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Chiropractic Examination

Back Clinic Chiropractic Examination. An initial chiropractic examination for musculoskeletal disorders will typically have four parts: a consultation, case history, and physical examination. Laboratory analysis and X-ray examination may be performed. Our office provides additional Functional and Integrative Wellness Assessments in order to bring greater insight into a patient’s physiological presentations.

Consultation:
The patient will meet the chiropractor which will assess and question a brief synopsis of his or her lower back pain, such as:
Duration and frequency of symptoms
Description of the symptoms (e.g. burning, throbbing)
Areas of pain
What makes the pain feel better (e.g. sitting, stretching)
What makes the pain feel worse (e.g. standing, lifting).
Case history. The chiropractor identifies the area(s) of complaint and the nature of the back pain by asking questions and learning more about different areas of the patient’s history, including:
Family history
Dietary habits
Past history of other treatments (chiropractic, osteopathic, medical and other)
Occupational history
Psychosocial history
Other areas to probe, often based on responses to the above questions.

Physical examination:
We will utilize a variety of methods to determine the spinal segments that require chiropractic treatments, including but not limited to static and motion palpation techniques determining spinal segments that are hypo mobile (restricted in their movement) or fixated. Depending on the results of the above examination, a chiropractor may use additional diagnostic tests, such as:
X-ray to locate subluxations (the altered position of the vertebra)
A device that detects the temperature of the skin in the paraspinal region to identify spinal areas with a significant temperature variance that requires manipulation.

Laboratory Diagnostics:
If needed we also use a variety of lab diagnostic protocols in order to determine a complete clinical picture of the patient. We have teamed up with the top labs in the city in order to give our patients the optimal clinical picture and appropriate treatments.


Forearm Pain Chiropractic Care

Forearm Pain Chiropractic Care

Forearm pain refers to soreness, aches, or discomfort between the wrist and the elbow. An injury or inflammation can affect any tissues, including muscles, bones, blood vessels, tendons, and the skin. The causes usually include overuse injuries, pinched nerves, accidents causing trauma, lifting or heaving heavy objects, sports injuries, and fractures. If left untreated, issues like chronic muscle pain and decreased and disrupted blood/nerve circulation can develop, leading to numbness and weakness. Chiropractic treatment can release tension, massage, reset, and stretch the muscles to expedite healing.

Forearm Pain Chiropractor

Anatomy

The forearm comprises the radius and ulna, which extend the forearm’s length and cross at the wrist.

The Radius

  • This bone starts at the elbow and connects to the wrist on the thumb side.

Ulna

  • This bone begins at the elbow and connects to the wrist on the side of the little finger.

Muscles

  • Several muscles operate to rotate the forearm up/supination and down/pronation and flex and extend the fingers.

Causes

Forearm pain can happen to anyone and is usually related to traumatic or repetitive use injury. In other cases, pain may be associated with a benign growth, like a cyst or possibly a malignant tumor. Common causes include:

  • Pulled and/or strained muscles
  • Muscle ruptures or small tears
  • A direct blow, fall, or any extreme twisting, bending or jamming action.
  • Tendonitis from tennis or golfers elbow.
  • Tennis elbow is caused by inflammation or tiny tears in the forearm muscles and tendons outside the elbow.
  • Golfers’ elbow is on the inside of the elbow.
  • Carpal Tunnel Syndrome is a repetitive stress disorder that affects the nerves and tendons of the wrist and forearm.

Musculoskeletal Causes

The musculoskeletal causes involve issues in how the forearm components operate together.

  • Repetitive actions like lifting, gripping, and typing can compress nerves and blood vessels throughout the forearm.
  • Repetitive positional injury can lead to swelling.
  • Forearm problems like dislocations or sprains can also lead to chronic inflammation and pain.

Traumatic Causes

Traumatic causes include those that result in injury to components of the forearm.

  • Anything that causes a direct injury to the forearm, including an automobile crash or accident, fall, or a direct hit, can fracture bones in the forearm.
  • A sprain can twist or stretch a ligament or tendon.
  • Activities that cause bending, twisting, quick sudden movement or direct impact can result in sprained multiple ligaments in the forearm.

Chiropractic Treatment

Healing forearm pain depends on the type of injury, location, and cause of the pain. Chiropractic addresses arm pain, tingling, and numbness in ways often overlooked by general physicians.

  • A chiropractor will perform a physical examination to determine if there are any underlying causes.
  • They may apply an ice pack to help control inflammation before the massage.
  • The chiropractor will perform gentle adjustments to the wrist, arm, and shoulder.
  • They may recommend a forearm brace to help retrain positioning and movement.
  • They will recommend exercises and stretches to strengthen and maintain the adjustments.

Carpal Tunnel Pain Treatment


References

Ellenbecker, Todd S et al. “Current concepts in examination and treatment of elbow tendon injury.” Sports health vol. 5,2 (2013): 186-94. doi:10.1177/1941738112464761

Shamsoddini, Alireza, and Mohammad Taghi Hollisaz. “Effects of taping on pain, grip strength and wrist extension force in patients with tennis elbow.” Trauma monthly vol. 18,2 (2013): 71-4. doi:10.5812/traumamon.12450

Suito, Motomu, et al. “Intertendinous epidermoid cyst of the forearm.” Case reports in plastic surgery & hand surgery vol. 6,1 25-28. 28 Jan. 2019, doi:10.1080/23320885.2018.1564314

Motorized Non-Surgical Spinal Decompression

Motorized Non-Surgical Spinal Decompression

Motorized non-surgical decompression helps relieve pain, removes pressure on the nerves, promotes healing, and increases blood flow to the spine. Spinal discs cannot attain nutrients from the blood without circulation. Decompression opens the spine, flooding the discs with nutrients that result in quicker and optimal healing. This, combined with manual chiropractic adjustments and therapeutic massage, can help get an individual to a pain-free lifestyle.

Motorized Non-Surgical Spinal Decompression

Spinal Discs

The soft disc material that separates each spinal bone can lose hydration, causing the material to dry out and compress. The discs can also compress from pressure from added weight, trauma from an automobile accident, work, school, and sports injury. Often the soft gel center of the discs spills out, causing a disc herniation. This is usually accompanied by:

  • Numbness
  • Tingling
  • Soreness
  • Stiffness
  • Sharp pain
  • Dull pain
  • Achiness
  • Muscle Weakness
  • Stinging/Burning sensation
  • Leg pain
  • Poor balance

These are often indicators of a nerve or nerve bundle, including the sciatic nerve becoming compressed by a herniated disc, bulging disc or slipped disc, stenosis, facet syndrome, or degenerative disc disease. When this happens, the symptoms may be felt in the back or neck area, and/or they may spread out into the arms, hands, legs, or feet.

Motorized Decompression

Spinal decompression is relaxing and helps maintain range of motion throughout the body. The benefits of motorized decompression include:

  • Relaxation
  • Increased energy
  • Pain relief
  • Stress relief
  • Headache relief
  • Improved posture
  • Improved range of motion
  • Improved circulation
  • Improved sleep

We focus on providing expert chiropractic treatment that incorporates the most current research and technology into personalized treatment plans. Our goal is to help the individual heal as quickly as possible while educating and training them to use tools to maintain health and wellness.


What Is Spinal Decompression?


References

Andersson, G B, and R A Deyo. “History and physical examination in patients with herniated lumbar discs.” Spine vol. 21,24 Suppl (1996): 10S-18S. doi:10.1097/00007632-199612151-00003

Apfel, Christian C et al. “Restoration of disk height through non-surgical spinal decompression is associated with decreased discogenic low back pain: a retrospective cohort study.” BMC musculoskeletal disorders vol. 11 155. 8 Jul. 2010, doi:10.1186/1471-2474-11-155

Cherkin, DC, and F A MacCornack. “Patient evaluations of low back pain care from family physicians and chiropractors.” The Western journal of medicine vol. 150,3 (1989): 351-5.

Koçak, Fatmanur Aybala et al. “Comparison of the short-term effects of the conventional motorized traction with non-surgical spinal decompression performed with a DRX9000 device on pain, functionality, depression, and quality of life in patients with low back pain associated with lumbar disc herniation: A single-blind randomized controlled trial.” Turkish Journal of physical medicine and rehabilitation vol. 64,1 17-27. 16 Feb. 2017, doi:10.5606/tftrd.2017.154

Urban, Jill PG, and Sally Roberts. “Degeneration of the intervertebral disc.” Arthritis research & therapy vol. 5,3 (2003): 120-30. doi:10.1186/ar629

Disc Bulge & Herniation Chiropractic Care Overview

Disc Bulge & Herniation Chiropractic Care Overview

Disc bulge and disc herniation are some of the most common conditions affecting the spine of both young and middle-aged patients. It is estimated that approximately 2.6% of the US population annually visits a clinician to treat spinal disorders. Roughly $ 7.1 billion alone is lost due to the time away from work.

Disc herniation is when the whole or part of the nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. This is also known as the slipped disc and frequently occurs in the lower back, sometimes also affecting the cervical region. Herniation of the intervertebral disc is defined as a localized displacement of disc material with 25% or less of the disc circumference on an MRI scan, according to the North American Spine Society 2014. The herniation may consist of nucleus pulposus, annulus fibrosus, apophyseal bone or osteophytes, and the vertebral endplate cartilage in contrast to disc bulge.

There are also mainly two types of disc herniation. Disc protrusion is when a focal or symmetrical extension of the disc comes out of its confines in the intervertebral space. It is situated at the intervertebral disc level, and its outer annular fibers are intact. A disc extrusion is when the intervertebral disc extends above or below the adjacent vertebrae or endplates with a complete annular tear. In this type of disc extrusion, a neck or base is narrower than the dome or the herniation.

A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. Here, the displacement is more than 25% of the circumference of the intervertebral disc. It also does not extend below or above the margins of the disc because the annulus fibrosus attachment limits it. It differs from disc herniation because it involves less than 25% of the disc’s circumference. Usually, the disc bulge is a gradual process and is broad. The disc bulge can be divided into two types. In a circumferential bulge, the whole disc circumference is involved. More than 90 degrees of the rim is involved asymmetrically in asymmetrical bulging.

Normal Intervertebral Disc Anatomy

Before going into detail about the definition of disc herniation and disc bulge, we need to look at the standard intervertebral disc. According to spine guidelines in 2014, a standard disc is something that has a classic shape without any evidence of degenerative disc changes. Intervertebral discs are responsible for one-third to one-fourth of the height of the spinal column.

One intervertebral disc is about 7 -10 mm thick and measures 4 cm in anterior-posterior diameter in the lumbar region of the spine. These spinal discs are located between two adjacent vertebral bodies. However, no discs can be found between the atlas and axis and the coccyx. About 23 discs are found in the spine, with six in the cervical spine, 12 in the thoracic spine, and only five in the lumbar spine.

Intervertebral discs are made of fibro cartilages, forming a fibrocartilaginous joint. The outer ring of the intervertebral disc is known as the annulus fibrosus, while the inner gel-like structure in the center is known as the nucleus pulposus. The cartilage endplates sandwich the nucleus pulposus superiorly and inferiorly. The annulus fibrosus comprises concentric collagen fiber sheets arranged in a radial tire-like structure into lamellae. The fibers are attached to the vertebral endplates and oriented at different angles. With their cartilaginous part, the endplates anchor the discs in their proper place.

The nucleus pulposus is composed of water, collagen, and proteoglycans. Proteoglycans attract and retain moisture, giving the nucleus pulposus a hydrated gel-like consistency. Interestingly, throughout the day, the amount of water found in the nucleus pulposus varies according to the person’s level of activity. This feature in the intervertebral disc serves as a cushion or a spinal shock-absorbing system to protect the adjacent vertebra, spinal nerves, spinal cord, brain, and other structures against various forces. Although the individual movement of the intervertebral discs is limited, some form of vertebral motion like flexion and extension is still possible due to the features of the intervertebral disc.

Effect of Intervertebral Disc Morphology on Structure and Function

The type of components present in the intervertebral disc and how it is arranged determine the morphology of the intervertebral disc. This is important in how effectively the disc does its function. As the disc is the most important element which bears the load and allows movement in the otherwise rigid spine, the constituents it is made up of have a significant bearing.

The complexity of the lamellae increases with advancing age as a result of the synthetic response of the intervertebral disc cells to the variations in the mechanical load. These changes in lamellae with more bifurcations, interdigitation and irregular size and number of lamellar bands will lead to the altered bearing of weight. This in turn establishes a self-perpetuated disruption cycle leading to the destruction of the intervertebral discs. Once this process is started it is irreversible. As there is an increased number of cells, the amount of nutrition the disc requires is also increasingly changing the normal concentration gradient of both metabolites and nutrients. Due to this increased demand, the cells may also die increasingly by necrosis or apoptosis.

Human intervertebral discs are avascular and hence the nutrients are diffused from the nearby blood vessels in the margin of the disc. The main nutrients; oxygen and glucose reach the cells in the disc through diffusion according to the gradient determined by the rate of transport to the cells through the tissues and the rate of demand. Cells also increasingly produce lactic acid as a metabolic end product. This is also removed via the capillaries and venules back to the circulation.

Since diffusion depends on the distance, the cells lying far from the blood capillaries can have a reduced concentration of nutrients because of the reduced supply. With disease processes, the normally avascular intervertebral disc can become vascular and innervated in degeneration and in disease processes. Although this may increase the oxygen and nutrient supply to the cells in the disc, this can also give rise to many other types of cells that are normally not found in the disc with the introduction of cytokines and growth factors.

The morphology of the intervertebral disc in different parts of the spine also varies although many clinicians base the clinical theories based on the assumption that both cervical and lumbar intervertebral discs have the same structure. The height of the disc was the minimum in the T4-5 level of the thoracic column probably due to the fact that thoracic intervertebral discs are less wedge-shaped than those of cervical and lumbar spinal regions.

From the cranial to caudal direction, the cross-sectional area of the spine increased. Therefore, by the L5-S1 level, the nucleus pulposus was occupying a higher proportion of the intervertebral disc area. The cervical discs have an elliptical shape on cross-section while the thoracic discs had a more circular shape. The lumbar discs also have an elliptical shape though it is more flattened or re-entrant posteriorly.

What is a Disc Bulge?

The bulging disc is when the disc simply bulges outside the intervertebral disc space it normally occupies without the rupture of the outer annulus fibrosus. The bulging area is quite large when compared to a herniated disc. Moreover, in a herniated disc, the annulus fibrosus ruptures or cracks. Although disc bulging is more common than disc herniation, it causes little or no pain to the patient. In contrast, the herniated disc causes a lot of pain.

Causes for Disc Bulging

A bulging disc can be due to several causes. It can occur due to normal age-related changes such as those seen in degenerative disc disease. The aging process can lead to structural and biochemical changes in the intervertebral discs and lead to reduced water content in the nucleus pulposus. These changes can make the patient vulnerable to disc bulges with only minor trauma. Some unhealthy lifestyle habits such as a sedentary lifestyle and smoking can potentiate this process and give rise to more severe changes with the weakening of the disc.

General wear and tear due to repeated microtrauma can also weaken the disc and give rise to disc bulging. This is because when the discs are strained, the normal distribution of weight loading changes. Accumulated micro-trauma over a long period of time can occur in bad posture. Bad posture when sitting, standing, sleeping, and working can increase the pressure in the intervertebral discs.

When a person maintains a forward bending posture, it can lead to overstretching and eventually weakness of the posterior part of the annulus fibrosus. Over time, the intervertebral disc can bulge posteriorly. In occupations that require frequent and repetitive lifting, standing, driving, or bending, the bulging disc may be an occupational hazard. Improper lifting up of items, and improper carrying of heavy objects can also increase the pressure on the spine and lead to disc bulges eventually.

The bulging intervertebral discs usually occur over a long period of time. However, the discs can bulge due to acute trauma too. The unexpected sudden mechanical load can damage the disc resulting in micro-tears. After an accident, the disc can become weakened causing long-term microdamage ultimately leading to bulging of the disc. There may also be a genetic component to the disc bulging. The individual may have a reduced density of elastin in the annulus fibrosus with increased susceptibility to disc diseases. Other environmental facts may also play a part in this disease process.

Symptoms of Disc Bulging

As mentioned previously, bulging discs do not cause pain and even if they do the severity is mild. In the cervical region, the disease will cause pain running down the neck, deep pain in the shoulder region, pain radiating along the upper arm, and forearm up to the fingers.

This may give rise to a diagnostic dilemma as to whether the patient is suffering from a myocardial infarction as the site of referred pain and the radiation is similar. Tingling feeling on the neck may also occur due to the bulging disc.

In the thoracic region, there may be pain in the upper back that radiates to the chest or the upper abdominal region. This may also suggest upper gastrointestinal, lung, or cardiac pathology and hence need to be careful when analyzing these symptoms.

The bulging discs of the lumbar region may present as lower back pain and tingling feeling in the lower back region of the spine. This is the most common site for disc bulges since this area holds the weight of the upper body. The pain or the discomfort can spread through the gluteal area, thighs, and to the feet. There may also be muscle weakness, numbness or tingling sensation. When the disc presses on the spinal cord, the reflexes of both legs can increase leading to spasticity.

Some patients may even have paralysis from the waist down. When the bulging disc compresses on the cauda equine, the bladder and bowel functions can also change. The bulging disc can press on the sciatic nerve leading to sciatica where the pain radiates in one leg from the back down to the feet.

The pain from the bulging disc can get worse during some activities as the bulge can then compress on some of the nerves. Depending on what nerve is affected, the clinical features can also vary.

Diagnosis of Disc Bulging

The diagnosis may not be apparent from clinical history due to similar presentations in more serious problems. But the chronic nature of the disease may give some clues. Complete history and a physical examination need to be done to rule out myocardial infarction, gastritis, gastro-oesophageal reflux disease, and chronic lung pathology.

MRI of Disc Bulge

Investigations are necessary for the diagnosis. X-ray spine is performed to look for gross pathology although it may not show the bulging disc directly. There may be indirect findings of disk degeneration such as osteophytes in the endplates, gas in the disc due to the vacuum phenomenon, and the loss of height of the intervertebral disc. In the case of moderate bulges, it may sometimes appear as non-focal intervertebral disc material that is protruded beyond the borders of the vertebra which is broad-based, circumferential, and symmetrical.

Magnetic resonance imaging or MRI can exquisitely define the anatomy of the intervertebral discs especially the nucleus pulposus and its relationships. The early findings seen on MRI in disc bulging include the loss of normal concavity of the posterior disc. The bulges can be seen as broad-based, circumferential, and symmetrical areas. In moderate bulging, the disc material will protrude beyond the borders of the vertebrae in a non-focal manner. Ct myelogram may also give detailed disc anatomy and may be useful in the diagnosis.

Treatment of Disc Bulging

The treatment for the bulging disc can be conservative, but sometimes surgery is required.

Conservative Treatment

When the disc bulging is asymptomatic, the patient does not need any treatment since it does not pose an increased risk. However, if the patient is symptomatic, the management can be directed at relieving the symptoms. The pain is usually resolved with time. Till then, potent pain killers such as non-steroidal anti-inflammatory drugs like ibuprofen should be prescribed. In unresolved pain, steroid injections can also be given to the affected area and if it still does not work, the lumbar sympathetic block can be tried in most severe cases.

The patient can also be given the option of choosing alternative therapies such as professional massage, physical therapy, ice packs, and heating pads which may alleviate symptoms. Maintaining correct posture, tapes, or braces to support the spine are used with the aid of a physiotherapist. This may fasten the recovery process by avoiding further damage and keeping the damaged or torn fibers in the intervertebral disc without leakage of the fluid portion of the disc. This helps maintain the normal structure of the annulus and may increase the recovery rate. Usually, the painful symptoms which present initially get resolved over time and lead to no pain. However, if the symptoms get worse steadily, the patient may need surgery

If the symptoms are resolved, physiotherapy can be used to strengthen the muscles of the back with the use of exercises. Gradual exercises can be used for the return of function and for preventing recurrences.

Surgical Treatment

When conservative therapy does not work with a few months of treatment, surgical treatment can be considered. Most would prefer minimally invasive surgery which uses advanced technology to correct the intervertebral disc without having to grossly dissect the back. These procedures such as microdiscectomy have a lower recovery period and reduced risk of scar formation, major blood loss, and trauma to adjacent structures when compared to open surgery.

Previously, laminectomy and discectomy have been a mainstay of treatment. However, due to the invasiveness of the procedure and due to increased damage to the nerves these procedures are currently abandoned by many clinicians for disc bulging.

Disc bulging in the thoracic spine is being treated surgically with costotransversectomy where a section of the transverse process is resected to allow access to the intervertebral disc. The spinal cord and spinal nerves are decompressed by using thoracic decompression by removing a part of the vertebral body and making a small opening. The patient may also need a spinal fusion later on if the removed spinal body was significant.

Video-assisted thoracoscopic surgery can also be used where only a small incision is made and the surgeon can perform the surgery with the assistance of the camera. If the surgical procedure involved removing a large portion of the spinal bone and disc material, it may lead to spinal instability. This may need bone grafting to replace the lost portion with plates and screws to hold them in place.

What is a Disc Herniation?

As mentioned in the first section of this article, disc herniation occurs when there is disc material displaces beyond the limits of the intervertebral disc focally. The disc space consists of endplates of the vertebral bodies superiorly and inferiorly while the outer edges of the vertebral apophyses consist of the peripheral margin. The osteophytes are not considered a disc margin. There may be irritation or compression of the nerve roots and dural sac due to the volume of the herniated material leading to pain. When this occurs in the lumbar region, this is classically known as sciatica. This condition has been mentioned since ancient times although a connection between disc herniation and sciatica was made only in the 20th century. Disc herniation is one of the commonest diagnoses seen in the spine due to degenerative changes and is the commonest cause of spinal surgery.

Classifications of Disc Herniation

There are many classifications regarding intervertebral disc herniation. In focal disc herniation, there is a localized displacement of the disc material in the horizontal or axial plane. In this type, only less than 25% of the circumference of the disc is involved. In broad-based disc herniation, about 25 – 50 % of the disc circumference is herniated. The disc bulge is when 50 – 100 % of the disc material is extended beyond the normal confines of the intervertebral space. This is not considered a form of disc herniation. Furthermore, the intervertebral disc deformities associated with severe cases of scoliosis and spondylolisthesis are not classified as a herniation but rather adaptive changes of the contour of the disc due to the adjacent deformity.

Depending on the contour of the displaced material, the herniated discs can be further classified as protrusions and extrusions. In disc protrusion, the distance measured in any plane involving the edges of the disc material beyond intervertebral disc space (the highest measure is taken) is lower than the distance measured in the same plane between the edges of the base.

Imaging can show the disc displacement as a protrusion on the horizontal section and as an extrusion on the sagittal section due to the fact that the posterior longitudinal ligament contains the disc material that is displaced posteriorly. Then the herniation should be considered an extrusion. Sometimes the intervertebral disc herniation can occur in the craniocaudal or vertical direction through a defect in the vertebral body endplates. This type of herniation is known as intravertebral herniation.

The disc protrusion can also be divided into two focal protrusion and broad-based protrusion. In focal protrusion, the herniation is less than 25% of the circumference of the disc whereas, in broad-based protrusion, the herniated disc consists of 25 – 50 % of the circumference of the disc.

In disc extrusion, it is diagnosed if any of the two following criteria are satisfied. The first one is; that the distance measured between the edges of the disc material that is beyond the intervertebral disc space is greater than the distance measured in the same plane between the edges of the base. The second one is; that the material in the intervertebral disc space and material beyond the intervertebral disc space is having a lack continuity.

This can be further characterized as sequestrated which is a subtype of the extruded disc. It is called disc migration when disk material is pushed away from the site of extrusion without considering whether there is continuity of disc or not. This term is useful in interpreting imaging modalities as it is often difficult to show continuity in imaging.

The intervertebral disc herniation can be further classified as contained discs and discs that are unconfined. The term contained disc is used to refer to the integrity of the peripheral annulus fibrosus which is covering the intervertebral disc herniation. When fluid is injected into the intervertebral disc, the fluid does not leak into the vertebral canal in herniations that are contained.

Sometimes there are displaced disc fragments that are characterized as free. However, there should be no continuity between disc material and the fragment and the original intervertebral disc for it to be called a free fragment or a sequestered one. In a migrated disc and in a migrated fragment, there is an extrusion of disc material through the opening in the annulus fibrosus with a displacement of the disc material away from the annulus.

Even though some fragments that are migrated can be sequestered the term migrated means just to the position and it is not referred to the continuity of the disc. The displaced intervertebral disc material can be further described with regard to the posterior longitudinal ligament as submembranous, subcapsular, subligamentous, extra ligamentous, transligamentous, subcapsular, and perforated.

The spinal canal can also get affected by an intervertebral disc herniation. This compromise of the canal can also be classified as mild, moderate, and severe depending on the area that is compromised. If the canal at that section is compromised only less than one third, it is called mild whereas if it is only compromised less than two-thirds and more than one third it is considered moderate. In a severe compromise, more than two-thirds of the spinal canal is affected. For the foraminal involvement, this same grading system can be applied.

The displaced material can be named according to the position that they are in the axial plane from the center to the right lateral region. They are termed as central, right central, right subarticular, right foraminal, and right extraforaminal. The displaced intervertebral disc material’s composition can be further classified as gaseous, liquefied, desiccated, scarred, calcified, ossified, bony, nuclear, and cartilaginous.

Before going into detail on how to diagnose and treat intervertebral disc herniation, let us differentiate how cervical disc herniation differs from lumbar herniation since they are the most common regions to undergo herniation.

Cervical Disc Herniation vs. Thoracic Disc Herniation vs Lumbar Disc Herniation

Lumbar disc herniation is the most commonest type of herniation found in the spine which is approximately 90% of the total. However, cervical disc herniation can also occur in about one-tenth of patients. This difference is mainly due to the fact that the lumbar spine has more pressure due to the increased load. Moreover, it has comparatively large intervertebral disc material. The most common sites of intervertebral disc herniation in the lumbar region are L 5 – 6, in the Cervical region between C7, and in the thoracic region T12.

Cervical disc herniation can occur relatively commonly because the cervical spine acts as a pivoting point for the head and it is a vulnerable area for trauma and therefore prone to damage in the disc. Thoracic disc herniation occurs more infrequently than any of the two. This is due to the fact that thoracic vertebrae are attached to the ribs and the thoracic cage which limits the range of movement in the thoracic spine when compared to the cervical and lumbar spinal discs. However, thoracic intervertebral disc herniation can still occur.

Cervical disc herniation gives rise to neck pain, shoulder pain, pain radiating from the neck to the arm, tingling, etc. Lumbar disc herniation can similarly cause lower back pain as well as pain, tingling, numbness, and muscle weakness seen in the lower limbs. Thoracic disc herniation can give rise to pain in the upper back radiating to the torso.

Epidemiology

Although disc herniation can occur in all age groups, it predominantly occurs between the fourth and fifth decade of life with the mean age of 37 years. There have been reports that estimate the prevalence of intervertebral disc herniation to be 2 – 3 % of the general population. It is more commonly seen in men over 35 years with a prevalence of 4.8% and while in women this figure is around 2.5%. Due to its high prevalence, it is considered a worldwide problem as it is also associated with significant disability.

Risk Factors

In most instances, a herniated disc occurs due to the natural aging process in the intervertebral disc. Due to the disc degeneration, the amount of water that was previously seen in the intervertebral disc gets dried out leading to the shrinking of the disc with the narrowing of the intervertebral space. These changes are markedly seen in degenerative disc disease. In addition to these gradual changes due to normal wear and tear, other factors may also contribute to increasing the risk of intervertebral disc herniation.

Being overweight can increase the load on the spine and increase the risk of herniation. A sedentary life can also increase the risk and therefore an active lifestyle is recommended in preventing this condition. Improper posture with prolonged standing, sitting, and especially driving can put a strain on the intervertebral discs due to the additional vibration from the vehicle engine leading to microtrauma and cracks in the disc. The occupations which require constant bending, twisting, pulling and lifting can put a strain on the back. Improper weight lifting techniques are one of the major reasons.

When back muscles are used in lifting heavy objects instead of lifting with the legs and twisting while lifting can make the lumbar discs more vulnerable to herniation. Therefore patients should always be advised to lift weights with their legs and not the back. Smoking has been thought to increase disc herniation by reducing the blood supply to the intervertebral disc leading to degenerative changes of the disc.

Although the above factors are frequently assumed to be the causes for disc herniation, some studies have shown that the difference in risk is very small when this particular population was compared with the control groups of the normal population.

There have been several types of research done on genetic predisposition and intervertebral disc herniation. Some of the genes that are implicated in this disease include vitamin D receptor (VDR) which is a gene that codes for the polypeptides of important collagen called collagen IX (COL9A2).

Another gene called the human aggrecan gene (AGC) is also implicated as it codes for proteoglycans which is the most important structural protein found in the cartilage. It supports the biochemical and mechanical function of the cartilage tissue and hence when this gene is defective, it can predispose an individual to intervertebral disc herniation.

Apart from these, there are many other genes that are being researched due to the association between disc herniation such as matrix metalloproteinase (MMP) cartilage intermediate layer protein, thrombospondin (THBS2), collagen 11A1, carbohydrate sulfotransferase, and asporin (ASPN). They may also be regarded as potential gene markers for lumbar disc disease.

Pathogenesis of Sciatica and Disc Herniation

The sciatic pain originated from the extruded nucleus pulposus inducing various phenomena. It can directly compress the nerve roots leading to ischemia or without it, mechanically stimulate the nerve endings of the outer portion of the fibrous ring and release inflammatory substances suggesting its multifactorial origin. When the disc herniation causes mechanical compression of the nerve roots, the nerve membrane is sensitized to pain and other stimuli due to ischemia. It has been shown that in sensitized and compromised nerve roots, the threshold for neuronal sensitization is around half of that of a normal and non-compromised nerve root.

The inflammatory cell infiltration is different in extruded discs and non-extruded discs. Usually, in non-extruded discs, the inflammation is less. The extruded disc herniation causes the posterior longitudinal ligament to rupture which exposes the herniated part to the vascular bed of the epidural space. It is believed that inflammatory cells are originating from these blood vessels situated in the outermost part of the intervertebral disc.

These cells may help secrete substances that cause inflammation and irritation of the nerve roots causing sciatic pain. Therefore, extruded herniations are more likely to cause pain and clinical impairment than those that are contained. In contained herniations, the mechanical effect is predominant while in the unconfined or the extruded discs the inflammatory effect is predominant.

Clinical Disc Herniation and What to Look for in the History

The symptoms of the disc herniation can vary a great deal depending on the location of the pain, the type of herniation, and the individual. Therefore, history should focus on the analysis of the main complaint among the many other symptoms.

The chief complaint can be neck pain in cervical disc herniation and there can be referred pain in the arms, shoulders, neck, head, face, and even the lower back region. However, it is most commonly referred to as the interscapular region. The radiation of pain can occur according to the level at the herniation is taking place. When the nerve roots of the cervical region are affected and compressed, there can be sensory, and motor changes with changes in the reflexes.

The pain that occurs due to nerve root compression is called radicular pain and it can be described as deep, aching, burning, dull, achy, and electric depending on whether there is mainly motor dysfunction or sensory dysfunction. In the upper limb, the radicular pain can follow a dermatomal or myotomal pattern. Radiculopathy usually does not accompany neck pain. There can be unilateral as well as bilateral symptoms. These symptoms can be aggravated by activities that increase the pressure inside the intervertebral discs such as the Valsalva maneuver and lifting.

Driving can also exacerbate pain due to disc herniation due to stress because of vibration. Some studies have shown that shock loading and stress from vibration can cause a mechanical force to exacerbate small herniations but flexed posture had no influence. Similarly, activities that decrease intradiscal pressure can reduce the symptoms such as lying down.

The main complaint in lumbar disc herniation is lower back pain. Other associated symptoms can be a pain in the thigh, buttocks, and anogenital region which can radiate to the foot and toe. The main nerve affected in this region is the sciatic nerve causing sciatica and its associated symptoms such as intense pain in the buttocks, leg pain, muscle weakness, numbness, impairment of sensation, hot and burning or tingling sensation in the legs, dysfunction of gait, impairment of reflexes, edema, dysesthesia or paresthesia in the lower limbs. However, sciatica can be caused by causes other than herniation such as tumors, infection, or instability which need to be ruled out before arriving at a diagnosis.

The herniated disc can also compress on the femoral nerve and can give rise to symptoms such as numbness, tingling sensation in one or both legs, and a burning sensation in the legs and hips. Usually, the nerve roots that are affected in herniation in the lumbar region are the ones exiting below the intervertebral disc. It is thought that the level of the nerve root irritation determines the distribution of leg pain. In herniations at the third and fourth lumbar vertebral levels, the pain may radiate to the anterior thigh or the groin. In radiculopathy at the level of the fifth lumbar vertebra, the pain may occur in the lateral and anterior thigh region. In herniations at the level of the first sacrum, the pain may occur in the bottom of the foot and the calf. There can also be numbness and tingling sensation occurring in the same area of distribution. The weakness in the muscles may not be able to be recognized if the pain is very severe.

When changing positions the patient is often relieved from pain. Maintaining a supine position with the legs raised can improve the pain. Short pain relief can be brought by having short walks while long walks, standing for prolonged periods, and sitting for extended periods of time such as in driving can worsen the pain.

The lateral disc herniation is seen in foraminal and extraforaminal herniations and they have different clinical features to that of medial disc herniation seen in subarticular and central herniations. The lateral intervertebral disc herniations can when compared to medial herniations more directly irritate and mechanically compress the nerve roots that are exiting and the dorsal root ganglions situated inside the narrowed spinal canal.

Therefore, lateral herniation is seen more frequently in older age with more radicular pain and neurological deficits. There is also more radiating leg pain and intervertebral disc herniations in multiple levels in the lateral groups when compared to medial disc herniations.

The herniated disc in the thoracic region may not present with back pain at all. Instead, there are predominant symptoms due to referred pain in the thorax due to irritation of nerves. There can also be predominant pain in the body that travels to the legs, tingling sensation and numbness in one or both legs, muscle weakness, and spasticity of one or both legs due to exaggerated reflexes.

The clinician should look out for atypical presentations as there could be other differential diagnoses. The onset of symptoms should be inquired about to determine whether the disease is acute, sub-acute, or chronic in onset. Past medical history has to be inquired about in detail to exclude red flag symptoms such as pain that occurs at night without activity which can be seen in pelvic vein compression, and non-mechanical pain which may be seen in tumors or infections.

If there is a progressive neurological deficit, with bowel and bladder involvement is there, it is considered a neurological emergency and urgently investigated because cauda equine syndrome may occur which if untreated, can lead to permanent neurological deficit.

Getting a detailed history is important including the occupation of the patient as some activities in the job may be exacerbating the patient’s symptoms. The patient should be assessed regarding which activities he can and cannot do.

Differential Diagnosis

  • Degenerative disc disease
  • Mechanical pain
  • Myofascial pain leading to sensory disturbances and local or referred pain
  • Hematoma
  • Cyst leading to occasional motor deficits and sensory disturbances
  • Spondylosis or spondylolisthesis
  • Discitis or osteomyelitis
  • Malignancy, neurinoma or mass lesion causing atrophy of thigh muscles, glutei
  • Spinal stenosis is seen mainly in the lumbar region with mild low back pain, motor deficits, and pain in one or both legs.
  • An epidural  abscess can cause symptoms similar to radicular pain involving spinal disc herniation
  • Aortic aneurysm which can cause low back pain and leg pain due to compression can also rupture and lead to hemorrhagic shock.
  • Hodgkin’s lymphoma in advanced stages can lead to space-occupying lesions in the spinal column leading to symptoms like that of intervertebral disc herniation
  • Tumors
  • Pelvic endometriosis
  • Facet hypertrophy
  • Lumbar nerve root schwannoma
  • Herpes zoster infection results in inflammation along with the sciatic or lumbosacral nerve roots

Examination in Disc Herniation

Complete physical examination is necessary to diagnose intervertebral disc herniation and exclude other important differential diagnoses. The range of motion has to be tested but may have a poor correlation with disc herniation as it is mainly reduced in elderly patients with a degenerative disease and due to disease of the joints.

A complete neurological examination is often necessary. This should test muscle weakness and sensory weakness. In order to detect muscle weakness in small toe muscles, the patient can be asked to walk on tiptoe. The strength of muscle can also be tested by comparing the strength to that of the clinician. There may be dermatomal sensory loss suggesting the respective nerve root involvement. The reflexes may be exaggerated or sometimes maybe even absent.

There are many neurologic examination maneuvers described in relation to intervertebral disc herniation such as the Braggart sign, flip the sign, Lasegue rebound sign, Lasegue differential sign, Mendel Bechterew sign, Deyerle sign both legs or Milgram test, and well leg or Fajersztajin test. However, all these are based on testing the sciatic nerve root tension by using the same principles in the straight leg raising test. These tests are used for specific situations to detect subtle differences.

Nearly almost all of them depend on the pain radiating down the leg and if it occurs above the knee it is assumed to be due to a neuronal compressive lesion and if the pain goes below the knee, it is considered to be due to the compression of the sciatic nerve root. For lumbar disc herniation detection, the most sensitive test is considered to be radiating pain occurring down the leg due to provocation.

In the straight leg raising test also called the Lasegue’s sign, the patient stays on his or her back and keeps the legs straight. The clinician then lifts the legs by flexing the hip while keeping the knee straight. The angle at which the patient feels pain going down the leg below the knee is noted. In a normal healthy individual, the patient can flex the hip to 80- 90? without having any pain or difficulty.

However, if the angle is just 30 -70? degrees, it is suggestive of lumbar intervertebral disc herniation at the L4 to S1 nerve root levels. If the angle of hip flexion without pain is less than 30 degrees, it usually indicates some other causes such as tumor of the gluteal region, gluteal abscess, spondylolisthesis, disc extrusion, and protrusion, malingering patient, and acute inflammation of the dura mater. If pain with hip flexion occurs at more than 70 degrees, it may be due to tightness of the muscles such as gluteus maximus and hamstrings, tightness of the capsule of the hip joint, or pathology of sacroiliac or hip joints.

The reverse straight leg raising test or hip extension test can be used to test higher lumbar lesions by stretching the nerve roots of the femoral nerve which is similar to the straight leg raising test. In the cervical spine, in order to detect stenosis of the foramina, the Spurling test is done and is not specific to cervical intervertebral disc herniation or tension of the nerve roots. The Kemp test is the analogous test in the lumbar region to detect foraminal stenosis. Complications due to the disc herniation include careful examination of the hip region, digital rectal examination, and urogenital examination is needed.

Investigation of Disc Herniation

For the diagnosis of intervertebral disc herniation, diagnostic tests such as Magnetic resonance imaging (MRI), Computed tomography (CT), myelography, and plain radiography can be used either alone or in combination with other imaging modalities. Objective detection of disc herniation is important because only after such a finding the surgical intervention is even considered. Serum biochemical tests such as prostate-specific antigen (PSA) level, Alkaline phosphatize value, erythrocyte sedimentation rate (ESR), urine analysis for Bence Jones protein, serum glucose level, and serum protein electrophoresis may also be needed in specific circumstances guided by history.

Magnetic Resonance Imaging (MRI)

MRI is considered the best imaging modality in patients with history and physical examination findings suggestive of lumbar disc herniation associated with radiculopathy according to North American Spinal Society guidelines in 2014. The anatomy of the herniated nucleus pulposus and its associated relationships with soft tissue in the adjacent areas can be delineated exquisitely by MRI in cervical, thoracic, and lumbosacral areas. Beyond the confines of the annulus, the herniated nucleus can be seen as a focal, asymmetric disc material protrusion on MRI.

On sagittal T2 weighted images, the posterior annulus is usually seen as a high signal intensity area due to radial annular tear associated with the herniation of the disc although the herniated nucleus is itself hypointense. The relationship between the herniated nucleus and degenerated facets with the nerve roots which are exiting through the neural foramina are well-demarcated on sagittal images of MRI. Free fragments of the intervertebral disc can also be distinguished from MRI images.

There may be associated signs of intervertebral disc herniation on MRI such as radial tears on the annulus fibrosus which is also a sign of degenerative disc disease. There may be other telling signs such as loss of disc height, bulging annulus, and changes in the endplates. Atypical signs may also be seen with MRI such as abnormal disc locations, and lesions located completely outside the intervertebral disc space.

MRI can detect abnormalities in the intervertebral discs superiorly to other modalities although its bone imaging is a little less inferior. However, there are limitations with MRI in patients with metal implant devices such as pacemakers because the electromagnetic field can lead to abnormal functioning of the pacemakers. In patients with claustrophobia, it may become a problem to go to the narrow canal to be scanned by the MRI machine. Although some units contain open MRI, it has less magnetic power and hence delineates less superior quality imaging.

This is also a problem in children and anxious patients undergoing MRI because good image quality depends on the patient staying still. They may require sedation. The contrast used in MRI which is gadolinium can induce nephrogenic systemic fibrosis in patients who had pre-existing renal disease. MRI is also generally avoided in pregnancy especially during the first 12 weeks although it has not been clinically proven to be hazardous to the fetus. MRI is not very useful when a tumor contains calcium and in distinguishing edema fluid from tumor tissue.

Computed Tomography (CT)

CT scanning is also considered another good method to assess spinal disc herniation when MRI is not available. It is also recommended as a first-line investigation in unstable patients with severe bleeding. CT scanning is superior to myelography although when the two are combined, it is superior both of them. CT scans can show calcification more clearly and sometimes even gas in images. In order to achieve a superior imaging quality, the imaging should be focused on the site of pathology and thin sections taken to better determine the extent of the herniation.

However, a CT scan is difficult to be used in patients who have already undergone laminectomy surgical procedures because the presence of scar tissue and fibrosis causes the identification of the structures difficult although bony changes and deformity in nerve sheath are helpful in making a diagnosis.

The herniated intervertebral discs in the cervical disc can be identified by studying the uncinate process. It is usually projected posteriorly and laterally to the intervertebral discs and superiorly to the vertebral bodies. The uncinate process undergoes sclerosis, and hypertrophy when there is an abnormal relationship between the uncinate process and adjacent structures as seen in degenerative disc disease, intervertebral disc space narrowing, and general wear and tear.

Myelopathy can occur when the spinal canal is affected due to disc disease. Similarly, when neural foramina are involved, radiculopathy occurs. Even small herniated discs and protrusions can cause impingement of the dural sac because the cervical epidural space is narrowed naturally. The intervertebral discs have attenuation a little bit greater than the sac characterized in the CT scan.

In the thoracic region, a CT scan can diagnose an intervertebral disc herniation with ease due to the fact that there is an increased amount of calcium found in the thoracic discs. Lateral to the dural sac, the herniated disc material can be seen on CT as a clearly defined mass that is surrounded by epidural fat. When there is a lack of epidural fat, the disc appears as a higher attenuated mass compared to the surrounding.

Radiography

Plain radiography is not needed in diagnosing herniation of the intervertebral discs, because plain radiographs cannot detect the disc and therefore are used to exclude other conditions such as tumors, infections, and fractures.

In myelography, there may be deformity or displacement of the extradural contrast-filled thecal sac seen in herniation of the disc. There may also be features in the affected nerve such as edema, elevation, deviation, and amputation of the nerve root seen in the myelography image.

Diskography

In this imaging modality, the contrast medium is injected into the disc in order to assess the disc morphology. If pain occurs following injection that is similar to the discogenic pain, it suggests that that disc is the source of the pain. When a CT scan is also performed immediately after discography, it is helpful to differentiate the anatomy and pathological changes. However, since it is an invasive procedure, it is indicated only in special circumstances when MRI and CT have failed to reveal the etiology of back pain. It has several side effects such as headache, meningitis, damage to the disc, discitis, intrathecal hemorrhage, and increased pain.

Treatment of Herniated Disc

The treatment should be individualized according to the patient-guided through history, physical examination, and diagnostic investigation findings. In most cases, the patient gradually improves without needing further intervention in about 3 – 4 months. Therefore, the patient only needs conservative therapy during this time period. Because of this reason, there are many ineffective therapies that have emerged by attributing the natural resolution of symptoms to that therapy. Therefore, conservative therapy needs to be evidence-based.

Conservative Therapy

Since the herniation of the disc has a benign course, the aim of treatment is to stimulate the recovery of neurological function, reduce pain, and facilitate early return to work and activities of daily living. The most benefits of the conservative treatment are for younger patients with hernias that are sequestered and in patients with mild neurological deficits due to small disc hernias.

Bed rest has long been considered a treatment option in herniation of the disc. However, it has been shown that bed rest has no effect beyond the first 1 or 2 days. The bed rest is regarded as counterproductive after this period of time.

In order to reduce the pain, oral non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can be used. This can relieve the pain by reducing inflammation associated with the inflamed nerve. Analgesics such as acetaminophen can also be used although they lack the anti-inflammatory effect seen in NSAIDs. The doses and the drugs should be appropriate for the age and severity of the pain in the patient. If pain is not controlled by the current medication, the clinician has to go one step up on the WHO analgesics ladder. However, the long-term use of NSAIDs and analgesics can lead to gastric ulcers, liver, and kidney problems.

In order to reduce the inflammation, other alternative methods such as applying ice in the initial period and then switching to using heat, gels, and rubs may help with the pain as well as muscle spasms. Oral muscle relaxants can also be used in relieving muscle spasms. Some of the drugs include methocarbamol, carisoprodol, and cyclobenzaprine.

However, they act centrally and cause drowsiness and sedation in patients and it does not act directly to reduce muscle spasm. A short course of oral steroids such as prednisolone for a period of 5 days in a tapering regime can be given to reduce the swelling and inflammation in the nerves. It can provide immediate pain relief within a period of 24 hours.

When the pain is not resolved adequately with maximum effective doses, the patient can be considered for giving steroid injections into the epidural space. The major indication for the steroid injection into periradicular space is discal compression causing radicular pain that is resistant to conventional medical treatment. A careful evaluation with CT or MRI scanning is required to carefully exclude extra discal causes for pain. The contraindications for this therapy include patients with diabetes, pregnancy, and gastric ulcers. Epidural puncture is contraindicated in patients with coagulation disorders and therefore the foraminal approach is used carefully if needed.

This procedure is performed under the guidance of fluoroscopy and involves injecting steroids and an analgesic into the epidural space adjacent to the affected intervertebral disc to reduce the swelling and inflammation of the nerves directly in an outpatient setting. As much as 50% of the patients experience relief after the injection although it is temporary and they might need repeat injections at 2 weekly intervals to achieve the best results. If this treatment modality becomes successful, up to 3 epidural steroidal injections can be given per year.

Physical therapy can help the patient return to his previous life easily although it does not improve the herniated disc. The physical therapist can instruct the patient on how to maintain the correct posture, walking, and lifting techniques depending on the patient’s ability to work, mobility, and flexibility.

Stretching exercises can improve the flexibility of the spine while strengthening exercises can increase the strength of the back muscles. The activities which can aggravate the condition of the herniated disc are instructed to be avoided. Physical therapy makes the transition from intervertebral disc herniation to an active lifestyle smooth. The exercise regimes can be maintained for life to improve general well-being.

The most effective conservative treatment option that is evidence-based is observation and epidural steroid injection for the relief of pain in the short-term duration. However, if the patients so desire they can use holistic therapies of their choice with acupuncture, acupressure, nutritional supplements, and biofeedback although they are not evidence-based. There is also no evidence to justify the use of trans electrical nerve stimulation (TENS) as a pain relief method.

If there is no improvement in the pain after a few months, surgery can be contemplated and the patient must be selected carefully for the best possible outcome.

Surgical Therapy

The aim of surgical therapy is to decompress the nerve roots and relieve the tension. There are several indications for surgical treatment which are as follows.

Absolute indications include cauda equina syndrome or significant paresis. Other relative indications include motor deficits that are greater than grade 3, sciatica that is not responding to at least six months of conservative treatment, sciatica for more than six weeks, or nerve root pain due to foraminal bone stenosis.

There have been many discussions over the past few years regarding whether to treat herniation of intervertebral disc disease with prolonged conservative treatment or early surgical treatment. Much research has been conducted in this regard and most of them show that the final clinical outcome after 2 years is the same although the recovery is faster with early surgery. Therefore, it is suggested that early surgery may be appropriate as it enables the patient to return to work early and thereby is economically feasible.

Some surgeons may still use traditional discectomy although many are using minimally invasive surgical techniques over recent years. Microdiscectomy is considered to be the halfway between the two ends. There are two surgical approaches that are being used. Minimally invasive surgery and percutaneous procedures are the ones that are being used due to their relative advantage. There is no place for the traditional surgical procedure known as a laminectomy.

However, there are some studies suggesting microdiscectomy is more favorable because of its both short-term and long-term advantages. In the short term, there is a reduced length of operation, reduced bleeding, relief of symptoms, and reduced complication rate. This technique has been effective even after 10 years of follow-up and therefore is the most preferred technique even now. The studies that have been performed to compare the minimally invasive technique and microdiscectomy have resulted in different results. Some have failed to establish a significant difference while one randomized control study was able to determine that microdiscectomy was more favorable.

In microdiscectomy, only a small incision is made aided by an operating microscope and the part of the herniated intervertebral disc fragment which is impinging on the nerve is removed by hemilaminectomy. Some part of the bone is also removed to facilitate access to the nerve root and the intervertebral disc. The duration of the hospital stay is minimal with only an overnight stay and observation because the patient can be discharged with minimal soreness and complete relief of the symptoms.

However, some unstable patients may need more prolonged admission and sometimes they may need fusion and arthroplasty. It is estimated that about 80 – 85 % of the patients who undergo microdiscectomy recover successfully and many of them are able to return to their normal occupation in about 6 weeks.

There is a discussion on whether to remove a large portion of the disc fragment and curetting the disc space or to remove only the herniated fragment with minimal invasion of the intervertebral disc space. Many studies have suggested that the aggressive removal of large chunks of the disc could lead to more pain than when conservative therapy is used with 28% versus 11.5 %. It may lead to degenerative disc disease in the long term. However, with conservative therapy, there is a greater risk of recurrence of around 7 % in herniation of the disc. This may require additional surgery such as arthrodesis and arthroplasty to be performed in the future leading to significant distress and economic burden.

In the minimally invasive surgery, the surgeon usually makes a tiny incision in the back to put the dilators with increasing diameter to enlarge the tunnel until it reaches the vertebra. This technique causes lesser trauma to the muscles than when seen in traditional microdiscectomy. Only a small portion of the disc is removed in order to expose the nerve root and the intervertebral disc. Then the surgeon can remove the herniated disc by the use of an endoscope or a microscope.

These minimally invasive surgical techniques have a higher advantage of lower surgical site infections and shorter hospital stays. The disc is centrally decompressed either chemically or enzymatically with the use of chymopapain, laser, or plasma (ionized gas) ablation and vaporization. It can also be decompressed mechanically by using percutaneous lateral decompression or by aspirating and sucking with a shaver such as a nucleosome. Chemopapin was shown to have adverse effects and was eventually withdrawn. Most of the above techniques have shown to be less effective than a placebo. Directed segmentectomy is the one that has shown some promise in being effective similar to microdiscectomy.

In the cervical spine, the herniated intervertebral discs are treated anteriorly. This is because the herniation occurs anteriorly and the manipulation of the cervical cord is not tolerated by the patient. The disc herniation that is due to foraminal stenosis and that is confined to the foramen are the only instances where a posterior approach is contemplated.

The minimal disc excision is an alternative to the anterior cervical spine approach. However, the intervertebral disc stability after the procedure is dependent on the residual disc. The neck pain can be significantly reduced following the procedure due to the removal of neuronal compression although significant impairment can occur with residual axial neck pain. Another intervention for cervical disc herniation includes anterior cervical interbody fusion. It is more suitable for patients with severe myelopathy with degenerative disc disease.

Complications of the Surgery

Although the risk of surgery is very low, complications can still occur. Post-operative infection is one of the commonest complications and therefore needs more vigorous infection control procedures in the theatre and in the ward. During the surgery, due to poor surgical technique, nerve damage can occur. A dural leak may occur when an opening in the lining of the nerve root causes leakage of cerebrospinal fluid which is bathing the nerve roots. The lining can be repaired during the surgery. However, headache can occur due to loss of cerebrospinal fluid but it usually improves with time without any residual damage. If blood around the nerve roots clots after the surgery, that blood clot may lead to compression of the nerve root leading to radicular pain which was experienced by the patient previously. Recurrent herniation of the intervertebral disc due to herniation of disc material at the same site is a devastating complication that can occur long term. This can be managed conservatively but surgery may be necessary ultimately.

Outcomes of the Surgery

There has been extensive research done regarding the outcome of lumbar disc herniation surgery. Generally, the results from the microdiscectomy surgery are good. There is more improvement of leg pain than back pain and therefore this surgery is not recommended for those who have only back pain. Many patients improve clinically over the first week but they may improve over the following several months. Typically, the pain disappears in the initial recovery period and it is followed by an improvement in the strength of the leg. Finally, the improvement of the sensation occurs. However, patients may complain of feeling numbness although there is no pain. The normal activities and work can be resumed over a few weeks after the surgery.

Novel Therapies

Although conservative therapy is the most appropriate therapy in treating patients, the current standard of care does not address the underlying pathology of herniation of the intervertebral discs. There are various pathways that are involved in the pathogenesis such as inflammatory, immune-mediated, and proteolytic pathways.

The role of inflammatory mediators is currently under research and it has led to the development of new therapies that are directed at these inflammatory mediators causing damage to the nerve roots. The cytokines such as TNF ? are mainly involved in regulating these processes. The pain sensitivity is mediated by serotonin receptor antagonists and ?2 adrenergic receptor antagonists.

Therefore, pharmacological therapies that target these receptors and mediators may influence the disease process and lead to a reduction in symptoms. Currently, cytokine antagonists against TNF ? and IL 1? have been tested. Neuronal receptor blockers such as sarpogrelate hydrochloride etc have been tested in both animal models and in clinical studies for the treatment of sciatica. Cell cycle modifiers that target the microglia that are thought to initiate the inflammatory cascade have been tested with the neuroprotective antibiotic minocycline.

There is also research on inhibiting the NF- kB or protein kinase pathway recently. In the future, the treatment of herniation of the intervertebral disc will be much more improved thanks to the ongoing research. (Haro, Hirotaka)

 

El Paso Chiropractor Near Me

Dr. Alex Jimenez DC, MSACP, RN, CCST

 

A disc bulge and/or a herniated disc is a health issue that affects the intervertebral discs found in between each vertebra of the spine. Although these can occur as a natural part of degeneration with age, trauma or injury as well as repetitive overuse can also cause a disc bulge or a herniated disc. According to healthcare professionals, a disc bulge and/or a herniated disc is one of the most common health issues affecting the spine. A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. A herniated disc is when a part of or the whole nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. Treatment of these health issues focuses on reducing symptoms. Alternative treatment options, such as chiropractic care and/or physical therapy, can help relieve symptoms. Surgery may be utilized in cases of severe symptoms. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

Curated by Dr. Alex Jimenez D.C., C.C.S.T.

 

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  • Jacobs, Wilco C. H. et al. Surgical Techniques For Sciatica Due To Herniated Disc, A Systematic Review. European Spine Journal, vol 21, no. 11, 2012, pp. 2232-2251. Springer Nature, doi:10.1007/s00586-012-2422-9.
  • Rutkowski, B. Combined Practice Of Electrical Stimulation For Lumbar Intervertebral Disc Herniation.Pain, vol 11, 1981, p. S226. Ovid Technologies (Wolters Kluwer Health), doi:10.1016/0304-3959(81)90487-5.
  • Weber, Henrik. Spine Update The Natural History Of Disc Herniation And The Influence Of Intervention.Spine, vol 19, no. 19, 1994, pp. 2234-2238. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-199410000-00022.
  • Disk Herniation Imaging: Overview, Radiography, Computed Tomography.Emedicine.Medscape.Com, 2017,
  • Carvalho, Lilian Braighi et al. Hrnia De Disco Lombar: Tratamento. Acta Fisitrica, vol 20, no. 2, 2013, pp. 75-82. GN1 Genesis Network, doi:10.5935/0104-7795.20130013.
  • Kerr, Dana et al. What Are Long-Term Predictors Of Outcomes For Lumbar Disc Herniation? A Randomized And Observational Study. Clinical Orthopaedics And Related Research, vol 473, no. 6, 2014, pp. 1920-1930. Springer Nature, doi:10.1007/s11999-014-3803-7.
  • Buy, Xavier, and Afshin Gangi. Percutaneous Treatment Of Intervertebral Disc Herniation. Seminars In Interventional Radiology, vol 27, no. 02, 2010, pp. 148-159. Thieme Publishing Group, doi:10.1055/s-0030-1253513.
  • Haro, Hirotaka. Translational Research Of Herniated Discs: Current Status Of Diagnosis And Treatment. Journal Of Orthopaedic Science, vol 19, no. 4, 2014, pp. 515-520. Elsevier BV, doi:10.1007/s00776-014-0571-x.

 

 

Sacral Fracture

Sacral Fracture

For older individuals, experiencing frequent low back pain could turn out to be a sacral fracture. They tend to occur in individuals over the age of 60 often because there has been a degree of bone loss. Sacral fractures tend not to be the first thing doctors think of when low back pain symptoms are presenting. They are often not picked up on X-rays and are either not diagnosed early enough to take steps or not diagnosed at all. However, they are common.

Sacral Fracture

Sacrum

The sacrum is shaped like a triangle and comprises five segments fused into one large bone. It sits at the base of the spine,  between the two halves of the pelvis, connecting the spine to the lower half of the body. It stabilizes the body when walking, sitting, or standing. The nerves in the lower spine control the bowels bladder and provide sensation to the region.

  • The two dimples that can be seen on individuals’ backs are where the sacrum joins the hipbones or the sacroiliac joint.
  • The point where the low back joins the sacrum can develop discomfort, soreness, and pain.
  • This area experiences stress from bending, twisting, reaching, lifting, carrying during physical activities or sitting for long periods.

Sacral Fracture

Most sacral fractures result from trauma, like slips, falls, and automobile accidents. Stress fractures that happen without a specific injury are also called insufficiency fractures.

Types of Sacral Fractures

  • Low-energy fractures usually happen to older individuals with weak bones due to osteoporosis.
  • An individual trips on something, lands hard on their butt, lifts a heavy object awkwardly, or over-exerts themselves from some physical activity.
  • Then persistent back or buttock pain begins to present.
  • The pain is often centered in the lower back, the hips, and butt.
  • It is more than just back achiness.
  • The individual goes to the doctor, and X-rays are ordered.
  • A lot of the time, these fractures are missed on X-rays.
  • The doctor may diagnose a sprain, but the pain symptoms do not improve.
  • Sometimes there is no apparent cause for the pain.
  • It can be misdiagnosed as a lower back compression fracture or urinary tract infection.

 

  • High-energy fractures are due to trauma and are more common among the young.
  • The individual sustains injuries from an auto accident, has fallen from a significant height, or suffers a sports injury.
  • It results in severe pain.
  • A woman who has just had a baby and gone through some bone loss because of the pregnancy can experience a sacral stress fracture.

Diagnosis

The most common causes for low back pain include:

  • Frequent improper posture.
  • Muscle weakness or tightness.
  • Ligament strain.
  • Joint inflammation.
  • A pilonidal cyst or an anal fissure can also cause pain.

For individuals that have been to a doctor and had an X-ray that reveals no fracture, and there is no improvement after 5 to 7 days, it is recommended to schedule another appointment and ask for a CAT scan or MRI, which is highly effective at finding a sacral fracture.

Treatment

Treatment consists of resting the bone but still being safely active in most cases.

  • Medication is prescribed for pain relief.
  • Many individuals have been found to do well with anti-inflammatory medications, topical medications, and lidocaine patches.
  • Older individuals may be recommended to use a walker during the treatment/healing process.
  • Depending on the severity, crutches may be recommended.
  • Engaging in regular exercise is not recommended, but too much bed rest is also not recommended.
  • Too much rest may not allow the injury to heal correctly, worsen the injury, and/or cause new injuries.
  • Chiropractic and physical therapy are not recommended to let the sacrum naturally heal.
  • After the pain subsides, chiropractic and physical therapy can be implemented to maintain agility and flexibility and strengthen the pelvic and core muscles.

In some cases, if the bone does not heal correctly or some other issue, sacroplasty could be recommended. This is a minimally invasive procedure that injects bone cement into the fracture. It offers quick and long-lasting pain relief with a low percentage of complications. It is considered low risk and can be done by an interventional radiologist or spine surgeon.

Prevention

To minimize the risk of a sacral fracture, it is highly recommended to maintain bone strength. This consists of:


Body Composition


Sitting Posture Adjustments

Adjust Sitting

Change Chair

  • Try a solid wooden chair if unable to use a ball or sit-stand desk.
  • It will make the body sit up straight and increase proper posture.

Move Around Alarm

References

Gibbs, Wende Nocton, and Amish Doshi. “Sacral Fractures and Sacroplasty.” Neuroimaging clinics of North America vol. 29,4 (2019): 515-527. doi:10.1016/j.nic.2019.07.003

Holmes, Michael W R, et al. “Evaluating Abdominal and Lower-Back Muscle Activity While Performing Core Exercises on a Stability Ball and a Dynamic Office Chair.” Human factors vol. 57,7 (2015): 1149-61. doi:10.1177/0018720815593184

Santolini, Emmanuele et al. “Sacral fractures: issues, challenges, solutions.” EFORT open reviews vol. 5,5 299-311. 5 May. 2020, doi:10.1302/2058-5241.5.190064

Fever and Back Pain

Fever and Back Pain

It is one thing to wake up with back pain, but another when the pain is combined with a fever, body aches, and chills. It could be the flu or another infection. However, after checking the body’s temperature and fever is present with no other symptoms than back pain unless it is the flu; the fever could be another issue that may or may not be related as there are a variety of causes for back pain like:

  • Inflamed muscles
  • Muscle or ligament strain – If in poor physical condition, repeated and constant tension on the back can cause muscle spasms. Repeated heavy lifting or a sudden awkward movement can strain the back muscles and spinal ligaments.
  • Bulging or ruptured discs – Discs act as cushions between the bones/vertebrae in the spine. The soft material inside a disc can bulge or rupture and press on a nerve. However, a bulging or ruptured disc can present without back pain. Disc disease is often found by accident when spine X-rays are performed for another reason.
  • Arthritis – Osteoarthritis can affect the lower back. In some cases, arthritis in the spine can narrow the space around the spinal cord, a condition called spinal stenosis.
  • Osteoporosis – The spine’s vertebrae can develop painful fractures if the bones become porous and brittle.

Back pain without a fever is usually an indication of a misaligned spine.

Fever and Back Pain

Fever A Sign of Something Else

A fever is the body’s way of trying to raise its core temperature in an attempt to kill off a virus or a bacterial infection. Possible causes of back pain with fever include:

Kidney Infection

  • This type of infection often presents with low back pain and fever.

Spinal Epidural Abscess

  • This is an infection of the lower region of the spine, causing fever and lower back pain.

Vertebral Osteomyelitis

  • This is an infection of the lower spine that causes pain in the arms, lower back, and legs, along with a fever.

Meningitis

  • This causes swelling and inflammation of the brain and spine and needs to be addressed immediately.

Spinal Cord Abscess

  • This is an infection of the internal part of the spine. It is rare but can happen, causing low back pain and fever.

Symptoms

This is when seeing a chiropractor can help. A few signs that should not be ignored include:

  • Recently involved in an automobile accident.
  • Suffered a serious fall.
  • Feeling a tingling in the legs.
  • Having balance issues.
  • Having abdominal pain.
  • Pain is not going away, or it goes away for a while, then comes back.
  • Have weakness in the arms or legs.
  • Having bowel or urinary problems that were not present previously.
  • The pain is worse when sitting or standing up after sitting.
  • Have upper back pain after alcohol consumption.

A chiropractor will take a complete medical history, X-rays, an MRI if necessary, and a thorough physical examination will be performed to determine the cause. After a diagnosis is reached, the chiropractor will perform adjustments to relieve the pain and open the nerve pathways to increase circulation to the area. A chiropractic massage will help reduce stress, relieve back pain, and reduce depression, which can also help reduce the fever unless it is from another issue.


Body Composition


Influenza

Influenza or the flu is a contagious respiratory illness caused by viruses that infect the nose, throat, and lungs. It can cause mild to severe illness and, in extreme cases, can lead to death. Like a common cold, the flu is spread primarily through tiny droplets that get expelled from an infected person when they sneeze, cough, or talk. Approximately 8% of the population gets the flu each season. Flu symptoms are sudden, causing the following:

  • Fever
  • Chills
  • Muscle or body aches
  • Headaches
  • Sore throat
  • Runny or stuffy nose
  • Cough
  • Fatigue
  • Vomiting and diarrhea which is more common in children.

Most individuals with healthy immune systems will recover around seven days. However, the elderly, pregnant women, individuals of any age with certain chronic medical conditions like asthma, diabetes, or heart disease, and children under the age of five have an increased risk of developing complications. Flu vaccination is currently recommended for anyone older than six months in the U.S. and effectively prevents infection in 50 – 80% of the population. The primary treatment method for the flu is to support the immune system with plenty of rest, proper nutrition, and hydration.

References

Ameer MA, Knorr TL, Mesfin FB. Spinal Epidural Abscess. [Updated 2021 Feb 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK441890/

Kehrer, Michala et al. “Increased short- and long-term mortality among patients with infectious spondylodiscitis compared with a reference population.” The spine journal: official journal of the North American Spine Society vol. 15,6 (2015): 1233-40. doi:10.1016/j.spinee.2015.02.021

Rubin, Devon I. “Epidemiology and risk factors for spine pain.” Neurologic clinics vol. 25,2 (2007): 353-71. doi:10.1016/j.ncl.2007.01.004

Tsantes, Andreas G et al. “Spinal Infections: An Update.” Microorganisms vol. 8,4 476. 27 Mar. 2020, doi:10.3390/microorganisms8040476

Pain Under The Shoulder Blade

Pain Under The Shoulder Blade

There are various causes for achiness or soreness under the shoulder blades. The shoulder blade is the triangular bone that forms the back of the shoulder. This pain can range from dull, sharp, burning, or a combination between the spine and shoulder blade to tender or achy across the shoulder or upper back. Pain can spread from another body part or structure, like the neck or spine. Inflammation from injury or overuse is noticeable at onset or gradually after engaging in physical activity and can limit arm movements and interfere with regular activities.

Pain Under The Shoulder Blade

Improper Posture

Improper poster combined with prolonged sitting can cause the spine to develop structural changes that cause pain under the shoulder blade. Habits that lead to poor posture include:

  • Hunching the back.
  • Tilting the head down – looking at the phone.
  • Leaning to one side while sitting, working.

Poor posture habits cause the muscles to weaken, placing added pressure on the spinal discs, muscles, and ligaments. This body imbalance can contribute to upper back and shoulder pain.

Lifting Improperly

Lifting weight above the head and not using the proper technique can leave the upper back and shoulders vulnerable to injury. Lifting an object that is too heavy or is held in an awkward way causing the spine to be misaligned creates added pressure in the upper back. This can strain the muscles, sprain ligaments, injure the shoulder joint, or spine, which can cause spreading pain under and/or near the shoulder blade.

Repetitive Overuse Injury

Painting, moving furniture, or participating in sports are activities that can overwork the upper back muscles and shoulders. Overuse can lead to muscle strains and ligament sprains. This can cause pain in the upper back between the shoulder blade and the spine. Scapulothoracic bursitis, also known as snapping scapula syndrome, is when the bursa between the shoulder blade/scapula and the thoracic spine becomes inflamed, causing pain.

Cervical Herniated Disc

A herniated disc in the cervical spine/neck happens when a disc’s outer layer/annulus fibrosus tears and the inner layer/nucleus pulposus starts to leak outward. This can cause pain and cause the nearby nerve roots to become inflamed, causing pain to run down into the shoulder, arm, and/or hand. A disc herniation in the lower part of the neck usually radiates pain into or near the shoulder blade area. Although less common, a herniation in the upper back can cause pain around or near the shoulder blade.

Dislocated Rib

An accident or fall could cause a rib to become dislocated or misaligned after repetitive/overuse strain or reaching too far overhead. Sharp pain near the shoulder blade can result from this activity and can sometimes make it challenging to take a deep breath.

Compression Fracture

A compression fracture occurs when a vertebral bone in the upper back weakens and compresses. This can lead to back pain with a heightened sensitivity across the shoulder area. The pain usually decreases with rest. Compression fractures are commonly caused by osteoporosis in older individuals. Any back or shoulder pain that persists for weeks or interferes with regular activities should be evaluated by a doctor or chiropractor. If the pain is severe or accompanied by symptoms like headache, tingling, weakness, or nausea, individuals are recommended to seek medical attention.


Body Composition


Carbohydrate/Carb Loading

Carbohydrates are macronutrients that serve a critical function in the body, as they are the body’s primary energy source. The body breaks down carbohydrates into sugar that enters the bloodstream and is stored for energy use in the muscles and liver as glycogen. The muscles only store small quantities of glycogen. And when engaging in physical activity or exercise, the energy stores get used up.

Carbohydrate loading can raise glycogen stores in the muscles from 25 to 100 percent of their average amount in men. Women have shown mixed results in studies on carbohydrate loading. Women need to take in more calories than men when carb-loading to experience the same gains in glycogen. Reasons to carb load are either to:

  • Build-up stores of glycogen so an individual can use the extra energy storage to help improve endurance.
  • Fill the muscles with glycogen to bring water into the muscles to help gain mass and tone.
References

Hanchard, Nigel C A et al. “Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement.” The Cochrane database of systematic reviews vol. 2013,4 CD007427. 30 Apr. 2013, doi:10.1002/14651858.CD007427.pub2

Mizutamari M. et al. Corresponding scapular pain with the nerve root involved in cervical radiculopathy. J Orthop Surg. 2010; 18(3): 356–60.

Sergienko, Stanislav, and Leonid Kalichman. “Myofascial origin of shoulder pain: a literature review.” Journal of bodywork and movement therapies vol. 19,1 (2015): 91-101. doi:10.1016/j.jbmt.2014.05.004

Initial Chiropractic Examination

Initial Chiropractic Examination

Chiropractic treatment/care is a recommended pain relief option for musculoskeletal automobile, sports, personal – injuries, strains, sprains, pain, and rehabilitation. An initial chiropractic examination is similar to a standard examination administered by health care providers. What an individual can expect at their first consultation includes:

  • Condition or pain symptoms
  • Medical history
  • Physical examination
  • Initial exams last around 45 minutes or more.
  • Follow-up appointments are shorter.

Initial Chiropractic Examination

Online Conference or Phone Call

Some chiropractors offer individuals an initial interview over a video conference and/or phone call. It is focused on discussion with topics like the chiropractors:

  • Types of insurance taken
  • Cost
  • Types of forms to fill out
  • Philosophy
  • Expertise
  • Specialization areas
  • Approaches
  • Techniques
  • Individual’s preferences

Initial Clinic Visit

The initial in-office clinical exam generally includes:

Patient History and Symptoms

The patient will be asked to fill out forms that can also be filled out online before the visit, saving a patient time if they so choose. This provides background information about symptoms and conditions in preparation for the in-person chiropractic consultation. Questions include:

  • Did the pain start as a result of an auto, sports, personal, work injury?
  • How did the pain start – activities, sports, work, etc.?
  • When did the pain start – a few days, weeks, months, years?
  • Where is the pain located?
  • Does the pain spread out to other areas?
  • Is the pain dull, sharp, burning, or throbbing?
  • Does the pain come and go, or is it constant?
  • What activities or body positions make it better and/or worse?
  • Patients are also asked to provide information on pre-existing medical conditions, family medical history if necessary, prior injuries, and previous and current treatments provided by other medical professionals.

Physical Examination

A chiropractic examination includes:

  • Reflexes
  • Respiration
  • Blood pressure
  • Pulse

Certain orthopedic and neurological tests can also be used. These include:

  • Range of motion
  • Neurological integrity
  • Muscle strength
  • Muscle tone
  • Walking gait
  • Posture analysis

Diagnostic Studies

Based on the medical history and physical exam results, diagnostic studies could help reveal pathologies and identify structural abnormalities to diagnose more accurately. X-rays are the most commonly used during an initial chiropractic exam and are used to:

  • Diagnose recent trauma
  • Diagnose bone fractures
  • Study spinal deformities

An MRI scan is recommended for soft tissue damage like a herniated disc, torn muscle/s, or nerve compression.

Patient Diagnosis after the Chiropractic Exam

All the findings from the medical history, physical exam, and diagnostic tests help the chiropractor form a diagnosis. Once the diagnosis is established, the chiropractor will discuss personalized treatment options.


Body Composition


Heart Disease

Many factors can contribute to heart disease, and research has pointed to inflammation caused by obesity as one of the most significant factors to its development. The main contributor is cytokines produced by excess body fat. Cytokines cause inflammation in the walls of the arteries causing damage and increasing pressure. Blood pressure is the force of blood pushing against the walls of the vessels. High blood pressure means that the heart is not pumping blood effectively, and the heart begins to enlarge. An enlarged heart is a significant risk factor that can lead to heart failure if interventions are not taken to repair the damage.

References

Jenkins HJ, Downie AS, French SD. Current evidence for spinal x-ray use in the chiropractic profession. Chiropr Man Therap. 2018; 26:48.

Wang, Zhaoxia, and Tomohiro Nakayama. “Inflammation, a link between obesity and cardiovascular disease.” Mediators of inflammation vol. 2010 (2010): 535918. doi:10.1155/2010/535918

Weeks, William B et al. “Public Perceptions of Doctors of Chiropractic: Results of a National Survey and Examination of Variation According to Respondents’ Likelihood to Use Chiropractic, Experience With Chiropractic, and Chiropractic Supply in Local Health Care Markets.” Journal of manipulative and physiological therapeutics vol. 38,8 (2015): 533-44. doi:10.1016/j.jmpt.2015.08.001

Nervous System Health and Chiropractic Assistance

Nervous System Health and Chiropractic Assistance

According to chiropractic physiological concepts, the body is in a state of relaxation when the body’s natural intelligence can properly function. With regular movement, work, school, chores, tasks, the body takes a beating getting pushed, pulled, and twisted. This results in loss of function, disharmony, chronic conditions, and disease. Chiropractic assistance restores the communication flow with various types of adjustments.

Nervous System Health and Chiropractic Assistance

Like a vehicle that has something loose or is out of place, but can still move, so do individuals continue to work despite their body telling them that something is wrong or out of place. As they continue the body can start to break down. Even with a minor vertebral subluxation. A subluxation is when a vertebra/spine’s bones interfere with the transmission of information along the spine and throughout the central nervous system. The messages/transmissions to and from the brain disrupt the body’s ability to function properly resulting in health issues. A chiropractor adjusts the body to correct the subluxation. This facilitates the body’s natural ability to:

  • Adapt
  • Regulate
  • Heal itself through its own natural intelligence.

Chiropractic is based on principles of physiology. These principles have a significant impact on individuals:

  • Overall health
  • Vitality
  • Well-being

Self-healing and Regulating

When individuals cut themselves, or when a bone gets broken, the body will heal itself. No thought or practice is needed. The body breathes, digests food, the heart continues to beat and the kidneys filter out waste products.

Brain, Nervous System, and Body Health

The brain and nervous system are what controls and coordinate the body’s ability to heal and self-regulate. The brain sends out information through the nervous system to the organs of the body. The information tells the organs what to do and when to do it. The organs reply to the brain through the nervous system letting the brain know everything is operating correctly.

To function properly and maintain optimal function, the body depends on the proper circulation of nerve transmissions/information traveling through the nervous system.

Spinal State

The condition or state of the spine if out of place even just a little could interfere with the transmission of information via the nerve pathways. Misalignments and subluxations don’t always hurt so individuals don’t know this is happening. The nervous system is protected by the skull and spinal bones, known as the vertebrae. The spinal bones allow for free movement. Subluxations and misalignments:

  • Stretch
  • Pinch
  • Irritate
  • Choke
  • Rub the nerve fibers.

This alters the information/messages traveling and interferes with the body’s ability to function as it should.

Chiropractic Assistance

Chiropractic assistance will diagnose and correct misalignments and subluxations, restoring proper nerve circulation. These spinal adjustments unlock and realign the bones allowing for optimal movement and the communication pathways are fixed. A healthy spine and nervous system are vital to healthy body function. This is the body’s natural state. How to know if you have a subluxation, have your spine checked by a chiropractor.


Body Health Assistance


Body Composition Goals

For individuals that fall within the extremely overweight and obese body fat percentage category, an effective strategy is to lose fat while preserving the existing Lean Body Mass. Individuals with high body fat percentages often have existing muscle developed from carrying the added weight when moving. Preserving this muscle is important. Having more muscle means increased metabolism and more strength.

  • To start losing body fat it is recommended to cut down/cut out processed foods and reduce caloric intake.
  • Consult with a health coach and nutritionist to find out about different types of diets and types of physical activity.

One study showed that obese individuals could quickly improve body composition by:

References

Maltese, Paolo Enrico et al. “Molecular foundations of chiropractic therapy.” Acta bio-medica : Atenei Parmensis vol. 90,10-S 93-102. 30 Sep. 2019, doi:10.23750/abm.v90i10-S.8768

Pickar, Joel G. “Neurophysiological effects of spinal manipulation.” The spine journal: official journal of the North American Spine Society vol. 2,5 (2002): 357-71. doi:10.1016/s1529-9430(02)00400-x

Rosner, Anthony L. “Chiropractic Identity: A Neurological, Professional, and Political Assessment.” Journal of chiropractic humanities vol. 23,1 35-45. 20 Jul. 2016, doi:10.1016/j.echu.2016.05.001

Vining, Robert et al. “Assessment of chiropractic care on strength, balance, and endurance in active-duty U.S. military personnel with low back pain: a protocol for a randomized controlled trial.” Trials vol. 19,1 671. 5 Dec. 2018, doi:10.1186/s13063-018-3041-5

Chiropractic Treatment and Adjustment Schedule

Chiropractic Treatment and Adjustment Schedule

A proper diagnosis goes a long way. Treatment and recovery can happen relatively quickly or broken up into parts, phases, and sessions, as part of a treatment and rehabilitation plan. This depends on the individual, their age, underlying conditions, and the severity of their injury/s. It is not uncommon to have a treatment schedule that could be weeks/months long. This can be tough on individuals with limited abilities and/or a slow progressive rehab to get back to normal. It is arduous, but to achieve optimal healing and health, it is expected.

Chiropractic medicine is no different.  It’s non-invasive compared to surgery but not as immediate as medication/s. This places it in between. Recovery timelines can vary significantly based on the nature of the condition, the patient, their injury/s, and everything attached. Most chiropractic treatment and adjustment plans are scheduled according to the individual’s injury and/or condition. Every case is different, meaning that treatment could be a couple of sessions for an individual with mild sciatica to a few weeks or months for more severe injuries/conditions. Most want to know why chiropractors execute these plans over weeks and months.

Chiropractic Treatment and Adjustment Schedule

The Body Needs To Get Used To The Adjustments

One reason for an extended adjustment schedule is to prevent adjustment shock. Adjustment shock often presents through soreness and tenderness, and there could be a feeling of soreness when sitting or standing or difficulty when trying to move with a normal range of motion. This happens when trying to heal the body too much and too fast. Trying to perform massive chiropractic adjustments without preparing the body could worsen and/or create further injury/s.

For example, correcting severe lordosis requires repositioning the spine’s curvature through properly planned out adjustment sessions. If a chiropractor tries to adjust/align the spine into place over a few days, this would be extremely uncomfortable and more than likely painful for the individual. Plus, there is a lack of musculoskeletal support from the rest of the body that is needed to make sure that the adjustments/changes take hold and are maintained. A chiropractor wants to avoid these issues to focus on getting the individual back to proper health.

Preparing The Body With A Solid Foundation

Chiropractic manipulations and adjustments need time to settle in, ensuring that they take hold and not shift back to the incorrect position. Spinal problems are not solved overnight. This means that the causes of misalignment will remain for a period as the treatment/adjustment process begins. A spaced-out schedule ensures that the adjustments are made accordingly to strengthen the spine through the process. This enables adjustments and the body to develop the necessary support system and prevent any negative re-shifting. As time goes on, the adjustments achieve total realignment, restoring the positive curvature that can be maintained.

Schedule Benefits

Finally, the step-by-step nature of a chiropractic adjustment schedule enables the treatment team to check the status of an adjustment plan. If radiological imaging shows changes, setbacks, or new issues arise, the treatment plan and schedule can be changed and adapted accordingly.


Body Composition Testing


Too Much Alcohol Can Slow Recovery From Tissue Injuries

Alcohol is often associated with celebrations, anniversaries, etc. But drinking too much can damage the immune system. Too much alcohol contributes to organ damage, specifically the liver. However, it is known to slow down recovery from tissue injuries, as well. Moderate drinking is defined as drinking up to 1 drink a day for women and up to 2 a day. Exceeding the recommended intake disrupts the immune pathways and impairs the body’s ability to fight off infections. Alcohol-related immune system damage has been associated with the development of certain types of cancer, including head and neck cancers among alcohol users. Before thinking that this is a problem that only affects chronic alcohol users, acute binge drinking can also severely impair the body’s immune system.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Holt, Kelly, et al. “The effects of a single session of chiropractic care on strength, cortical drive, and spinal excitability in stroke patients.” Scientific Reports vol. 9,1 2673. 25 Feb. 2019, doi:10.1038/s41598-019-39577-5

Iben, Axén, et al. “Chiropractic maintenance care – what’s new? A systematic review of the literature.” Chiropractic & manual therapies vol. 27 63. 21 Nov. 2019, doi:10.1186/s12998-019-0283-6

Mior, Silvano et al. “Chiropractic services in the active-duty military setting: a scoping review.” Chiropractic & manual therapies vol. 27 45. 15 Jul. 2019, doi:10.1186/s12998-019-0259-6

Pasala, Sumana et al. “Impact of Alcohol Abuse on the Adaptive Immune System.” Alcohol research: current reviews vol. 37,2 (2015): 185-97.

Lifestyle Adjustments and Chiropractic Enhancements

Lifestyle Adjustments and Chiropractic Enhancements

Individuals are realizing the enhancements that chiropractic produces along with lifestyle adjustments. Chiropractic is about total body health. This includes:

  • Alleviating pain from injuries and musculoskeletal conditions
  • Reversing low energy levels
  • Healthy lifestyle adjustment support
  • Neck Pain
  • Back Pain
  • Chronic Pain
  • Herniated Disc/s
  • Headaches
  • Migraines
  • Sciatica
  • Sports Injuries

Healthy living and regular chiropractic adjustments will elevate the body’s health to new levels.

Chiropractic unlocks the body’s potential

Getting to the root cause of any symptoms that are presenting and addressing them is essential before the body can be at its optimum. A common root cause of pain, low energy, and various general health complaints is spinal misalignment. Poor spinal alignment leads to poor nerve energy flow and poor blood circulation. When the body and nervous system function incorrectly, there is interference with the body’s ability to process normal functions that leads to various forms of dysfunction. A chiropractor can recognize the smallest of changes in the spine that could be affecting the body’s health.

11860 Vista Del Sol, Ste. 128 Lifestyle Adjustments and Chiropractic Enhancements

Good Health to Optimal Health

Restoring spinal alignment is the first step in improving body health. If condition/s are present, first the pain will need to be reduced and under management, then the energy can be increased. A chiropractor will recommend lifestyle adjustments to start building a routine to take good health to optimal health. Recommendations include:

Physical Activity/Exercise

Regular physical activity/exercise for weight management, building muscle and maintaining balance. Specific exercises could be recommended for spinal alignment and core strength reinforcement.

Health Coaching/Diet

The nutrients consumed can have positive and negative effects on the body’s ability to function and heal. A health coach and nutritionist can recommend a nutrition plan that will elevate the body’s health to new levels, increasing energy and helping with weight loss if it is necessary.

11860 Vista Del Sol, Ste. 128 Lifestyle Adjustments and Chiropractic Enhancements

Stress management techniques

Stress is a major player when it comes to poor health. Chiropractic can help develop techniques and strategies to manage stress and reduce the strain on the body’s systems. This could include sleep hygiene, mindfulness, and more.

Neutral spine training

Healthy posture is highly neglected during daily activities, especially when sitting or lying down. A chiropractor will educate the individual on how to hold the spine and posture optimally to reduce awkward positions and unnecessary strain.

Consult a Chiropractic Provider

When making lifestyle changes, a vital component is learning how to incorporate the new adjustments consistently. This encourages the adjustment into becoming a healthy habit that can maintain optimal body health.

Body Composition

Reducing stress levels

There are various techniques that support relaxation, and help turn off the stress response. Here are a few science-backed options:

  1. Free-range eggs
  2. Nuts
  3. Seeds
  4. Shellfish
  5. Parsley
  6. Garlic

Stress-related eating is associated with an increased craving for calorie-dense and highly palatable/tasty usually unhealthy foods. When stress rises, food cravings rise triggering fat gain.

Disclaimer

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP, CIFM, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico

References

Hawk, Cheryl et al. “Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline.” Journal of alternative and complementary medicine (New York, N.Y.) vol. 26,10 (2020): 884-901. doi:10.1089/acm.2020.0181

Walsh, Roger. “Lifestyle and mental health.” The American psychologist vol. 66,7 (2011): 579-92. doi:10.1037/a0021769

Stonerock, Gregory L, and James A Blumenthal. “Role of Counseling to Promote Adherence in Healthy Lifestyle Medicine: Strategies to Improve Exercise Adherence and Enhance Physical Activity.” Progress in cardiovascular diseases vol. 59,5 (2017): 455-462. doi:10.1016/j.pcad.2016.09.003

Chiropractic Examination Fibromyalgia Diagnosis

Chiropractic Examination Fibromyalgia Diagnosis

A fibromyalgia diagnosis involves the process of eliminating other disorders and conditions with similar symptoms. It can be difficult to diagnose fibromyalgia. There is no common exam or test that a doctor can use to definitively diagnose fibromyalgia. The elimination process is utilized because of several other conditions with similar symptoms. These include:
  • Rheumatoid arthritis
  • Chronic fatigue syndrome
  • Lupus
11860 Vista Del Sol, Ste. 128 Chiropractic Examination Fibromyalgia Diagnosis
 
It can take some time when an individual first notices symptoms and actually being diagnosed with fibromyalgia, which can be frustrating. Doctors have to become detectives, working hard to find the right cause of pain and other symptoms. Developing the right diagnosis is necessary to create an optimal treatment plan.  

Fibromyalgia Diagnosis Criteria

  • Pain and symptoms based on the total number of painful areas
  • Fatigue
  • Poor sleep
  • Thinking problems
  • Memory problems
In 2010, a study was published that updated fibromyalgia diagnosis criteria for fibromyalgia. The new criteria remove the emphasis on tender point examination. The 2010 criteria’s focus is more on the widespread pain index or WPI. There is an item checklist about where and when an individual experiences pain. This index is combined with a symptom severity scale, and the end result is a new way to classify and develop a fibromyalgia diagnosis.  
 

Diagnostic Process

Medical History

A doctor will look at an individual’s complete medical history, asking about any other conditions present and family condition/disease history.

Symptoms Discussion

The most common questions asked by a doctor are where it hurts, how it hurts, how long it hurts, etc. However, an individual should offer as much or added details of their symptoms. Diagnosing fibromyalgia is very dependent on the report of the symptoms, so it is important to be as specific and accurate as possible. A pain diary, which is a record of all symptoms that present will make it easier to remember and share information with the doctor. An example is giving information on trouble sleeping, with a feeling of tiredness a majority of the time, and headache presentation.

Physical Examination

A doctor will palpate or apply light pressure with the hands around the tender points.  
11860 Vista Del Sol, Ste. 128 Chiropractic Examination Fibromyalgia Diagnosis
 

Other Tests

As previously stated symptoms can be very similar to other conditions like: A doctor wants to rule out any other conditions, so they will order various tests. These tests are not to diagnose fibromyalgia but to eliminate other possible conditions. A doctor could order:

Anti-nuclear antibody – ANA test

Anti-nuclear antibodies are abnormal proteins that can present in the blood if an individual has lupus. The doctor will want to see if the blood has these proteins to rule out lupus.

Blood count

By looking at an individual’s blood count, a doctor will be able to develop other possible causes for extreme fatigue like anemia.

Erythrocyte sedimentation rate – ESR

An erythrocyte sedimentation rate test measures how quickly red blood cells fall to the bottom of a test tube. In individuals with a rheumatic disease like rheumatoid arthritis, the sedimentation rate is higher. The red blood cells fall quickly to the bottom. This suggests that there is inflammation in the body.  
 

Rheumatoid factor – RF test

For individuals with an inflammatory condition like rheumatoid arthritis, a higher level of the rheumatoid factor can be identified in the blood. A higher level of RF does not guarantee that the pain is caused by rheumatoid arthritis, but doing an RF test will help the doctor explore a possible RA diagnosis.

Thyroid tests

Thyroid tests will help a doctor rule out thyroid problems.

Final Note Fibromyalgia Diagnosis

Again, diagnosing fibromyalgia can take awhile. A patient’s job is to be proactive in the diagnostic process. Be sure you understand what the results will tell and how that specific test will help figure out the cause of the pain. If you don’t understand the results, keep asking questions until it makes sense.

InBody


 

Body composition and Diabetes Connection

The body needs a balance of lean body mass and fat mass to function properly/optimally and maintain overall health. The balance can be disrupted in overweight and obese individuals because of excess fat. Individuals that are overweight should focus on improving body composition by reducing fat mass while maintaining or increasing lean body mass. Balanced body composition can reduce the risk of diabetes, other obesity-related disorders, and a positive effect on metabolism. Metabolism is the breaking down of foods for energy, the maintenance, and repair of body structures. The body breaks down the food nutrients/minerals into elemental components and directs them to where they need to go. Diabetes is a metabolic disorder meaning it changes the way the body makes use of the nutrients, in such a way that the cells are unable to utilize digested glucose for energy. Without insulin, the glucose cannot get into the cells, so it ends up lingering in the blood. When the glucose can�t make its way out of the blood, it builds up. All the excess blood sugar can potentially be converted to triglycerides and stored as fat. With an increase in fat mass, hormone imbalances or systemic inflammation can happen or progress. This increases the risk for other diseases or conditions. A buildup of fat and diabetes are associated with increased risk for:
  • Heart attacks
  • Nerve damage
  • Eye problems
  • Kidney disease
  • Skin infections
  • Stroke
Diabetes can even cause the immune system to become impaired. When combined with poor circulation to the extremities, the risk of wounds, infections, can lead to amputation of the toes, foot/feet, or leg/s.  

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*  
References
American College of Rheumatology. Fibromyalgia. 2013.�http://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Fibromyalgia/. Accessed December 5, 2014. Living with Fibromyalgia:�Mayo Clinic Proceedings.�(June 2006) �Improvement in Fibromyalgia Symptoms With Acupuncture: Results of a Randomized Controlled Trial��www.sciencedirect.com/science/article/abs/pii/S0025619611617291 What Are Common Fibromyalgia Symptoms and How Does It Cause Back Pain?:�Clinical Biomechanics.�(July 2012) �Functional capacity, muscle strength and falls in women with fibromyalgia��www.sciencedirect.com/science/article/abs/pii/S0268003311003226
Cauda Equina Syndrome Nerve Compression

Cauda Equina Syndrome Nerve Compression

Cauda equina syndrome is an emergency that needs to be treated as soon as possible. It is a form of spinal nerve compression, but if left untreated, it can lead to permanent paralysis of one or both legs and permanent loss of bowel/bladder control. Lower back pain after sitting for too long or improperly lifting something heavy happens to most if not all of us.
However, sometimes pain in the lower back can be an indicator of something more serious. Especially, for individuals that are dealing with or managing back pain. One condition is cauda equina syndrome. It�s not like sciatica or arthritis, but it does have specific symptoms that individuals should be aware of.

Cauda Equina Syndrome

The term comes from Latin that means horse�s tail. The cauda equina forms the group of nerves that run through the lumbar spinal canal. Generally, the condition means two things:
  • There is nerve compression of most of the lumbar spinal canal
  • Compression symptoms like numbness or weakness in the leg/s
How cauda equina syndrome differs from typical compression of the lumbar spinal canal is that it can be caused by different issues, from fractures, tumors, and infections. More commonly, it is disc herniations that cause the problems. The key difference is the degree of nerve compression, and the number of nerves compressed. For example, compression of a single nerve will not cause loss of bladder function. But compression of multiple nerves, especially the sacral nerves can cause loss of function. Nerve compression that leads to pain or numbness can be treated differently. Surgery is reserved for severe cases and for individuals that are not improving with non-invasive treatment.
11860 Vista Del Sol, Ste. 128 Cauda Equina Syndrome Nerve Compression Chiropractic Diagnosis

Sneaky Presentation

One of the major factors is long-term compression that individuals do not realize they have. Individuals are more likely to be aware of symptoms from another spinal condition before cauda equina syndrome presents. However, the condition presents quickly but often other overlapping back problems mask cauda equina syndrome.

Causes

The syndrome can be brought on from anything that compresses the nerves. Most commonly, it is a root compression from degenerative processes, specifically lumbar disc herniations. Other causes include:
  • Bleeding like an epidural hematoma
  • Trauma like fractures or penetrating trauma
  • Tumors growing in the canal or the collapse of a tumor-affected bone
  • Disc herniations can progressively grow in size, which leads to a slowly-evolving cauda equina syndrome.
  • An enlarging disc herniation or synovial cyst can further compromise the already compressed nerves.
  • Overgrowth of arthritic joints or bone spurs into the spinal canal can lead to long-term compression.

Symptoms

The symptoms vary based on the degree that the spinal canal has been affected:
  • Back pain
  • Leg pain
  • Sciatica
  • Saddle numbness that extends into other areas of the legs
  • Neurogenic bladder dysfunction. This can range from difficulty starting to urinate or limited and/or non-voluntary control urinating.
  • Bowel dysfunction
  • Sexual dysfunction

Diagnosis

A doctor will examine any significant changes in bladder, bowel, or leg function that are considered red flags prompting an early and complete assessment. A physician will ask for a complete/detailed history of the onset and progression of symptoms. The second is a close physical examination which includes testing sensation and strength along with a rectal exam to assess voluntary contraction. Also checking the body’s reflexes, assess walking gait and alignment. If most or all of the symptoms are presenting this will set in motion spinal imaging or an MRI. If the symptoms, exam, and imaging match, it will lead to an emergency admission to the hospital.
11860 Vista Del Sol, Ste. 128 Cauda Equina Syndrome Nerve Compression Chiropractic Diagnosis

Body Composition Spotlight


 

Obesity and Osteoarthritis Connection

A variety of factors contribute to the development of osteoarthritis, including genetic factors and lifestyle choices. Research supports obesity is a significant risk factor in the development of osteoarthritis. It is pretty straightforward as body weight increases this equals increased load on the spine, and joints, especially the weight-bearing ones like the hips and knees. Increased pressure leads to early wearing, tearing, and eventual development of osteoarthritis. Added weight affects the body’s biomechanics and gait patterns. However, obesity has also been shown to be a risk factor even on the non-weight-bearing joints. This is based on adipose tissue, which is more than just insulation. Adipose tissue is metabolically active and is involved in the secreting adipokines and cytokines which promote an inflammatory response. Pro-inflammatory adipokines and cytokines can have detrimental effects on joint tissue including damage to cartilage, synovial joints, and subchondral bone. The effect of inflammation on the joints in the body can contribute to the development of osteoarthritis.

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at�915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Causes of Cauda Equina:�Neurosurgical Focus.�(June 2004) �Spinal epidural hematoma causing acute cauda equina syndrome��pubmed.ncbi.nlm.nih.gov/15202871/ Arriving at a Diagnosis:�British Journal of Neurosurgery. (August 2010) �Reliability of clinical assessment in diagnosing cauda equina syndrome��www.tandfonline.com/doi/abs/10.3109/02688697.2010.505987
Achieve Health Goals With Chiropractic, and Nutritional Coaching

Achieve Health Goals With Chiropractic, and Nutritional Coaching

The new year offers a blank slate to better our lives and try new things that will help us achieve our life goals. Health goals can be achieved through chiropractic treatment and nutritional coaching. Improving one’s health is one of the quickest ways to boost the body and mind’s quality of life.  
11860 Vista Del Sol, Ste. 128 Achieve Health Goals With Chiropractic, and Nutritional Coaching
 

Health Goals and A New Year

Individuals set health goals only to forget about them after a few weeks or months. When setting goals that don�t stick, the biggest issue is the focus is on the wrong process to achieve these goals. Individuals tend to aim for goals that are doable but too advanced to jump right into. Much like someone that has never worked on home renovation, but decides they can knock out a kitchen, or bathroom remodel in two weeks. This is where training comes in to learn how to go about achieving these goals properly and in a healthy fashion. Common goals include:
  • Weight loss
  • Maintaining a healthy diet
  • Regular exercise
  • Increased energy
  • Stress management skills improvement
  • More time with the family
  • Quitting smoking
 

Chiropractic Motivation

If there are health goals that have been a struggle to maintain then it is time to get expert professional help. Chiropractic and health coaching could be a practical option. Chiropractic addresses whole-body health with sustainable changes/adjustments to achieve optimal health. Chiropractic is a specialized branch of medicine dedicated to addressing body dysfunction through non-invasive spinal realignment. A misaligned spine leads to poor nerve and blood circulation that affects the body’s functional health at every level. Treatment with a chiropractic provider can help achieve health goals from the ground up. Once spinal alignment has been achieved and the body is ready, then guidance and recommendations with lifestyle changes, like exercise and stress management can be addressed to reach full health potential.  
11860 Vista Del Sol, Ste. 128 Achieve Health Goals With Chiropractic, and Nutritional Coaching
 

Stop Waiting

There is no better time than now to start working toward health goals that can actually be controlled. We can control how we perceive our lives, treat our bodies and minds. A chiropractor and health coach will help set small attainable goals that can be kept, contact Injury Medical and Chiropractic Clinic today.

The Body’s Composition


 

Invest In Your Body

It is easy to think of your body as healthy and invincible. This is true when young, but age will catch up. The muscles will begin to plateau in strength in an individual’s 30s, which can lead to less physical activity. Being aware of the body’s fat percentage and keeping track is a great way to determine if body composition is declining. If weight has not changed over a couple of years but body fat percentage seems to have increased, this is a red flag that could indicate age-related muscle loss is taking place.

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Maiers, Michele et al. �Chiropractic in Global Health and wellbeing: a white paper describing the public health agenda of the World Federation of Chiropractic.��Chiropractic & manual therapies�vol. 26 26. 17 Jul. 2018, doi:10.1186/s12998-018-0194-y
Post-Injury Chiropractic Health and Wellness

Post-Injury Chiropractic Health and Wellness

Post-Injury: We push ourselves throughout our lives, and accidents that result in injuries are just part of the process. The top causes of injury include:
  • Falls
  • Automobile accidents
  • Sports injuries
  • Work injuries
Many of them lead to prolonged injury to the spine, knees, hands, and feet. The objective after an injury is to make sure the body heals properly. Without proper treatment, disability, chronic pain, and the development of other health issues are increased.  
11860 Vista Del Sol, Ste. 128 Post-Injury Chiropractic Health and Wellness
 

Post-Injury Care

Injuries cause pain that can result in spinal misalignment, range of motion problems, and a poor quality of life. Seeking care from a spinal expert in alignment and movement will help recover quicker and sustainably. Chiropractic is a research-oriented, top-quality approach that provides natural whole-body care. A chiropractic practitioner will promote proper recovery and decrease the risk of disability and chronic suffering.  

Proper spinal alignment

Chiropractic providers are experts in spinal alignment. Here are a few of the amazing benefits that chiropractic provides. Even the most subtle misalignments affect blood and nerve circulation/energy leading to decreased overall body function, slow down the healing process, increases pain, and other health issues. Misalignment is associated frequently as a root cause for symptoms. This allows the body to restore its normal function and heal the recovery process.  

Tissue restoration and flexibility

Once alignment has been restored, the continued chiropractic adjustments will maximize the effectiveness of the treatment plan. A personalized treatment plan focuses on the most effective, optimal, non-invasive techniques. The objective is to maintain body balance/alignment allowing the body to recover and rehabilitate properly. Treatment can include:
  • Pain management with modalities
  • Soft tissue massage
  • Exercises
  • Stretching
  • Health coaching
11860 Vista Del Sol, Ste. 128 Post-Injury Chiropractic Health and Wellness
 

Maximize the benefits

Initial symptoms can become chronic and worsen with time if left untreated/ignored and are not medically addressed. Properly maintained recovery will minimize this risk of exacerbating or developing new injuries. Long-term issues typically stem from:
  • Improper mechanics
  • Misunderstanding of the injury
  • Scar tissue
  • Spinal misalignments
Chiropractic experts are trained to recognize subtle changes that can make differences in the long run and will help minimize all issues right from the start.

Chiropractic for injuries

After an injury has been sustained chiropractic post-injury will increase recovery potential and get the body back on track. Chiropractic post-injury will reduce pain, and get the body back at its best. Find a chiropractor to maximize the recovery process today.

Best Sports Chiropractor

 
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Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Piper, Steven et al. �The effectiveness of soft-tissue therapy for the management of musculoskeletal disorders and injuries of the upper and lower extremities: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration.� Manual therapy�vol. 21 (2016): 18-34. doi:10.1016/j.math.2015.08.011
Patient Medical History Importance for Optimal Treatment

Patient Medical History Importance for Optimal Treatment

The first step in chiropractic care is getting the individual’s medical history. Many visit a chiropractor with certain expectations of how things will go. They will lay down on a table while the chiropractor adjusts the spine. There will be pops and cracks, and the tension will go away. And afterward, they�ll feel better. However, without an individual’s medical history, the treatment will not be as effective because of the lack of information. This means that a chiropractor is only able to perform general adjustments but is not able to get to the root cause and maximize the full potential of the adjustments. Patient education starts the moment someone walks into the clinic.  
11860 Vista Del Sol, Ste. 128 Patient Medical History Importance for Optimal Treatment
 

The nature of holistic medicine

Some questions a chiropractor might ask include:
  • What type of pain is presenting – shooting, burning, aching, throbbing, etc?
  • Have you had any recent surgeries?
  • Is there a history of chronic pain?
  • What medications are being taken?
Each will be explained in further detail and what they mean for the development of a treatment plan. An individual needs to understand how important their medical histories are for treatment progress. Patient history prevents executing the wrong treatment plan by having an informed understanding of the individual’s body. For example, a chiropractor can�t perform the same adjustments on a senior with osteoporosis that they do on a middle-aged athlete. And someone recovering from surgery will not have the range of motion when healthy. An adjustment can result in X, Y, or Z, depending on the factors at work. Medical history is vital as it eliminates any unknowns, so a chiropractor can solve for X, Y, or Z by being able to provide the best outcome for the individual.  
 

The more information, the better the treatment plan

When an individual has neck pain, a doctor is not going to prescribe immediate surgery, unless it is an emergency. Rather, they will perform a full examination, ask questions, try to find the cause, and analyze the intensity of the pain. A chiropractor is no different, and individual medical history is vital. Obtaining as much information as possible can help a chiropractor reach a proper diagnosis and ensures the right course of action is taken. Individuals often do not realize but for example,
  • An automobile accident that happened last year could be manifesting symptoms now.
  • Shoulder surgery five years ago could be limiting the range of motion, affecting the musculature around the cervical spine.
  • Chronic plantar fasciitis and self-medicating for a while can cause instability in the lumbar spine affecting the cervical spine.
Every little bit of information can help put the puzzle together to get a clear picture of what is going on. The biggest contributor of information is patient medical history, formally documented and informally spoken.  
11860 Vista Del Sol, Ste. 128 Patient Medical History Importance for Optimal Treatment
 

Informed care

A visit to Injury Medical Chiropractic Clinic is a collaboration between patient and chiropractor that leads to informed and the best treatment possible. Medical history informs optimal care. For more information or for more tips on chiropractic care, contact us today.

New Patient Chiropractic Care

 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Hunter, J. �Medical history and chronic pain.��The Clinical journal of pain�vol. 17,4 Suppl (2001): S20-5. doi:10.1097/00002508-200112001-00007