Back Clinic Chiropractic. This is a form of alternative treatment that focuses on the diagnosis and treatment of various musculoskeletal injuries and conditions, especially those associated with the spine. Dr. Alex Jimenez discusses how spinal adjustments and manual manipulations regularly can greatly help both improve and eliminate many symptoms that could be causing discomfort to the individual. Chiropractors believe among the main reasons for pain and disease are the vertebrae’s misalignment in the spinal column (this is known as a chiropractic subluxation).
Through the usage of manual detection (or palpation), carefully applied pressure, massage, and manual manipulation of the vertebrae and joints (called adjustments), chiropractors can alleviate pressure and irritation on the nerves, restore joint mobility, and help return the body’s homeostasis. From subluxations, or spinal misalignments, to sciatica, a set of symptoms along the sciatic nerve caused by nerve impingement, chiropractic care can gradually restore the individual’s natural state of being. Dr. Jimenez compiles a group of concepts on chiropractic to best educate individuals on the variety of injuries and conditions affecting the human body.
Dr. Alex Jimenez, D.C., presents how the SBAR method is used in a clinical approach in a chiropractic office. Since pain in the body is one of the most common complaints worldwide, many individuals can be referred to the right healthcare professional to have a better understanding of what is happening to their bodies and have their health and wellness restored. We refer patients to certified providers specializing in treatments to aid individuals suffering from various chronic issues associated with muscle and joint pain affecting their bodies. We also guide our patients by referring them to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez, D.C., provides this information as an educational service only. Disclaimer
What Is The SBAR Method?
Dr. Alex Jimenez, D.C., presents: The term SBAR stands for situation, background, assessment, and recommendation. It is a communication method that many chiropractors or healthcare professionals use to help simplify communicating patient information to other healthcare team members. And the whole goal of the SBAR method is to help us strategically and systematically share a patient situation along with the background of that patient, the assessment findings that we have found, and recommendations that we recommend to that specific individual so they can easily understand what we need, want, and what is going on with that patient in a very clear and focused way. So the SBAR method can help the chiropractor or massage therapist stay organized whenever they’re having to communicate and cut out unnecessary information that may be in the conversation that wastes time or may confuse the listener and help prevent those moments where the specialist may get questions from the person they are talking to, and they may not know.
The SBAR method allows chiropractors to communicate efficiently with patients about where the pain is located in their bodies. So the SBAR will help many health professionals stay organized. Some examples of the SBAR method used for communication include: a nurse needs to speak with a healthcare provider like a physician, a nurse practitioner, or a PA to let them know that the patient’s condition is deteriorating, and they need to call and report that. If they need something for that patient, the healthcare provider can follow the SBAR method, which will help them clearly and concisely communicate that issue to the listener. Chiropractors can also use the SBAR to share with other associated medical providers or massage therapists when they have a patient’s report to be handed or transferred to a different unit.
The SBAR method can be used with other healthcare team members, like speech therapy, occupational therapy, chiropractic therapy, and physical therapy. This method helps and guides chiropractors with what information they need to provide to the patient, so they can fully understand what is going on with them. An example would be a patient coming into a chiropractic clinic with back pain; however, they are experiencing gut issues and having areas of complaints in their hips, causing mobility issues. So by using the SBAR method, chiropractors and other healthcare providers can communicate better with their patients and develop a solution with the APPIER process and a treatment plan that caters to the individual. When creating your SBAR to communicate better with someone, it’s better to ensure that you are fully prepared before initiating that conversation. Having a little system to comply with the SBAR method can help you quickly and allow you to note what is happening with the patient in your head or take note of their condition. Getting the layout of the SBAR method is the first step, and many healthcare units will have them created so the doctor can fill them in and put all the information they need when they call or talk to their patients.
Chiropractors using the SBAR method would go into the room, look at that patient, assess that patient, collect their vital signs and look in the chart, look at the latest progress now, and know who’s on board taking care of that patient. The SBAR method also allows the doctor to review that patient’s chart thoroughly and understand what’s going on with that patient. So by the time they step into the room, they will have an idea of what is going on with the patient when those questions come up. Plus, when they have looked at the latest lab results from their associated medical providers. They can have an insight into what medication the patient is taking because those questions will probably come up and be included in the SBAR method. This will allow the chiropractor to gather all that information from the patient and be comfortable and ready to initiate the conversation.
Dr. Alex Jimenez, D.C., presents: Now let’s look at each of the sections of the SBAR method. Since the SBAR method is very focused and concise with communication, it is straightforward. So the situation is the first thing you’re going to start with whenever you’re communicating using the SBAR method. So by having your computer on that specific patient, doctors can easily look at something in case the person asks them a question and have the information in front of them quickly. So with the situation, just as it says, the goal is to communicate why the patient is calling. That’s its purpose, as it helps start things off and allows the doctor and the patient to introduce themselves and briefly explain what is going on with their bodies. An example would be a person with back pain introducing themselves to the chiropractor and vice versa and briefly describing where they are in pain.
Dr. Alex Jimenez, D.C., presents: The background portion of the SBAR method helps paint a picture of what the patient is going through and will provide a brief description of the situation. Then after that, we’ll go straight into the patient’s background, and this part of the communication will be very focused again. And how you would transition from situation to background in the SBAR method by going into the patient’s diagnosis. So the patient was admitted with whatever diagnosis on the date of admission. Then the chiropractor will tailor and include important patient information based on what the patient is experiencing pain-wise. The pain can vary from each person and can affect the body differently.
Many doctors can include the patient’s code status and discuss any other significant health problems that accompany the patient’s current situation. An example would be if a person is dealing with cardiac issues, their primary doctor can ask them if they had any health history with cardiovascular disorders, medications for heart diseases, chest pain, etcetera. Getting their background history can provide many doctors with a treatment plan that won’t cause any issues for the patient. When chiropractors work with other healthcare professionals, they can provide a background history of the patient, including bloodwork, previous procedures, and any additional information to develop a treatment plan. Along with consults, what other doctor groups are on board with this patient and any pending procedures the patient may have? That lets them know, okay, I don’t need to order this test or product because they will be having this procedure.
Dr. Alex Jimenez, D.C., presents: The next section of the SBAR method is the assessment part, where the doctor will tell the patient what they have assessed or found in the patient. Many healthcare professionals, like chiropractors, provide those assessment findings and current vital signs to back up what they think is going on. An example would be a functional medicine doctor explaining to the patient what they found in their body, like possible respiratory, cardiac, or GI issues, and what they think is going on based on what they discovered.
But let’s say, for example, that the nurse or doctor doesn’t know; however, they know that something’s wrong with the patient and they need something. In this situation, the doctor or the nurse can take note of what is going on with the patient and explain to their associated medical providers that they are worried or that the patient is deteriorating; they’re unstable and have changed from when they previously saw them. By using the SBAR method, chiropractors can asses the situation the patient is dealing with and provide insightful solutions to develop a treatment plan for the patient.
Dr. Alex Jimenez, D.C., presents: And finally, the final part of the SBAR method is recommendations. So recommendations are where the doctor communicates with the patient on what they want or need. By laying out the framework from using the SBAR method, the recommendation part allows the doctor to specifically communicate with the patient on what needs to be done to improve their health and wellness. An example is if a patient is dealing with gut issues associated with metabolic syndrome and their doctor gives them a treatment plan to incorporate more nutritional foods in their diets, exercising more and getting an adjustment from a chiropractor can help alleviate pain affecting their backs or hips.
Since body pain is one of the most common complaints worldwide, chiropractic care can assist in managing the symptoms associated with joint and muscle pain while being cost-efficient and non-invasive. Utilizing the SBAR method in a chiropractic clinic can give the chiropractor the right tools to develop a treatment plan for the individual to relieve any pain affecting their body. Chiropractic care can also use the APPIER method combined with the SBAR method to fully alleviate any disorder in the body structure to restore a person’s health and wellness.
Noninvasive treatments like chiropractic care, non-surgical decompression, massage therapy, non-steroidal anti-inflammatory drugs/NSAIDs, targeted/specific exercises, and ice/heat therapy successfully treat most cases of sciatica. However, more aggressive treatment could be necessary for severe cases, and this is where sciatica nerve block injections come in. The Injury Medical Chiropractic team can help you understand the diagnosis and explain the benefits.
Sciatica Nerve Block
Sciatic nerve block treatments can provide profound relief for intense, non-stop symptoms. The procedure can also provide important diagnostic information to help the spine specialist locate the exact nerve fibers contributing to the symptoms.
The nerve block stops sciatic pain signals from transmitting.
The procedure involves injecting an anesthetic and a steroid into the nerve roots.
The steroid reduces inflammation.
The anesthetic prevents nerve impulses from reaching the central nervous system – CNS.
If the procedure is successful, surgery could be avoided altogether.
What to Expect
Individuals undergoing a sciatic nerve block will be awake during the procedure. Individuals that rather be sedated are recommended to speak with their healthcare provider during the planning phase.
When the procedure begins, a nurse sterilizes the area around the injection site and applies a local anesthetic.
The nurse will check the injection area for numbness.
Then the spine physician inserts a needle using direct visualization from an ultrasound, fluoroscope, or CT scan and then injects the medications.
After the procedure, the individual is moved to a recovery area and monitored.
Most individuals can walk almost immediately after the injection, and vigorous exercise can be resumed a few days following the procedure, depending on the injury and what the spine specialist recommends.
The procedure is done under direct visualization to minimize the risk of complications. However, possible complications could present and are usually linked to the needle insertion into the spinal column. These include:
Complications are rare, but side effects like soreness around the injection site, nausea, and a headache are common and only last a little while.
Individuals with underlying conditions and that are taking various medications may not qualify for a sciatic nerve block or have to consult their doctor for reasons that include the following:
Long-Term Anticoagulant Use
Individuals taking blood thinners like daily aspirin, Plavix, or coumadin, will need to stop taking these medications before the procedure.
Allergy to Contrast Dye
Sciatic nerve blocks are done using contrast dye or ultrasound.
Individuals with an allergy to contrast dye will need to verify with their doctor or surgeon the feasibility of only using ultrasound guidance.
Abnormal Spinal Anatomy
Individuals with abnormal spine anatomy have an increased risk for complications and are recommended not to have the procedure.
Morbid obesity is a significant risk factor for developing sciatica.
The pain and symptoms often improve with weight loss.
Inserting a needle with an injury, wound, or active infection near or around the injection site could cause spreading.
There is a wide range of responses to sciatic nerve blocks.
Most individuals experience pain and symptom relief between two weeks and two to four months.
Some individuals have a long-term resolution of their symptoms.
However, it is also possible for the nerve block to be unsuccessful.
The sciatic nerve is the longest in the body, and there are multiple potential sites for an anesthetic blockade.
If a sciatic nerve block does not work, the spine specialist will reanalyze the diagnosis and see if the injection site was correct.
Identifying the exact section of the nerve to anesthetize can be difficult and may require multiple nerve block attempts.
Individuals who continue to experience debilitating sciatica symptoms after a sciatic nerve block could be recommended to undergo surgical procedures.
Sciatic nerve ablation is a procedure that destroys nerve pathways identified to cause pain and can provide long-term relief.
If sciatica is caused by misalignment of the vertebrae or intense external pressure on the sciatic nerve, surgery to correct the underlying cause could offer a permanent solution.
Jönsson, B et al. “Diagnostic lumbar nerve root block.” Journal of spinal disorders vol. 1,3 (1988): 232-5.
Kanaan, Tareq, et al. “The Efficacy of Therapeutic Selective Nerve Block in Treating Lumbar Radiculopathy and Avoiding Surgery.” Journal of pain research vol. 13 2971-2978. 18 Nov. 2020, doi:10.2147/JPR.S276331
Rodziewicz TL, Stevens JB, Ajib FA, et al. Sciatic Nerve Block. [Updated 2022 June 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK470391/
Dr. Alex Jimenez, D.C., presents how hormonal dysfunction can be assessed and treated through various therapies specializing in hormones and how to regulate them in this 3 part series. This presentation will provide valuable information to many people dealing with hormonal dysfunction and how to utilize different holistic methods to optimize their health and wellness. Part 2 will look at the assessment for hormonal dysfunction. Part 3 will look at various treatments available for hormonal dysfunction. We refer patients to certified providers incorporating various hormone therapies to ensure optimal health and wellness. We encourage and appreciate each patient by referring them to associated medical providers based on their diagnosis when it is appropriate. We understand that education is an excellent way when asking our providers intricated questions at the patient’s request and understanding. Dr. Alex Jimenez, D.C., only utilizes this information as an educational service. Disclaimer
What Are Hormones?
Dr. Alex Jimenez, D.C., presents: Today, we will look at utilizing foundational PTSD treatment strategy steps. As a treatment strategy, it is about the production, transportation, sensitivity, and detoxification of the hormone in PTSD. So let’s start with how interventions and major factors that influence these pathways within the access impact other body areas. How does an intervention on one hormone affect other hormones? So did you know that thyroid replacement can change the HPATG access in the body? So when people are dealing with hypothyroidism or subclinical hyperthyroidism and are being treated with suppressive thyroid hormone replacement, it induces changes in their bodies. This means they will become hypersensitive from ACTH to CRH or corticotropin-releasing hormone.
What this means is that they will produce and release more ACTH. When the patient becomes hypersensitive from an influx of hormones, it could lead to various issues with the other body systems that affect organ and muscle functionality. This is another reason patients feel great on even low doses of thyroid replacement; it stimulates the adrenals. Many patients tend to overrun their adrenals, and when they get treatment, they get a little hit to their adrenals when their doctors are helping their thyroid. So looking at the thyroid, we see the thyroid gland is producing t4, forming reverse T3 and t3. So when doctors look at the thyroid pharmacological doses of glucocorticoids, which is what they give for anti-inflammatory therapy to their patients, or if people have elevated glucocorticoids as in Cushing syndrome, what that does is it inhibit thyroid secretion because it reduces the TSH response to TRH, which makes less TSH. When there is less secretion in the thyroid can lead to overlapping issues associated with unnecessary weight gain, joint pain, and even metabolic syndrome.
To that point, stress inhibits the thyroid. In contrast, estrogens have the opposite effect, where they increase TSH secretion and the thyroid gland’s activity. So that’s a reason why women feel so much better on even low doses of estrogen replacement. So just like thyroid replacement in low amounts that bump the adrenals, if we’re giving low estrogen doses, it can bump up thyroid function. However, many doctors have to go slow when providing hormone treatments to patients because the additional hormones will affect the other hormones in the body. When it comes to hormone replacement therapy, it is important to learn how interventions within the communication node impact other nodes in the matrix. So, for example, let’s look at how the communication node affects the defense and repair node in the body. Research studies reveal HRT’s effects on inflammation markers and look at 271 women who used conjugated equine estrogen alone, who had a 121% increase in CRP after a year.
And if they used that in addition to synthetic progestin, they had a 150% increase in CRP after a year. So synthetic estrogen is not bioidentical; this is synthetic pregnant mare’s urine, and synthetic progestins are pro-inflammatory. What about the communication node and the assimilation node? This is an interesting study because many doctors are trying to help their patients and the future generation in society. So it’s important to know when the mother is stressed during pregnancy since that can change the baby’s microbiome. That means doctors have an opportunity to support early intervention in microbiome support. Knowing this is vital for prenatal stress based on questionnaires or elevated cortisol was strongly and persistently associated with infants’ microbiome and colonization patterns.
So we’re also here to learn how interventions on the matrix affect the hormone node or the communication node. So as an example, we’ll look at what happens in the assimilation node involving the communication node, as this affects antibiotics on the intestinal metabolome. Everyone knows about antibiotics’ impact on the microbiome, but a metabolome is a change in the metabolic function of a particular organ, the intestine. To that point, when there are so many metabolic pathways that antibiotics affect, the metabolism of steroid hormones was the most profoundly impacted. So eight metabolites that are part of this hormone pathway, which gives us PTSD, were increased in feces after antibiotic treatment. Then we have another way that the gut affects hormones, and this is looking at metabolic endotoxemia. Many doctors learn about metabolic endotoxemia in AFMCP, which mentions leaky gut or increased intestinal permeability. When many individuals are dealing with gut issues affecting their well-being, like problems in their joints or muscles causing them pain, we provide various solutions and develop a treatment plan with our associated providers based on the diagnosis.
Endotoxins Affecting Hormones
Dr. Alex Jimenez, D.C., presents: Endotoxins or lipopolysaccharides are from the cell membranes of bacteria. So bacterial endotoxins are translocated from the gut lumen because of increased intestinal permeability. So with that increased permeability, those endotoxins are translocated, which starts an inflammatory cascade. When endotoxins cause GI issues, the inflammatory markers can affect the upper and lower portions of the body and the gut-brain axis. When the gut-brain axis is affected by inflammation, it could lead to joint and muscle pain associated with somato-visceral and visceral-somatic problems. To that point, the inflammatory cascade from the leaky gut affects the ovary, reduces progesterone production, and contributes to luteal phase deficiency. That’s incredibly important for doctors to take care of patients that are there to optimize fertility. It is especially important for patients to let their doctors know when they have excess estrogen and that they are producing as much progesterone as possible. So we must worry about gut permeability in ovulation, luteal phase deficiency, and estrogen-progesterone imbalance. What about the biotransformation node? How does that affect the communication node? In preschool children, phthalates and thyroid function have an inverse association between the metabolites or the amount of folate and thyroid function in the system measured in children at age three. When inflammatory issues affect thyroid function in children, it can affect cognitive outcomes, thus reducing phthalates production in the thyroid, leading to mental problems.
How do mental, emotional, and spiritual considerations contribute to the communication node? We want to start with the bottom of the matrix like we always do, which involves functional medicine. Functional medicine provides holistic approaches to identifying the root problem affecting the body and developing a personalized treatment plan for the patient. By looking at the lifestyle factors at the bottom of the Living Matrix, we can see how hormone dysfunction affects the communication nodes in the body. A recent paper found that there was a positive relationship between menopausal symptoms and social support and that menopausal symptom decrease as social support increases. Now let’s talk about how stress impacts HPA access. By looking at how stimulation from the sex hormone-producing parts of the body or the goads, the thyroid access, the adrenals, and the sympathetic nervous system (fight or flight) can add up all the stressors affecting us, called allostatic load.
And allostasis refers to our ability to respond to those stressors through stress-coping mechanisms. Many patients are asking us for guidance. They’re asking how they can frame their personal experiences and stressors. Still, they’re also asking how they prepare the societal events in a larger context, And many of us as functional medicine practitioners are seeking the same thing. And so, we’re going to show you in detail what stress does to the body and how to find ways of decreasing anxiety or stress in the body to prevent future issues in the organs, muscles, and joints.
How Stress Inhibits Estrogen
Dr. Alex Jimenez, D.C., presents: Does stress creates adrenal stress, and does it affect our fight or flight primary response hormone (adrenaline)? Stress can cause the sympathetic nervous system to increase blood pressure, respiration, heart rate, and general alertness while redirecting our blood to increase our adrenaline. So when you are in a situation, your adrenaline can cause you to fight or run, which causes your muscles to get blood, which decreases blood to your core or your non-essential organs. So the functional medicine model would identify various triggers or mediators, whether acute or chronic, that can act as an instigator of hormone dysfunction that can create overlapping issues that can disrupt adrenal function in the thyroid.
So, looking at these responses can help us see the physical problems that are happening if adrenaline is chronically increased over the long term, leading to anxiety, digestion problems, et cetera. Now cortisol is our vigilance hormone that helps maintain the emergency response to back up or support the adrenaline. An example would be a fire truck or police that come in after the immediate first responder. So cortisol facilitates the quick adrenaline response to keep the body going as needed. And it has many other roles as well. It helps with increased blood sugar and causes fat storage. So when people come in with weight around the middle and dealing with overlapping issues in their body, think of cortisol since it’s anti-inflammatory and regulates the nervous system. Cortisol can be both good and bad for the body, especially when an individual is dealing with stressful events affecting their health and causing issues affecting their mobility.
So now, let’s talk about how stress impacts the entire body and the immune system. Stress can increase susceptibility to infections, increasing their severity in the body. So here we see stress affecting the defense and repair node, leading to immune dysfunction and stress-induced immune dysfunction. An example would be if a person is dealing with a disorder that affects their gut, like SIBO or leaky gut; it can increase the production of pro-inflammatory cytokines and causes joint and muscle pain to the lower back, the hips, the knees, and overall wellness. When the pro-inflammatory cytokines affect the gut system, they can also cause thyroid dysfunction, disrupting hormone production.
So if someone’s taking that hormone replacement therapy (HRT), it can increase their inflammation, especially if they are stressed. So, as functional medicine practitioners, we’re always thinking and looking for pattern recognition as we start thinking about things differently from conventional methods regarding health and wellness.
What is it when you see a person dealing with chronic stress, and what is their response? They will usually answer, “I sweat a lot; I get nervous and anxious just remembering what has happened to me. I’m afraid of experiencing that ever again. Sometimes these pathways give me nightmares. Whenever I hear a loud noise, I think of carbon rings and get nauseous.” These are some tell-tale signs of someone dealing with chronic stress associated with PTSD, which can affect the hormone levels in the body. Many functional medicine providers can utilize available treatment regarding hormonal dysfunction in PTSD. So the general strategy for treating hormone dysfunction is the production, transport sensitivity, and detoxification of hormones in the body. Remember that when you have someone dealing with hormonal issues, it is best to devise a strategy to deal with this issue.
So what can we do to affect how hormones are produced or have been over-produced in the body? We want to look at how hormones are made, how they may be secreted within the body, and how they’re transported. Because what if they’re transported in a way that the transport molecule is low in concentration, allowing them to be free hormones? So that’s the interaction with other hormone sensitivity, and how do we change or look at cellular sensitivity to the hormonal signal? For example, progesterone affects estrogen receptors which cause detoxification or excretion of the hormone.
So before we think about giving or replacing a hormone, we ask what we can do to affect that hormone in the body. Specifically, how can we influence the hormone’s production, transport, sensitivity, detoxification, or elimination? So when it comes to hormone production, what are the building blocks for thyroid hormones and cortisol? So if we’re low on thyroid hormones, we want to ensure that we have the building blocks of serotonin. So what affects synthesis? If a gland is inflamed with autoimmune thyroiditis, it may not be able to make enough thyroid hormone. And that’s why people with autoimmune thyroiditis have low thyroid function. What about hormone transportation? Do the levels of one hormone in the body impact the levels of another? Estrogen and progesterone are often in a dance in the body. So does a hormone transport from the origin glands to the target tissue, which can impact its effectiveness?
If there is an overproduction of hormones attached to the transport protein, there won’t be enough free hormone, and there can be hormone deficiency symptoms. Or it can be the opposite if there needs to be more transport protein, then there will be too many free hormone molecules and hormone excess symptoms. Therefore, we want to know if we can impact the free hormone level and see if it is transformed. So we know that T4 becomes the active form of T3 or a thyroid inhibitor, reverse t3, and can we modulate those pathways? What about sensitivity? Are nutritional or dietary factors influencing the cellular response to cortisol, thyroid hormones, testosterone, estrogen, et cetera? With many cell membrane binding proteins, the cell membrane is involved in hormone metabolism. And if the cell membranes are rigid, insulin, for example, has a hard time getting in it now as we look into hormone detoxification. How do we alter the metabolism of estrogens or testosterone?
And what can we do to affect estrogen’s binding and excretion? So, can estrogen have to be eliminated healthily? And that depends on whether there’s hydroxylation on a particular carbon, but it also has to be excreted in terms of total amounts. So constipation, for example, will decrease the quantity of estrogen excreted. So we use the vault as a metaphor and the theme, as we said, is to treat the matrix first before directly addressing hormone dysfunction.
Dr. Alex Jimenez, D.C., presents: In the Living Matrix, we have to unlock or treat all the nodes to open the vault to get inside and address hormones. This is because the endocrine system is so complex it often self-corrects when other imbalances are addressed. And remember, hormonal imbalance is often an appropriate response by the body to imbalances elsewhere. That’s why treating other imbalances often addresses the hormonal issue. And also, remember hormones like picograms are in very low concentrations. So it’s very hard to be precise when we give patients hormones and allow the body to auto-correct. That’s why we say to treat the matrix first. And when we get inside the communication node in the body, we look at the center of the matrix and discover the body’s emotional, mental, and spiritual functions to help normalize hormones. And while these are addressed, how can we fix the hormonal communication nodes?
When inside the communication node, the treatment must follow an order: adrenal, thyroid, and sex steroids. So these are important concepts to remember, treat adrenals, thyroid, and finally, sex steroids. And the way we depict the pathways will be consistent. So here you see the standard representation we will use for the steroidogenic path. And you see all of the different hormones here. The enzymes in the steroidogenic pathway are color-coded, so many doctors can know which enzyme affects which step. Next, we will look at the modulation of the steroid pathways through lifestyle, like exercise, and how stress affects aromatase, making estrogen.
Now, as we get into the real, heavy part here about the steroid pathways, we inform many of our patients to take a deep breath as it shows that taking a deep breath can increase a person’s cognition and provide the ability to understand everything. So the big picture here is everything starts with cholesterol and how it affects the hormones in the body. So cholesterol forms the mineral corticoid aldosterone, which then develops cortisol, ultimately creating androgens and estrogens. When patients are given consultation on what is going on with their bodies, many don’t realize that high cholesterol could potentially lead to chronic stress, which is associated with cardiovascular issues that can ultimately invoke visceral-somatic disorders.
Dr. Alex Jimenez, D.C., presents: When a female patient is dealing with fibroids or endometriosis, many doctors devise a treatment plan with other medical providers to reduce the formation of the estrogen hormones by inhibiting and modulating the aromatase enzymes. This allows the patient to make small changes to their lifestyle habits by ensuring their zinc levels are normal, not drinking alcoholic beverages constantly, finding ways to reduce their stress levels, and normalizing their insulin intake. Each treatment plan caters to the individual as they find ways to reduce their cortisol levels and regulate healthy hormone production. This will allow the body to increase estrogen production while decreasing the aromatase. So when we are discussing stress, it can negatively impact the hormone pathways directly by increasing cortisol, thus causing the pituitary glands to increase the CTH when stress is responding to the body. Many individuals are dealing with chronic stress in their bodies, which can cause overlapping risk profiles to the musculoskeletal system, causing muscle and joint pain.
So the pituitary system produces cortisol when the body calls for it directly when the individual is dealing with acute stress. However, chronic stress can indirectly increase cortisol levels; it causes the enzyme 1720 lyase to be inhibited in the body, causing a decrease in anabolism, thus slowing down the body’s energy levels. So stress inhibits this enzyme. So when stress inhibits the 1720 lyase enzyme in the body, it can cause the pituitary system to produce more cortisol and cause more issues like joint to affect the individual. So those are the two ways that stress leads to more cortisol directly through ACTH and indirectly by inhibiting 1720 lyase.
Inflammation is important in the body as it also has a two-way path, as it can impact these pathways the same way stress does. Inflammation can inhibit the 1720 lyase enzyme, causing the body to be pro-inflammatory and can stimulate aromatase. Like stress, when the body is dealing with inflammation, the pro-inflammatory cytokines stimulate aromatase enzymes to cause an increase in estrogen formation. When this happens, it allows the doctors to notice why their patients are overly stressed and have inflammatory markers in their gut, muscles, and joints. To that point, inflammation can also increase an enzyme called 5alpha reductase. Now, 5alpha reductase causes the formation of a hormone called dihydrotestosterone (the active form of testosterone in the body cells other than the muscles, causing hair loss. So insulin, stress, and inflammation contribute to hair loss because insulin has the same effect. Insulin or blood sugar gives the body energy to move throughout the day. When individuals have too much or too little insulin in the body, it can lead to insulin resistance, correlating to metabolic syndrome associated with hair loss.
Holistic Methods For Hormones
Dr. Alex Jimenez, D.C., presents: How do insulin, cortisol, and inflammation play their part in the thyroid? Well, all of these hormones help make the body functional. When the thyroid has an underlying condition like hypo or hyperthyroidism, it can cause the body to over or underproduce hormones to regulate healthy normal body functions. So this forward feed cycle can cause the individual to have various issues affecting their body due to hormonal dysfunction. This combination of insulin resistance, high insulin, weight gain, and stress affects many patients, causing metabolic syndrome. To normalize hormonal function, we must look at all these factors driving hormonal dysfunction in patients.
When going for hormonal treatment, it is important to know about the different nutraceuticals and botanicals because before, it was called a lifestyle change back in the day. In a health clinic, specific neutraceuticals and botanicals can affect estrogen formation through the enzyme aromatase. However, various factors like diseases, medications, toxins, and elevated insulin can also increase aromatase enzymes, leading to more estrogen in the body. And then diseases, medications, and toxins do the same thing. A research study reveals that when men and women interact, the men’s cognitive performance declines, followed up with a mix-sex encounter. This can change how hormone function in the body when there are changes in formal function that can affect the central nervous system’s cognitive function in the body.
When middle age patients get examined by their doctors, the results can show if they have elevated insulin, an increase in stress and if there is inflammation in their bodies. This allows the doctors to work with associated specialists to develop a treatment plan that caters to the patient to begin small changes in their health and wellness journey.
Ankylosing spondylitis, or AS, is a type of inflammatory arthritis that usually impacts the spine, causing back stiffness and pain, pain in the hips, and decreased range of motion. Brain fog can also be a symptom of AS and other chronic inflammatory conditions. Brain fog can affect memory, concentration, decision-making, learning, and problem-solving. Injury Medical Chiropractic and Functional Medicine Clinic can educate on the causes of ankylosing spondylitis brain fog and how to reduce its effects.
Experts do not fully understand how conditions like AS cause brain fog and how it affects the brain and central nervous system. However, they believe brain fog is linked to chronic inflammation and pain associated with the condition, along with certain factors.
Inflammation occurs when the body’s immune system attacks healthy cells.
This triggers the release of inflammation-causing cytokines.
Cytokines can interfere with normal brain function.
Ankylosing Spondylitis Chronic Pain
Chronic pain can cause fatigue and unhealthy sleep quality.
Fatigue and poor sleep can worsen chronic pain, leading to intense fatigue and extreme sleep issues, becoming a vicious cycle.
Doctors typically treat ankylosing spondylitis with corticosteroids.
Individuals with cardiovascular risk factors have an increased risk of brain fog from the medications.
Individuals with AS can present symptoms of depression, which has been linked to cognitive impairment.
Depression can contribute to the development of brain fog.
Cornelson, Stacey M et al. “Chiropractic Care in the Management of Inactive Ankylosing Spondylitis: A Case Series.” Journal of chiropractic medicine vol. 16,4 (2017): 300-307. doi:10.1016/j.jcm.2017.10.002
Vitturi, Bruno Kusznir et al. “Cognitive Impairment in Patients with Ankylosing Spondylitis.” The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques vol. 47,2 (2020): 219-225. doi:10.1017/cjn.2020.14
Zhang, Jun-Ming, and Jianxiong An. “Cytokines, inflammation, and pain.” International anesthesiology clinics vol. 45,2 (2007): 27-37. doi:10.1097/AIA.0b013e318034194e
A certified/licensed massage therapist performs chiropractic therapeutic massage under the direction of a chiropractor to soothe tense muscles, release pressure on the nerve/s, break up scar tissue and stimulate the release of endorphins. Studies have shown that a therapeutic chiropractic massage is as effective as nonsteroidal anti-inflammatory medications for pain relief caused by various musculoskeletal conditions, including sciatica. Although medications can work for a time, they do not deal with the underlying cause of sciatica.
A sciatica massage offers several benefits that include the following:
Improved and increased blood circulation.
Lowered blood pressure.
Release of hormones that help reduce anxiety, depression, and pain.
Relieves body discomfort and soreness by decreasing the activation of pain receptors in the spine and muscles.
Muscle stress relief.
Flare-up relief and prevention.
Each type of massage is designed for a different purpose.
Improves mobility and reduces pain.
Stretches tendons, ligaments, and muscles.
Focuses on the musculoskeletal system to improve mobility.
A deeper massage that targets connective tissues like ligaments and tendons.
Deep Tissue Massage
Designed to reach the deep layers to realign the muscles and fascia.
Releases trigger points, adhesions, and nerve endings.
Most cases of sciatica resolve in less than 4 to 6 weeks with conservative treatment. More severe cases with neurologic symptoms can have a longer recovery period.
Alleviates discomfort, numbness, tingling, pain, and other symptoms.
The pain is reduced so the chiropractor and therapists can begin to address the cause, although the other symptoms and sensations could still be experienced.
If muscle spasms are present, they will be less frequent and with less intensity.
The individual can focus on functioning within their normal environment.
The chiropractor and therapists examine if they can get up and stand from a chair without problems, get in and out of a car, sit for longer periods, and walk with less discomfort.
A reflex test will be performed to analyze how the healing process is coming along.
If there is significant nerve damage, reflexes could be lessened.
For example, if sciatic inflammation is present, and the Achilles tendon is tapped with a reflex hammer, there could be little or no movement of the calf muscles.
If there is an improvement, there will be a healthy reflex.
The straight leg test will show if the individual can lift their leg with little or no pain.
The final healing phase provides the ability of normal movements and full strength.
This is when the individual can resume normal activities, specifically those stopped because of the pain.
This can include walking, driving, house chores, sports, or working out.
Contact our office for treatment options customized to the individual and their injury.
Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2022 June 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK539717/
Chang C, Jeno SH, Varacallo M. Anatomy, Bony Pelvis, and Lower Limb, Piriformis Muscle. [Updated 2022 October 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK519497/
Davis D, Maini K, Vasudevan A. Sciatica. [Updated 2022 May 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK507908/
Marian Majchrzycki, Piotr Kocur, Tomasz Kotwicki, “Deep Tissue Massage and Nonsteroidal Anti-Inflammatory Drugs for Low Back Pain: A Prospective Randomized Trial,” The Scientific World Journal, vol. 2014, Article ID 287597, 7 pages, 2014. doi.org/10.1155/2014/287597
Miller, Kenneth Jeffrey. “Physical assessment of lower extremity radiculopathy and sciatica.” Journal of chiropractic medicine vol. 6,2 (2007): 75-82. doi:10.1016/j.jcme.2007.04.001
Dr. Alex Jimenez, D.C., presents how to assess different hormones in the body and how different hormone tests can be used to determine the level in the body. This presentation allows many individuals to know what to expect when they are being diagnosed by their primary doctors. We refer patients to certified providers incorporating various hormone therapies to ensure optimal health and wellness. We encourage and appreciate each patient by referring them to associated medical providers based on their diagnosis when it is appropriate. We understand that education is an excellent way when asking our providers intricated questions at the patient’s request and understanding. Dr. Alex Jimenez, D.C., only utilizes this information as an educational service. Disclaimer
Dr. Alex Jimenez, D.C., presents: Welcome to everything you need to know about assessing hormones and how to do the testing. We have decided to do this as a webinar because we only have a little time to do it during the module. After all, that’ll make your life easier. You’ll need to have this information under your belt because here is the most important thing you need to know. Hormone therapy is an art, not a science. If you find five or six practitioners who do hormone therapy, you will find five or six different ways to make a prescription and way more ways than that actually to do testing to monitor it.
Dr. Alex Jimenez, D.C., presents: The important thing is that you keep in mind what we know scientifically is a better or not-so-good way of taking care of the patients in terms of testing. Then find what works for you and become the expert in that. Because if you are consistent over time, you can work around the pros and cons of every given testing modality and figure out what you need to do, regardless of what type of test you end up doing. All right, so what do we need to worry about? There are many potential problems in measuring hormone levels because so many hormone levels fluctuate significantly. In order to evaluate hormones in the body, doctors need to know what, when, and who to test. So we’re going to talk about all of that.
Diagnosing Hormones In A Patient
Dr. Alex Jimenez, D.C., presents: Some vary during the day, some vary during a cycle, and some hormones don’t vary at all. So you need to remember which ones you need to worry about in terms of fluctuation. The studies that have been done don’t measure hormone levels. So, finding normal hormone levels is sometimes problematic. It may be different from what the labs currently use. And in the studies where they have come up with normal hormone levels, a lot of them are much older studies, and the methodology was more unreliable than what we use now. So by keeping that in mind regarding what people call normal hormone levels, many of these studies also would average out non-comparable groups. What this means is that they would be comparing, let’s say, a group of apples, oranges, and grapes and put them all together and say, oh yeah, so this average is going to work.
Dr. Alex Jimenez, D.C., presents: So it’s like doing a meta-analysis, and if you are taking a bunch of different data, you can’t necessarily say that this average makes sense. You probably are already aware of the fact that other labs end up developing different reference ranges. And so if you use multiple different labs, you can’t necessarily compare the test results you’re getting because the reference ranges are different. And, sometimes, even within a given lab, depending on which test kit patients use, like a test from Quest, they may one day use one test kit. So a reference range will be XYZ, and they went to the same lab another day, but they used a different test kit and have an entirely different reference range. And so you have to the point that out to the patients. If you’ve got a smart patient trying to track what’s happening with themselves, they may have the wrong impression during an examination.
Estrogen & Progesterone
Dr. Alex Jimenez, D.C., presents: If you’ve got different reference ranges showing up on your test results, it is best to keep track of that in case you need to remember. Now there are big variations between individuals and even within the same individual. The serum concentrations of both natural and synthetic steroids might need to be clarified between other individuals. There’s a huge variation irrespective of the root of the administration of the hormones. What you expect from one person may be different from the next person. And, of course, within any individual, you’re going to get levels of fluctuation throughout the day based on lots of different things. Everything from perceived or actual stress that will change their hormone levels to foods they were eating that day can make a difference. Hydration status can make a difference. So some of the variations you see within a person, but with different blood draws, can be based on what was going on that day.
Dr. Alex Jimenez, D.C., presents: So try to impress upon your patients as you’re getting testing done to keep the blood draw days the same. Now measuring in different body fluids like serum, urine, or saliva doesn’t necessarily tell us about concentration in other tissues, and doctors need to keep this in mind because the patient may get a false sense of security, and it won’t necessarily have anything to do with the tissue they are trying to treat. Now, many doctors must remember all the different kinds of estrogens they might need to keep track of during examination. So, when they notice estrogen, there’s an estrogen pool. There is free and bound estrogen in the body and estrogen production in the woman or a man in themselves. There are exogenous estrogens that you may be giving them. There are stored estrogens, metabolites, and all these different estrogens doctors need to keep track of. So this is just one example of having many estrogen levels in the body, and the patient is wondering, what is it the doctor is looking at? Could one test give me all this different information? And this is only estrogen. The same thing is true, although not quite as complicated. The same thing is true about the other hormones in the body.
Dr. Alex Jimenez, D.C., presents: Now for progesterone, it is the same ordeal. Other results look like this for estrogens and testosterone, and this is to remind us of all the different variability there is. By showing the variation between different people at their biological stages, for example, premenopausal and postmenopausal. The results that the doctor presents to the patient establish a lighter shade of green on the outside of the intercycle variability from within a given woman. And then the yellowy green is the inter-woman variability, meaning one woman to the next. And then that blue line in the middle is the average; this provides what information they might need to diagnose.
Testing Hormone Levels
Dr. Alex Jimenez, D.C., presents: All right, so let’s look at testing and assessing hormones as we look at all the hormone types, the different ways of testing them, and the pros and cons. There are decades of well-validated research on serum hormone levels. So for the estrogens, estrone, estradiol, and estriol, as well as the estrogen metabolites in the serum, the good news is it measures endogenous hormone production. So if you get a serum hormone level, we know what those results mean.
Dr. Alex Jimenez, D.C., presents: The bad news is these results give you the free and bound hormone. It shows you the total estrogens. However, you can’t order total estradiol and free estradiol test as they don’t offer them. There are limited data regarding serum levels of these metabolites in terms of prediction for health risk. And it can be difficult for some labs to get accurate quantification in postmenopausal women because the estrogen levels are very low. So, keeping that in mind is a matter of knowing your lab and how accurate they are. Now when it comes to saliva, the good news is it’s non-invasive. Patients can do this at home, making it convenient if doctors try to do a serial measurement of estradiols across a whole cycle in a premenopausal woman. Cause no one in the right mind will go to the lab and get blood drawn daily.
Dr. Alex Jimenez, D.C., presents: Knowing that salivary estradiol correlates well to free estradiol in serum allows doctors to see what’s in the saliva and what they want to see in the serum. The bad news about saliva is that there are fewer validation studies than serum. There are still quite a few, so it’s a valid testing method. It’s just that it’s not as well validated as a serum because it still needs to be done. Again, it can be very challenging for some labs because the estrogen levels in the saliva are much lower than in the serum. So doctors must ensure the lab is doing a good enough job assessing these very low levels. All saliva testing can be contaminated by blood from the oral mucosa.
Dr. Alex Jimenez, D.C., presents: So if the patient has periodontitis or something along those lines, doctors don’t want them to salivary levels; it is important to tell them to do it before they brush their teeth, not after, in case they bleed when they brush their teeth. But that’s true of any salivary test; you can’t get estrogen metabolites done through the saliva. And the bigger problem in a postmenopausal woman is that many get dry mouth after menopause. And so, it can be really difficult to do the test because they need to produce more saliva to get an adequate specimen. Now, if that happens, they can go for a 24-urine test. The 24-hour urine testing for estrogen and estrogen metabolites can be helpful if you’re trying to get the total daily production of the hormones. You can get measurements of estrogen metabolites, which are stable for a long time.
Dr. Alex Jimenez, D.C., presents: You have plenty of time for processing and get both free and conjugated estrogen measurements. So that’s helpful. The bad news, which is true for any 24-hour urine test, is it relies on accurate volume measurements and complete collections by the patients. Many patients will inadvertently screw that up. When they have a busy day, they’ll go pee and need to remember what they are supposed to do, which can be a problem. So, making sure the patient understands can help with the test results. You cannot use this for people with renal dysfunction because it’s based on creatinine correction. So if their creatinine is abnormal, they will need to be able to give you an adequate, appropriate level and sometimes give you some of these tests that do 24-hour urines will provide you with many metabolites that could be more clinically useful but are not.
Dr. Alex Jimenez, D.C., presents: Now for dried spot, you’re in testing, and you can get estrogen metabolites, which is good because the metabolites are stable for a long time, so that’s no problem. And you can measure both the free and conjugated estrogens on these spots in urine tests. The biggest problem here is that it has the least clinical validation studies. So, it’s a newer way of testing. It is popular and easy for patients, but there is little concern because of the few clinical validation studies they’ve done. Now, additional challenges are mentioned: to think about what a lab has to do; the measurements they need to be able to provide can vary enormously because there are very low levels of estrogen in older women, not on hormone replacement therapy.
Dr. Alex Jimenez, D.C., presents: And then up to measuring these super high doses in women getting ready for IVF. And, you know, the levels can vary by 10,000. Is it reasonable to assume that any test will be accurate for all those circumstances? It is also difficult to assess estrogen levels in women treated with aromatase inhibitors because they will likely have very low estrogen concentrations. So that may not be accurately detected by standardized testing. And then specificity is a problem because we talk about how estradiology focuses mostly on how it gets broken down into estrone and then how the estrones get broken down. But the reality is that estradiols convert it to more than a hundred different metabolites, which may interfere with accurate quantification.
Dr. Alex Jimenez, D.C., presents: So, labs must keep that in mind and ensure that they’re getting adequate specificity for you. Another interesting tidbit is that exogenous sources of S-trial can lead to falsely elevated estradiol levels. So keep that in mind if you have a funny test result that makes no sense.
Dr. Alex Jimenez, D.C., presents: Progesterone and progesterone metabolites in the serum; there’s lots of literature to support using a progesterone level drawn hopefully on day 21 of a 28-day cycle to confirm ovulation. Progesterone has problems as it differs from estradiol. So it is acceptable to use serum progesterone levels for that, as the reproducibility of serum levels is limited if the serum levels are low. So if what that means is if you were to take a person in the first half of her cycle and draw a progesterone level three days in a row at the very beginning of the process and the progesterone should be low, you may not get similar numbers just because the hormone levels are low.
Dr. Alex Jimenez, D.C., presents: So the reproducibility makes doctors a little crazy, but that’s something they need to keep in mind with the serum. Again, saliva testing is not invasive; it’s convenient if you want to follow an entire cycle in a premenopausal woman. Also, research shows that a salivary level of 17 alpha hydroxyprogesterone is just as acceptable as a serum level for diagnosing congenital adrenal hyperplasia. Now the downside for progesterone’s metabolites salivary levels of progesterone in its metabolites is that you’ve got a rapid fluctuation of progesterone levels in the saliva. So, if you’ve got somebody who doesn’t wanna get their blood drawn and doesn’t mind spitting into a tube, you can use this instead.
Dr. Alex Jimenez, D.C., presents: So you should use more than one test result to make a decision; you may need serial sampling to get a feel for the average. There’s also a problem with cross-reactivity that might interfere with immunoassays and affect the results. And again, the same problem is having much lower progesterone levels in the saliva than in the serum. So for some labs, that can be challenging to get preliminary analysis and the same problem in terms of contamination by blood; however, that’s true of all cellular tests. The 24-hour urine and the spot dry urine testing for progesterone have the same problem because the progesterone metabolites will correlate with symptoms. So they’ve studied, for instance, allopregnanolone in urine. The level of that does connect with the sleep quality in perimenopausal women.
Dr. Alex Jimenez, D.C., presents: The implication is that if it’s correlating, it’s probably an accurate level; however, progesterone is hard to quantify in urine. And so, they use metabolites for assessment and determine the progesterone level based on the metabolites. That’s great, except there’s no literature describing the clinical utility of progesterone metabolites. So progesterone in the urine is relatively problematic regarding the accuracy and what you are getting. Part of the issue with serum progesterone is that very little of it is available, and non-protein ground, most of it is bound to all and other proteins; it’s the free progesterone that is available to the target tissues and also to saliva. So the progesterone that you’re measuring in the serum is mostly the bound-up progesterone, not what is clinically important.
Dr. Alex Jimenez, D.C., presents: Transdermal progesterone is extremely difficult to measure because anyone gets metabolism by five alpha reductases in the skin. It’s rapidly absorbed by red blood cell membranes and delivered to the tissue. And really, it comes down to that after the patient uses exogenous progesterone cream or gel, they get these crazy high levels of progesterone in the saliva and the capillary beds, but not in the serum. And so there could be a better way to measure what’s happening to the patient. So transdermal progesterone, trying to follow that with any testing is difficult.
Dr. Alex Jimenez, D.C., presents: There are decades of research on serum hormone levels. In serum testing, testosterone, and its metabolites, you can get both a total and a free hormone level test, and you can also get a DHT level, which is helpful. There are established serum ranges for the diagnosis of androgen insufficiency. So serum levels for testosterone are fine in general. It can be difficult to assist the whole serum if the levels are low, like in women and kids and hypogeal men. So, you need to know your lab and its methodology. Suppose you’re assessing testosterone in women, hypogeal men, or kids because they must ensure they’re doing the appropriate serum test to get these really low levels accurately.
Dr. Alex Jimenez, D.C., presents: For saliva testing, it is very convenient to obtain the sample. There are established ranges for diagnosis of antigen insufficiency, and it’s easy to use this testing for differentiating between gonadal and hypogonadal men. And you can get a free hormone level as lots of published research on using salivary levels for assessing testosterone. However, the problem is like with progesterone; you get this rapid fluctuation in saliva. You might need more than one saliva test result to get reliable information. So you don’t necessarily want to decide based on just one result. And again, you need to know your lab because the levels are much lower than in the serum. So it is challenging to get an accurate story and be careful about blood contamination. In urine testing, the 24-hour and spot urine have slightly different issues.
Dr. Alex Jimenez, D.C., presents: The 24-hour urine testing for testosterone can be used to get a total daily testosterone production. Patients will get a free hormone level and metabolites, which is nice. They can use that information to indirectly assess five alpha-reductase and aromatase activities based on how many different metabolites they’re getting. Only a few data support the clinical utility of all the measured metabolites. There is a polymorphism of UGT to B17; if the patient has that, their urinary testosterone level will return to zero, so keep that in mind if you ever get a test result. After all, it’s so low because it may be that your patient has this issue. Now spot urine will give you some of the same pros as you will get free hormone levels and metabolites. This allows you to use that information to assess the five alpha-reductase aromatase activities; however, the problem is there; like with the other hormones we’ve discussed, this testing generally has fewer clinical validation studies because it’s a newer form of testing, so keep that in mind.
Dr. Alex Jimenez, D.C., presents: Cortisol and its metabolites in the serum are similar to the other hormones mentioned, as there are validated reference ranges for cortisol. Lots of peer review literature detailing the use of this test, and patients can feel comfortable getting these results. It will tell them just total cortisol, not their free cortisol. So by keeping that in mind, they’ll get the diurnal pattern. They can only get a four-point test as they would with saliva because they don’t have normal ranges for four different times in the day. And many patients mention to their doctors as they get the serum cortisol, they go, “Wait, you don’t understand. I am so scared of my blood being drawn that it shoots my cortisol up, and I don’t normally look this bad.”
Dr. Alex Jimenez, D.C., presents: Keep in mind that in serum, they only have normal reference ranges for two times of the day, 7 to 9:00 AM and 3 to 5:00 PM. So you have to ensure that if you use serum cortisol, they go in fasting before nine o’clock, or they can go later in the day. And if they go later in the day, they don’t have to fast. So if you get cortisol at 10 or 11 in the morning, it isn’t very helpful to the results. Now the salivary testing, lots of people are becoming familiar with this.
Dr. Alex Jimenez, D.C., presents: You can get your diurnal pattern because many companies have kits where you’ve got four or five samples throughout the day. There is abundant peer-reviewed literature detailing the use of this. And this is for cortisol, not for the cortisol metabolic. It reflects the unbound plasma concentration, which is not what we’re seeing with the serum. The problem is that 11 beta hydroxy steroid dehydrogenase is an enzyme in the salivary glands that significantly converts cortisol to cortisone. So there are some questions about the results doctors are getting in the salivary cortisol and what’s happening or did it get converted to cortisone, and you’re not picking that up in the test?
Dr. Alex Jimenez, D.C., presents: So when looking at cortisol metabolites in the saliva, which some companies do and some don’t, the salivary cortisone correlates with cortisol exposure over 24 hours. There’s a moderate level of literature using this test but enough that you should feel comfortable. There are issues when your serum cortisol is really low, making it seem like the patient is crashing or under hydrocortisone therapy. That makes the salivary cortisone a superior serum marker compared to the salivary cortisol. Under these circumstances, because of how this is being processed, only a few companies are even looking at cortisone directly in the saliva. So at this point, because especially of the moderate literature level, you will primarily be doing cortisol levels in the saliva.
Urine Testing For Hormones
Dr. Alex Jimenez, D.C., presents: So let’s move on to the urine test. Now, in a 24-hour urine test, you can assess the cortisol ratio, which can be helpful when diagnosing. And 24-hour free cortisol correlates with the serum-free cortisol level; however, the only problem is there are limited clinical validation studies for this. And, in the 24-hour urine test, you’re not getting a diurnal cortisol pattern. And, in the spot urine, you can get the cortisol ratio, which can be helpful. You can have the patient do the spot urine test multiple times a day so you can get the diurnal change just like you would with saliva. But unfortunately, the spot you’re in testing has the least clinical validation studies. So you have to keep that in mind. So with this, primarily, people feel most comfortable with using either serum levels done at the right time of day, understanding that you’re not getting the unbound cortisol, or they’re doing a four-point salivary test.
Dr. Alex Jimenez, D.C., presents: The four-point salivary test could see a pattern between what the patient told their doctors about their energy level throughout the day and how they felt and compared that with what the result returned. Many doctors note what they had expected the test result to be before the national labs even had it available.
Dr. Alex Jimenez, D.C., presents: We will discuss DHEA and DHEA sulfates separately since DHEA in the serum has many clinical validation studies that can make you feel comfortable getting adequate results. Now, DHEA has a diurnal pattern. So you have to ensure they get it done at the right time of day since this is fasting before nine o’clock in the morning, just like with cortisol. A DHEA done later in the day means nothing; however, a DHEA sulfate in the serum doesn’t follow a circadian pattern, so a single test done at any time is okay.
Dr. Alex Jimenez, D.C., presents: There are numerous clinical validation studies about DHEA; unfortunately, there is a problem with DHEA sulfate since it has a little circadian pattern. You may miss small variations in a DHEA over time in a person based on how they’re feeling and stressed out. So occasionally, it’s nice to check the DHEA in a patient as long as they’re done in the morning because then you’ll get a feel for the changes over time in the same individual you wouldn’t see with the DHEA sulfate.
Dr. Alex Jimenez, D.C., presents: Salivary testing for DHEA is where you measure free DHEA in the body, which is great. There’s a correlation with serum levels, and it’s not invasive. The problem is that the concentration is inversely related to the salivary flow rate and is also affected by the salivary pH. An example would be someone walking past the bakery, starting to salivate heavily based on what they just smelled. This could change their results for their salivation rate when they are doing their DHEA test. DHEA sulfate has the same basic problem in the saliva, related to the salivary flow rate and the salivary pH. So keep that in mind if you’re looking at salivary levels in urine, whether this is 24-hour or spot urine; there are no clinical validation studies about looking at either DHEA or DHEA sulfate in the urine. So, keep that in mind if you’re doing urine testing and they’re giving you a whole panel that includes DHEA or DHEA sulfate, you may need to know what those results mean.
Dr. Alex Jimenez, D.C., presents: For pituitary hormones, the preferred testing is the FSH, LH, and prolactin serum. Not convenient for serial measurements throughout the day to detect the LH surge, for instance, but the results are very accurate. And in saliva, there’s limited peer-reviewed literature detailing salivary pituitary hormones and whether or not they’re adequate. LH detection kits at home are convenient for urine tests since they are widely used and have been around for a long time. The LH surge correlates with the urine and works well with the LH surge’s serum. So if you’re trying to help people figure out where they are in their cycle and whether or not they’ve ovulated, this test is the way to go. It doesn’t do a good job of quantifying it; it just tells you there’s a surge because these are bigger hormones, so they don’t get into urine very easily.
Dr. Alex Jimenez, D.C., presents: So you’re going to know whether or not you’ve gotten the surge, you’re not going to know what the actual level is, and that’s okay because most of the time, it doesn’t matter what the hormone level is. So essentially, unless you’re just trying to find out if they got an LH surge, you want to use the serum for either FSH, LH, or prolactin. For sex hormone-binding globulin, most clinical validation studies are in the serum; you can’t measure it in saliva or urine, so that’s easy to remember. So we’ve already talked about the issues with different forms of testing, and there are only a few forms of testing that will give you everything you need to know about every hormone you need to know.
When Is The Best Time For Hormones?
Dr. Alex Jimenez, D.C., presents: So now, when is the best time to test hormones? Early morning is when the hormones will be the highest for most hormones. So, the best way to go and test hormone levels like cortisol and gonadal hormones is first thing in the morning since you have to be consistent and fast because what you’ve eaten can change hormone levels. So if you’ve always fasting, at least you’ll find consistency between specimens and the same person. You also need to know where they were in their cycle for certain tests. So, women patients who are still cycling need to record the first day of their next period to know what day you did their testing. Otherwise, they’ll have to use ovulation kits to know exactly where they are.
Dr. Alex Jimenez, D.C., presents: And of course, the downside here is that if you’re trying, for instance, to get a day-21 progesterone, and she typically has a 28-day cycle, so you tell her to go on day 21, but that particular month she has a 35-day cycle, you didn’t get the level that you were looking for. So it can be a little problematic, but remind them to keep track of it so that you won’t be able to look back and know where they were when they had their tests done. So, when do we want these tests in pre and perimenopausal women? Suppose you want progesterone on day 21. You can also do a sex hormone-binding globulin on that day. Menstruating women shoot for as close to day three for estradiol, estrone, FSH, testosterone, or a sex hormone-binding globulin.
Dr. Alex Jimenez, D.C., presents: Now, even though these are ideal, can you get them on other days of their cycle? Yes, but they will have different accuracy. And, of course, it may be an additional day than day three because what if day three happens to land on the weekend and the lab’s not open? So, please consider that what you are looking for here is to test the hormone levels when they’re at their highest. And that’s why we’re shooting for three and 21. So, you know, here’s day three and four. And so the FSH is going to be a nice level here. The estradiol bounces around a lot at this point, so trying to get it in this part of the cycle would be less helpful. And, with progesterone, you’re going to get your peak here, so that’s why you want to try to shoot for 21 days because you know that’s going to be the easiest way to ensure you’re getting it. And also, it’ll help you be more consistent from cycle to cycle if you’re always trying to get it at the same time of the process.
Hormone Replacement Therapy
Dr. Alex Jimenez, D.C., presents: Now here’s where it gets tricky since it’s one thing to find out where the person is before you put them in any hormone replacement therapy; however, monitoring hormone replacement therapy gets more problematic still. If you’re using oral estrogen, it is recommended to get a serum baseline before HRT and then monitor during treatment; if you’re doing oral estrogen, the salivary levels don’t reflect the exogenous estrogen use at all, so they’re not very helpful.
Dr. Alex Jimenez, D.C., presents: And oral estrogen or any hormones that undergo this test must accurately reflect the liver’s first-pass metabolism and the urines’ levels. So if you’re doing oral estrogen replacement therapy, the only way to assess it is with serum because doctors will convince the patient with the module, so you probably don’t want to use oral estrogen anyway. If you’re using sublingual estrogen, the levels will rise and fall rapidly within hours. And so the serum’s not effective in terms of measuring. The saliva will make no sense if you’re doing sublingual because you just had your estrogen there. So what does it mean? It means that 24-hour urine and drive urine testing with sublingual hormones aren’t recommended because there’s always a question of how much you are swallowing and how much is getting absorbed sublingually.
Dr. Alex Jimenez, D.C., presents: Now, if you notice that it says in sublingual, there could be better testing methods. Since you don’t know how much was swallowed and got the first-pass metabolism effect, the result in a 24-hour or dried spot urine may need to be clarified. So that’s problematic. You can still do sublingual estrogen replacement therapy; it just means there’s no great way to test it. If you’re using estrogen creams, serum testing can be effective, and we know that clinical parameters correlate to serum levels when using estrogen creams, so we can do that. In saliva, estradiol and estriol are actively transported into the saliva; the levels are way higher than you would see in the serum and are highly variable. So salivary levels for creams don’t make sense, and there are no good peer-reviewed studies detailing the effective estrogen cream on urinary levels.
Using Hormone Creams & Patches
Dr. Alex Jimenez, D.C., presents: It is probably not a great idea to use urine levels for someone using estrogen creams at the time. If you’re using labial or vaginal estrogen, the serum test appears to be the best choice for monitoring absorption. The salivary levels don’t reflect any dose changes. So basically, it’s probably a waste of time to get a salivary level trying to do urine testing; using vaginal or labial estrogen might be problematic because how do you know you didn’t contaminate the urine specimen. And if you’re using a patch, serum values will rise dose-dependently and then rapidly decline the following removal. It may be helpful, we know that the serum values change based on when you put the patch on and when you take it off, but it is still problematic.
Dr. Alex Jimenez, D.C., presents: There’s no peer-reviewed evidence showing that salivary estrogen can be used to monitor the estrogen patch. And when it comes to the urine testing and the estrogen patch, it does appear that the values in the urine will go up dose-dependently. It may be relatively accurate, but it’s not the best clinically validated test for an estrogen patch. The take-home message here is that no testing is perfect and many of us adjust the dose to the lowest amount, the lowest level we can get, and still have our symptoms controlled. That doesn’t mean they don’t test; you must try to ensure you’re not overdosing on this person. But keep in mind that there are a lot of limitations around what testing can be helpful depending on what form of estrogen replacement you’re using.
Dr. Alex Jimenez, D.C., presents: Now, progesterone and oral progesterone, if you’re using that, the levels rise and fall quickly. You may not be able to catch a serum level that makes sense if you’re taking your progesterone in the evening and then measuring in the morning. Because most women, if they’re taking oral progesterone, will take it in the evening because it helps them sleep. There’s also a problem with the cross-reactivity of metabolites with the immunoassays. So progesterone replacement therapy, if oral, you must take the serum levels with a grain of salt. The same thing with saliva and 24-hour urine testing. We talked about how you’re not getting progesterone; you’re getting progesterone metabolites, so that might be useful. But there’s the problem of how clinically valid the use of progesterone metabolites is. So oral use of progesterone, getting a level, and following it is a little tricky.
Dr. Alex Jimenez, D.C., presents: Now with creams and transdermal progesterone, none of the tests makes any sense because you get mentally increased levels in the serum that don’t rise in any particular way that makes sense. Like all steroid hormones, these are fat-soluble, so if it goes and sits in adipose rather than getting into the bloodstream, it doesn’t necessarily reflect a serum level. Doesn’t necessarily reflect the tissue levels in the uterus and the breast, which is where we care about it. So a serum level for progesterone cream is problematic. Salivary levels after progesterone cream go way up and don’t correspond to symptoms at all. So don’t bother getting salivary level after a progesterone cream. There’s some evidence in urine testing that you can get small increases in the pregnant dial three glucosides if you use progesterone cream. And so it may turn out that we can use that as a measure of what your progesterone is doing.
Dr. Alex Jimenez, D.C., presents: But this still needs some more testing. So it would be best if you remembered that there needs to be a reliable method to track what’s happening when a person uses progesterone cream. So please take your time with getting a level and making a decision based on it. Now, vaginal progesterone suppositories have the same problem. You get minimally increased levels in the serum, which will not give you an adequate result. Progesterone melts or atrocious; you can use serum levels in at troche because you get a more accurate level in the serum than if you had taken it orally. There’s a lack of peer-reviewed research on salivary levels after vaginal progesterone suppositories. And you have to be careful if you’re trying to do urine testing because how do you know you didn’t contaminate the sample?
Dr. Alex Jimenez, D.C., presents: You can’t use a salivary level because you just had the troche or the melt in the person’s mouth. And then, there is at least a potential problem with getting a urine level for a troche or melt because, like a sublingual, how much of this are you swallowing? Individuals may consume some of it and are subject to first-pass metabolism, which means you won’t be able to pick it up in the urine. The larger portion will be absorbed into the capillary blood and probably be accurate in the 24-hour or dry urine test. But that needs to be adequately studied, so keep that in mind if you’re using atrocious or melts. And this is a study that showed that after applying topical progesterone, the saliva and the capillary blood levels were very different compared to those seen in the serum or whole blood.
It’s Important To Do Research
Dr. Alex Jimenez, D.C., presents: So this is just an important research study to remind you of the reliance on serum levels for progesterone. If you’re monitoring, topical dosing can lead to underestimated tissue levels, so you’ll give more than you need. So, be careful about relying on serum levels for topical progesterone because you’re going to overdose people like crazy. And remember, if you overdose on progesterone, it’s high up in the steroid hormone pathway, and you don’t know what this person’s body will do with it; they might turn it into pretty much anything else. Now, testosterone replacement therapy creams or gels can cause blood levels, and the serum level rapidly increases with the application and doesn’t reliably reflect dose changing, any dose changes. So the serum and blood levels are probably not the great way to go. In the saliva, the levels are much higher than the serum and are highly variable since they may give a false indication of overdose.
Dr. Alex Jimenez, D.C., presents: In the urine testing, there’s not good in the 24-hour urine. You probably want to use something other than 24-hour urine. The good news is the dried urine. Now in dried urine, the epitestosterone can be measured if there’s going to be suppression due to exogenous testosterone production if that’s what you think is going on. You can measure the epitestosterone in dry urine testing, which will tell you whether or not, you’ve suppressed this person’s production of testosterone by giving them some. Now, vaginal or labial application of testosterone, there’s no good way to get a blood level that makes sense. The salivary levels, like any other cream or application we might have on your hands, you have to be careful because if you’re handling the specimen vials, to get the saliva, you might get it into the testing medium.
Dr. Alex Jimenez, D.C., presents: And then, just like any vaginal or labial application, if you’re trying to get urine specimens, you have to be careful that you’re not contaminating the urine and getting a falsely elevated level. Blood levels are good if you’re doing testosterone injections, either injection or pellet. Get one-third baseline, and use them for monitoring. It gives you adequate levels. You’ll get a significant elevation in saliva after an IM injection, but there’s wide variability from person to person. So you must take that with a grain of salt regarding how accurate your result might be. The same thing happens in the 24-hour urine specimen. You’re going to get an elevation after an IM injection, but then, there’s a great deal of variability, so who knows how accurate it is?
Dr. Alex Jimenez, D.C., presents: With a salivary level, there’s only some correlation to the bioavailable testosterone. If you’re using a testosterone patch, you can get adequate levels, and there are good studies to show that a blood level will be okay. If you’re using a testosterone patch, the urinary levels, both in 24-hour urine and dry urinary levels, will reflect the increasing doses. You’re getting a reasonably good level with using that. Now, if you’re using DHEA treatment or oral DHEA, you’re going to get a rapid increase in the blood levels right after the oral supplementation as you get with the saliva. You get that also in saliva and also in urine. So you’re picking up on the fact that you took the DHEA test.
Dr. Alex Jimenez, D.C., presents: The problem is variability in the blood, saliva, and urine results. Many don’t particularly appreciate using a lot of oral DHEA anyway because, like all steroid hormones, your body’s going to take it to the liver, and the liver has the opportunity to change it into something else before it even gets into the bloodstream to do its job. Other applications may be more helpful, like transdermal DHEA or topical DHEA; you’ll have to see how the patient feels in terms of symptoms because if you use topical DHEA, the blood levels you’ll get a big rise right after the initial application.
Dr. Alex Jimenez, D.C., presents: So what does that mean because it drops right away? Then, in the saliva after transdermal application of DHEA, the levels will increase, but not linearly. So that doesn’t make any sense. And there is no peer-reviewed research detailing what happens in DHEA levels in the urine after transdermal application. The bigger issue then becomes you might want to keep an eye on what the downstream breakdown products are doing because if you’re not able to get a good DHEA level, you might want at least look at testosterone and estradiol. And that’ll give you some fuel if you’ve overdosed or underdosed on the DHEA. Now, with the vaginal or labial application, the levels in the blood don’t go off at all.
Dr. Alex Jimenez, D.C., presents: There’s no research detailing levels after vaginal application looking at salivary or urinary levels. So you can’t use that as a way of monitoring it. So again, this will be just a matter of following the person and how they feel after using it. You’re not going to need to worry about getting any measurements afterward. It’s simply clinical. The test you choose depends on what you’re giving the person, the form you’re giving it in, and then what you’re trying to find out. By finding a treatment form you like and feel comfortable with, understand whether or not to get testing depending on the structure and replacement you’re using. And then, make sure that you are getting helpful information and not misleading information.
The 0blique muscles support and aid in side-to-side movement, helping maintain back strength and healthy posture. There are two oblique muscle sets, the internal and external obliques. Maintaining a strong core is one recommended way to protect the body and spine. However, many forget to train and strengthen all of the oblique muscles. Individuals tend to focus on the superficial core muscle, or rectus abdominis, and not enough or any attention goes to the lateral stabilizers or the internal and external obliques. Chiropractic and functional medicine can restore musculoskeletal flexibility, mobility, and function.
The external obliques make up a large part of the trunk area. There are two external obliques on either side of the body, located on the lateral sides of the abdominal region. These muscles have an essential role in daily movements.
External obliques help with trunk rotation and support spine rotation.
They assist with pulling the chest down to compress the abdominal cavity.
They help with bending from side to side.
Any strain or injury to these muscles can lead to abdominal, hip, and back issues.
Maximizing external oblique strength is important to maintain a strong core.
The internal oblique is a muscle deep within the lateral side of the abdomen.
The internal oblique muscle is one of the main stabilizers and functions to flex the trunk and compress the chest.
Its positioning makes it invisible, but it still has an essential role in body movement.
This muscle can function bilaterally, meaning both sides can operate at the same time.
These muscles provide spinal and posture support.
Strain or injury in this area can cause posture problems and abdominal, hip, and back issues.
Rotation and Mobility
The internal and external obliques are the primary rotators of the spine and provide thoracic spine mobility.
Whiplash is a neck injury where, because loads and displacements develop in the neck, they have become the main interest in the study of whiplash injury mechanisms. Human subject studies, however, have only reported the peak speed of the head relative to a fixed reference frame.
Since head acceleration is often the result of the head-restraint impact, these peak values might be conducive to whiplash injury and do not reflect loads developed in the tissues of the neck. The kinematics of the head have been computed relative to the axis between the C7-T1 vertebra to supply a better indication of the dynamics. The first peak in the acceleration trace results from the torso’s acceleration relative to the still-stationary head.
This peak is the larger and later acceleration peak, governed by the impact between the head restraint and the head. When head acceleration is measured, a result that highlights the importance of quantifying the head’s relative rather than absolute dynamics, the first negative peak isn’t observed.
Cause of Whiplash Injuries
Cadaveric, animal and human subject experiments have led investigators to propose various anatomical sites for whiplash injury, including the cervical facet joints, facet capsular ligaments, vertebral arteries, dorsal root ganglia, craniovertebral junction, and cervical muscles. Muscle injury could be responsible for some symptoms in patients; however, of the anatomical sites listed above, only the facet joints have been linked to chronic whiplash pain. The facet joints have become the focus of research directed at understanding the mechanical basis for chronic whiplash injuries.
In a study conducted by researchers and colleagues (1996), chronic whiplash pain was relieved in about 60% of whiplash patients by anesthetizing medial branches of the cervical dorsal rami. Articular branches from these nerves run through the capsular tissues and presumably originate in the capsular tissue from mechanoreceptors and nociceptors. Possible injury sites inside the facet joints include fractures of the bony elements, bruising of the rectal folds (menisci), or ruptures or tears of the capsular ligament. Skeletal fractures and aspect hemarthroses are not commonly observed in whiplash patients and are therefore related to loading. Bruising of the folds is common after fatal chest or head injury, and motions of the cervical vertebra consistent with this type of injury have been documented during the severe loading associated with whiplash injury in human subjects.
Cineradiography used to inspect the intervertebral motion of subjects exposed to simulated influences has shown that the C5 vertebra rotates about a stage than during voluntary expansion moves. This movement pattern resulted in compression of the facet joints posteriorly through impact-induced motion during activity and increased distraction of the vertebral bodies anteriorly. These researchers proposed that the posterior synovial fold might be pinched by rear compression of the facet joints though this altered motion was detected in only four of six subjects. This proposed mechanism of injury is promising. Follow-up research that quantifies the loads applied to the meniscus during whiplash exposures and the loads necessary to injure the meniscus is needed to confirm whether this proposed injury mechanism occurs at the loads generated during collisions that produce a whiplash injury.
The facet joint capsules contain fine, unmyelinated nerves that likely have a nociceptive function. Distending these ligaments by injection of contrast media has generated whiplash-like pain patterns in normal individuals. Tears or ruptures to the cervical facet joint capsular ligaments have also been observed under severe loading conditions. Excess capsular ligament strain was proposed as a mechanism for whiplash injury under minor- to moderate-loading requirements. With subsequent loading to failure, the technology strain in the capsular ligaments under both whiplash-like heaps and cadaveric motion sections has recently been quantified. Maximum strains in the facet joint capsular ligaments under loads were, on average, half. In two of the 13 specimens, the top songs observed in the ligament under whiplash-like heaps were larger than those detected in their initial failure.
This finding suggested that the neck loads developed during an automobile accident could injure some individuals’ facet capsular ligaments. Further work is needed to determine if these ruptures generate pain and whether the subcatastrophic failures identified with breaks inside the capsular ligaments in the response of the tissues correlate.
Whiplash injury has proved difficult to research because its pathoanatomy has remained poorly understood. The facet joints have been isolated as a site of chronic pain in many populations.
A better understanding of the etiology of whiplash injury will lead to improved care and injury prevention methods. Human subject testing has provided the essential kinematic and kinetic response information needed to conduct tests of those cells, and tissue evaluations have led to a possible mechanical explanation for whiplash injury. Additional research is required to complete the connection between the whiplash symptoms experienced by some people and an automobile accident.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please ask Dr. Jimenez or contact us at 915-850-0900.
By Dr. Alex Jimenez
Additional Topics: Automobile Accident Injuries
Whiplash, among other automobile accident injuries, is frequently reported by victims of an auto collision, regardless of the severity and grade of the accident. Whiplash is generally the result of an abrupt, back-and-forth jolt of the head and neck in any direction. The sheer force of an impact can cause damage or injury to the cervical spine and the rest of the spine. Fortunately, a variety of treatments are available to treat automobile accident injuries.
Sports Chiropractor: To figure out what these professionals dont want you to do before making an appointment, Runners World asked two chiropractors who specialize in running about what common training flaws are leading to patients ending up in their offices over and over again.
The nurse recommends going to a run specialty store and having someone watch your gait outside or on the treadmill. This will allow someone at the store to find a range of shoes that might work best for your specific running/walking mechanics. (You can find a nearby running store by checking out our Store Finder.) From there, you can go by what feels the best when running.
The nurse said he also asked his patients if there had been a change in running shoes from one style to another. For example, switching to a zero-drop shoe from a normal shoe, without easing into them, may increase your risk of injury. Like a fitter at a running store, a sports chiropractor like a Nurse may even look at your running gait in the office to diagnose imbalances in your foot’s motion mechanics.
The whole biomechanics starts in your foot, Nurse said. We all have different foot strikes. If it hits the ground in a certain way, the shoe has to support that. If you are a forefoot striker, rearfoot striker, overpronator, or under pronator, all of those foot strikes can lend themselves to various running injuries.
DONT Do Static Stretching Before A Run
Holding a static stretch for longer than 10 seconds can take away from your explosive muscular power before a run, according to Derek Vinge, D.C. at Fit Chiropractic & Sports Therapy in Courtenay, British Columbia. One study even showed that stretching cold muscles before a tough 3K left individuals starting their runs slower and at a greater perceived effort. And when your muscles aren’t signaling properly, it can lead to small injuries turning into larger problems over time.
You are better off with a series of dynamic stretches like lunges and squats to get the blood flowing in the body. (This 2-minute warmup should do the trick.) The benefits will be noticeable if you add five to 10 minutes of dynamic stretching before hitting the roads or trails.
If you do some activation and dynamic warmups, you will be a stronger, faster runner. I also forget to do a busy stretch, and I think maybe it is a time thing where you tell yourself I’ll do this later. I’ll deal with it later, Vinge said.
DONT Overdo It On Foam Rollers
Foam rolling and other ways to work out a knot or refresh your legs can be a good thing in moderation. But less sometimes is more, according to Nurses.
I see a lot of people who tend to go overboard on that, Nurse said. They do so much foam rolling on their IT band and quads and are even more in pain. It’s more like a finesse, where you are trying to get blood flow into the area, but you aren’t trying to beat up the room so badly that you are causing more damage.
Stop if you’re working out on a foam roller and something continues to hurt or gets worse. Overdoing a problem spot may inflame it more. If you’re feeling relatively good, the Nurse suggests doing light work on the foam roller after a run to hit any problem areas for one to two minutes.
DONT Clam Up When You Get Into The Office
It would be best if you didn’t arrive at an office visit with pages and notes from WebMD. But you shouldn’t be silent and think a sports chiropractor has all the answers just by looking at you.
Going into an appointment, think about what has been consistently driving you crazy on a stiff run neck, a cranky left ankles that will allow a dog to focus on what’s bothering you.
Runners know their bodies a lot better than a lot of people, Nurse said. As we run, we are constantly checking in on different body parts, and people can recognize what is wrong, and they can tell if their gait is altered and what is hanging them up. The information I get from my patients helps me a lot.
DONT Forget To See Someone If You Need It & Listen To Your Sports Chiropractor
With training goals and miles to complete, runners often dont admit when there is something wrong. It’s almost a badge of honor to stay off the table for long periods.
But Vinge thinks there’s more to what he does than fixing injuries. Once an underlying issue is taken care of, you can teach your body to perform at a higher level than you thought was possible.
After they start to get better, then we can work on other issues to get some more performance out of them, said Vinge. If you’ve never been looked at, you have no idea what’s going wrong.
Studies on the effectiveness of chiropractic care for patients afflicted with pain secondary to whiplash injury are emerging. In 1996, Woodward et al. published a study on the efficacy of chiropractic treatment of whiplash injuries.
In 1994, Gargan and Bannister published a paper on the recovery rate of patients and found that when patients were still symptomatic after three months, there was almost a 90% chance they would remain injured. The study’s authors were from the Department of Orthopedic Surgery in Bristol, England. No conventional treatment was shown to be effective in these based chronic whiplash injury patients. However, high success rates have been found by whiplash injury patients through chiropractic care in recovering these types of patients.
Whiplash Treatment Study Results
In the Woodward study, 93 percent of the 28 patients studied retrospectively were found to have a statistically significant improvement following chiropractic care. Chiropractic care in this study consisted of PNF, spinal manipulation, and cryotherapy. Most of the 28 patients had prior therapy with NSAIDs collars and physiotherapy. The average length of time before when the patients began chiropractic care was 15.5 months post-MVA (range of 3-44 months).
This study documented what most DCs experience in clinical practice: chiropractic care is effective for individuals hurt in a motor vehicle accident. Symptoms ranging from headaches to back pain, neck pain, interscapular pain, and extremity pain related to paresthesias all responded to quality chiropractic care.
Normal & Whiplash X-Rays
Whiplash MRI Findings
The literature has also suggested cervical disc injuries aren’t uncommon after a whiplash injury. In a study published on chiropractic care for disk herniations, it was demonstrated that patients improve clinically and that repeated MRI imaging often shows decreased size or resolution of the disk herniation. Of the 28 patients studied and followed, many had disc herniations that reacted well to chiropractic care.
In a recent retrospective study by Khan et al., published in the Journal of Orthopedic Medicine, on whiplash-injured patients concerning cervical pain and dysfunction, patients were stratified into groups based on levels of a good outcome to chiropractic care:
Group I: Patients with neck pain only and restricted neck ROM. Patients had a “coat hangar” distribution of pain with no neurologic deficits; 72 percent had a fantastic outcome.
Group II: Patients with neurological symptoms or signs and limited spinal ROM. Patients had numbness, tingling, and paresthesias in the extremity.
Group III: Patients had severe neck pain with full neck ROM and bizarre pain distributions from the extremities. These patients often described chest pain, nausea, vomiting, blackouts, and dysfunction.
The results of the study showed that in class I, 36/50 patients (72%) reacted well to chiropractic care: in group II, 30/32 patients (94 percent) responded well to chiropractic care; and in group III, only 3/11 instances (27%) responded well to chiropractic care. There was a significant difference in outcomes between the three groups.
This study provides new evidence that chiropractic care is effective for whiplash-injured patients. However, the study didn’t consider patients with back injuries, extremity injuries, and TMJ injuries. It did not identify which patients had disc injuries, radiculopathy, and concussive brain injury (most likely group III patients). These types of patients respond better to a model of chiropractic care in combination with multidisciplinary providers.
These studies show what most DCs have already experienced, that the doctor of chiropractic should be the principal care provider in these cases. It’s a common opinion that in cases like group III patients, care should be multidisciplinary to achieve the best possible outcome in difficult scenarios.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please ask Dr. Jimenez or contact us at 915-850-0900.By Dr. Alex Jimenez
Additional Topics: Automobile Accident Injuries
Whiplash, among other automobile accident injuries, is frequently reported by victims of an auto collision, regardless of the severity and grade of the accident. Whiplash is generally the result of an abrupt, back-and-forth jolt of the head and neck in any direction. The sheer force of an impact can cause damage or injury to the cervical spine and the rest of the spine. Fortunately, a variety of treatments are available to treat automobile accident injuries.
After a car accident, you may notice neck pain. It could be a slight soreness you think is nothing but take care of. More than likely, you have whiplash. And that little soreness can turn into a lifetime of chronic neck pain if only treated with pain meds and not treated at the source.
Whiplash trauma, aka neck sprain or neck strain, is an injury to the soft tissues around the neck.
Whiplash can be described as a sudden extension or backward movement of the neck and flexion or forward movement of the neck.
Some people will tell you that whiplash is a made-up injury that people use to get more money in a settlement stemming from an accident. They do not believe it is possible in a low-speed rear-end accident and see it as a legitimate injury claim, mainly because there are no visible marks.
Some insurance experts claim that about a third of whiplash cases are fraudulent, leaving two-thirds of the cases legitimate. Much research also supports the claim that low-speed accidents can indeed cause whiplash, which is very real. Some patients suffer from pain and immobility for the rest of their lives.
Chiropractors will use different techniques to relieve the pain of whiplash and help with healing.
Chiropractic Adjustment The chiropractor performs spinal manipulation to move the joints into alignment gently. This will help to align the body to relieve pain and encourage healing.
Muscle Stimulation and Relaxation This involves stretching the affected muscles, relieving tension, and helping them relax. Finger pressure techniques may also be combined with trying to alleviate pain.
McKenzie Exercises These exercises help with disc derangement that whiplash causes. They are first performed in the chiropractor’s office, but the patient can be taught how to do them at home. This helps the patient have some degree of control over their healing.
Each whiplash case is different. A chiropractor will evaluate the patient and determine the appropriate treatment case-by-case basis. The chiropractor will determine the best course of treatment that will relieve your pain and restore your mobility and flexibility.
The calves are extremely important to the lower portions of the legs as they allow the individual to move around and help stabilize the entire body. The calves have two muscles: the gastrocnemius and the soleus, which provide plantarflexion and stability at the ankle joint. These two muscles work together to ensure that the upper body’s weight doesn’t lean forward too much to let the individual fall. However, when many people overuse the calf muscles constantly, it can cause the muscle fibers in the lower legs to be overstretched and develop small nodules known as trigger points to cause referred pain to the calves and the ankles that can affect a person’s ability to walk, run, or jump. Today’s article looks at the soleus muscle, how trigger points affect the muscle, and different methods to reduce pain while managing trigger points along the calves. We refer patients to certified providers that incorporate various techniques in the lower body extremities, like lower leg and calve pain therapies correlating to trigger points, to aid many people dealing with pain symptoms along the soleus muscles, causing muscle cramps and issues along the ankles. We encourage and appreciate each patient by referring them to associated medical providers based on their diagnosis when it is appropriate. We understand that education is an excellent way when asking our providers intricated questions at the patient’s request and understanding. Dr. Alex Jimenez, D.C., only utilizes this information as an educational service. Disclaimer
Do you feel a cramping sensation in your calves? Do your feet hurt when you are walking, jumping, or running? Or are you experiencing tightness in your calve muscles? When a person is experiencing calf pain in their legs, it could be trigger points causing overlapping issues in the soleus muscles. As stated earlier, the calves have two muscles: the gastrocnemius and the soleus. The gastrocnemius makes up the round shape of the calves and is a complex, superficial muscle. At the same time, the soleus is a large, flat muscle deep within the gastrocnemius and forms the calcaneal tendon (Achilles tendon), which can be mistaken as a nerve for the ankle. Studies reveal that the soleus muscle works together with the gastrocnemius, and these muscles constitute a plantar flexor. The soleus is part of a group of muscles known as antigravity muscles. It acts like a skeletal muscle and helps maintain good posture in the body to prevent the sheer body weight from falling forwards at the ankle when standing.
How Do Trigger Points Affect The Soleus Muscle?
The calves are essential for the movement and mobility functions of the body. When the calve muscles have been overused to repetitive movements or have been dealing with trauma, it can cause the muscle fibers to tear and develop trigger points along the calves causing referred pain to travel down the ankles. Trigger points along the soleus muscle are tricky to diagnose since they cause referred pain to the surrounding muscles. “Myofascial Pain and Dysfunction,” written by Dr. Janet G. Travell, M.D., mention that, unlike the latent trigger points that can affect the gastrocnemius, active trigger points can affect the soleus muscle and cause tenderness referred to the heel. When muscle tenderness affects the heels, it can cause trigger points to mimic chronic conditions like plantar fasciitis. Additional studies reveal that musculoskeletal impairments like trigger points in the soleus muscle could potentially lead to biomechanical changes in the ankle. When trigger points cause hypersensitivity spots in the skeletal muscle taut band, it can restrict the soleus muscle to allow ankle dorsiflexion. Individuals with active soleus trigger points are prone to develop low back pain due to ankle dorsiflexion restriction, leading to them leaning over and lifting objects improperly.
Trigger Point Of The Week: Soleus – Video
Have you been dealing with pain traveling down from your calves to your ankles? Experiencing stiffness around your ankles? Or do you feel like you are about to fall? These pain-like issues are associated with trigger points along the soleus muscles along the calves. The soleus is one of the two muscles (the other is the gastrocnemius) that make up the calves and acts as a skeletal muscle to help maintain good posture in the body. When trigger points affect the soleus muscle, they can cause referred pain to the calves and mimic chronic issues like plantar fasciitis at the ankles. The video above explains where the soleus muscles are located, deep within the gastrocnemius, where the trigger points are causing referred pain to the ankles, and where they are in the soleus muscle fibers in the calves. Even though trigger points can cause referred pain in the affected muscle fibers of the body, they are treatable and can be managed through different methods to help the calves.
Different Methods To Reduce Pain And Manage Trigger Points In The Calves
Even though trigger points can affect the soleus muscles and cause referred pain to the ankles, different methods can reduce the pain and help manage trigger points in the calves. Studies reveal that when there are multitudes of therapies that can help manage trigger points, it can help reduce the pain affecting the soleus muscle by optimizing muscle function and preventing the development of chronic pain syndromes. Besides therapies that target trigger points, corrective actions and stretches can help release the pain from the soleus muscle. Incorporating calf stretches, having a correct posture when sitting down, wearing long loose socks while sleeping, and wearing low heels can prevent the soleus muscle from shortening and help manage trigger points from re-occurring in the calves. When people start to take care of their calve muscles, it can help their mobility and stability at the ankles.
As part of the calf muscles and an antigravity muscle, the soleus works with the gastrocnemius to help with stability and plantarflexion to the ankles. This muscle is deep within the gastrocnemius and helps maintain good posture in the body that prevents a person from falling forward at the ankles when standing. When the soleus muscles have been overused, they can develop tiny knots in the muscle fibers known as trigger points that can cause referred pain to the ankles. Trigger points along the soleus muscles can cause overlapping features in the calves by restricting ankle dorsiflexion, causing individuals to develop low back pain associated with leaning forward. However, various therapies can manage trigger points through multiple treatments that can reduce the pain and allow stability back to the calves, enabling the individual to continue walking without feeling pain.
Binstead, Justin T, et al. “Anatomy, Bony Pelvis and Lower Limb, Calf – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 29 May 2022, www.ncbi.nlm.nih.gov/books/NBK459362/.
Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.
Valera-Calero, Juan Antonio, et al. “Prediction Model of Soleus Muscle Depth Based on Anthropometric Features: Potential Applications for Dry Needling.” Diagnostics (Basel, Switzerland), U.S. National Library of Medicine, 7 May 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7277950/.
Various muscles help support the lower legs in the body and allow movement to the host. The lower extremities include the hips, pelvis, thighs, legs, knees, and feet. At the same time, the various muscles help provide support and stability to the upper body’s weight and incorporate mobility and movement for the entire body to go from one location to another. The legs have two sections connected with the knees; the upper portion has the hips and thigh muscles, while the lower legs have the calve muscles, shin muscles, and the Achilles tendon. The calve muscles have two groups of muscles, and when the calve intense exercises, or normal factors have overused muscles may potentially lead to muscle cramps associated with trigger points. Today’s article examines one of the calve muscles known as the gastrocnemius, how the calves are affected by trigger points and corrective actions to prevent muscle cramps in the calves. We refer patients to certified providers that incorporate various techniques in the lower body extremities, like lower leg and calve pain therapies correlating to trigger points, to aid many people dealing with pain symptoms along the gastrocnemius muscles, causing muscle cramps. We encourage and appreciate each patient by referring them to associated medical providers based on their diagnosis when it is appropriate. We understand that education is an excellent way when asking our providers intricated questions at the patient’s request and understanding. Dr. Alex Jimenez, D.C., only utilizes this information as an educational service. Disclaimer
Have you been dealing with walking from one place to another? Do your calves feel hard or tense with the slightest touch or movement? Or are you feeling excruciating pain in your calves that make it hard to move? These pain-like symptoms are indicators of trigger points associated with the calves affecting the gastrocnemius muscles. The calves are mostly referred to as the posterior portion of the lower legs responsible for the foot and ankle plantarflexion while also engaging in activities like running or jumping. The two muscles that make up the calves are the gastrocnemius and the soleus. The gastrocnemius is a complex, superficial muscle fundamental to good posture or walking. This muscle has a casual relationship with the lower body as it affects hip movement and the lumbar area of the spine. The gastrocnemius provides a round shape for the calves to form and narrows down to the ankles, where it forms a tendon.
How Are The Calves Affected By Trigger Point Pain?
Since the gastrocnemius provides the round shape to form the calves when the muscles have become overused or injured in a sports activity, it can cause the individual to have limited mobility. Studies reveal that a tear in the gastrocnemius muscles can implicate lower leg trauma and affect the muscle function to plantar flex the foot at the ankle joint and reduce flexion on the leg to the leg knee joint. When it comes to the development of trigger points along the gastrocnemius muscles that are affecting the calves, according to “Myofascial Pain and Dysfunction,” written by Dr. Janet Travell, M.D., the book states that latent trigger points along the gastrocnemius may cause individuals to complain about calf cramps on the legs, however, when the trigger points are active, the individual is aware of the calf pain and would complain about experiencing pain in the back of their knees. The book also mentioned that trigger points associated with the gastrocnemius muscle could be mistaken for other conditions like plantar foot pain or radiculopathy in the sacroiliac joints. When trigger points affect the calf muscles, it can lead to mobility issues and causes people to be unstable when walking.
Trigger Point Of The Week: Gastrocnemius Muscle- Video
Have you been dealing with calf pain when walking for a short distance? Do your calf muscles ache or tense up when you put slight pressure when stepping down? Or do you feel that your calf muscles are hard when resting? Many of these issues affecting the calves are associated with trigger points affecting the gastrocnemius muscles. The gastrocnemius muscle is one of the muscles that make up the calves in the lower legs. This complex, superficial muscle provides a round shape to the calves and can become overused in various activities that can cause a person to have limited mobility. When the gastrocnemius muscle is overused, it can develop tiny nodules in the muscle fibers known as trigger points that mimic other conditions affecting leg mobility. The video above shows where this complex muscle is in the calves and where the trigger points are located in the muscle fibers. Trigger points along the affected muscle can cause referred pain while mimicking other conditions that can often confuse people about what they are feeling. All is not lost, however, as trigger points are treatable and can be managed through various treatments.
Corrective Actions To Prevent Muscle Cramps On The Calves
When the calf muscles like the gastrocnemius are causing symptoms of pain and muscle cramps due to trigger points, there are various treatments and corrective actions that can prevent muscle cramps from causing more issues in the legs and even help manage trigger points from re-forming in the muscle fibers. Some corrective actions that can help improve calve function are gently flexing the foot at the ankle joint to allow the calf muscles to tract and retract to reduce swelling and pain. Other correction actions that people should incorporate to prevent muscle cramping in the calves when they are sitting is to gently rock in a chair to reduce prolonged immobility to the calves and increase blood flow. Studies reveal that dry needling and other various treatments can help reduce muscle stiffness in the gastrocnemius and improve muscle strength in the calves.
The calves are part of the legs that allow plantarflexion at the ankle joint. Known as the gastrocnemius muscle, it makes up the calves’ round shape. The gastrocnemius muscle is complex and superficial as it forms a rounded shape at the calves and narrows down at the ankles. However, when the muscle has been through various activities and is constantly overstretched, it can affect a person’s walking mobility and develop tiny nodules known as trigger points. Trigger points in the gastrocnemius muscle can cause referred pain in the calve muscles and mimic conditions like plantar foot pain to the feet. Fortunately, various treatments and corrective actions can prevent referred pain from re-occurring in the calves and bring mobility back to the legs so a person can continue to their destination.
Albin, S R, et al. “The Effect of Dry Needling on Gastrocnemius Muscle Stiffness and Strength in Participants with Latent Trigger Points.” Journal of Electromyography and Kinesiology : Official Journal of the International Society of Electrophysiological Kinesiology, U.S. National Library of Medicine, 9 Oct. 2020, pubmed.ncbi.nlm.nih.gov/33075711/.
Binstead, Justin T, et al. “Anatomy, Bony Pelvis and Lower Limb, Calf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 29 May 2022, www.ncbi.nlm.nih.gov/books/NBK459362/.
Bordoni, Bruno, and Matthew Varacallo. “Anatomy, Bony Pelvis and Lower Limb, Gastrocnemius Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 26 Apr. 2022, www.ncbi.nlm.nih.gov/books/NBK532946/.
Nsitem, Virginia. “Diagnosis and Rehabilitation of Gastrocnemius Muscle Tear: A Case Report.” The Journal of the Canadian Chiropractic Association, U.S. National Library of Medicine, Dec. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3845475/.
Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.
Back pain after eating is often the result of conditions and/or disorders in other areas of the body that radiate to the back. These problems range from unhealthy posture, digestive issues, bowel problems, ulcers, allergies, etc. This is because the nerves of the back and the abdominal area run through areas of the spine. In addition to the classic symptoms like bloating and gas, individuals can develop symptoms beyond the gut, including sleep problems, fatigue, headaches, urinating problems, muscle aches, pelvic discomfort, and back pain. Chiropractic care and functional medicine can realign the body, alleviate symptoms, and restore function.
Back pain after eating can be linked to the body’s digestive process.
Individuals in this group can experience inflammation after consuming specific foods.
Inflammation could worsen existing back problems.
Individuals with food intolerance will have uncomfortable but usually not dangerous symptoms.
Individuals with food allergies can experience life-threatening allergic reactions.
Heartburn results from acid reflux, when stomach contents and acid flow back into the esophagus. Heartburn’s key symptom is a burning sensation in the chest. However, heartburn and indigestion do not directly cause back pain. But for individuals with back problems, heartburn can worsen back discomfort.
Gastroesophageal reflux disease, or GERD, could cause back pain in individuals with more than two weekly heartburn episodes.
The digestive system condition results from the chronic backflow of stomach acid.
Over time, the powerful acid can inflame the esophageal lining.
A stomach or esophageal ulcer can develop if GERD is not managed.
Pain could be felt in the lower to middle back around the stomach and lower intestines.
Ulcers can also result from a bacterial infection of Helicobacter pylori (or H. pylori).
Long-term use of nonsteroidal anti-inflammatory drugs (or NSAIDs) can also enable ulcer formation.
A peptic ulcer (or open sore) can develop on your stomach’s interior lining.
The small intestine’s upper portion can also be affected.
Peptic ulcers cause burning pain in the stomach. These flare-ups can worsen existing back problems and pain. Spicy foods and stress don’t cause peptic ulcers but can worsen their effects. In severe cases, a peptic ulcer can cause referred back pain felt in another location than where the pain originates. This means pain could be felt in the lower to middle back adjacent to the stomach and lower intestines.
Back pain could result from a bacterial kidney infection.
Kidney dysfunction infections, kidney stones, and chronic kidney diseases can be mistaken for general back and side pain.
Other symptoms can include chills, fever, nausea, and vomiting.
Pancreatitiscan develop if the pancreas becomes inflamed, brought on by excess alcohol consumption or gallstones. This definitely can cause back discomfort and pain.
Pancreatitis is the inflammation of the pancreas.
After eating, individuals can experience worsening abdominal pain that can refer to the back.
The body’s network of interconnecting sensory nerves causes the pain to be felt in other areas.
Most individuals will experience pain in the upper left or middle abdomen.
Besides the back discomfort, there could be a burning sensation during urination or other urinary tract symptoms. Stools could be dark or black, a possible ulcer symptom. To reduce the chances of back discomfort after eating, avoid sugary, spicy, fatty foods or anything that triggers heartburn and reduce alcohol consumption. If you are experiencing frequent episodes of back pain after eating or the pain worsens, contact your physician, healthcare provider, or a chiropractor.
The ankles and the lower legs have a casual relationship by allowing movement to the foot that causes an up-and-down motion. The lower leg has various muscles and tendons that surround the shin bone and allows the feet to take the body from one location to another. The peroneal muscles in the legs allow ankle stability to ensure that the weight from the host’s body doesn’t cause overload to the legs and ankles. However, factors like obesity, trauma, or overexerting can cause the peroneal muscles to be inflamed and develop issues like weak ankles or trigger points that can cause referred pain to the ankles and affect how a person walks. Today’s article examines the peroneal muscles, how weak ankles correlate with trigger points, and ways to strengthen the ankles while managing trigger points. We refer patients to certified providers that incorporate various techniques in the lower body extremities, like lower leg and ankle pain therapies correlating to trigger points, to aid many people dealing with pain symptoms along the peroneal muscles, causing weak ankles. We encourage and appreciate each patient by referring them to associated medical providers based on their diagnosis when it is appropriate. We understand that education is an excellent way when asking our providers intricated questions at the patient’s request and understanding. Dr. Alex Jimenez, D.C., only utilizes this information as an educational service. Disclaimer
Have you been experiencing pain when walking around constantly? What about feeling a sharp or dull ache in the back or side of your legs? Or do you feel like falling when you are just standing around? Many people experiencing these issues on their legs and ankles could be dealing with trigger points along the peroneal muscles in the ankles. The peroneal muscles consist of two muscles in the lateral compartment of the lower legs: the peroneus longus and peroneus brevis. The peroneus longus is an important long muscle in the lower legs as it is at the top of the fibula and then runs down the outer leg while connecting to the foot. One of the primary functions of the peroneus longus is allowing plantarflex and evert the foot at the ankle. This means that the peroneus longus helps provide motor strength and range of motion to the ankles.
The peroneus brevis is one of the shorter peroneal muscles in the legs that go down to the ankles and provides assistance to allow eversion to the foot and plantarflexion to the ankles. This shorter muscle is important since the ankle joint is relatively mobile and needs stability from the surrounding ligaments and muscles. These two muscles work together for ankle stability when walking and positioning when the body is moving. Studies reveal that depending on a person’s environment, the peroneal muscles allow support and stability to the ankle in various positions. A good example is if the foot is placed in a sloped position, the peroneal muscles and the surrounding ligaments help stabilize the ankle so it won’t induce pain, causing the individual not to fall over.
Weak Ankles & Trigger Points
When factors like obesity, trauma, or injuries begin to affect the lower half of the body, it can cause instability in the legs and cause the surrounding muscles, tendons, and ligaments to be overstretched, take on more of an overload to the legs, or suffer from a muscle or tendon tear. These factors are associated with various issues that can invoke pain along with developing trigger points along the lower legs. When there are issues in the peroneal muscles, it can lead to muscle weakness in the ankles or “weak ankles,” which causes instability in the body and causes the individual to sprain their ankles. Studies reveal that when the peroneal tendons have a tear in the lower extremities, it can lead to lateral ankle pain that is often missed when examined. However, to that point, if the incision has been left untreated, it can lead to persistent ankle pain, instability, and ankle dysfunction. In “Myofascial Pain and Dysfunction,” written by Dr. Janet G. Travell, M.D., stated that when individuals suffer from weak ankles or have an ankle sprain, active trigger points can cause pain and tenderness to the ankles and cause the person to become unstable. If left untreated, it can cause them to lose balance and have foot drop and ankle fractures to their foot. The book also mentioned that any ruptures in the tendons and muscles might cause lateral compartment syndrome. When there is instability in the ankles, many people resort to using mobility aids like a cane or a walker to be mobile to compensate for the function lost in their feet.
Trigger Point Therapy On The Peroneal Muscles- Video
Do you feel the pain from the bottom of your feet to your ankles? Does it hurt to walk around for a short period? Or have you sprained your ankle, and there is a dull ache when you try to rotate? Some ankle issues are associated with trigger points affecting the peroneal muscles. The peroneal muscles help the lower legs by allowing eversion to the foot and plantarflexion to the ankles. The two muscles that make up the peroneal muscles are the peroneus longus and the peroneus brevis, and they, along with the other tendons and ligaments, help with ankle stability. Since the ankle is a mobile joint, it can succumb to sprains, tears, and instability in the body, allowing trigger points to develop and causing even more issues. The great news is that there are ways to manage trigger points along the peroneal muscles and reduce ankle instability. The video above shows where the peroneal muscles are located on the leg, where the trigger points are, and how to use K-tape to help support the ankle and prevent more injuries on this moveable joint.
Strengthening The Ankles & Managing Trigger Points
Instability in the ankles can be a bummer to many individuals that are on the move, but when it comes to treatment, it can prevent future injuries from re-occurring. Studies reveal that when pain specialists incorporate joint mobilization techniques and dry needling therapy into their patients, it can allow them to reduce the pain and disability to the ankles, thus managing the trigger points along the peroneal muscles. Another way many people can reduce pain in their peroneal muscles is by incorporating stretches and exercises to strengthen their ankles. This allows the peroneal muscles to be loose and gently stretched while slowly strengthening the ankles in a semi-lock position. When people utilize these techniques on their legs and ankles, it can bring mobility and stability back to the body without fear of falling or causing more issues in the ankles.
As one of the most mobile skeletal joints in the lower body, the ankles work together with the legs to provide mobility and stability to the body. The lower legs have various muscles, tendons, and ligaments that travel down and help support the legs and ankles. One of the muscles that provide that support is the peroneal muscle. The peroneal muscles consist of two muscles known as the peroneus longus and peroneus brevis help with eversion to the foot and allow plantarflexion to the ankle. When a person has sprained their ankle, it causes the peroneal muscle to become overstretched and develop trigger points. The great news is that trigger points are treatable, and various treatments can reduce pain in the affected muscle. This allows stability and mobility back to the ankles and improves the body’s functionality.
Abd-Rasid, A F, and M Y Bajuri. “Isolated Peroneus Longus Tear – Commonly Missed Diagnosis of Lateral Ankle Pain: A Case Report.” Malaysian Orthopaedic Journal, U.S. National Library of Medicine, July 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7513650/.
Basit, Hajira, et al. “Anatomy, Bony Pelvis and Lower Limb, Foot Peroneus Brevis Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 8 Feb. 2022, www.ncbi.nlm.nih.gov/books/NBK535427/.
Lezak, Bradley, and Matthew Varacallo. “Anatomy, Bony Pelvis and Lower Limb, Calf Peroneus Longus Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 25 Aug. 2022, www.ncbi.nlm.nih.gov/books/NBK546650/.
Salom-Moreno, Jaime, et al. “Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial.” Evidence-Based Complementary and Alternative Medicine : ECAM, U.S. National Library of Medicine, 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4430654/.
Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.
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