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.
Dr. Alex Jimenez collaborates with top rated diagnosticians and imaging specialists. We are blessed to have in our association, imaging specialists that provide fast, courteous & premiere board certified specialists. In collaboration with our offices we can provide the quality of service our patients mandate and deserve.
Who We Are
Diagnostic Outpatient Imaging (DOI) is a state-of-the-art Radiology center in El Paso, TX. It is the only center of its kind in El Paso, owned and operated by a Radiologist.
This means when you come to DOI for a radiologic exam, every detail, from the design of the rooms, the choice of the equipment, the hand-picked technologists, and the software which runs the office, is carefully chosen or designed by the Radiologist and not by an accountant.
Our market niche is one center of excellence. Our values related to patient care are: We believe in treating patients the way we would treat our family and we will do our best to ensure that you have a good experience at our clinic.
Dear Doctors,
We are pleased to inform you of the arrival of our Titan 3-Tesla MRI at Diagnostic Outpatient Imaging. This is El Paso’s only radiology imaging center that offers this technology. Patients do not always realize how important image quality is: It can make the difference in the diagnosis.
3-Tesla MRI is like HD TV and once you try it, you will not want to go back. The increased magnet strength gives us many benefits at no additional expense to the patient. It gives us the ability to scan faster or to scan with higher detail. An MRI of the brain can take 20 minutes and have exceptional quality, or we can perform the scan in less time, with better quality that is achieved on most 1.5 Tesla “high field” MRIs. This is incredibly useful for children.
Our 3T MRI can perform Diffusion Tensor Imaging, MRI Spectroscopy and CSF flow studies to name just a few of its possibilities.
This scanner is not only very fast, it is very large. Our open MRI has a clearance of 35 cm. The 3T has a diameter of 71 cm! This is welcome news for nervous or claustrophobic patients, and combined with its speed, it can actually eliminate the need for sedation for some patients. 3T MRI is faster, clearer, and has more diagnostic possibilities. We are certain you and your patients will notice the difference.
Our Services
MRI’s:
DOI has three MRI’s under one roof. All are American College of Radiology (ACR) Certified.
Good
Open MRI (0.35 Tesla): This MRI perfect for claustrophobic and very large patients. There is no table weight limit on this MRI
Better
High Field 1.5 Tesla MRI- This is a eight channel MRI with high end image quality. It is in a beautiful room and has ‘pianissimo’ technology, which makes the MRI relatively quiet. This machine has been the best MRI in private practice in El Paso for years. It will soon be eclipsed by our new 3.0 Tesla MRI.
Best
High Field 3.0 Tesla MRI- This is the only 3.0 Tesla MRI in private practice in El Paso. This technology can deliver stunning image quality, which can actually make a difference in your diagnosis. The increased magnet strength gives us many benefits at no additional expense to the patient.�??It gives us the ability to scan faster, or to scan with higher detail. This is welcome news for nervous or claustrophobic patients, and as well as for children as it can actually eliminate the need for sedation in some patients. 3T is faster, clearer, more diagnostic for a better for MRI. It is like HD TV. Once you have tried it, you won’t want to go back. This MRI effectively doubles our MRI capacity. If needed most exams can be completed in under 5 minutes, instead of the normal 30-45 minutes.
Breast MRI:
DOI began Breast MRI in July 2007, being the first facility in El Paso to perform the exam. We have now performed over 2500 breast MRI’s and many MRI-guided breast biopsies. All have been interpreted and/or performed by Dr. Boushka, making him the most experienced radiologist in the city with this exam. This is the most powerful tool for the detection of Breast cancer to date.
Hours: Monday to Thursday 7 am to 9 pm Friday 7 am to 5 pm Saturday 8 am to 4 pm
Prostate MRI:
Guys, you need great medical care also. We are the only facility in El Paso performing this leading edge exam. MRI can see cancers when other imaging methods cannot. Not only can we see prostate cancers with MRI, we can perform MRI-guided prostate biopies for pathologic (definitive) diagnosis.
Monday to Thursday 7 am to 9 pm Friday 7 am to 5 pm Saturday 8 am to 4 pm
CT:
We have a 16 slice Toshiba Aquillion CT scanner, with newly updated in Dec 2013. The upgrade allows for reduced X-ray dose, higher resolution, more patient comfort, shorter breath holds and doubles the speed of the scanner. This scanner performs CT X-ray exams as helical volume acquisitions in 3D from a single patient exam. Most exams are finished in under 60 seconds, unless delayed images with contrast are indicated. Additionally we have a powerful 3D post processing workstation.
Hours Monday to Friday 7 am to 6 pm
Ultrasound:
DOI has just doubled our Ultrasound capacity with newly purchased Philips 34 XRL scanner. We have Three certified Ultrasonographers with cumulative experience of 45 years. We are confident you will find them professional and compassionate. Beverly Bruner RDMS, Sonographer, formally of Desert Imaging has joined our team.
3D OB Ultrasounds:
You better believe it. Available whenever our US department is open. No referral necessary. Images are reviewed by an actual radiologist.
Ultrasound Hours: Monday, Tuesday, Thursday 8 am to 5 pm Wednesday 8 am to 8 pm Friday 8 am to 5 pm Saturday 8 am to 12 pm
Digital Mammography
DOI was the first facility in El Paso to acquire Hologic Full Field Digital Mammography and thus we have more experience with this technology than any facility in El Paso. Our Mammographer has 20 years of experience and has her own following of patents who seek her out to perform their mammograms because of her excellent and compassionate care. Our private pay screening mammography price of $90, including the interpretation is an unbeaten price in El Paso.
Hours Mon – Fri 8am to 4pm Extended hours Wednesday until 8pm) Saturdays 8am to 12pm
Bone Denisity (DEXA)
We have a brand new, Hologic Discovery CI bone densitometer scanner. This is the latest technology.
X-Ray
Our digital computed radiography was just updated February 2014. No appointments are necessary.
Many Americans in the United States will visit a healthcare professional’s office reporting some type of pain. While most cases of pain are considered acute, or temporary, resolving after the injury or condition causing the symptoms has healed, a large percentage of individuals will still report pain long after the source has disappeared. This is known as chronic pain. Fortunately, there are a variety of treatment methods which can also help ease these symptoms.
Are injections used to treat chronic pain?
From physical therapy and chiropractic care, to drugs and medications, numerous types of treatment methods and therapies can be used to treat chronic pain, each more beneficial to certain people than others. Epidural steroid injections and facet joint injections are some of the most common types of injections utilized to ease chronic pain symptoms. For some individuals, injections may be more useful than other forms of treatment. As with any medical procedure, however, it’s important to understand how helpful these can be for each, individual patient.
Epidural Corticosteroid Injections for Chronic Pain
Although epidural steroid injections (also called epidural corticosteroid injections) can be helpful to confirm a diagnosis, they should be used primarily after a specific presumptive diagnosis has been established. Additionally, injections shouldn’t be used in isolation, but rather in combination with a program strengthening, stressing muscle flexibility, and operational recovery, most commonly associated with chronic pain, in this case.
Appropriate follow-up after shots to rate ability and the individual’s treatment response to progress in the rehabilitation program is indispensable. Observation of this response is necessary prior to a second or third shot, although a number of injections can be attempted to decrease pain. Epidural steroid injections are an adjunct treatment, which facilitates participation in an active exercise program and may assist in avoiding the need for surgical intervention.
Treatment Rationale
The rationale for the use of epidural corticosteroid injection has enhanced with the signs of an inflammatory basis for radicular pain from disc herniation. Although prospective trials are lacking, epidural steroids have been proven to be effective in pain reduction in patients with referred pain. If used in the initial weeks after onset the efficacy is increased.
The goal of these injections would be to facilitate an active exercise program and also to progress sufferers through the pain and inflammation phase of healing as quickly as possible. As with all injections, it needs to be a part of a comprehensive treatment plan involving active exercise programs.
How the Injection Is Applied
To ensure proper needle placement of corticosteroids, fluoroscopic guidance is recommended. Meaning a healthcare professional will use special imaging gear during the injection to be sure the needle is going in at the right place. Some patients may require more than one injection. Repeat shots should be based on goals and the response after the injection. It is not necessary for many patients to experience a set number or “series” of injections. If minimal to no advancement is found following two shots, then further similar shots aren’t warranted. The recent usage of the approach allows the medicine to be delivered in a fashion to the ventral part of the spinal canal. All patients must be followed by consecutive injections (10-14 days later) to assess therapeutic reaction.
Utilization of Epidural Steroid Injections
Epidural shots and intradiscal injections have been used in treating non-radicular degenerative disc disorder with limited success. In addition, epidural steroids are used in patients with neurogenic claudication from spinal stenosis with mixed outcomes. A number of shots can be tried to decrease pain thought to be at least in part mediated by inflammation.
Facet Joint Injections for Chronic Pain
The therapeutic advantage of facet injections remains controversial. The controversy starts with the significance of the background and examination with lower back pain. Many patients will complain of back and lower extremity pain with standing, walking, and extension-type pursuits. The examination is normal, and also tests for nerve root inflammation are often negative. Many patients may have increased pain on passive expansion, or extension and rotation.
Additionally, radiographic and bone scanning imaging hasn’t been useful in selecting appropriate patients for facet injections. Consequently, the primary job of facet injections remains diagnostic. There is support for the impact of shots or ablations of the nerves. Facet injections should be used for patients who have failed a guided non-operative treatment program that incorporates various manipulation/mobilization methods. They should be done under fluoroscopic guidance and are not suggested in the initial four to six weeks of treatment.
Goal of Facet Joint Injections
The goal of facet injections is to verify the diagnosis and perhaps assist with pain reduction to be able to alleviate an active physical treatment program. If prior injections were helpful and there’s a recurrence of pain, they can be replicated replicate injections should be limited. This process should be used only in people failing a comprehensive application and in no manner should be considered at the initial management of an incident of acute low back pain.
Be sure to seek the proper guidance from an experienced and qualified healthcare professional before attempting any medical procedure, method or therapy. Injections for chronic pain are only one form of treatment used for the mentioned symptoms. Other treatment options can be used alongside these or in place of the above.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
When affected by chronic pain, an individuals initial concern often involves what type of treatment they should seek for their particular issue. While many doctors are qualified and experienced in treating a variety of injuries and conditions, only some specialists can be classified as pain experts: pain management specialists.
What is a pain management specialist?
Pain medicine or pain management specialists provide varied treatments, including medications, action modification, therapeutic injections, physical therapy, and alternative kinds of care like acupuncture, manipulation, and music or art therapy for chronic pain. Multidisciplinary pain medicine joins two or more treatments to maximize pain management.
Concerning Pain Management Specialists
A pain management specialist is a physician or osteopathic physician who treats pain. Although called interventional pain management specialists or pain medicine specialist, a number of these doctors are physiatrists or anesthesiologists. Pain management and medication treatment is a team effort frequently involving the patient’s primary care doctor or other treating doctor, and specialists in radiology, psychiatry, psychology, oncology, nursing, physical therapy, complimentary alternative medicine, and other fields.
Education and Training
After graduating medical school and finishing a one-year internship, the doctor enters a program in anesthesiology or physical medicine but from different fields such as psychiatry and neurology. Upon completion of a residency program (typically 3 years long), the doctor completes a one-year fellowship for advanced training in pain medicine.
Pain medication specialists are board certified. The associations that board certify physiatrists, anesthesiologists, neurologists, and psychiatrists all collaborate to provide the board examination to the subspecialty of pain medicine. Pain medicine and management specialists keep their education and training throughout their careers. There are many opportunities for pain management specialists to remain current with technical and medical improvements in pain medication, such as society meetings and journals.
Goals of Pain Management
By reducing pain, frequency and intensity, a pain management specialist’s goal is to handle chronic or acute pain. A pain management program can manage your operational goals for activities of daily living besides fixing pain problems. In general, a pain medication program intends to give you a feeling of well-being, increase your level of action (like return to work), and reduce or eliminate your dependence on drugs.
Kinds of Pain Treated
Pain medicine specialists treat all kinds of pain. Intense pain is described as severe or sharp and may signal something isn’t right. The pain experienced during care is an instance of acute pain. Infection lasting more or even 6 months is described as chronic. This kind of pain is persistent and varies from moderate to severe. Spinal arthritis (spondylosis) pain is often chronic. A good outcome is produced by combining different treatments although chronic pain is difficult to manage.
Treatment may include:
Limit activities that increase pain (activity modification)
Prescription medication: Nonsteroidal anti inflammatory medications, muscle relaxants, narcotics (opioids), anti-depressants, and antiseizure drugs. Some antiseizure and antidepressant medications have proven to help manage specific types of chronic pain.
Injection therapy: provide pain relief, as well as Injections may help to pinpoint the reason behind pain. Therapies include facet joint anabolic steroid, and joint injections; and nerve rootbranch, peripheral and sympathetic nerve block .
Physical Therapy: Heat/ice, massage, spinal traction, transcutaneous electric nerve stimulation (TENS), ultrasound, and therapeutic practice.
Pulsed Radiofrequency Neurotomy is a minimally invasive procedure that prevents nerves from sending pain signals to the brain.
Rhizotomy utilizes electrodes that are heated to turn off pain signals from nerves that are particular.
Spinal Cord Stimulation is an implanted device that produces electrical impulses to block pain perception.
Intrathecal Pumps are sometimes referred to as pain pumps. The device is surgically implanted and dispenses doses of medication within the spinal tract.
Acupuncture is the insertion of needles to some of 2,000 acupuncture points or the body’s 20 Meridian factors. Acupuncture is central to Traditional Chinese Medicine (TCM), which includes other holistic treatments.
Manipulation is performed by chiropractors, osteopathic doctors (DO), and some physical therapists, even though the treatment varies among these careers. Manipulation is described as the use of force or pressure to take care of a disorder.
Art and music therapy are approaches to distract your mind. Besides a creative outlet, comfort is promoted by these therapies, provide a way for expression, help to reduce anxiety, raises self-esteem, and are fun.
What to Expect During an Appointment
Your consultation with interventional pain management specialist is much like other physician visits. Even though there are a number of similarities, the focus is quickly managing it, and on your pain, the cause or contributing factors.
Pain medication doctors perform a physical and neurological evaluation, and review your medical history paying special attention to pain history. You may be asked many questions about your pain, such as:
On a scale from zero to 10, with 10 being the worse pain possible, speed your pain.
When did pain begin? When pain began what were you doing?
Does pain disperse into different areas of the human body?
Is its intensity continuous, or can it be worse at different times of the night or day?
What helps to relieve the pain? Why is pain worse?
What treatments have you tried? What worked? What failed?
Do you take herbal supplements, vitamins, or over-the-counter medications?
Can you take prescription medication? If so, what, how much, and how?
Most pain medication specialists utilize a standardized drawing of the front/back of the human body to let you indicate where pain is sensed, as well as indicate pain spread and type (eg, gentle, sharp). You may be requested to complete the form each time you stop by the pain physician. The drawing can help to evaluate your treatment progress.
Accurate Diagnosis Key to Remedy
Pain medication involves diagnosing the cause or source of pain. Making the proper diagnosis may entail obtaining an X-ray, CT scan, or MRI study to confirm the cause of your neck or back pain. When treating spine-related pain (which may include leg or arm signs), additional tests, such as discography, bone scans, nerve studies (electromyography, nerve conduction study), and myelography could be carried out. The identification is essential to a successful treatment program.
Some spinal disorders and pain therapy requires involvement including orthopaedic surgeon, neurosurgeon, your primary care doctor, and practitioners in radiology, psychiatry, psychology, oncology, nursing, physical therapy, and complimentary medicine. The pain medicine specialist may consult with and/or consult with spine surgeon or a neurosurgeon to ascertain whether spine surgery is required by your pain issue.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
Pain is defined as a physical discomfort caused by illness or injury. Most cases of pain are temporary, or they disappear once the source of the symptom is treated or healed, however, what happens when the pain becomes persistent?
How can you diagnose chronic pain?
Diagnosing chronic pain can be a long procedure. Because there are lots of possible causes behind the painful symptoms, the health care provider may need to conduct a variety of examinations and tests to attempt to find the source of your own pain. Below are a few of the methods the physician may try to diagnose chronic pain.
Medical History
Your doctor will take a comprehensive health history, going over any injuries, illnesses, and medical problems that run in your family. It is essential to be thorough so that the doctor can take a look at the full assortment of causes because chronic pain can generally be a result after injury or illness.
You’ll also have to be very particular about your pain: description, frequency, intensity, duration, activities that make it worse, even whether it is better at a certain time of day, etc.. It may be a good idea to initiate a pain journal where you record details of your pain. You’ll be better able to share information with the healthcare professional.
Physical, Neurological, and Mental Health Exams
For the physical examination, the physician will see your range of movement (that is how well and how much you can move specific joints), posture, and general physical condition. He or she will make note of any movements that increase or cause you pain.
The neurological examination will test your nerves, so this test is particularly critical for chronic pain. The doctor will test your reflexes, muscle power, and how well it is possible to feel. The physician might test if you can feel a touch in your skin. That may indicate nerve damage if you can’t. The healthcare provider will see whether your pain is currently spreading through the examination, �or whether you came in complaining of back pain.
Because chronic pain frequently has an emotional or psychological element, you might have to have a mental health examination. This is to check for symptoms such as stress or depression, that could develop alongside pain. The health exam may also give your doctor a complete picture of your overall health and wellness.
Diagnostic Tests
To see if there is an injury or identifiable illness causing your chronic pain, the healthcare professional will need to conduct diagnostic tests. For the imaging evaluations (x-rays, MRIs), you may have to go to an imaging center to have these done; the results will probably be sent back to your physician, who will interpret them for you.
Some possible diagnostic tests include:
Blood evaluation: Your doctor may be able to tell if you have specific forms of arthritis or a disease based on a blood test.�A blood test also allows the doctor to check your liver and kidney functions.
Bone scan: To help your doctor detect spinal problems such as osteoarthritis, sacroiliac joint dysfunction, fractures, or illnesses (which can all lead to chronic pain), you could have a bone scan. You will have a small amount of radioactive substance. That can travel through your blood flow and be absorbed by your bones. An area where there is abnormal action, like an inflammation, will absorb substances. A scanner can detect the quantity of radiation from all your muscles and also show the “hot spots” (the areas with more radioactive material) to help your doctor figure out where the issue is.
CT scan: A CT scan, which stands for computerized axial tomography, reveals the bones, but in addition, it reveals the soft tissues and nerves.
EMG: An electromyography (EMG) will check if your muscles are responding well to nerve stimuli.
MRI: An MRI, which stands for magnetic resonance imaging, shows the bones, but in addition, it shows the soft tissues and nerves. MRIs do not expose you to radiation by using magnets to get the picture.
Myelogram: To see whether you have a spinal canal or spinal cord disorder, maybe nerve compression causing weakness and pain, you might need a myelogram. In this evaluation, you’ll have a special dye injected into the fluid that surrounds your spinal cord and nerves. Then you’ll have a CT scan or an x-ray. The image will offer a detailed anatomic picture of your spine of the bones, which will assist your doctor.
NCV: A nerve conduction velocity (NCV) test will help the doctor evaluate your nerves and ascertain if there is any damage. This test is done together using the EMG test.
Nerve block: When the doctor suspects that a particular nerve is damaged and that is what is causing your chronic, they may do a nerve block. This is a special type of injection that may help identify if the nerve is the source of pain.
X-ray: This gives your doctor a clear picture of your bones.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
A range of factors can play an essential part in the experience of chronic pain. Pain is the body’s normal reaction to an injury or illness, But for many people, pain can be a constant.
When pain lasts for 3 to 6 months or more, it�s called chronic pain. If you hurt day after day, it can take a toll on your emotional and physical health. And, if your emotional and physical health are affected, a variety of fundamental microorganisms can be affected as well. In order to maintain overall health and wellness, following a biocentric approach can often help best understand the impact of maintaining the health of every part which makes the human body. It may be beneficial to view this model to conceptualize the complex nature of this frequent condition.
Tissue Damage
This is damage or injury to the tissue which often generally can be the start of pain. The tissue damage causes input to the nervous system, commonly identified as the pain signal. This is also termed as “nociceptive input.” Each cell in the body comes together to form a variety of complex tissues, which independently come together to form organs and other important structures, each in charge of performing essential functions for the body.
Biocentrism,�the view or belief that the rights and needs of humans alone are not more important than those of other living things, explains how taking care of every single structure in the body, such as the cells which form tissues, even including microorganisms, can ensure the well-being of the body as a whole. Damaged tissues can often be a sign of a deeper issue within the human body. Tissue damage can be additionally caused by a variety of other issues.
Pain Sensation
In the simplest terms of this model, pain sensation is the actual perception that occurs in the brain following the nerve signals, due to nociception, which travel from the periphery into the central nervous system. Whilst nociception occurs at the site of injury, pain sensation is experienced in the brain. The human body is not simply a single organism, it is comprised of a wide variety of microorganisms, many of which help maintain the well-being of the nervous system.
Thoughts
Cognitions or ideas occur and are an assessment of the pain sensation signal coming into the nervous system as well as events surrounding it. These thoughts can be unconscious or conscious and will influence the way pain signals are perceived. For example, general body aches and stiffness are traditionally considered to be “good pain” when those happen after a vigorous exercise session, whereas they’re perceived as bad pain when related to a health illness, such as fibromyalgia,�a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness.
Emotions
The psychological component of pain is a person’s response to thoughts about the pain. If you believe (thoughts) that the pain is a serious danger (e.g. a tumor), subsequently emotional responses will incorporate fear, depression, and anxiety, amongst others. If you believe the pain isn’t a threat, then the psychological response will probably be negligible. Chronic pain has been a misunderstood condition and it’s effects have been reported to cause an array of emotional as well as mental disorders, due to the difficult ability to assess such conditions.
Suffering
The term “suffering” is often employed as a synonym for “pain” even though they’re theoretically and conceptually distinct. For example, a broken bone might cause pain without discomfort (since the individual knows the pain isn’t deadly and the bone will heal). By comparison, bone pain due to a tumor might cause the identical pain for a break but the distress will be much greater because of the “meaning” behind the pain (that tumor could be life-threatening). Suffering is connected to the psychological component of pain. For certain conditions which cause chronic pain, often seen in patients with fibromyalgia, a condition believed to have no cure, the fact alone that the individual’s symptoms of discomfort will never “go away” can implement a great deal of suffering.
Pain Behaviors
Pain behaviors are defined as things people do if they are in pain or suffer. These are behaviors that others observe as indicating pain, like limping, grimacing, talking about the pain, moving and taking pain medication. Pain behaviors are in reaction to all the other facets in the pain system model (tissue damage, pain feeling, thoughts, emotions, and distress). Life experiences, expectations, and ethnic influences also affect pain behaviors of the way the pain is expressed in terms. Interestingly, pain behaviors are also influenced by the environment, like how others react.
According to biocentrism, taking care of the environment, including taking care of all forms of life, such as its plants and animals, among others, is ultimately important towards the health and wellness of every organism. For example, if the food we eat is being properly taken care of, its full benefits can be properly absorbed. Nutrition is an important contributing factor for people with chronic pain. A balanced nutrition, consisting of healthy products, can help.
Additionally,�the�psychosocial environment includes each of the environments where an individual resides, works, and plays. Studies have consistently proven that these surroundings influence how an individual will reveal pain behaviors.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
Most of us will experience it at some point — but how does it influence on athletic performance? Chiropractic injury specialist, Dr. Alexander Jimenez investigates.
Research postulates that 80 percent of the populace will undergo an acute onset of back pain at least once in their lifetimes. This adds a considerable financial burden not just on the medical system (physician consultations, prescribed drugs, physiotherapy) but also the financing of the workforce in lost employee hours and loss in productivity.
The types of lower back pain that an individual may experience include (but are not limited to):
1. Lumbar spine disc herniation with/ without sciatica
8. Inflammatory arthritis such as rheumatoid and anklyosing spondylitis
9. Facet joint sprains
10. Bone injuries such as stress fractures, pars defects and spondylolisthesis.
The focus for this paper will be on the previous group — that the bone injuries. This may be simply postural (slow onset repetitive trauma) or related to sports; for instance, gymnastics.
The two demographic groups that tend to endure the most extension-related low back pain are:
1. People who endure all day, for instance, retailers, army, security guards etc.. Prolonged position will obviously force the pelvis to start to migrate to an anterior tilt management. This may begin to place compressive pressure on the facet joints of the spinal column as they also change towards an expansion position since they accompany the pelvic tilt.
2. Extension sports such as gymnastics, tennis, swimming, diving, football codes, volleyball, basketball, track and field, cricket fast bowlers. This is more pronounced in sports that involve extension/rotation.
Pathomechanics
With normal extension of the lumbar spine (or backward bending), the facet joints begin to approximate each other and compress.�The articular processes of this facet above will abut the articular process of the facet below. This is a normal biomechanical movement. However, if the extension ranges are excessive, the procedures will impinge quite aggressively and damage to the cartilage surfaces within the facet joint can result. Sports such as gymnastics, functioning in tennis, and handling in American Soccer may all involve uncontrolled and excessive extension.
It would be unlikely that a bone stress response or even a stress fracture could be brought on by an isolated expansion injury. It would be more likely that a sudden forced extension injury may damage an already pre-existing bone strain reaction.
Similarly, if an individual stands daily and the pelvis migrates into lateral tilt, then the aspects will be placed under low load compression but for extensive intervals.
With ongoing uncontrolled loading, stress is then transferred from the facet joint to the bone below (pars interarticularis). This originally will manifest as a pressure reaction on the bone. This bone strain may advance to a stress fracture throughout the pars if uncorrected. This fracture is also referred to as a “pars flaw”, or spondylolysis.
It was initially considered that stress fractures of the pars was a congenital defect that introduced itself at the teenage years. However, it is now agreed that it is probably obtained through years of overuse into extension positions, especially in young sportspeople involved with expansion sports. What’s more, one-sided pars defects often occur more commonly in sport which also included a rotational component such as tennis serving or fast bowling in cricket.
The stress fracture can then advance to impact the opposite side, causing a bilateral strain fracture, with anxiety subsequently being transferred to the disk in between both levels.
Spondylolisthesis features bilateral pars defects which could possibly be a result of repetitive stress into the bilateral pars in extension athletics, but more likely it is an independent pathology that manifests in the early growing stages (9-14) as this pathology is often viewed in this age category. If they become symptomatic in later years because of involvement in expansion sports, it is exceedingly likely that the defects were there by a young age but presented asymptomatically. As a result of rapid growth spurts in teenage years and the high-volume training experienced by teenaged athletes, it is possible that these dormant spondylolisthesis then pose as ‘acute onset’ back pain in teenage years.
In summary, the progression of this bone stress reactions tends to follow the following continuum:
1. Facet joint irritation
2. Pars interarticularis stress response
3. Stress fracture to the pars
4. Pars defect (or spondylolysis)
5. Spondylolisthesis due to activity or more likely congenital and found later in teenage years due to participation in�extension sports.
The landmark publication related to spondylolysis and spondylolisthesis was presented by Wiltse et al (1976) and they classified these injuries as follows:
1. Type I: dysplastic � congenital abnormalities of L5 or the upper sacrum allow anterior displacement of L5 on the sacrum.
2. Type II: isthmic � a lesion in the pars interarticularis occurs. This is subclassified as
a. lytic, representing a fatigue fracture of the pars,
b. elongated but intact pars, and c. acute fracture.
3. Type III: degenerative � secondary to long-standing intersegmental instability with associated remodeling of the articular processes.
4. Type IV: traumatic � acute fractures in vertebral arch other than the pars.
5. Type V: pathological � due to generalized or focal bone disease affecting the vertebral arch.
The vast majority of spondylolysis and sponylolisthesis accidents are Type II — the isthmic variety.
For the purposes of this paper, we will refer to the above stages as the posterior arch bone stress injuries (PABSI).
Epidemiology
It is a lot more widespread at the L5 level (85-90 percent). It’s a high asymptomatic prevalence in the general population and is often found unintentionally on x ray imaging. Nonetheless, in athletes, particularly young athletes, it is a common reason for persistent low back pain. From the young athlete, the problem is often referred to as ‘active spondylolysis’.
Active spondylolysis is normal in virtually every gamenevertheless, sports such as gymnastics and diving and cricket pose a much greater danger due to the extension and turning character of the sport. The progression from an active spondylolysis into a non-union type spondylolisthesis has been associated with a greater prevalence of spinal disk degeneration.
Early detection through screening and imaging, therefore, will highlight those early at the bone stress phase and if caught early enough and managed, the progression to the larger and more complicated pathologies are avoided as a result of therapeutic capacity of the pars interarticularis in the early stages.
It is more common to find teens and young adults afflicted by PABSI. This will highlight the rapid growth of the spine through growth spurts that is also characterized by a delay in the motor control of the muscle system during this period. Furthermore, it’s thought that the neural arch actually gets stronger in the fourth decade hence possibly explaining the low incidence of bone stress reactions in mid ages.
The incidence of spondylolysis has been reported to be around 4-6% in the Caucasian population (Friedrikson et al 1984). The rates seem to be lower in females and also in African-American males. It has also been suggested that a link exists between pars defects and spina bifida occulta.
The incidence of spondylolysis seems to be higher in the young athletic population than in the general population. Studies in gymnasts, tennis, weightlifting, divers and wrestlers all show disproportionately high incidence of spondylolysis compared with the general population of age-matched subjects.
Tennis
The tennis serve generates excessive extension and rotation force. In addition, the forehand shot may also produce elevated levels of spinning/ extension. The more traditional forehand shot demanded a great deal of weight shift through the legs to the torso and arms. However, a more favorite forehand shot is to currently face the ball and also generate the force of this shot utilizing hip rotation and lumbar spine extension. This action does increase ball speed but also puts more extension and compressive loads on the spine potentially resulting in a greater degree of stress on the bone components.
Golf
The most likely skill component involved in golf that may cause a PABSI are the tee shot with a 1 wood when forcing for distance. The follow-through of this shot entails a significant quantity of spine rotation with maybe a level of spine expansion.
Cricket
Fast bowlers in cricket are the most susceptible to PABSI. This will occur on the opposite side to the bowling arm. As the front foot engages on plant stage, the pelvis abruptly stops moving but the spine and chest continue to proceed. With the wind-up of this bowling action (rotation), when coupled with expansion this can place large forces on the anterior arch of the thoracic. More than 50% of fast bowlers will create a pars stress fracture. Young players (up to 25) are most vulnerable. Cricket governments have implemented training and competition guidelines to avoid such injuries by restricting the number of meals in training/games.
Field Events
The more common field events to cause a PABSI would be high leap followed by javelin. Both these sports create enormous ranges of backbone extension and under significant load.
Contact Sports
Sports like NFL, rugby and AFL all require skill components that need backbone expansion under load.
Gymnastics/Dancers
It goes without saying that gymnastics and dancing involves a substantial amount of repetitive spine expansion, particularly backflips and arabesques. It has been suggested that nearly all Olympic degree gymnasts could have suffered from a pars defect. Many organizing bodies now put limits on the number of hours young gymnasts can instruct to prevent the repetitive loading on the spine.
Diving
Spine extension injuries occur mostly off the spring board and on water entrance.
Diagnosis Of PABSI In Athletes
Clinical investigation
These can pose as preventable injuries. Research shows that the incidence was emphasized from the general population that have nil indicators of back pain. But, individuals will typically complain of back ache that is deep and generally unilateral (one side). This may radiate into the buttock area. The most offending movements tend to be described as expansion moves or backward bending movements. This may be a slow progression of pain or might be initiated by one acute episode of back pain in a competitive extension motion.
On clinical examination:
1. Pain may be elicited with a one-leg extension/rotation test (standing on the leg on the affected side) � stork test.
2. Tenderness over the site of the fracture.
3. Postural faults such as excessive anterior tilt and/or pelvic asymmetry.
The one-legged hyperextension test (stork test) was suggested to be pathognomonic for busy spondylolysis. A negative evaluation was stated to effectively exclude the diagnosis of a bone stress-type injury, thus creating radiological investigations unnecessary.
But, Masci et al (2006) examined the connection between the one-legged hyperextension test and gold standard bone scintigraphy and MRI. They discovered that the one-legged hyperextension test was neither sensitive nor specific for active spondylolysis. Moreover, its negative predictive value was so poor. Thus, a negative test can’t exclude energetic spondylolysis as a possible cause.
Masci et al (2006) go on to indicate that the bad relationship between imaging and the one-legged test may be because of a number of factors. The extension test would be expected to move a significant extension force on to the lower back spine. In addition to putting substantial strain on the pars interarticularis, it might also stress different regions of the spinal column like facet joints as well as posterior lumbar disks, and this may subsequently induce pain in the existence of other pathology such as facet joint arthropathy and spinal disc disease. This will explain the poor specificity of the test. Conversely, the inadequate sensitivity of the test may be related to the subjective reporting of pain by issues performing the maneuvre, which may vary based on individual pain tolerance. Additionally, this evaluation can preferentially load the fifth cervical vertebra, and so bone stress located in the upper lumbar spine may not test positive.
Grade 1 spondylolisthesis are normally asymptomatic; nonetheless, grade 2+ lesions often present with leg pain, either with or without leg pain. On examination, a palpable slip could be evident.
Imaging
Clinical assessment of active spondylolysis and the more severe pars defects and spondylolisthesis can be notoriously non-specific; this is, not all patients suffering PABSI will present with favorable abstract features or positive signs on analyzing. Thus, radiological visualization is important for diagnosis. The imaging methods available in the diagnosis of bone stress injury are:
1. Conventional radiology. This test is not very sensitive but is highly unique. Its limits are partially because of the cognitive orientation of the pars defect. The oblique 45-degree films may show the timeless ‘Scotty Dog’ appearance. Spondylolisthesis can be looked at simply on a lateral movie x-ray.
2. Planar bone scintigraphy (PBS) and single photon emission computed tomography (SPECT). SPECT enhances sensitivity in addition to specificity of PBS than straightforward radiographic study. Comparative research between PBS and conventional radiology have shown that scintigraphy is more sensitive. Patients with positive SPECT scan must then undergo a reverse gantry CT scan to assess whether the lesion is active or old.
3. Computed tomography (CT). The CT scan is considered to be more sensitive than conventional radiology and with higher specificity than SPECT. Regardless of the type of cross-sectional image utilized, the CT scan provides information on the state of the flaw (intense fracture, unconsolidated flaw with geodes and sclerosis, pars in procedure for consolidation or repair). The “inverse gantry” perspective can evaluate this condition better. Repeat CT scan can be used to track progress and recovery of the pars defect.
4. Magnetic resonance imaging (MRI). This technique shows pronounced changes in the signal in the amount of the pars. This is recognized as “stress response” and can be classified into five different degrees of action. MRI can be helpful for evaluating elements that stabilize isthmic lesions, for example intervertebral disc, common anterior ligament, and related lesions. The MRI isn’t as specific or sensitive as SPECT and CT combination.
Therefore, the current gold standards of investigation for athletes with low back pain are:
1. bone scintigraphy with single photon emission computed tomography (SPECT); if positive then
MRI has many advantages over bone scintigraphy, for instance, noninvasive nature of the imaging along with the absence of ionizing radiation. MRI changes in active spondylolysis include bone marrow edema, visualized as increased signal in the pars interarticularis on edema-sensitive sequences, and fracture, visualized as reduced signal in the pars interarticularis on T1 and T2 weighted sequences.
However, there is greater difficulty in detecting the changes of busy spondylolysis from MRI. Detecting pathology from MRI relies on the interpretation of distinct contrasts of signals compared with normal tissue. Unlike stress fractures in different parts of the body, the little region of the pars interarticularis may make detection of those changes harder.
However, unlike MRI, computed tomography has the capability to differentiate between acute and chronic fractures, and this differentiation might be an important determinant of fracture healing. Accordingly, in areas using pars interarticularis fractures discovered by MRI, it might nonetheless be necessary to execute thin computed tomography slices to determine whether or not a fracture is severe or chronic — an important factor in fracture resolution.
A herniated disc can lead to pain as well as disrupt your daily activities, as you likely know. That is probably what brings you to the office of the doctor: You have back pain or neck pain, and you’d love to understand why.
Your doctor will ask you questions and execute a few exams. This is to try to find the origin of your pain and also to find out which intervertebral disks are herniated. An accurate diagnosis will help your doctor develop a treatment plan method to help you recover and to handle your herniated disc pain and other spine symptoms.
Physical Exam: Herniated Disc Diagnosis
As part of the physical exam, your doctor will ask about your current symptoms and remedies you have already tried for your pain. Some average herniated disc diagnostic questions include:
When did the pain begin? Where’s the pain (cervical, thoracic or mid-back, or lumbar or lower back)?
What activities did you lately do?
What do you do for your herniated disc pain?
Can the disc herniation pain radiate or travel to other parts of your body?
Does anything reduce the disk pain or make it even worse?
Your doctor may also observe your position, range of movement, and physical condition both lying down and standing up. Movement that causes pain will be noticed. A Las�gue evaluation, also referred to as the Straight-Leg Raising evaluation, may be accomplished. You’ll be asked to lie down and extend your knee with your hip bent. If it produces pain or makes your pain worse, this may indicate a herniated disc.
With a herniated disc (or a bulging or ruptured disc), you might feel stiff and may have lost your normal spinal curvature because of muscle strain. Your physician may also feel for tightness and note the spine’s curvature and alignment.
Neurological Exam: Herniated Disc Diagnosis
Your spine specialist will also run a neurological exam, which tests your reflexes, muscle strength, other nerve changes, and pain disperse. Radicular pain (pain that travels away from the source of the pain) can increase when stress is applied directly to the affected area. You might, for instance, have sciatica; this is radicular pain that might be caused by the herniated disk. Since the disc is compressing a nerve, you might experience pain and symptoms in other areas of the body, although the origin of the pain is on your spine.
Imaging Tests for Herniated Discs
Your spine specialist may order imaging tests to help diagnose your injury or condition; you might have to see an imaging facility for those evaluations.
An X-ray may demonstrate a secondhand disk space, fracture, bone spur, or arthritis, which might rule out disk herniation. A computerized axial tomography scan (a CT or CAT scan) or a magnetic resonance imaging test (an MRI) equally can show soft tissue of a bulging disk or herniateddisc. So that you may get treatment these tests will demonstrate location and the stage of the herniated discs.
Other Tests to Diagnose�a Herniated Disc
To obtain the most accurate identification, your spine specialist may order additional tests, for example:
Electromyography (EMG): He or she may order an examination known as an electromyography to measure your nerves respond, if your spine pro suspects you’ve got nerve damage.
Discogram or discography: A sterile procedure where dye is injected into one of your vertebral disc and seen under special conditions (fluoroscopy). The goal is to pinpoint which disk(s) might be causing your pain.
Bone scan: This technique generates film or computer images of bones. A very small number of radioactive substance is injected into a blood vessel throughout the blood flow. It collects on your bones and can be detected by a scanner. This procedure helps doctors detect spinal problems such as disease, a fracture, tumor, or arthritis.
Laboratory evaluations: Typically blood is attracted (venipuncture) and tested to determine if the blood cells are normal or abnormal. A metabolic disease which might be contributing to a back pain may be indicated by Chemical changes in the blood.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Sciatica
Lower back pain is one of the most commonly reported symptoms among the general population. Sciatica, is well-known group of symptoms, including lower back pain, numbness and tingling sensations, which often describe the source of an individual’s lumbar spine issues. Sciatica can be due to a variety of injuries and/or conditions, such as spinal misalignment, or subluxation, disc herniation and even spinal degeneration.
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