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.
The Cobb angle is a mathematical measurement tool for assessing the curvature of the spine. Along with physical exams and other tests, how is it used to evaluate scoliosis and kyphosis of the spine?
Cobb Angle
The Cobb angle is used to quantify the curvature of the spine, particularly in conditions like scoliosis. It measures the degree of side-to-side spinal curvature, a deformity called scoliosis. The angle’s size helps determine what kind of treatment is needed. Monitoring may be all that’s necessary for mild curvature. With severe scoliosis, treatment may require spinal fusion surgery. Named for orthopedic surgery pioneer John Robert Cobb, it describes the distance a scoliotic curve may deviate from being straight. (Botterbush K. S. et al., 2023) Generally, it takes at least 10 degrees of deviation from straight before scoliosis is confirmed.
X-Ray and Interpretation
An X-ray is taken to measure the Cobb angle. Side and back views are taken. The healthcare provider or examiner then views the X-rays and locates the most affected vertebra in the curve, the apical vertebra. In a scoliotic curve, the apical vertebra is the spinal bone with the greatest degree of rotation that takes the biggest curve away from the center of a normal spine column.
Visualizing the Angle
The apical vertebra is where two lines drawn from the X-rays meet. Two lines are drawn along the edge of the top and bottom bones of the curve. The lines extend out as follows:
On the top bone, the line starts on the high side, continues along the top edge, and then slopes down according to the angle of the vertebra. (Jin, C. et al., 2022)
On the bottom vertebra, the line starts on the low side, continues along the bottom edge, and slopes upward.
The Cobb angle is found by measuring the angle of the two intersecting lines where they meet.
Then, the top and bottom vertebrae of the side-to-side curve are identified to create a number for the Cobb angle. These bones have the most tilt but the least rotation and displacement and are located above and below the apical vertebra. Computer software is commonly used to calculate the Cobb angle. (Jin, C. et al., 2022) Treatment is based on the:
Angle size
Gender: Scoliosis is more common and likely to progress in females
Scoliosis is diagnosed when the Cobb angle reaches 10 degrees or more. However, this is not generally considered a significant curvature (American Association of Neurological Surgeons, 2024). In around 80% of cases, the scoliosis is considered idiopathic or without congenital or other underlying causes.
Less Than 25 Degrees Cobb Angle
If a scoliotic curve is less than 25 degrees, individuals may only need to visit their healthcare provider periodically so long as the scoliosis is monitored. These are mild cases, often without symptoms, but there is a chance that the curvature can progress. This usually means reassessing the Cobb angle every four to six months in a growing child or adolescent. (National Scoliosis Foundation, 2015) A 5-degree or more progression can change the diagnosis and treatment. (Jin, C. et al., 2022)
Between 25 and 40 Degrees Cobb Angle
A Cobb angle of 25 to 40 degrees usually requires wearing a back brace and intensive physical therapy. The goal of these treatments is to help halt the curve’s progression. Braces are generally worn 16 to 23 hours every day. (National Scoliosis Foundation, 2015) The healthcare provider will provide a referral for physical therapy. Many report excellent results with the Schroth or other scoliosis-specific exercise methods. A study found that core stabilization exercise programs can decrease Cobb angles in adolescents with idiopathic scoliosis. (Ko K. J. & Kang S. J. 2017)
Scoliosis in Adults
Scoliosis is diagnosed in adults, usually in those who have had the condition, treated or not, that was identified in their youth. A study that followed various cases for 20 years found disease progression occurred in 40% of adults but was usually less than one degree per year. However, degenerative scoliosis can also occur in individuals aged 65 and older. (American Association of Neurological Surgeons, 2024)
40 Degrees or More Cobb Angle
Surgery may be recommended once the Cobb angle reaches 40 to 50 degrees. A spinal fusion is often used to force the curve to stop developing. In adults, surgery may be needed if the angle reaches 50 degrees and they experience complications, such as nerve damage or bowel/bladder dysfunction. Risk factors in adults include older age, a history of smoking, and a diagnosis of other conditions, including being overweight. (American Association of Neurological Surgeons, 2024)
Variations
Variations occur in measuring scoliosis, and it is important to understand the difference between a change in scoliosis and a change in the tools or measurement. Equipment errors, imaging errors, and the subjective reading of the healthcare provider can change the values. (Jin, C. et al., 2022) Scoliosis measurement software and intelligent medical devices continue to improve how scoliosis is evaluated and treated. Physical exams, symptoms, and careful monitoring of changes in posture or function are still critical to an accurate diagnosis. The healthcare provider will explain the Cobb angle and other test results.
Injury Medical Chiropractic & Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Academic Low Back Pain: Impact and Chiropractic Solutions
References
Botterbush, K. S., Zhang, J. K., Chimakurty, P. S., Mercier, P., & Mattei, T. A. (2023). The life and legacy of John Robert Cobb: the man behind the angle. Journal of neurosurgery. Spine, 39(6), 839–846. https://doi.org/10.3171/2023.7.SPINE23146
Jin, C., Wang, S., Yang, G., Li, E., & Liang, Z. (2022). A Review of the Methods on Cobb Angle Measurements for Spinal Curvature. Sensors (Basel, Switzerland), 22(9), 3258. https://doi.org/10.3390/s22093258
National Scoliosis Foundation. (2015). Scoliosis Media & Community Guide. https://www.scoliosis.org/nsf2/wp-content/uploads/2015/06/ScoliMediaGuide_9June3.pdf
American Association of Neurological Surgeons. (2024). Scoliosis. https://www.aans.org/patients/conditions-treatments/scoliosis/
Ko, K. J., & Kang, S. J. (2017). Effects of 12-week core stabilization exercise on the Cobb angle and lumbar muscle strength of adolescents with idiopathic scoliosis. Journal of Exercise Rehabilitation, 13(2), 244–249. https://doi.org/10.12965/jer.1734952.476
Can the straight leg test help find the cause of back or hamstring pain in individuals experiencing it?
Straight Leg Test
The straight leg raise test is often used to diagnose sciatica/radiculopathy, herniated discs, and other spinal problems. The healthcare provider giving the test performs most of the movement as they assess what’s causing the leg and/or back pain. The patient lies on their back with the legs straight. The provider will have the patient perform specific movements and inform them of how it feels. Then, they’ll raise the leg to see if and at what point symptoms begin to show. Providers often use this test alongside imaging studies.
Some studies suggest the straight leg test helps diagnose sciatica and other causes. (Pesonen J. et al., 2021)
Purpose
The straight leg raise is one of the most common manual tests done during physical exams. The straight leg raise test seeks to reproduce the pain or other symptoms in a controlled fashion to provide clues to what’s happening. It is a manual exam, and the healthcare provider will:
Position the patient
Moves the patient
Create pressure to see how well the patient can resist it
This is often used alongside imaging tests, such as an X-ray or CT scan. (Allegri M. et al., 2016) Its goal is to check for nerve movement and sensitivity of nerve tissue to compression. The straight leg lift test is neurodynamic because it uses movement to diagnose nerve problems. (Baselgia L.T. et al., 2017)
During the Test
Expect to feel some pain during the test, as the whole point is to see what aggravates the symptoms. They may be caused by:
Most of the tests are passive, with the provider doing the lifting. The patient can help achieve the most accurate result by staying as relaxed as possible and being clear about what is felt. (Pande K. 2015) The procedure:
The patient lies on their back with their legs straight.
The provider will ask the patient to turn one of the legs in.
This tells them what hip position affects the lower back symptoms.
They’ll then ask you to bring the leg toward the body’s center.
Then, they’ll lift the straight leg until the patient experiences symptoms.
Pain suggests a herniated disc.
If there is no pain, this also provides valuable information.
The procedure is repeated with the other leg.
Modifications
It’s important to let the examiner know about any limitations. The straight leg raise test has modifications if the patient cannot lift their leg while it’s straight or if they have difficulty lying on their back, which can also help avoid an injury during the test.
Variations
The healthcare provider may repeat the test with the ankle in a dorsiflexed position/raising the foot. Then, they’ll have the patient do it with their chin tucked into their chest. (Young R. et al., 2013) These variations can help check for nerve involvement in specific locations, such as the spinal cord or the dura mater, the membrane covering the brain and spinal cord. (Venne G. et al., 2017) The spinal cord nerves are likely involved and affected if the usual pain is in the back or leg but not the chin, neck, or foot. (Camino Willhuber GO, Piuzzi NS. 2023)
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
From Injury to Recovery with Chiropractic Care
References
Casiano, V. E., Sarwan, G., Dydyk, A. M., & Varacallo, M. A. (2025). Back Pain. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30844200
Pesonen, J., Shacklock, M., Suomalainen, J. S., Karttunen, L., Mäki, J., Airaksinen, O., & Rade, M. (2021). Extending the straight leg raise test for improved clinical evaluation of sciatica: validity and diagnostic performance with reference to the magnetic resonance imaging. BMC musculoskeletal disorders, 22(1), 808. https://doi.org/10.1186/s12891-021-04649-z
Allegri, M., Montella, S., Salici, F., Valente, A., Marchesini, M., Compagnone, C., Baciarello, M., Manferdini, M. E., & Fanelli, G. (2016). Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research, 5, F1000 Faculty Rev-1530. https://doi.org/10.12688/f1000research.8105.2
Baselgia, L. T., Bennett, D. L., Silbiger, R. M., & Schmid, A. B. (2017). Negative Neurodynamic Tests Do Not Exclude Neural Dysfunction in Patients With Entrapment Neuropathies. Archives of physical medicine and rehabilitation, 98(3), 480–486. https://doi.org/10.1016/j.apmr.2016.06.019
Pande K. (2015). The Use of Passive Straight Leg Raising Test: A Survey of Clinicians. Malaysian Orthopaedic Journal, 9(3), 44–48. https://doi.org/10.5704/MOJ.1511.012
Young, R., Nix, S., Wholohan, A., Bradhurst, R., & Reed, L. (2013). Interventions for increasing ankle joint dorsiflexion: a systematic review and meta-analysis. Journal of foot and ankle research, 6(1), 46. https://doi.org/10.1186/1757-1146-6-46
Venne, G., Rasquinha, B. J., Kunz, M., & Ellis, R. E. (2017). Rectus Capitis Posterior Minor: Histological and Biomechanical Links to the Spinal Dura Mater. Spine, 42(8), E466–E473. https://doi.org/10.1097/BRS.0000000000001867
Camino Willhuber, G. O., & Piuzzi, N. S. (2025). Straight Leg Raise Test. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30969539
For individuals who have to be in one position for long periods, have poor postural alignment, and perform repetitive motions, what are myofascial pain syndrome spasm cycles?
Myofascial Pain Syndrome Spasm Cycles
Myofascial pain syndrome is a common condition that causes pain symptoms in a particular body area (Jafri M. S. 2014). A myofascial pain syndrome spasm cycle is a recurring pattern in which muscle tension and spasms in affected regions, caused by myofascial pain syndrome, lead to pain, triggering more muscle spasms. This creates a vicious cycle of discomfort and tightness that can be difficult to break without treatment; the pain perpetuates muscle spasms and vice versa.
Spasm Pain Cycle
Left untreated, myofascial pain is often experienced as a recurring cycle of spasm, pain, and spasm. (Kojidi M. M. et al., O2016) The exact cause of the spasm is not known. It may be related to excessive accumulation and release of acetylcholine, which causes sustained muscle contraction. (Nicol A, Crooks M, Hsu E, Ferrante M. 2018) Another theory is that repetitive small muscle trauma helps create a trigger point or knot in the muscle. (Thorne. 2021)
Active trigger points in muscles characterize myofascial pain syndrome. (Shah J. P. et al., 2015) These trigger points cause pain in the area where they are located and sometimes in other places, known as referred pain. Each muscle has a particular referral pattern of pain that goes from a trigger point in that muscle to another place in the body. (Shah J. P. et al., 2015) Medical providers and massage therapists trained in this area can identify trigger points by their pain patterns. With myofascial pain syndrome, muscles tense, and joint range of motion may decrease. (Jafri M. S. 2014)
Trigger Points
Myofascial pain syndrome is characterized by trigger points and sensitive knots within muscles that can cause referred pain when pressed, contributing to the spasm cycle.
Muscle Tension
A repeatedly tense or injured muscle can develop trigger points, which can lead tocle tightness and potential spasms.
Pain-Spasm-Pain Cycle
The pain from a trigger point can cause the muscle to further contract and spasm, leading to even more pain and perpetuating the cycle.
How Spasms and Pain Present
Myofascial pain is often caused by long periods of poor postural alignment, muscle injury, and repetitive motions. (Cleveland Clinic, 2023) For example, the upper body slumps forward when sitting at a desk workstation all day. The upper section of the trapezius muscle is located on the back of the neck and the top of the shoulder. The upper trapezius muscle works to raise the head. (Yoo W. G. 2015) The trapezius muscle now has to work more than it is used to. This overuse may cause microscopic muscle injury, leading to muscle spasms and pain. (Bron C., & Dommerholt J. D. 2012) (Nicol A, Crooks M, Hsu E, Ferrante M. 2018) Without treatment, the muscle spasms, pain, and microscopic muscle injury may persist or worsen, leading to trigger points and chronic pain. (Jafri M. S. 2014)
Causes
Repetitive Motions
Repeating the same movement, like typing on a computer, can trigger muscle tension and points.
Poor Posture
Maintaining incorrect posture for extended periods can strain muscles and contribute to trigger point development.
Muscle Injury
Past injuries can leave muscles susceptible to developing trigger points and pain cycles.
Stress
Psychological stress can lead to muscle tension and exacerbate existing trigger points.
Break the Cycle
Physical Therapy
A physical therapist can use stretching, massage, and trigger point therapy to release muscle tension and address trigger points.
Exercise
Regular exercise, including gentle stretching, can help improve muscle flexibility and reduce tension.
Heat Therapy
Applying heat to affected areas can help relax muscles and alleviate pain.
Ergonomics
Modifying work habits and posture to reduce strain on muscles.
Stress Management
Techniques like deep breathing and meditation can help reduce stress-related muscle tension.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Personal Injury Rehabilitation
References
Jafri M. S. (2014). Mechanisms of Myofascial Pain. International scholarly research notices, 2014, 523924. https://doi.org/10.1155/2014/523924
Kojidi, M. M., Okhovatian, F., Rahimi, A., Baghban, A. A., & Azimi, H. (2016). Comparison Between the Effects of Passive and Active Soft Tissue Therapies on Latent Trigger Points of Upper Trapezius Muscle in Women: Single-Blind, Randomized Clinical Trial. Journal of Chiropractic Medicine, 15(4), 235–242. https://doi.org/10.1016/j.jcm.2016.08.010
Nicol A, C. M., Hsu E, Ferrante M. (2018). Myofascial Pain Syndrome. Science Direct, 207-212. https://doi.org/https://doi.org/10.1016/B978-0-323-40196-8.00025-5
THORNE. (2021). Understanding Muscle Pain, Fascia, and Myofascial Release. https://www.thorne.com/take-5-daily/article/understand-muscle-pain-fascia-and-myofascial-release?srsltid=AfmBOop3Pp0wWEeiQEqpfPgAaTOpLvU7lOAGUv5VRYQdoH8OBcW4D_wk
Shah, J. P., Thaker, N., Heimur, J., Aredo, J. V., Sikdar, S., & Gerber, L. (2015). Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM & R: the journal of injury, function, and rehabilitation, 7(7), 746–761. https://doi.org/10.1016/j.pmrj.2015.01.024
Yoo W. G. (2015). Comparison of activation and change in the upper trapezius muscle during painful and non-painful computer work. Journal of Physical Therapy Science, 27(10), 3283–3284. https://doi.org/10.1589/jpts.27.3283
Bron, C., & Dommerholt, J. D. (2012). Etiology of myofascial trigger points. Current pain and headache reports, 16(5), 439–444. https://doi.org/10.1007/s11916-012-0289-4
Can understanding the planes of motion help individuals adjust fitness training to maximize fitness for physical and sports performance and reduce the risk of injury?
Planes of Motion
The body’s planes of motion are the sagittal, frontal, and transverse planes, which divide it into left and right, front and back, and top and bottom halves. The body moves in different dimensions during daily work, house chores, and physical activity/exercises. The movements in each plane correspond to forward/backward, side-to-side, and rotational motions. Think of each plane as an imaginary line or a pane of glass that divides the body into opposing segments when standing in the anatomical position. (National Academy of Sports Medicine, 2024)
Sagittal plane -Divides the body into right and left sides.
Frontal plane – Divides the body into front and back.
Transverse plane – Divides the body into top and bottom sections.
To determine the plane of motion of a particular movement, consider how the movement would interact with the imaginary lines or plates. When a movement runs parallel to the imaginary line, the movement is occurring in that plane of motion. For example, when going upstairs, the forward and upward movement at the hip, knee, and ankle occurs primarily in the sagittal plane because that movement runs parallel to the imaginary line that divides the body into right and left sides. Frontal plane movements occur while you walk up the stairs and reach for the handrail. The movement is in the frontal plane because the lateral hand reach runs parallel to the line, dissecting the body into front and back sections. If you turn around to look behind, the rotational movement occurs in the transverse plane because your upper torso runs parallel to the line, dissecting the body into an upper and lower section. Individual movements at any joint in the body can occur in a single plane or multiple planes. Complex movements usually happen in several planes of motion concurrently.
Sagittal Plane
Movement in the sagittal plane generally happens in front or behind. This is the most familiar plane of motion because many typical day-to-day activities happen within arm’s reach in front. Walking, texting, or computer work involves movement primarily in the sagittal plane. Several eating mechanics occur in the sagittal plane. Movements include:
Flexion – A bending movement that decreases the angle at a joint.
Extension – An extending movement that increases the angle at a joint.
Hyperextension – Extending the angle at a joint beyond neutral.
Dorsiflexion – Bending at the ankle so the top of the foot moves toward the shin.
Plantarflexion – Pushing the foot down and away from the body.
Many strength-training exercises in the sagittal plane include biceps curls, forward or reverse lunges, squats, vertical jumping, running, downward dog, and yoga chair poses.
Frontal Plane
The frontal plane divides the body into front/anterior and back/posterior sections. Frontal plane movements are lateral or side-to-side and include:
Abduction – Moving the body or a limb laterally and away from the body’s midline.
Adduction – Moving the body or a limb towards the body’s midline.
Elevation – Moving the shoulder blades up.
Depression – Moving the shoulder blades down.
Eversion – Rolling the foot towards the inside/medial side.
Inversion – Rolling the foot towards the outside/lateral side.
Frontal plane movements are less common than sagittal movements. For example, individuals walk forward more than side to side or reach for something in front rather than directly to the side. Frontal plane movements in fitness include side lunges, lateral shoulder raises, and side shuffles, and in yoga poses, standing side bends and the triangle.
Transverse Plane
The transverse plane divides the body into upper/superior and lower/inferior sections. Transverse plane movements generally involve rotation. Movement in this plane is less common. Exercise injuries most often occur during transverse/rotational movements. (National Academy of Sports Medicine, 2024) Movements include:
Rotation – Moving the torso or a limb around its vertical axis.
Pronation – Rotating the forearm or foot to a palm-side or foot-side down position.
Supination – Rotating the forearm or foot to a palm-side or foot-side-up position.
Horizontal Abduction – Moving the upper arm away from the body’s midline when elevated to 90 degrees.
Horizontal Adduction – Moving the upper arm towards the body’s midline when elevated to 90 degrees.
Typical everyday activities in the frontal plane include turning the head to look behind or turning a doorknob. Exercises in the transverse plane include hitting a golf ball, swinging a baseball bat, or performing a seated twist.
Training Within the Planes of Motion Benefits
Training in all three planes can help with movement in several ways, providing greater ease in life and sports.
Prepares Body for Daily Tasks
Many traditional strength-training programs focus on training one muscle at a time, often in a single plane of motion. For example, weight lifters might do bicep curls to primarily work the biceps in the sagittal plane, a chest fly exercise to primarily work the pectoral muscles in the transverse plane, or lateral raises to work the shoulders in the frontal plane. However, compound exercises have recently become much more common. Compound movements allow individuals to train several muscle groups simultaneously and in different planes of motion.
In this way, training activities mimic daily living activities. For example, individuals often lift several heavy bags of groceries and turn to open the car or trunk, involving both sagittal and transverse movement. Preparing the body for complex activities with compound exercises allows individuals to perform them more easily throughout the day.
Prepares Body for Sports and Physical Activities
Complex multi-planar movements help prepare for safe and effective physical activity and sports performance (National Academy of Sports Medicine, 2024). Researchers and experts understand that many physical and athletic activities require the body to move in different directions, often quickly and under high stress. Several studies have found that anterior cruciate ligament/ACL injuries are more likely to occur during multi-planar rather than single-planar movements. (Quatman C. E., Quatman-Yates C. C., & Hewett T. E. 2010) Training the body to perform multi-planar movements safely and effectively through exercise can help reduce the risk of injury during daily activities or stressful athletic competitions.
Encourages Variation For Full Body Strengthening
Individuals tend to fall into certain movement patterns, such as repeatedly performing the same fitness activity or exercises. This can cause them to have a favorite plane of motion. One way to break away from the same routine is to include movement from all planes of motion. For example, many abdominal workout machines help train in multiple planes of motion, challenging your body to move in different ways. Dumbbells, kettlebells, TRX straps, and bands allow individuals to move joints freely in various planes of motion and work several muscles.
Runners train primarily in the sagittal plane, even if they cross-train by swimming, cycling, or using cardio machines. For this reason, trainers and coaches often recommend doing some form of yoga or weight training that allows them to move their joints in different ways, including lateral movements or rotation. Even flexibility training should incorporate all three planes of motion. For example, walkers might choose to do a simple calf or hamstring stretch at the end of their workout but may also benefit from a seated spine rotation or a lying hip stretch.
Injury Medical Chiropractic and Functional Medicine Clinic
Understanding the concept and importance of training in the three planes of motion can help improve sports and physical performance and prevent musculoskeletal injuries. Chiropractic care aims to help individuals enhance movement with less pain due to condition, after injury, or surgery. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
The Difference of Using Custom Foot Orthotics
References
National Academy of Sports Medicine. (2024). Sagittal, Frontal and Transverse Body Planes: Exercises & Movements. NASM. https://blog.nasm.org/exercise-programming/sagittal-frontal-traverse-planes-explained-with-exercises?utm_source=blog&utm_medium=referral&utm_campaign=organic&utm_content=ReasonsToBecomeCES
Quatman, C. E., Quatman-Yates, C. C., & Hewett, T. E. (2010). A ‘plane’ explanation of anterior cruciate ligament injury mechanisms: a systematic review. Sports medicine (Auckland, N.Z.), 40(9), 729–746. https://doi.org/10.2165/11534950-000000000-00000
While some disc herniations don’t cause symptoms, individuals who are overweight with a herniated disc may experience obesity pressure symptoms such as pain, weakness, numbness, or tingling. Can implementing a physical therapy and weight loss treatment program help individuals find relief?
Obesity Pressure
Obesity is one major factor that can contribute to a herniated disc and chronic back pain. When the body has to carry added weight, it can lead to obesity pressure on the intervertebral discs and affect posture and spine position. Researchers have found that other factors, such as inflammation or metabolic changes associated with obesity, can also be involved. (Sheng B. et al., 2017) For individuals who are overweight, weight loss can help resolve a herniated disc combined with physical therapy and can significantly increase herniated disc prevention. (Tokmak M. et al., 2015)
Spine Problems
According to Dr. Alexander Jimenez, owner and head chiropractor at Injury Medical Chiropractic and Functional Medicine Clinic, “When the position of the pelvis and lumbar spine shift out of alignment and become altered, it can profoundly contribute to advanced wearing away of outer fibers in the back region of the discs. These outer fibers house and protect the soft material that cushions and absorbs shock in the spine. Over time, the obesity pressure wear and tear on the fibers can cause chronic pain and microscopic radial tears, leading to a complete rupture.” A rupture causes the soft material to leak, irritate, and inflame surrounding nerve roots. Most herniated discs occur between the sides and back of the vertebra.
Movement Problems
Obesity makes movement difficult, often causing symptoms like shortness of breath and/or early fatigue and exhaustion even with minimal physical activity.
Physical therapy and exercise help relieve obesity and disc herniation.
However, the obesity pressure and herniation pain can make it hard to participate in cardiovascular exercises on a regular basis.
Diagnosis Complications
Obesity can interfere with the diagnosis and treatment of spinal diseases.
This is because weight restrictions and certain imaging tests, like a spinal MRI, can be difficult or impossible to obtain.
A physical examination might not be able to identify signs of nerve compression if an individual is obese. These factors can delay diagnosis.
Disc Position and Posture
Obesity is not the only thing that places pressure on the discs. An individual’s body position significantly influences the health of the shock-absorbing cushions. Sitting generates the most pressure, followed by standing, while lying on your back places the least strain on the discs and, depending on the injury, may help relieve symptoms.
Symptoms depend on the location of the herniation.
The two most common locations are the cervical spine/neck area and the lumbar spine/lower back.
Disc herniations in the neck can affect the arms.
Disc herniations in the lower back affect the buttocks and legs.
Injury Medical Chiropractic and Functional Medicine Clinic
See a healthcare provider if you’re experiencing any of these symptoms. If it is a herniated disc causing symptoms, you might be started on 6 weeks of conservative treatment. This can include physical therapy, rest, health coaching, medication, and surgery, which may be recommended in certain cases. Overcoming these limitations is possible. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Weight Loss Techniques
References
Sheng, B., Feng, C., Zhang, D., Spitler, H., & Shi, L. (2017). Associations between Obesity and Spinal Diseases: A Medical Expenditure Panel Study Analysis. International journal of environmental research and public health, 14(2), 183. https://doi.org/10.3390/ijerph14020183
Tokmak, M., Altiok, I. B., Guven, M., Aras, A. B., & Cosar, M. (2015). Spontaneous Regression of Lumbar Disc Herniation After Weight Loss: Case Report. Turkish neurosurgery, 25(4), 657–661. https://doi.org/10.5137/1019-5149.JTN.9183-13.1
How are MRIs used to help diagnose bulging and herniated discs and help healthcare providers develop effective treatment programs for individuals experiencing back pain symptoms?
Herniated Bulging Disc MRI
A herniated bulging disc is often identified during magnetic resonance imaging (MRI); however, it’s usually an incidental finding that was done for other reasons where spinal problems and/or injuries are found. A bulging disc is relatively common, even in individuals who experience no symptoms. A herniated or bulging disc in the back can be identified with an MRI test, typically recommended when someone experiences back pain symptoms for at least six weeks. (American Academy of Neurological Surgeons, 2024) Normal wear and tear and age cause changes in the spinal disc/s cushion to bulge and become misaligned with the spine. (Brinjikji W. et al., 2015) And with a herniated disc, it can press against the spinal cord and nerves. Repeated heavy lifting, practicing unhealthy postures, a history of back injuries, or underlying health conditions are common causes.
Bulging Disc
Bulging discs are common even in healthy individuals but can be difficult to interpret independently on an MRI, so other symptoms and findings are as important in diagnosis.
Causes
A bulging disc is usually considered age-related degenerative changes that cause the disc to bulge downward with gravity. (Penn Medicine, 2018)
A significant bulge is expected to cause leg pain due to irritation to the nerves going down the legs. (Amin R. M., Andrade N. S., & Neuman B. J. 2017) As the condition progresses, more than one disc can be affected, leading to other spinal conditions, including spinal stenosis.
A Bulging Disc On MRI
A disc bulge will measure over 25% of the total disc circumference. Its displacement is usually 3 millimeters or less from the normal shape and position of the disc. (Radiopaedia, 2024)
Herniated Disc
A herniated disc shifts out of its correct position and compresses nearby spinal nerves, causing pain and mobility issues.
Herniated discs will measure less than 25% of the total disc circumference. However, herniation is based on the type and can include: (Wei B., & Wu H. 2023)
Disc Protrusion – the displacement is limited, and the ligaments are intact.
Disc Extrusion – part of the disc remains connected but has slipped through the annulus or outer covering of the disc.
Disc Sequestration – a free fragment has separated and broken off from the main disc.
Candidates For Spinal MRI
The MRI is generally safe for most, including those with implanted cardiac devices like newer-model pacemakers. (Bhuva A. N. et al., 2020) However, it’s important to ensure that the healthcare team is aware of cochlear implants or other devices so that necessary precautions can be taken. It is recommended for all individuals that symptoms be present for six weeks before an MRI. A specialist may want to see MRI results sooner, especially if symptoms include: (American Academy of Neurological Surgeons, 2024)
A specific injury, like a fall that caused the pain
Recent or current infection or fever with spinal symptoms
Significant weakness in arms or legs
Loss of pelvic sensation.
A history of metastatic cancer.
Loss of bladder or bowel control
An MRI may be needed if symptoms are rapidly worsening. However, many with a disc bulge don’t have symptoms at all. In most cases, an MRI is an outpatient procedure that can be completed in an hour or less but can take longer if contrast dye is used. The healthcare provider will provide specific instructions about MRI preparation.
Treatment
Treatment for a herniated or bulging disc depends on the cause and severity of symptoms.
Over-the-counter pain relief, including nonsteroidal anti-inflammatory drugs (NSAIDs).
Physical therapy
In rare cases that have not resolved with conservative treatment, surgery may be recommended.
Remember that the MRI findings may not identify or rule out all conditions, including muscle strains or ligament injuries, which may require different treatments, such as targeted stretches and exercises. (Brinjikji W. et al., 2015) (Fujii K. et al., 2019)
Herniated Disc
Treatment depends on the cause and severity of symptoms, if any. It can include stand-alone or a combination of physical therapy, medication, and steroid injections. Cases usually resolve in six to 12 weeks (Penn Medicine, 2018). Electrical nerve stimulation may be performed through specialized devices and/or acupuncture to help with nerve compression. (National Institute of Neurological Disorders and Stroke, 2020) Surgery may be recommended if conservative treatments fail to achieve significant pain relief and healing. (Wang S. et al., 2023)
Injury Medical Chiropractic and Functional Medicine Clinic
A healthcare provider can discuss treatment options such as pain medication, physical therapy, and surgery. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Root Causes of Spinal Stenosis
References
American Academy of Neurological Surgeons. (2024). Herniated disc. https://www.aans.org/patients/conditions-treatments/herniated-disc/
Brinjikji, W., Diehn, F. E., Jarvik, J. G., Carr, C. M., Kallmes, D. F., Murad, M. H., & Luetmer, P. H. (2015). MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis. AJNR. American journal of neuroradiology, 36(12), 2394–2399. https://doi.org/10.3174/ajnr.A4498
Penn Medicine. (2018). Bulging Disc vs. Herniated Disc: What’s The Difference? Penn Musculoskeletal and Rheumatology Blog. https://www.pennmedicine.org/updates/blogs/musculoskeletal-and-rheumatology/2018/november/bulging-disc-vs-herniated-disc
Wu, P. H., Kim, H. S., & Jang, I. T. (2020). Intervertebral Disc Diseases PART 2: A Review of the Current Diagnostic and Treatment Strategies for Intervertebral Disc Disease. International journal of molecular sciences, 21(6), 2135. https://doi.org/10.3390/ijms21062135
Amin, R. M., Andrade, N. S., & Neuman, B. J. (2017). Lumbar Disc Herniation. Current reviews in musculoskeletal medicine, 10(4), 507–516. https://doi.org/10.1007/s12178-017-9441-4
American Academy of Orthopaedic Surgeons. (2022). Herniated disk in the lower back. https://orthoinfo.aaos.org/en/diseases–conditions/herniated-disk-in-the-lower-back/
Wei, B., & Wu, H. (2023). Study of the Distribution of Lumbar Modic Changes in Patients with Low Back Pain and Correlation with Lumbar Degeneration Diseases. Journal of pain research, 16, 3725–3733. https://doi.org/10.2147/JPR.S430792
Bhuva, A. N., Moralee, R., Moon, J. C., & Manisty, C. H. (2020). Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change. European radiology, 30(3), 1378–1384. https://doi.org/10.1007/s00330-019-06449-5
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American journal of neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173
Fujii, K., Yamazaki, M., Kang, J. D., Risbud, M. V., Cho, S. K., Qureshi, S. A., Hecht, A. C., & Iatridis, J. C. (2019). Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment. JBMR plus, 3(5), e10180. https://doi.org/10.1002/jbm4.10180
Wang, S., Zhao, T., Han, D., Zhou, X., Wang, Y., Zhao, F., Shi, J., & Shi, G. (2023). Classification of cervical disc herniation myelopathy or radiculopathy: a magnetic resonance imaging-based analysis. Quantitative imaging in medicine and surgery, 13(8), 4984–4994. https://doi.org/10.21037/qims-22-1387
National Institute of Neurological Disorders and Stroke. (2020). Low back pain fact sheet. Retrieved from https://www.ninds.nih.gov/sites/default/files/migrate-documents/low_back_pain_20-ns-5161_march_2020_508c.pdf
The iliacus muscle is a triangle-shaped muscle in the pelvic bone that flexes and rotates the thigh bone. It works with the other muscles in the hip and thigh to help bend, run, walk, sit, and maintain correct posture. Injuries and common medical conditions can affect its function, causing pain and stiffness. Can physical therapy help?
The Iliacus Muscle
The iliacus is one of the body’s most important hip flexor muscles. The iliacus and surrounding muscles work together to produce the stability and range of motion required for bending, dancing, sitting, and walking.
Anatomy
The iliacus muscle is part of a complex muscle system in the hip and pelvis. Two iliacus muscles on each side of the pelvic bone enable the thigh to flex and rotate. They are innervated by the femoral nerve, which provides movement and sensation to the lower limbs. (Bordoni B. and Varacallo M. 2023) The iliacus muscle sits on the wing-shaped ilium and fits into the curved surface of the ilium, called the iliac fossa. The top of the muscle is attached to the upper wings of the ilium or iliac crest. It extends past the hip joint, which connects to the upper thigh bone/femur at the lesser trochanter protrusion. The iliacus is part of a major trio of muscles called the iliopsoas, including the major psoas and minor psoas muscles. These muscles are also attached to the upper femur but extend upward, connecting to the lumbar/lower spine at several attachment points. The iliopsoas also interact with the quadratus lumborum muscle, the deepest muscle of the lower back that starts at the iliac crest and attaches to the lumbar spine at several points. The quadratus lumborum enables flexion and elevation of the spine, while the iliopsoas enable the flexion and rotation of the hip and thigh.
Functions
The iliacus muscle has many functions that include: (Physiopedia, 2024)
Flexing and rotating the femur.
Helps maintain proper body posture while standing and sitting.
Produces hip movement that enables walking, running, and climbing stairs.
Provides hip flexion – bringing the knee to the chest.
Enables the forward tilt of the pelvis and side-bending.
Conditions
Several conditions can affect the iliacus muscle, specifically from under and/or overuse injuries. These conditions, collectively known as Iliopsoas syndrome, are typically the result of overuse/repetitive strain or injuries. These include:
Iliopsoas tendinopathy – which affects tendons.
Iliopsoas bursitis – which affects cushioning sacs known as bursae.
Iliopsoas syndrome can affect anyone but is common in:
Individuals and athletes who repeatedly use movements that flex the hips.
Track-and-field athletes
Gymnasts
Dancers
Iliopsoas Bursitis
This is the inflammation of the cushioning sac or bursa under the iliacus muscle, which helps the muscle slide over the pelvic bone. Symptoms can range from mild discomfort to pain that radiates through parts of the leg and hips. Runners, skiers, and swimmers are commonly affected, and individuals who regularly have tight hips and individuals with different forms of arthritis can also be affected. Early treatment can prevent the symptoms from worsening. Mild cases can be treated with self-care and stretching to help relieve tightness, rest, ice application, and over-the-counter nonsteroidal anti-inflammatory drugs. In severe cases, treatment options that may be recommended include: (Physiopedia, 2024)
Physical therapy
Assistant walking devices to relieve pressure – for example, a cane.
Corticosteroid steroid injections
Prescription anti-inflammatory medications
Iliopsoas Tendinopathy
Another condition affecting the iliacus muscles is iliopsoas tendinopathy, sometimes called snapping hip syndrome, because individuals can hear an audible snapping sound (Davenport KL. 2019). The condition is often experienced by dancers who repeatedly flex and hyperextend their hips and can result in hip and groin pain that gets worse with kicking or rotation. Treatment of iliopsoas tendinopathy can include:
Retraining muscle imbalances with strengthening and stretching exercises.
If these fail to provide relief, corticosteroid injections may be used. A saline hydro dissection can relieve stress around the tendon by injecting fluids that cushion and release trapped tissues.
Tendon release surgery may be recommended when all other options have failed. The surgical release involves severing the tendon to reduce pain and improve the range of motion.
Rehabilitation
Core muscle strengthening is essential to the rehabilitation of iliacus muscle injuries. The iliopsoas is an integral component of the core group and can benefit from stretching and strengthening exercises (Yogateket, 2019)
Lunge stretches
Straight leg raises
Knee-to-chest stretches
Standing hip flexion with resistance bands
Certain yoga poses can also help and include variations on the bridge pose that encourage hip flexion. (Yoga International, 2024)
Injury Medical Chiropractic and Functional Medicine Clinic
Iliopsoas pain is often felt at the front of the hips, thigh, mid-back, and lower back. Chiropractic care can help with iliacus muscle injuries through:
Evaluation
A chiropractor can evaluate the condition and determine if the iliacus muscle is causing pain.
Treatment plan
A chiropractor can create a personalized treatment plan that may include exercise instructions, manipulation, and other therapies.
Rehabilitation
A chiropractor can create a rehabilitation program to expedite healing.
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Hip Labral Tear and Chiropractic Care
References
Bordoni, B., & Varacallo, M. (2024). Anatomy, Bony Pelvis, and Lower Limb, Iliopsoas Muscle. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30285403
Davenport KL. (2019). The professional dancer’s hip. Performing Arts Medicine, 77-87. https://doi.org/https://doi.org/10.1016/B978-0-323-58182-0.00009-2
Yogateket. Lizette Pompa. (2019). Essential yoga body parts. Hip flexor/psoas and yoga. Yogateket. https://www.yogateket.com/blog/hip-flexor-psoas-and-yoga
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