes inflamed, often from overuse or lifting something too heavy, and ranges from mild to severe. Mild tendonitis typically causes pain during the activity and improves with rest. (American Academy of Orthopaedic Surgeons, 2020) Common forms of tendonitis include:
Tennis elbow – tendonitis on the outside of the elbow
Golfer’s elbow – tendonitis on the inside of the elbow.
Add ice to the affected area for up to 20 minutes daily to decrease elbow pain.
Rest
Avoid lifting heavy objects as much as possible when pain is present.
Wearing A Brace
If the pain is at the tendons on the inside or outside of your elbow, try wearing a wrist brace to limit the use of your wrist muscles that connect to this area.
Stretching
Gently stretching the wrist flexors and extensors can help reduce elbow pain after lifting. Stretches can be performed several times daily, even after symptoms have resolved. (American Academy of Orthopaedic Surgeons, 2024)
Hold the arm out in front with the palm down. Keep the elbow straight.
Bend the wrist down so that the fingers are pointing toward the ground.
With the other hand, gently pull the wrist further down until a stretch is felt along the back of the forearm.
Hold this position for 15 seconds.
Repeat five times.
Next, bend the wrist upward so the fingers point toward the ceiling.
Using the other hand, gently pull the hand backward until the stretch is felt along the front of the forearm.
Mild cases can improve after a few days of self-care, whereas more pronounced elbow symptoms can take several weeks, months, or even a year. (Kheiran A. Pandey, A. & Pandey R. 2021) If self-care doesn’t work, physical therapy may be recommended. A physical therapy team can use various modalities and treatments to help reduce pain and inflammation from elbow injuries. The therapy can include targeted exercises to strengthen weak muscles and stretch tight muscles that might contribute to the condition. In addition, the therapy team will help individuals modify their lifting technique to help prevent further injury.
A biceps tendon rupture is a rare but serious injury usually caused from lifting. In addition to other visible signs of the injury, there will be a bulge at the top of the upper arm because the muscle bunches up as it is no longer attached to the elbow. (American Academy of Orthopaedic Surgeons, 2022) Individuals may hear an audible popping sound if an elbow ligament or tendon gets torn while lifting. (Johns Hopkins Medicine, 2024)
Treatment
Treatment depends on the severity of the injury, but most cases resolve on their own with rest and, if necessary, physical therapy. Conditions that cause severe pain require orthopedic surgeon expertise. These physicians specialize in treating musculoskeletal system injuries. Imaging such as X-rays, MRIs, or CT scans are often used to determine the extent of damage. Individuals with tendon or ligament tears in the elbow may need surgery to regain full range of motion and strength in their arm. After surgery, physical therapy will help 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 associated medical professionals to integrate a treatment plan to improve the body’s flexibility and mobility and resolve musculoskeletal issues.
Kheiran, A., Pandey, A., & Pandey, R. (2021). Common tendinopathies around the elbow; what does current evidence say?. Journal of clinical orthopaedics and trauma, 19, 216–223. doi.org/10.1016/j.jcot.2021.05.021
For pregnant individuals, dehydration during pregnancy increases the risk of health problems for the individual and the fetus. Is it possible to prevent dehydration by drinking more water and managing morning sickness?
Pregnancy Dehydration
Maintaining proper hydration is an important part of a healthy pregnancy. Dehydration during pregnancy can occur for several reasons. A pregnant body needs more water to support the increased physical demands. Pregnant individuals need more water than non-pregnant ones and risk losing more water throughout the day. (American College of Obstetricians and Gynecologists, 2023) Pregnant individuals need eight to 12 glasses of water daily to prevent dehydration. Risks of dehydration during pregnancy include:
Low amniotic fluid levels and preterm contractions.
Early symptoms can include decreased urination, increased thirst, and dry mouth.
Serious symptoms can include dizziness, confusion, fainting, and low blood pressure.
In severe cases, intravenous/IV intervention may be required to replenish fluids.
The body’s physiological changes during pregnancy cause it to require more water. Pregnant individuals need more water and lose more water throughout the day. Dehydration happens when the body loses more water than it takes in. Factors that contribute to dehydration during pregnancy include: (Song, Y. et al., 2023)
Increased Blood Volume
A pregnant body requires increased blood circulation.
Blood volume increases as much as 30% to 45%.
The body needs more water to keep up with the increased volume.
Changes In The Urinary System
The kidneys often increase slightly in size during pregnancy.
This causes changes in the urinary system, causing the body to lose more water.
Changes In The Respiratory System
The increased demands on the body cause increased breathing.
Each time the body exhales, it loses water through the breath.
Increased Metabolism
Pregnancy causes the adrenal and thyroid functions to become slightly hyperactive.
This leads to increased metabolism and sweating.
When the body loses water through sweat, dehydration risks increase.
Increased Nutrition
A pregnant individual requires 300 extra daily calories, which increases to 450 additional daily calories in late pregnancy.
Eating more means the individual needs added hydration to support digestion and prevent constipation.
Morning Sickness
Nausea and vomiting are common.
Morning sickness causes fluid loss, increasing the risk of dehydration.
If the body does not acquire enough water when mildly dehydrated further symptoms can present and include fatigue, dizziness, feeling overheated, and having Braxton Hicks contractions or tightening and release of the uterus that are not from labor contractions. (Mulyani E. Y. et al., 2021)
Emergency Symptoms
Severe dehydration can lead to serious pregnancy complications and require immediate medical care. Emergency signs and symptoms include: (National Library of Medicine, 2023)
Irritability
Confusion
Sunken eyes
Fainting
Low or no urine
Low blood pressure
Rapid heart and breathing rate
Shock
Risks
Staying hydrated is essential, and hydration status affects health and pregnancy outcomes. When pregnant, the body needs extra water to produce enough amniotic fluid, which fills the amniotic sac with the fetus. When amniotic levels are low, the fetus has little room to grow and move. This can lead to delayed growth and development and potential umbilical cord issues. If the umbilical cord becomes compressed, the baby cannot receive oxygen and nutrients, which can quickly lead to an emergency. (Song, Y. et al., 2023) Chronic, untreated dehydration during pregnancy increases the risk of complications and can include (Aziz M. M. et al., 2018) (Song Y. et al., 2023)
Preterm contractions
Decreased birth weight and length
Reduced head circumference and chest circumference
Neural tube defects – malformations in early development of the brain and spine.
Low milk production
Rehydrating and Adding Electrolytes
Individuals must drink eight to 12 glasses of water daily to prevent dehydration (American College of Obstetricians and Gynecologists, 2020). Rehydration with water and electrolytes, essential minerals the body needs for normal function, may also be recommended. Ask a healthcare provider if they recommend consuming electrolytes through sports drinks, Pedialyte, coconut water, or electrolyte powders.
Drink between meals if drinking water is difficult because of nausea or feeling full.
Always have a water bottle, and drink what is possible when nausea is not manifesting.
Other recommended sources can include milk, natural fruit juices, and broth.
To reduce water loss, avoid high-caffeine or sugar drinks.
Take frequent breaks and drink more water when in the heat.
Minor Dehydration Treatment
Most pregnant individuals can safely treat mild dehydration at home. Call a healthcare provider if there are any concerns about symptoms. To treat minor dehydration, rest in a cool area and replenish fluids. Drink water, a sports drink, or a rehydration solution like Pedialyte. If symptoms do not improve, contact a healthcare provider. (Song Y. et al., 2023)
Injury Medical Chiropractic and Functional Medicine Clinic
Fortunately, treating and preventing dehydration is possible by drinking plenty of water throughout the day, avoiding drinks with caffeine or sugar, and taking frequent breaks. 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 associated medical professionals to integrate a treatment plan to improve the body’s flexibility and mobility and resolve musculoskeletal issues.
Mulyani, E. Y., Hardinsyah, Briawan, D., Santoso, B. I., & Jus’at, I. (2021). Effect of dehydration during pregnancy on birth weight and length in West Jakarta. Journal of nutritional science, 10, e70. doi.org/10.1017/jns.2021.59
Song, Y., Zhang, F., Lin, G., Wang, X., He, L., Li, Y., Zhai, Y., Zhang, N., & Ma, G. (2023). A Study of the Fluid Intake, Hydration Status, and Health Effects among Pregnant Women in Their Second Trimester in China: A Cross-Sectional Study. Nutrients, 15(7), 1739. doi.org/10.3390/nu15071739
Aziz, M. M., Kulkarni, A., Tunde-Agbede, O., Benito, C. W., & Oyelese, Y. (2018). Are Women With Threatened Preterm Labor More Dehydrated Than Women Without It? Journal of obstetric, gynecologic, and neonatal nursing: JOGNN, 47(5), 602–607. doi.org/10.1016/j.jogn.2018.05.006
For individuals that are trying to change up their daily routine, can incorporating the beneficial properties of a HIIT workout reduce pain?
Introduction
When it comes to a person’s health and wellness, they need to exercise for at least 30 minutes. However, many individuals have hectic lifestyles, which correlates to a lack of time to work out, leading to various health conditions that can develop over time and lead to pain and discomfort. Around the world, many adults should get 150 to 300 minutes of exercise to reduce pain in their body system. This can include doing chores, exercising at home, or going to the gym. But people who want to get in a quick workout within their busy schedules can opt for a HIIT workout or high-intensity interval training. In today’s article, we will look at what HIIT is, its beneficial effects on the body, and how important it is to incorporate a HIIT workout as part of a daily routine. We talk with certified associated medical providers who inform our patients to include a HIIT workout in their daily routine. While asking their associated medical provider intricate questions, we advise patients to formulate a customized treatment plan to help with chronic pain affecting their bodies through various exercise routines. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.
What is HIIT?
Do you experience any weight changes that cause difficulty maintaining your ideal weight? How often do you feel stressed and tired after a hectic day that you don’t have time for yourself? Or do you feel unusual aches and pains in your body that make you feel fatigued throughout the day? When it comes to individuals making small changes in their health and well-being, try to work out with the minimum time they have but also achieve the benefits of a full workout, can try HIIT. HIIT, or high-intensity interval training, is defined by exercise activities that target 80% of the individual’s max heart rate with alternative explosive bursts of full-throttle efforts with rest periods. (Coates et al., 2023)
Additionally, a HIIT workout usually involves cardio and resistance training as part of its sub-categories. This is generally incorporated into gyms and fitness centers and still requires both a warm-up, recovery intervals, and cool-down to ensure that the body is getting the full beneficial properties and effects from a HIIT workout. This is because a HIIT workout involves an active, high-intensity training session that is less than 15 minutes long and helps improve cardiometabolic health and cardiovascular endurance. (Atakan et al., 2021)
Optimize Your Wellness- Video
The Beneficial Properties of HIIT
Since HIIT has beneficial properties, many individuals experiencing low back pain from stress, excessive sitting or standing, or lifting heavy objects can utilize HIIT workouts as part of their exercise routine. HIIT workouts for lower back pain can help through general resistance and core strength training, which helps improve muscle strength and decrease the pain and deconditioning of the trunk muscles. (Verbrugghe et al., 2020) The other beneficial properties of HIIT are that it can help improve a person’s cardiorespiratory system or stamina. This helps maintain healthy endurance levels and causes them to increase the length or intensity of a HIIT workout while enjoying the health benefits it can provide. (Martin-Smith et al., 2020)
Since HIIT has beneficial properties, many individuals experiencing low back pain from stress, excessive sitting or standing, or lifting heavy objects can utilize HIIT workouts as part of their exercise routine. HIIT workouts for lower back pain can help through general resistance and core strength training, which helps improve muscle strength and decrease the pain and deconditioning of the trunk muscles. (Verbrugghe et al., 2020) The other beneficial properties of HIIT are that it can help improve a person’s cardiorespiratory system or stamina. This helps maintain healthy endurance levels and causes them to increase the length or intensity of a HIIT workout while enjoying the health benefits it can provide. (Martin-Smith et al., 2020)
Incorporating HIIT As Part of A Routine
Additionally, anyone who wants to do a HIIT workout routine can do it since it is perfect for a quick workout in a short amount of time. Individuals with busy schedules can complete a workout with alternating bursts of exercises and rest periods that can build up a person’s endurance. With a HIIT workout, many individuals will begin to notice that they have more energy throughout the day and start making changes to improve their lives.
References
Atakan, M. M., Li, Y., Kosar, S. N., Turnagol, H. H., & Yan, X. (2021). Evidence-Based Effects of High-Intensity Interval Training on Exercise Capacity and Health: A Review with Historical Perspective. Int J Environ Res Public Health, 18(13). doi.org/10.3390/ijerph18137201
Coates, A. M., Joyner, M. J., Little, J. P., Jones, A. M., & Gibala, M. J. (2023). A Perspective on High-Intensity Interval Training for Performance and Health. Sports Med, 53(Suppl 1), 85-96. doi.org/10.1007/s40279-023-01938-6
Gjellesvik, T. I., Becker, F., Tjonna, A. E., Indredavik, B., Lundgaard, E., Solbakken, H., Brurok, B., Torhaug, T., Lydersen, S., & Askim, T. (2021). Effects of High-Intensity Interval Training After Stroke (The HIIT Stroke Study) on Physical and Cognitive Function: A Multicenter Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 102(9), 1683-1691. doi.org/10.1016/j.apmr.2021.05.008
Guimaraes, G. V., Ciolac, E. G., Carvalho, V. O., D’Avila, V. M., Bortolotto, L. A., & Bocchi, E. A. (2010). Effects of continuous vs. interval exercise training on blood pressure and arterial stiffness in treated hypertension. Hypertens Res, 33(6), 627-632. doi.org/10.1038/hr.2010.42
Martin-Smith, R., Cox, A., Buchan, D. S., Baker, J. S., Grace, F., & Sculthorpe, N. (2020). High Intensity Interval Training (HIIT) Improves Cardiorespiratory Fitness (CRF) in Healthy, Overweight and Obese Adolescents: A Systematic Review and Meta-Analysis of Controlled Studies. Int J Environ Res Public Health, 17(8). doi.org/10.3390/ijerph17082955
Verbrugghe, J., Agten, A., Stevens, S., Hansen, D., Demoulin, C., Eijnde, B. O., Vandenabeele, F., & Timmermans, A. (2020). High Intensity Training to Treat Chronic Nonspecific Low Back Pain: Effectiveness of Various Exercise Modes. J Clin Med, 9(8). doi.org/10.3390/jcm9082401
For individuals who may need to take pain medications to manage an injury or condition, can knowing the potential side effects help in treatment?
Medications For Pain Side Effects
Over-the-counter and prescription pain medications can help relieve physical discomfort and distress but can also cause side effects. Patients may not manifest side effects when using certain meds or experience mild, limited, severe, or intolerable effects. Pain medication side effects can include:
Allergic reactions
Upset stomach
Bruising
Dizziness
However, medication side effects don’t affect everyone in the same way.
Pain Relief
The patient and their healthcare provider can decide whether they risk developing side effects and which effects they are more predisposed to. Individuals may be susceptible to side effects from certain medications but are likely to tolerate others. For example, individuals with a history of ulcers may be recommended to avoid anti-inflammatories. For those who have trouble sleeping, it is recommended to avoid pain meds that are known to interfere with sleep.
Reading Labels and Asking Questions
When taking over-the-counter medications, read the label for side effects, then weigh the possible risks against the medicine’s benefits for pain relief. Ask a pharmacist or healthcare provider about anything that is not understood. Some side effects are medical emergencies, such as allergic reactions. Recognizing the signs of an allergic reaction and being prepared to call for emergency help if symptoms present. (American Academy of Allergy, Asthma & Immunology, 2024) These can include:
Itching
Hives
Rash
Mouth or facial swelling
Shortness of breath
If a healthcare provider prescribes medication, discuss the anticipated risks and benefits. The prescription will come with a label that lists the side effects associated with the drug.
Opioid Risks
Opioids are powerful prescription meds, usually used for severe, short-term use, like post-surgery pain or after a severe traumatic injury. Some effects of opioids include: (Plein L. M. and Rittner H. L. 2018) Common side effects include sedation, constipation, and nausea. Chronic use can lead to depression and/or sexual dysfunction. With narcotics, there is the risk of addiction that can change an individual’s life, as addiction can be difficult to overcome. One of the reasons the CDC published a guideline on opioid prescriptions was because of the number of overdoses and deaths.
The CDC recommends that practitioners not prescribe opioids as a first-line treatment for chronic back pain.
The CDC recommends that healthcare providers initially treat patients with chronic back or neck pain using non-pharmacological therapies or medications other than opioids.
Opioids should only be used if the expected benefits for pain and function are anticipated to outweigh the risks to the patient.
With more than half of regular opioid users experiencing back pain, they aren’t proven to help return individuals to work or normal life faster, nor did they improve functioning when used for the treatment of an acute episode. (Deyo R. A. Von Korff M. and Duhrkoop D. 2015) The effectiveness of opioids is about 30% for short-term relief and did not improve physical functioning.
Examples and Comparisons
Examples of common medications used to treat back pain.
Advil
Active Ingredient – Ibuprofen
Drug Class – NSAID
Over-the-counter or Prescribed – Available over-the-counter
Side Effects – GI-related symptoms and Reye’s Syndrome in children
Aleve and Other Generic Brands
Active Ingredient – Naproxen
Drug Class – NSAID
Over-the-counter or Prescribed – Available as both depending on strength.
Side Effects – GI-related symptoms, headaches
Tylenol and Other Generic Brands
Active Ingredient – Acetaminophen
Drug Class Analgesic – pain reliever
Over-the-counter or Prescribed – Available as both and can be prescribed with codeine.
Side Effects – Potential liver damage
Lyrica
Active Ingredient – Pregabalin
Drug Class – Anticonvulsant
Over-the-counter or Prescribed – Prescribed FDA-approved for shingles pain and neuropathy in diabetes. Other uses off-label.
Side Effects – Dizziness, drowsiness, swelling, weight gain.
Neurontin
Active Ingredient – Gabapentin
Drug Class – Anticonvulsant
Over-the-counter or Prescribed – Prescribed FDA-approved for shingles pain
Side Effects – Dizziness, drowsiness, allergic reaction, withdrawal, and seizures.
Injury Medical Chiropractic and Functional Medicine Clinic
Chiropractic therapy is among the more conservative treatment options and may be tried first. 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.
Plein, L. M., & Rittner, H. L. (2018). Opioids and the immune system – friend or foe. British journal of pharmacology, 175(14), 2717–2725. doi.org/10.1111/bph.13750
Deyo, R. A., Von Korff, M., & Duhrkoop, D. (2015). Opioids for low back pain. BMJ (Clinical research ed.), 350, g6380. doi.org/10.1136/bmj.g6380
Lower back leg pain depends on specific symptoms and their duration. Can having a better idea of symptoms help individuals inform their medical providers to develop an effective treatment plan?
Low Back Leg Pain
Lower back leg pain, sciatica, and weakness of the lower-extremity muscles are often diagnosed as a herniated (compressed or ruptured) disc. Nerves surrounding the spine are sensitive to irritation and pressure caused by a disc shifting out of position or physical damage to the disc and surrounding area, ranging from mild to severe. This is why it is important to be evaluated by a healthcare provider. Treatment depends on the type of spinal disc herniation and the severity, but getting an early medical evaluation helps ensure optimal outcomes. Non-surgical conservative treatments are often effective, but some cases may require more aggressive treatment, especially if the pain persists.
Spine and Nerves
Spinal discs are the shock absorbers between vertebrae. They consist of a tough outer layer, annulus fibrosis, covering a soft gel core, nucleus pulposus. When a disc is damaged, it can bulge and irritate surrounding nerves. In more severe cases, the annulus fibrosis can weaken and tear, allowing the material to leak and compress the spinal cord or nerves. As the nerves are not functioning properly, abnormal signals may be sent to and from the brain. The most common lower back herniations occur in the lumbar region, where five vertebrae near the base of the spine are classified from top to bottom as L1 through L5. (Dydyk A.M. et al., 2023) Pain resulting from an injury to this part of the spine can be debilitating because it may involve sciatic nerve irritation. Herniated disc causes are generally a combination of age-related degeneration, being overweight/obese, trauma, a sedentary lifestyle, and overloading of the spine. (Cleveland Clinic, 2021)
Symptoms
The most common symptoms include:
Back Pain
Caused by nerve irritation, muscle spasms, and inflammation.
Radiculopathy
Abnormal signaling of the nerves.
Electrical Shooting Pain
Nerve pressure can cause abnormal sensations, commonly experienced as electric shooting pains.
For low back herniations, the shocks go down one or both legs.
Tingling – Numbness
There are often abnormal sensations such as tingling, numbness, or pins and needles down one or both legs.
Muscle Weakness
Nerve signals may be interrupted, causing lower-body muscle weakness. (Dydyk A.M. et al., 2023)
Bowel – Bladder Symptoms
These symptoms may signal cauda equina syndrome, a rare condition resulting from a herniated disc between the L5 vertebrae and the first vertebrae of the sacrum.
Diagnosis
Diagnosing a herniated disc as the cause of low back leg pain involves testing sensation, muscle strength, and reflexes. MRI also aids this process (American Association of Neurological Surgeons, 2024). MRIs can often show herniated discs and other abnormalities, especially in older patients.
Treatment
A herniated disc treatment plan is based on patient symptoms, physical examination findings, and imaging results. Most herniated disc symptoms resolve themselves in four to six weeks. Lower back pain is generally treated conservatively through:
Topical pain ointments or creams for muscle spasms.
Non-surgical decompression relieves pressure, activates healing, and restores circulation and nutrients.
Chiropractic adjustments realign the spine and musculoskeletal system.
Massage loosens the muscles and maintains their relaxation.
Total rest is never recommended, even if movement is challenging,
Exercise and stretching help avoid muscle degeneration and strengthen the muscles.
Relaxation techniques and other natural pain therapies can help manage symptoms and restore overall health.
Pain-blocking injections which can include anesthetics or corticosteroids at the source (Cleveland Clinic, 2021)
Surgery is recommended only when conservative treatments are ineffective after six weeks, if there is significant muscle weakness from nerve damage, or if motor functions are compromised. (American Association of Neurological Surgeons, 2024)
Injury Medical Chiropractic and Functional Medicine Clinic
Chiropractic therapy is among the more conservative treatment options and may be tried first before proceeding with surgery. 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 associated medical professionals to integrate a treatment plan to improve the body’s flexibility and mobility and resolve musculoskeletal issues.
Disc Herniation
References
Dydyk AM, Ngnitewe Massa R, Mesfin FB. Disc Herniation. [Updated 2023 Jan 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK441822/
Can physical therapies help individuals with a Colles’ or wrist fracture?
Colles’ Fracture
A broken wrist or Colles fracture can be a painful and stressful experience. Individuals may be unable to perform their jobs or engage in recreational activities. A Colles fracture is a break in the radius bone of the forearm that occurs near the wrist, usually about an inch from the end of the bone. It’s a common type of broken wrist often caused by falling on an outstretched hand. (American Academy of Orthopaedic Surgeons, 2022) As the individual lands on their hand, the end of the radius bone breaks off and gets pushed toward the inner wrist. If the wrist is flexed when falling on the hand, the radius may break and move toward the front of the wrist. This is called a Smith’s fracture. (Matsuura, Y. et al., 2017) A physical therapy team can help improve functional mobility to quickly and safely return to normal activity.
Symptoms
Individuals who have suffered trauma to their wrist or have fallen onto their hand or wrist may have a Colles fracture. Common signs and symptoms of a wrist or Colles fracture include: (American Academy of Orthopaedic Surgeons, 2022)
Bruising
Loss of mobility in the wrist.
Swelling in the arm, wrist, or hand.
Pain
Visible deformity or a lump on the backside of the forearm near the wrist.
Initial Treatment
Individuals who have fallen and injured their wrist and hand and suspect a Colles fracture seek immediate medical attention. Call a healthcare provider or report to a local emergency clinic. Left untreated, it can result in complications and permanent loss of arm and hand function. (American Academy of Orthopaedic Surgeons, 2022)
An X-ray will show a wrist fracture.
Because of the pain and swelling, it is recommended that individuals put an ice pack on their wrists and hands until they can get to a healthcare provider or emergency room. The R.I.C.E. principle can help control swelling and lessen pain until a medical professional can provide treatment. The initial treatment is to reduce the fracture. This is where a healthcare provider situates the broken bone or bones back into the correct position to ensure proper healing. This is done manually if the fractured bone is not too far out. If the fracture is severe, a surgical procedure known as an open reduction internal fixation or ORIF may be required to reduce the fracture. (American Academy of Orthopaedic Surgeons, 2022)
Once the fracture has been reduced, it must be immobilized. This is done with a cast or a brace. Individuals may also be required to wear a sling. They may need to visit a physical therapist to learn how to wear the sling properly. It is essential to keep the bones immobilized for proper healing. Consult a healthcare provider for questions about cast, sling, or brace.
Physical Therapy
After four to six weeks of immobilization, a healthcare provider may remove the cast and refer a physical therapist or team. (American Academy of Orthopaedic Surgeons, 2022) A physical therapist may measure and evaluate pain, swelling, range of motion, and strengthening. The physical therapist may assess the surgical scar tissue and analyze the hand, wrist, and arm function of individuals who underwent an ORIF procedure to reduce the fracture. After the initial evaluation, a physical therapist will work with the patient to develop an appropriate plan of care to help improve the impairments and functional limitations. The therapist may prescribe a specific exercise program as well.
Pain and Swelling
Individuals may experience pain and swelling around their wrists and hands.
A physical therapist can provide individuals with various treatments and modalities to help decrease swelling and pain.
Range of Motion
After a Colles’ fracture, individuals may lose hand, wrist, and elbow mobility.
The shoulder may also be tight, especially after wearing a sling.
Range of motion exercises for the hand, wrist, and elbow can be prescribed.
Strength
Loss of strength is common after a Colles’ fracture.
Exercises focusing on hand, wrist, and elbow strength may be prescribed.
At-home exercises and stretches will get the best results from physical therapy.
Scar Tissue
Individuals who have had an ORIF procedure will likely have scar tissue that has developed around the surgical site.
A physical therapist may perform scar tissue massage and mobilization to help improve mobility and can train patients how to self-massage.
Injury Medical Chiropractic and Functional Medicine Clinic
After a few weeks of physical therapy, individuals should notice their mobility and strength improve while pain and swelling decrease. Individuals will find it easier to use their arms and hands to perform functional activities. While the fracture should be fully healed six to eight weeks after injury, individuals may still be limited for potentially 12 to 16 weeks. At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for every patient to restore function. If other treatment is needed, individuals will be referred to a clinic or physician best suited to their injury, condition, or ailment.
Matsuura, Y., Rokkaku, T., Kuniyoshi, K., Takahashi, K., Suzuki, T., Kanazuka, A., Akasaka, T., Hirosawa, N., Iwase, M., Yamazaki, A., Orita, S., & Ohtori, S. (2017). Smith’s fracture generally occurs after falling on the palm of the hand. Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 35(11), 2435–2441. doi.org/10.1002/jor.23556
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