Back Clinic Screening Tests. Screening tests are typically the first assessment completed and are used to determine if further diagnostic testing might be needed. Because screening tests are the first step towards diagnosis, they are designed to be more likely to overestimate the true incidence of a disease. Designed to be different from diagnostic tests in that they might demonstrate more positive results than a diagnostic test.
This can lead to both true positives as well as false positives. Once a screening test is found to be positive, a diagnostic test is then completed to confirm the diagnosis. Next, we will discuss the assessment of diagnostic tests. Many screening tests are available for physicians and advanced chiropractic practitioners to utilize in their practice. For some tests, there is quite a bit of research demonstrating the benefit of such tests on early diagnosis and treatment. Dr. Alex Jimenez presents appropriate assessment and diagnostic tools used in the office to further clarify and appropriated diagnostic assessments.
Detecting Hidden Traumatic Brain Injury: How Chiropractors and Nurse Practitioners Work Together for Better Recovery
Patient answers the doctor’s traumatic brain injury questions.
Traumatic brain injuries (TBIs) affect millions each year, often in ways that are hard to spot right away. These injuries happen from falls, car crashes, sports hits, or other sudden jolts to the head or body. While severe cases show clear signs like unconsciousness or seizures, milder ones can hide in plain sight. This can lead to ongoing problems with thinking, feelings, and daily life if not caught early. Healthcare providers like chiropractors and nurse practitioners play key roles in spotting these hidden signs through careful talks with patients. By asking the right questions, they uncover subtle clues that point to brain damage.
An integrative approach combines chiropractic adjustments with nurse-led medical care. This team effort targets both the body’s frame and the brain’s wiring, helping people heal better after a TBI. Treatments include gentle spine work, muscle therapies, and custom exercises to fix imbalances and boost brain power. Nurse practitioners add layers of support for mood, energy, and overall health. Advanced tools help confirm diagnoses, starting from simple checks to high-tech scans. Missing a TBI is easy because symptoms mimic stress or fatigue, but thorough checks and treatments can change lives. This article dives into how to detect, treat, and recover from these “invisible” wounds.
The Sneaky Nature of Traumatic Brain Injuries
TBIs disrupt brain function through direct hits or shaking forces. Mild forms, like concussions, might seem minor at first but can linger. According to the Mayo Clinic, symptoms can start right after the injury or pop up days later (Mayo Clinic, 2023). This delay makes them tricky. For example, someone might walk away from a car accident feeling fine, only to struggle with focus at work weeks later. Without prompt care, these issues can worsen, leading to long-term changes in how a person thinks or feels.
The brain controls everything from movement to emotions, so damage shows up in varied ways. Physical signs include headaches that won’t quit or a constant feeling of tiredness. Cognitive hints involve forgetting simple things or zoning out during talks. Emotional shifts, like sudden anger bursts, strain relationships. Sensory changes, such as a weird metallic taste in food or a loss of smell, add to the puzzle. These aren’t always dramatic, which is why they’re often ignored. Friends or family might notice first, saying, “You’ve been off since the fall.” Early spotting is vital because the brain can rewire itself if helped soon (Hauger et al., 2024).
Statistics paint a stark picture: About 1.7 million TBIs occur yearly in the U.S., with many going undiagnosed (Reis, 2022). Military personnel and athletes face higher risks, but anyone can be hit. Children and older adults show unique signs, such as kids losing interest in play or elders stumbling more often. The key? Listen to the body’s quiet signals. Untreated TBIs raise the chances of depression, job loss, or even repeat injuries. But with awareness, recovery paths open up.
Spotting Hidden Signs: A Step-by-Step Guide for Providers
Chiropractors and nurse practitioners are on the front lines for catching TBIs. They start with a deep dive into the patient’s story. This isn’t a quick chat—it’s a series of targeted questions to peel back layers. For instance, a chiropractor might ask, “Have you noticed foods tasting off, or smells fading since your accident?” This uncovers sensory shifts linked to brain areas involved in taste and smell (Fisher Stark, P.C., n.d.). Such details often slip past standard checkups.
A thorough history covers the injury event, immediate aftermath, and ongoing quirks. Questions probe cognitive slips: “Do tasks that used to take 10 minutes now drag on for hours?” This flags concentration woes common in TBIs (BrainLine, 2023). Emotional probes include, “Have small frustrations sparked big anger lately?” Irritability or mood swings signal disrupted emotional centers (U.S. Air Force, 2017). Balance checks ask, “Do you feel wobbly in crowds or after standing quickly?” These point to coordination hits.
Symptom questionnaire:
Nurse practitioners layer in health checks, asking about sleep: “Are you crashing early but waking foggy?” Disturbed rest is a red flag (Mayo Clinic, 2023). Fatigue questions follow: “Does everyday stuff leave you wiped out?” Together, these inquiries build a full picture. Dr. Alexander Jimenez, a chiropractor and nurse practitioner, stresses personalized histories in his practice. He notes that linking subtle symptoms to past traumas helps tailor care, drawing from his work in integrative injury recovery (Jimenez, n.d.a). By cross-checking answers, providers spot patterns missed in rushed visits.
This method shines in real cases. One patient described headaches as “just stress,” but questions revealed post-accident timing, leading to TBI confirmation (Denver Chiropractic, LLC, n.d.). Multiple angles—physical, mental, sensory—ensure nothing hides. It’s simple yet powerful: Listen actively, ask openly, and connect dots.
Nuanced Symptoms: What to Watch For
TBI signs aren’t always obvious; they whisper through daily life. Cognitive disturbances top the list. Trouble focusing might mean rereading the same page over and over or missing deadlines. Memory lapses, like forgetting recent chats, disrupt routines (BrainLine, 2023). These stem from damaged brain pathways handling attention and recall.
Emotional turbulence follows closely. Anger flares over minor things, or flat moods replace joy. Depression creeps in, with unexplained sadness (U.S. Air Force, 2017). Loved ones often spot this first, as the injured person might downplay it. Dr. Jimenez observes in his clinic that these shifts strain families, urging early emotional screens (Jimenez, n.d.b).
Sensory oddities add intrigue. Taste changes turn meals bland or metallic; smells vanish, making cooking a chore (Fisher Stark, P.C., n.d.). Vision blurs, or lights sting eyes. These links to brain regions processing senses are hit hard by jolts.
Physical clues include relentless headaches, pulsing behind the eyes. Fatigue hits like a wall, even after rest. Sleep goes haywire—too much or too little, with nightmares or insomnia (Mayo Clinic, 2023). Balance falters, turning walks into teeters; coordination slips, fumbling keys or tripping.
In kids, signs differ: cranky spells, play changes, or nap shifts (BrainLine, 2023). Elders might show confusion mimicking dementia. These nuances demand vigilance. As one source notes, symptoms overlap with those of stress, delaying help-seeking (Reis, 2022). Recognizing them early prevents cascades, like poor sleep fueling more fatigue.
Building an Integrative Recovery Team
Recovery thrives on teamwork. Chiropractic care fixes body mechanics, while nurse practitioners oversee whole-body health. This blend heals the brain’s hardware and software. Spinal tweaks ease nerve pressure, boosting signals to damaged areas (Northwest Florida Physicians Group, LLC, n.d.). Nurses handle meds, nutrition, and mood support, creating balance.
Dr. Jimenez embodies this, merging his DC and APRN roles for seamless care. His clinic uses functional assessments to link spine health to brain function, echoing collaborative models (Jimenez, n.d.a). Studies back this: Teams reduce recovery time by addressing root causes (Holden et al., 2010).
Chiropractic Tools for Brain and Body Healing
Chiropractors target the spine-brain link. Adjustments realign vertebrae, improving fluid flow and nerve flow (Pinnacle Health Chiropractic, 2023). This cuts headaches and fog. Soft-tissue work kneads tight muscles, easing tension from impacts (Calibration Mansfield, n.d.).
Targeted exercises build strength and balance. Simple drills, like ball tosses, retrain coordination (HML Functional Care, n.d.). Vestibular therapies steady dizziness. Low-level lasers reduce swelling, aiding neuron repair (Reis, 2022).
Benefits stack: Better circulation delivers oxygen to the brain; balanced nerves sharpen focus (Apex Chiropractic, n.d.). One case saw a survivor return to EMT work after such care (Reis, 2022). It’s drug-free, focusing on the body’s own fixes.
Nurse Practitioners: Holistic Health Guardians
Nurses round out the plan with metabolic and emotional aid. They monitor blood sugar and electrolytes, preventing crashes that slow healing (Kim et al., 2024). Nutrition plans help fight inflammation, a key factor in TBI recovery.
Mental support includes therapy referrals and family coaching. Sedation eases agitation; family visits calm nerves (Kim et al., 2024). Dr. Jimenez integrates this, using coaching for stress and hormones (Jimenez, n.d.b). This full-spectrum care lifts mood, energy, and resilience.
Diagnostic Tools: From Basics to High-Tech
Diagnosis starts simple, scaling with needs. Basic tools include the Glasgow Coma Scale (GCS), scoring eye, verbal, and motor responses for quick severity checks (Mayo Clinic, 2023). Vital signs track blood pressure and heart rate, spotting brain pressure rises.
Next, CT scans image bleeds or swells—fast for emergencies (Mayo Clinic, 2023). MRIs detail soft tissue damage, revealing axon tears invisible on CT.
Advanced options: EEGs catch hidden seizures via brain waves (Kim et al., 2024). Neuropsychological tests probe memory and focus. Functional MRIs map active brain areas; diffusion tensor imaging traces nerve paths (HML Functional Care, n.d.).
Eye-tracking tools like RightEye assess gaze for subtle deficits (Calibration Mansfield, n.d.). Blood tests measure biomarkers for the extent of damage. Order matters: Basics rule out crises; advanced confirm and guide plans.
Why TBIs Slip Through Cracks—and How to Fix It
Traumatic Brain Injuries (TBIs) often go unnoticed because their symptoms can be mistaken for everyday life stresses. A headache? Blame work. Irritability? “Bad day.” This oversight delays care, worsening outcomes (BrainLine, 2023). Providers miss them without deep histories, as one study shows that up to 50% of mild cases go undiagnosed (Reis, 2022).
Meticulous evaluation changes this. Multi-question intakes and team huddles catch clues. Treatment urgency: Early adjustments prevent scarring; holistic plans build lasting gains. Paula’s story proves it— from bedbound to marathon training via integrated care (Reis, 2022).
In military settings, recognition cuts long-term woes (U.S. Air Force, 2017). For all, it means reclaiming life. Push for thorough checks; the brain deserves it.
Holden, C. Q., et al. (2010). Chiropractors and collaborative care: An overview illustrated with a case report. Chiropractic & Osteopathy, 18(21). https://doi.org/10.1186/1746-1340-18-21
Kim, J., et al. (2024). Nursing interventions to prevent secondary injury in critically ill patients with traumatic brain injury: A scoping review. Journal of Clinical Medicine, 13(8), 2396. https://doi.org/10.3390/jcm13082396
Chiropractic & Manual Therapies. (2018). Be good, communicate, and collaborate: A qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team. Chiropractic & Manual Therapies, 26(17). https://doi.org/10.1186/s12998-018-0200-4
Gut Health for Faster Recovery—El Paso Back Clinic
Why your gut matters when you’re healing
After a back or neck injury—from daily strain, sports, work, or a car crash—pain and limited mobility can dominate your life. But there’s a powerful helper inside you: the gut microbiome. These trillions of microbes influence digestion, inflammation, immunity, energy, and even sleep. When they fall out of balance (called dysbiosis), bloating, irregular stools, fatigue, and higher inflammation can slow your rehab progress. The positive news is that simple daily steps can reset the balance and support your recovery. (Cleveland Clinic, 2023/2022). (Cleveland Clinic)
At El Paso Back Clinic, we often combine spine-focused care—such as chiropractic adjustments when appropriate, therapeutic exercise, soft-tissue work, and, if indicated, imaging—with practical gut-support strategies, helping patients recover more comfortably and steadily. (Dr. Alex Jimenez, El Paso clinic pages). (El Paso, TX Doctor Of Chiropractic)
Dysbiosis in plain language
Dysbiosis means your gut community is out of balance—too many “unhelpful” species, not enough beneficial ones, or less diversity overall. Diets high in refined sugars and ultra-processed foods, repeated courses of antibiotics, stress, poor sleep, and alcohol/environmental toxins are common triggers. (Cleveland Clinic, 2024; Better Health Channel, 2023; USDA ARS, 2025). (Cleveland Clinic)
Ultra-processed foods tend to be low in fiber and high in additives; over time, they’re linked with inflammation and a less favorable gut environment—exactly what you don’t want while healing. (Cleveland Clinic Newsroom, 2023). (Cleveland Clinic)
How “unhealthy” bacteria gain ground
Unwanted bacteria flourish when conditions favor them. Three everyday drivers:
Low fiber, high ultra-processed intake. Beneficial microbes feed on plant fibers and resistant starches from beans, whole grains, vegetables, and fruit. Starve them, and opportunistic species take over. (Wilson et al., 2020; Singh et al., 2017). (PMC)
Antibiotics and antimicrobials. Essential when needed, but they can also reduce helpful species; rebuilding with fiber-rich foods (and sometimes probiotics) helps restore balance. (Cleveland Clinic, 2024). (Cleveland Clinic)
Stress and poor sleep. Both alter motility and immune signaling via the brain–gut axis, nudging the microbiome toward dysbiosis. (Better Health Channel, 2023). (Better Health Channel)
SIBO: a special case to know about
Small Intestinal Bacterial Overgrowth (SIBO) happens when excess bacteria build up in the small intestine, which normally has low counts. Symptoms can include bloating, abdominal discomfort, diarrhea, early fullness, weight loss, or malnutrition. (Mayo Clinic, 2024). (Mayo Clinic)
Treatment often pairs targeted antibiotics with nutrition and root-cause fixes (e.g., motility support or addressing structural issues). Without tackling the cause, SIBO can recur. (Mayo Clinic, 2024). (Mayo Clinic)
If you notice persistent bloating, pain, or weight loss, ask your clinician about evaluation and a phased plan that treats the cause, then carefully re-expands fibers and fermented foods.
How better gut habits speed musculoskeletal recovery
Lower, steadier inflammation: A fiber-rich, plant-forward pattern boosts short-chain fatty acids (SCFAs) like butyrate that help protect the gut lining and may dampen systemic inflammation tied to pain. (Singh et al., 2017). (PMC)
Energy and participation: Balanced digestion supports energy, sleep, and mood—key drivers of successful physical therapy and home exercise. (Cleveland Clinic, 2022). (Cleveland Clinic)
Medication tolerance: If you need antibiotics or other meds, a microbiome-friendly plan can reduce GI side effects. (Cleveland Clinic, 2024). (Cleveland Clinic)
The El Paso Back Clinic approach (dual-scope care)
Our team—led by Alexander Jimenez, DC, APRN, FNP-BC—blends chiropractic care with nurse-practitioner medical evaluation. When appropriate, we use X-ray/MRI to clarify the diagnosis, and we coordinate conservative therapies with nutrition and lifestyle coaching. For injury cases, we also provide the documentation insurers and attorneys require. (El Paso, TX Doctor Of Chiropractic)
Common elements of a plan:
Dual-scope assessment: History, neuro/orthopedic testing, and imaging when indicated to pinpoint pain drivers (joint, nerve, soft tissue). (El Paso, TX Doctor Of Chiropractic)
Conservative therapies: Chiropractic adjustments (as indicated), therapeutic exercise, massage/soft-tissue work; acupuncture may be added to modulate pain and stress. (El Paso, TX Doctor Of Chiropractic)
Gut-support basics: Plant variety, fiber targets, and live-culture foods; stress and sleep tools that calm the gut–brain axis. (Cleveland Clinic Magazine; Penn State Health). (Cleveland Clinic)
Medical-legal readiness: Structured notes, imaging reports, and measurable outcomes for personal-injury and MVA cases. (El Paso, TX Doctor Of Chiropractic)
Clinical observation: Patients with back/neck pain who improve sleep and add one fermented food daily—while increasing beans/whole grains and veggies—often report less bloating and steadier energy within weeks, which helps them stay consistent with rehab.
A 4–6 week “gut-reset” that fits rehab
1) Make plants the base (daily)
Aim for colorful vegetables and fruits, beans/lentils 4–5 days/week, and whole grains (oats, barley, brown rice, quinoa). These choices feed beneficial microbes and boost SCFAs. (Wilson et al., 2020). (PMC)
2) Add one fermented food most days
Yogurt or kefir with live active cultures, kimchi, sauerkraut, or kombucha. Not all fermented foods have live microbes after processing—check the label. (Healthline; Cleveland Clinic Magazine). (Healthline)
3) Tame ultra-processed foods
Swap sugary drinks for water/unsweetened tea; favor whole-grain staples; keep packaged snacks as occasional treats. (Cleveland Clinic, 2023). (Cleveland Clinic)
4) Support sleep and stress
Target 7–9 hours with a consistent wind-down; try 5 minutes of slow breathing before bed; walk 20–30 minutes most days, and add two short strength sessions weekly. (Better Health Channel, 2023). (Better Health Channel)
5) Medications—coordinate with your clinician
Don’t stop prescribed meds on your own. If antibiotics are necessary, ask whether a food-first strategy and a short-term probiotic make sense for you. (Cleveland Clinic, 2024). (Cleveland Clinic)
6) Hygiene matters
Wash hands, rinse produce, and avoid kitchen cross-contamination to reduce exposure to harmful bacteria. (Better Health Channel, 2023). (Better Health Channel)
Two-week starter plan (easy, budget-minded)
Breakfast: Oats + kefir or yogurt + berries + nuts.
Dinner: Slow-cooker chili or lentil curry; salad with olive oil; baked potato (cool leftovers for resistant starch).
Snacks: Fruit + nut butter; carrots + hummus; plain popcorn; small kefir smoothie.
Small, steady changes add up; focus on what you can repeat during busy treatment weeks. (Penn State Health, 2018). (Penn State)
When to seek medical care now
Unintended weight loss, blood in stool, fever, severe or night-time symptoms, or a history of GI surgery.
Talk with your clinician about evaluation, including possible SIBO testing when appropriate. (Mayo Clinic, 2024). (Mayo Clinic)
Local help in El Paso
If you’re recovering from a back or neck injury and want a plan that connects spine care, gut health, and documentation for injury cases, our team can help you build a sustainable routine while we treat the root musculoskeletal drivers. (El Paso Back Clinic/Dr. Jimenez). (El Paso, TX Doctor Of Chiropractic)
Should individuals experiencing nerve pain or various sensations get a nerve conduction velocity study to examine nerve health and function?
Nerve Conduction Velocity
A nerve conduction velocity (NCV) is a noninvasive test that measures the speed and strength of nerve stimulation using electrical probes placed on the skin. It’s used to diagnose nerve damage or disease, often alongside an EMG (electromyogram) to differentiate between nerve and muscle problems. It can also evaluate sensory issues, pain, and weakness of the extremities.
This test involves safe electrical shocks that can be slightly uncomfortable but not painful.
Nerve conduction velocity (NCV) measures the speed at which electrical impulses travel along a nerve fiber, which measures how quickly electrical signals travel through a nerve.
This information indicates nerve health and function.
Electromyography (EMG) is a nerve test that involves placing tiny needles into the muscles.
A slower NCV can indicate nerve injury or dysfunction.
Test Uses
Generally, the test is ordered to assess peripheral nerve diseases, those that connect from the muscles, organs, and skin to the spinal cord or brain. It can help identify the type and location of nerve damage.
Peripheral nerve conditions typically cause pain, sensory loss, tingling, or burning.
Mild weakness and diminished reflexes can be detected during a neurological examination.
Conditions
Nerve conduction studies are performed to help diagnose conditions.
Nerve damage (neuropathy), such as from diabetes, chemotherapy, or autoimmune disorders
Charcot-Marie-Tooth disease
Nerve compression
Many different conditions, including trauma, inflammation, and tumors, can compress one or more nerves.
Radiculopathy
Often described as a pinched nerve, radiculopathy can affect an arm or a leg, causing pain and weakness.
Peripheral Neuropathy
This nerve damage begins in the most distal nerves, those farthest from the center of the body, such as the toes and fingers. It is often due to chronic alcohol misuse, uncontrolled diabetes, nutritional deficits, and inflammatory diseases. (Ferdousi M. et al., 2020)
Carpal Tunnel Syndrome
Commonly caused by inflammatory diseases or overuse of the wrists, such as from assembly line work, carpal tunnel syndrome causes numbness, pain, and weakness of the fingers and hands. (Tada K. et al., 2022)
Ulnar neuropathy
This common condition causes arm pain and sensory changes, usually due to repetitive movements or a prolonged position that causes pressure on the ulnar nerve.
Guillain-Barré syndrome (GBS)
This inflammatory condition causes demyelination, or loss of the insulating covering around nerves, which results in leg weakness.
It begins in the motor nerves, which send signals to muscles in the legs. (Shibuya K. et al., 2022)
The inflammation travels to nerves of the upper body, often affecting the muscles that control breathing.
Respiratory support is necessary until the condition improves.
Chronic Demyelinating Polyneuropathy (CIDP)
This condition is a chronic, recurrent form of GBS that usually affects the legs and causes episodes of weakness.
ICU neuropathy
Metabolic changes, severe illness, and not moving enough can cause nerves to develop a pattern of weakness and sensory loss.
Myasthenia gravis (MG)
This autoimmune condition affects the junction between the nerves and the muscles.
Myasthenia gravis causes drooping eyelids and weakness of the arms and shoulders.
Amyotrophic lateral sclerosis (ALS)
ALS is a serious, degenerative disease affecting the spinal cord’s motor neurons.
Amyotrophic lateral sclerosis progresses rapidly, resulting in substantial weakness of muscles throughout the body.
How it’s Done
Surface electrodes are placed on the skin over nerves, and a small electrical current is applied to stimulate the nerve.
The time it takes for the electrical signal to travel between the electrodes is measured, and this time is used to calculate the NCV.
Values
Normal NCV values are generally between 50 and 70 meters per second. However, these values can vary depending on the nerve and the individual.
NCV Factors
Various factors can influence NCV.
Age
Sex
Medical conditions like diabetes
Interpretation
A slower NCV can indicate nerve damage or demyelination (loss of the myelin sheath, which insulates nerve fibers), while an EMG can help determine if the problem is with the nerve or the muscle.
Results
The results of NCV testing can be used to determine the type, severity, and location of nerve damage. The results will be ready in report form about a week after the test.
The test measures velocity (how fast a nerve transmits signals) and amplitude (how many nerve fibers were activated). (Tavee J. 2019)
The measurements are transmitted to a computer and shown as waves and numerical values.
The values are compared to a standard measurement based on the tested nerve.
The distance between the electrodes.
The person’s age.
Compared to the standard, the NCV results can identify certain patterns of nerve damage. (Tada K. et al., 2022) Outcomes include: (Tavee J. 2019)
If one or more nerves are affected.
If motor nerves (control movement), sensory nerves (transmit sensory signals), or both are affected.
Whether a nerve is blocked or damaged.
The severity of the damage.
The type of nerve damage
Axonal (damage to the nerve itself)
Demyelination (damage to the protective fatty layer around the nerve)
The results can help point to certain diagnoses.
Preparation Before the Test
Individuals will not need to change their diet before having an NCV. However, patients will be asked to avoid lotions or creams on their skin before the test. Individuals who are also having an EMG at the time of their NCV might be asked to stop taking medications or supplements that increase the risk of bleeding and bruising. If a healthcare provider says not to stop taking the medicines for health reasons, the patient might be warned that they could have some bruising after the EMG test.
NCV may advise against getting the test for those with electrical device implants.
Make sure your healthcare providers are aware of your whole medical history.
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.
Peripheral Neuropathy and Chiropractic Care
References
Ferdousi, M., Kalteniece, A., Azmi, S., Petropoulos, I. N., Worthington, A., D’Onofrio, L., Dhage, S., Ponirakis, G., Alam, U., Marshall, A., Faber, C. G., Lauria, G., Soran, H., & Malik, R. A. (2020). Corneal confocal microscopy compared with quantitative sensory testing and nerve conduction for diagnosing and stratifying the severity of diabetic peripheral neuropathy. BMJ open diabetes research & care, 8(2), e001801. https://doi.org/10.1136/bmjdrc-2020-001801
Tada, K., Murai, A., Nakamura, Y., Nakade, Y., & Tsuchiya, H. (2022). In Carpal Tunnel Syndrome, Sensory Nerve Conduction Velocities Are Worst in the Middle Finger Than in the Index Finger. Frontiers in Neurology, 13, 851108. https://doi.org/10.3389/fneur.2022.851108
Shibuya, K., Tsuneyama, A., Misawa, S., Suzuki, Y. I., Suichi, T., Kojima, Y., Nakamura, K., Kano, H., Ohtani, R., Aotsuka, Y., Morooka, M., Prado, M., & Kuwabara, S. (2022). Different patterns of sensory nerve involvement in chronic inflammatory demyelinating polyneuropathy subtypes. Muscle & Nerve, 66(2), 131–135. https://doi.org/10.1002/mus.27530
Tavee J. (2019). Nerve conduction studies: Basic concepts. Handbook of Clinical Neurology, 160, 217–224. https://doi.org/10.1016/B978-0-444-64032-1.00014-X
What is a bone density test, how is it performed, and what do the results mean?
Bone Density Test
A bone density test examines bone mass, which indicates overall bone strength. Assessing bone density or mass is necessary for diagnosing osteopenia or osteoporosis, conditions that increase the risk of broken bones. The scan is performed through dual-energy X-ray absorptiometry (DEXA), which examines the thickness of the bones. Results from DEXA scans are compared to standardized values to determine whether bone density is lower than normal and whether osteopenia or osteoporosis is present.
Examination
The procedure examines bone density, or bone mass. The bones’ density, or mass, is an overall indicator of bone strength. The greater the bone density, the thicker and stronger the bones are. The test is used to diagnose osteoporosis, a condition characterized by brittle bones at risk of breaking due to significantly low bone density. A bone density test can also diagnose osteopenia, a condition characterized by lower than normal bone mass that can lead to osteoporosis. (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2025) It is recommended that all women aged 65 and older and all men aged 70 and older have a bone density scan to screen for bone loss to help prevent fractures. (Kling J. M., Clarke B. L., & Sandhu N. P. 2014)
Bone density scans can establish a baseline level of bone density and track changes over time.
For individuals with osteoporosis or osteopenia, a bone density scan can help track how well their bones respond to treatment.
During a DEXA scan, the patient will lie on their back on a table with their legs elevated on a padded platform.
An X-ray scanner will pass over the spine and hips while another scans beneath.
While the scan takes place, the patient will be asked to hold very still to obtain an accurate image.
The scan will obtain bone density readings from the spine and hip, the two most commonly fractured bones, and generally takes less than 30 minutes.
Results
A DEXA scan measures bone density in grams per centimeter squared (g/cm²). This number indicates how densely bone cells are packed together in a specific area of bone. This bone density reading is then compared to a standardized value to determine if bone density is within a normal range or lower than average.
Between minus 1.0 and minus 2.5: Low bone density (osteopenia)
Equal to minus 2.5 or below: Osteoporosis
Bone density values are reported as a Z score for women who have not undergone menopause and men under 50 years old.
Z scores are compared to bone density levels of individuals of the same age and sex.
A Z score of minus 2.0 or lower indicates low bone density, which can be caused by factors other than aging, such as medication side effects, nutritional deficiencies, or thyroid problems.
Arthritis Diagnosis
Because a DEXA scan only measures the thickness of bones, it doesn’t work to diagnose arthritis. An X-ray of the affected joint is currently the most accurate way to diagnose arthritis. The Kellgren-Lawrence classification system categorizes the extent of arthritis based on the severity of joint damage seen on an X-ray. According to this system, arthritis can be classified as: (Kohn M. D., Sassoon A. A., & Fernando N. D. 2016)
Grade 1 (minor)
Minimal or no joint space narrowing, with possible bone spur formation.
Grade 2 (mild)
Possible joint space narrowing, with definite bone spur formation.
Grade 3 (moderate)
Definite joint space narrowing, moderate bone spur formation, mild sclerosis (abnormal thickening of bone), and possible deformation of bone ends.
Grade 4 (severe)
Severe joint space narrowing, large bone spur formation, marked sclerosis, and definite deformation of bone ends.
Injury Medical Chiropractic & Functional Medicine Clinic
Exercise can be incredibly beneficial for improving bone density, joint mobility, and the strength of surrounding muscles, which support and protect joints and bones. Talk to a healthcare provider to learn what interventions and available treatment options would be the most effective. 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.
Osteoporosis
References
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2025). Bone mineral density tests: what the numbers mean. Retrieved from https://www.niams.nih.gov/health-topics/bone-mineral-density-tests-what-numbers-mean
Kling, J. M., Clarke, B. L., & Sandhu, N. P. (2014). Osteoporosis prevention, screening, and treatment: a review. Journal of women’s health (2002), 23(7), 563–572. https://doi.org/10.1089/jwh.2013.4611
Kohn, M. D., Sassoon, A. A., & Fernando, N. D. (2016). Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis. Clinical orthopaedics and related research, 474(8), 1886–1893. https://doi.org/10.1007/s11999-016-4732-4
Can the Oswestry Low Back Pain Disability Questionnaire help assess how low back pain impacts individuals’ ability to perform everyday tasks and activities and help physical therapists incorporate the outcome measure into an effective treatment plan?
Oswestry Disability Questionnaire
The Oswestry Disability Questionnaire, also known as the Oswestry Disability Index, provides objective data about an individual’s lower back pain. It determines the severity of the pain and how much it limits their daily activities. The questionnaire is a validated measure backed by research that can be used to justify the need for medical treatment. It includes questions regarding the symptoms and severity of low back pain and how these symptoms interfere with regular activities. Lower back pain can result from various causes (National Institute of Neurological Disorders and Stroke, 2020)
Arthritis, including inflammatory types of arthritis like psoriatic arthritis and ankylosing spondylitis.
Lumbar vertebrae compression fractures – usually from trauma or osteoporosis.
Low back surgery – including spinal fusions, discectomies, and laminectomies.
Spinal stenosis
Spondylolisthesis
Scoliosis
How The Questionnaire Works
The Oswestry Disability Questionnaire consists of 10 questions about the impact of lower back pain on daily life. The questions are divided into the following categories: (American Academy of Orthopedic Surgeons, N.D.)
Pain Intensity
How intense is the pain?
If painkillers are used, how much symptom relief do they provide?
Personal Care
Can the patient perform self-care activities like bathing and dressing when experiencing significant pain or limitations?
Whether physical assistance from another person is needed?
Lifting
Can the patient lift objects like weights with or without pain?
Can lifting be performed from the floor or a higher surface like a table if the objects are light, moderate, or heavy?
Walking
If and to what extent does the pain limit the patient’s walking distance and independence?
If an assistive device like a cane or crutches are needed?
Sitting
If so, how much pain limits the patient’s sitting tolerance?
Standing
If so, how much pain limits the patient’s standing tolerance?
Sleeping
If so, how much pain limits a patient’s sleeping duration?
Whether pain medication is needed to help the patient sleep comfortably?
Social Life
If and to what extent a patient’s social activities are limited because of pain symptoms?
Traveling
If so, to what extent does pain limit a patient’s ability to travel?
Employment and/or Homemaking Duties
Does pain limit a patient’s ability to perform job-related and/or household activities, including physically demanding and light duties?
Patients self-report the information and complete it on their own based on their understanding of the extent of their lower back pain and disability.
Each question can be scored between 0 and 5, with 0 indicating no limitations and 5 indicating complete disability.
The scores from all the questions are added together for a cumulative total score of 50 points.
Scores
The Oswestry Disability Questionnaire assesses how much a patient’s lower back pain limits daily activities. This information is used in clinical documentation for medical services. A higher score indicates a greater level of disability, according to the following scoring criteria:
0–4: No disability
5–14: Mild disability
15–24: Moderate disability
25–34: Severe disability
35–50: Completely disabled
Physical therapists must create individualized goals for each patient to develop a treatment plan and receive authorization from insurance companies. One of the most important aspects of a physical therapy goal is that it must be measurable. The Oswestry Disability Questionnaire provides a numerical score to track functional limitations and monitor the range of motion and strength testing. A baseline measurement is taken at the beginning of treatment, and progress is tracked in follow-up visits. A new score is used as a treatment goal. According to a study, the minimal clinically important difference (MCID) for the Oswestry Disability Questionnaire is 12.88. The MCID is the minimum score healthcare providers need to confirm a patient’s progress in function due to treatment. (Johnsen, L. G. et al., 2013)
By tracking changes in the total score before, during, and after treatment, healthcare providers can better assess whether treatment improves symptoms. A decrease in total score by 13 points or more would indicate that treatment is helping to improve a patient’s lower back pain and level of disability. Along with physical examination results, the patient’s score and the severity of symptoms can help healthcare providers determine an appropriate treatment plan.
No Disability
Treatment is unnecessary other than providing advice for lifting mechanics and general physical activity to maintain health.
Mild Disability
Conservative measures, such as physical therapy, exercise, hot or cold therapy, pain medication, and rest, are needed to help alleviate symptoms.
Moderate Disability
More aggressive intervention is needed, which can include extensive physical therapy services and pain management.
Severe Disability
Significant medical intervention is needed, including surgery, pain management, equipment like wheelchairs, and help from a caretaker.
Completely Disabled
Patients are either bedbound or have worsening symptoms, and a caretaker is needed to complete daily activities and self-care tasks.
Injury Medical Chiropractic and Functional Medicine Clinic
Improvements in range of motion, strength, and quality of movement and a decrease in total score can help show the treatment’s positive impact in managing lower back pain. A thorough medical exam and diagnostic tests, such as X-ray, MRI, or EMG, can help determine the underlying causes, discover the cause of the problem, and develop an effective treatment plan. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. Using an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility and help individuals return to normal activities. Our providers use Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers.
Optimizing Your Wellness
References
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
American Academy of Orthopedic Surgeons. (N.D.). Oswestry Low Back Pain Disability Questionnaire. https://www.aaos.org/globalassets/quality-and-practice-resources/patient-reported-outcome-measures/spine/oswestry-2.pdf
Johnsen, L. G., Hellum, C., Nygaard, O. P., Storheim, K., Brox, J. I., Rossvoll, I., Leivseth, G., & Grotle, M. (2013). Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease. BMC musculoskeletal disorders, 14, 148. https://doi.org/10.1186/1471-2474-14-148
The hip joint is a ball-and-socket joint composed of the femur head and a socket, which is part of the pelvis. The labrum is a cartilage ring on the socket part of the hip joint that helps keep joint fluid inside to ensure frictionless hip motion and alignment during movement. A labral tear of the hip is an injury to the labrum. The extent of the damage can vary. Sometimes, the hip labrum can have mini tears or fray at the edges, usually caused by gradual wear and tear. In other cases, a section of the labrum can separate or get torn away from the socket bone. These types of injuries are usually due to trauma. There are conservative hip labral tear tests to determine the type of injury. The Injury Medical Chiropractic and Functional Medicine Clinic team can help.
Symptoms
Symptoms are similar regardless of the type of tear, but where they are felt depends on whether the tear is in the front or the back. Common symptoms include:
Hip stiffness
Limited range of motion
A clicking or locking sensation in the hip joint when moving.
Pain in the hip, groin, or buttocks, especially when walking or running.
Night discomfort and pain symptoms when sleeping.
Some tears can cause no symptoms and can go unnoticed for years.
Hip Labral Tear Tests
A hip labral tear can occur anywhere along the labrum. They can be described as anterior or posterior, depending on which part of the joint is affected:
Anterior hip labral tears: The most common type of hip labral tear. These tears occur on the front of the hip joint.
Posterior hip labral tears: This type appears on the back of the hip joint.
Tests
The most common hip labral tear tests include:
The Hip Impingement Test
The Straight Leg Raise Test
The FABER Test – stands for Flexion, Abduction, and External Rotation.
The THIRD Test – stands for the Hip Internal Rotation with Distraction.
Hip Impingement Tests
There are two types of hip impingement tests.
Anterior Hip Impingement
This test involves the patient lying on their back with their knee bent at 90 degrees and then rotated inward towards the body.
If there is pain, the test is considered positive.
Posterior Hip Impingement
This test involves the patient lying on their back with their hip extended and their knee flexed and bent at 90 degrees.
The leg is then rotated outward away from the body.
If it results in pain or apprehension, it is considered positive.
Straight Leg Raise Test
This test is used on various medical conditions that involve back pain.
The test begins with the patient sitting or lying down.
On the unaffected side, the range of motion is examined.
Then the hip is flexed while the knee is straight on both legs.
The patient may be asked to flex the neck or extend the foot to stretch nerves.
The FABER Test
It stands for Flexion, Abduction, and External Rotation.
The test begins with the patient lying on their back with their legs straight.
The affected leg is placed in a figure four position.
The physician will then apply incremental downward pressure to the bent knee.
If there is hip or groin pain, the test is positive.
The THIRD Test
This stands for – the Hip Internal Rotation with Distraction
The test begins with the patient lying on their back.
The patient then flexes their knee to 90 degrees and turns it inward around 10 degrees.
The hip is then rotated inward with downward pressure on the hip joint.
The maneuver is repeated with the joint slightly distracted/pulled apart.
It is considered positive if the pain is present when the hip is rotated and diminished pain when distracted and rotated.
Chiropractic Treatment
Chiropractic treatment involves hip adjustments to realign the bones around the hip and up through the spine, soft tissue massage therapy to relax the muscles around the pelvis and thigh, targeted flexibility exercises to restore range of motion, motor control exercises, and strengthening exercises to correct muscular imbalances.
Treatment and Therapy
References
Chamberlain, Rachel. “Hip Pain in Adults: Evaluation and Differential Diagnosis.” American family physician vol. 103,2 (2021): 81-89.
Groh, M.M., Herrera, J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med 2, 105–117 (2009). https://doi.org/10.1007/s12178-009-9052-9
Karen M. Myrick, Carl W. Nissen, THIRD Test: Diagnosing Hip Labral Tears With a New Physical Examination Technique, The Journal for Nurse Practitioners, Volume 9, Issue 8, 2013, Pages 501-505, ISSN 1555-4155, https://doi.org/10.1016/j.nurpra.2013.06.008. (https://www.sciencedirect.com/science/article/pii/S155541551300367X)
Roanna M. Burgess, Alison Rushton, Chris Wright, Cathryn Daborn, The validity and accuracy of clinical diagnostic tests used to detect labral pathology of the hip: A systematic review, Manual Therapy, Volume 16, Issue 4, 2011, Pages 318-326, ISSN 1356-689X, https://doi.org/10.1016/j.math.2011.01.002 (https://www.sciencedirect.com/science/article/pii/S1356689X11000038)
Su, Tiao, et al. “Diagnosis and treatment of labral tear.” Chinese medical journal vol. 132,2 (2019): 211-219. doi:10.1097/CM9.0000000000000020
Wilson, John J, and Masaru Furukawa. “Evaluation of the patient with hip pain.” American family physician vol. 89,1 (2014): 27-34.
Diagnosing ankylosing spondylitis usually involves multiple tests. When doctors order blood tests to diagnose ankylosing spondylitis, an individual is experiencing worsening symptoms in their back and joints. Often, a blood test diagnosis means the doctor is looking for evidence of anything else that could be causing the symptoms. However, blood tests by themselves cannot definitively diagnose ankylosing spondylitis, but when combined with imaging and assessment, they can provide important clues that point to the answers.
Ankylosing Spondylitis Blood Test Diagnosis
Ankylosing spondylitis is arthritis that primarily affects the spine and hips. It can be difficult to diagnose as no single test can provide thorough information for a definitive diagnosis. A combination of diagnostic tests are utilized, including a physical exam, imaging, and blood tests. Doctors are not only looking for results that will point to ankylosing spondylitis, but they are looking for any results that might point away from the spondylitis results that might provide a different explanation for symptoms.
Physical Exam
The diagnostic process will begin with the individual’s medical history, family history, and physical exam. During the exam, the doctor will ask questions to help rule out other conditions:
How long have symptoms been presenting?
Do symptoms get better with rest or exercise?
Are the symptoms getting worse or staying the same?
Are the symptoms worse at a particular time of day?
The doctor will check for limitations in mobility and palpate tender areas. Many conditions can cause similar symptoms, so the doctor will check to see if the pain or lack of mobility is consistent with ankylosing spondylitis. The feature sign of ankylosing spondylitis is pain and stiffness in the sacroiliac joints. The sacroiliac joints are located in the lower back, where the base of the spine and pelvis meet. The doctor will look at other spinal conditions and symptoms:
Back pain symptoms caused by – injuries, posture patterns, and/or sleeping positions.
The HLA-B27 gene corresponds with ankylosing spondylitis; if an individual has it, one of their parents has it.
Imaging
X-rays often serve as the first step to a diagnosis.
As the disease progresses, new small bones form between the vertebrae, eventually fusing them.
X-rays work best at mapping the disease progression than the initial diagnosis.
An MRI provides clearer images in the early stages as smaller details are visible.
Blood Tests
Blood tests can help rule out other conditions and check for signs of inflammation, providing supportive evidence along with the results of imaging tests. It typically only takes about a day or two to get the results. The doctor may order one of the following blood tests:
Antinuclear antibodies, or ANA, go after the proteins in the cell’s nucleus, telling the body its cells are the enemy.
This activates an immune response that the body fights to eliminate.
A study determined that ANA is found in 19% of individuals suffering from ankylosing spondylitis and is higher in women than men.
Combined with other tests, the presence of ANA provides another clue to a diagnosis.
Gut Health
The gut microbiome plays an important role in triggering the development of ankylosing spondylitis and its treatment.
Tests to determine the gut’s health can give a doctor a complete picture of what is happening inside the body.
Blood test diagnoses for ankylosing spondylitis and other inflammatory conditions rely heavily on piecing together different tests alongside clinical exams and imaging.
Causes, Symptoms, Diagnosis, and Treatment
References
Cardoneanu, Anca, et al. “Characteristics of the intestinal microbiome in ankylosing spondylitis.” Experimental and therapeutic medicine vol. 22,1 (2021): 676. doi:10.3892/etm.2021.10108
Prohaska, E et al. “Antinukleäre Antikörper bei Spondylitis ankylosans (Morbus Bechterew)” [Antinuclear antibodies in ankylosing spondylitis (author’s transl)]. Wiener klinische Wochenschrift vol. 92,24 (1980): 876-9.
Sheehan, Nicholas J. “The ramifications of HLA-B27.” Journal of the Royal Society of Medicine vol. 97,1 (2004): 10-4. doi:10.1177/014107680409700102
Wenker KJ, Quint JM. Ankylosing Spondylitis. [Updated 2022 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470173/
Xu, Yong-Yue, et al. “Role of the gut microbiome in ankylosing spondylitis: an analysis of studies in the literature.” Discovery medicine vol. 22,123 (2016): 361-370.
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