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Hip Pain & Disorders

Back Clinic Hip Pain & Disorders Team. These types of disorders are common complaints that can be caused by a variety of problems. The precise location of your hip pain can give more information about the underlying cause. The hip joint on its own tends to result in pain on the inside of your hip or groin area. Pain on the outside, upper thigh, or outer buttock is usually caused by ailments/problems with the muscles, ligaments, tendons, and soft tissues surrounding the hip joint. Hip pain can also be caused by diseases and conditions in other areas of your body, i.e. the lower back. The first thing is to identify where the pain is coming from.

The most important distinguishing factor is to find out if the hip is the cause of the pain. When hip pain comes from muscles, tendons, or ligament injuries, it typically comes from overuse or Repetitive Strain Injury (RSI). This comes from overusing the hip muscles in the body i.e. iliopsoas tendinitis. This can come from tendon and ligament irritations, which typically are involved in snapping hip syndrome. It can come from inside the joint that is more characteristic of hip osteoarthritis. Each of these types of pain presents itself in slightly different ways, which is then the most important part in diagnosing what the cause is.

Sacroiliac Joint Dysfunction And Chiropractic Care

Sacroiliac Joint Dysfunction And Chiropractic Care

You try to stand up from a seated position and feel a stab of pain in your lower back. It may even shoot through your hip, buttock, or down the back of your thigh. The pain may even get worse then you walk uphill or sit for a long period of time. While these symptoms could mean a pinched nerve, lumbar disc herniation, hip bursitis, or degenerative hip disease, it could also be sacroiliac joint dysfunction.

What Is Sacroiliac Joint Dysfunction?

The sacroiliac (SI) joint is located in the pelvis. It is very strong as it is a weight bearing joint connecting the pelvis to the sacrum. It is surrounded by tough ligaments that reinforce it, providing added support.

There is an SI joint located on each side of the sacrum and they work together, moving as a single unit to act as a shock absorber for the spine and for transmitting force of the upper body. Just like any other joint in the body, the SI joint can be injured or diseased, causing it to become unstable and inflamed, causing pain and limited mobility.

sacroiliac joint dysfunction el paso tx.

What Causes SI Joint Inflammation?

While doctors have not established how the pain is generated, it is believed that it is due to a change in the normal motion of the joint. This could occur due to:

  • Hypermobility (Instability or Too Much Movement) � This can cause the pain to reside in the lower back. It can also be felt in the hip or both the hip and lower back and may even radiate into the groin.
  • Hypomobility (Fixation or Too Little Movement) � This can cause the pain to reside in the lower back or buttocks and may radiate down one leg, usually in the back of the thigh. It usually doesn�t reach the knee, but sometimes can even reach the ankle and foot. In this way, the condition mimics sciatica.

Sacroiliac joint dysfunction typically affects women who are young or middle aged. Older women and men are rarely affected although it does happen.

What Are Treatment Options For Sacroiliac Joint Pain?

When SI joint pain is initially diagnosed the treatment is usually fairly conservative. Medication, physical therapy, and injections are used by doctors for pain management.

NSAIDs and other similar medications decrease inflammation and reduce pain, while physical therapy can readjust the SI joint in cases where it is dislocated or immobilized. It also includes exercises that stabilize the joint for pain management over the long term.

Steroid injections directly into the sacroiliac joint can help with the reduction of inflammation and pain while making physical therapy more effective. When steroid injections are effective but the effects are temporary there is another non-surgical treatment that is sometimes used called RFA, or radiofrequency ablation.

In cases where the conservative methods do not achieve the desired results there are surgical options that provide pain reduction and stabilization on a more permanent scale. SI fusion involves fusing the joint, providing relief.

However, there is a treatment option that is non-invasive, doesn�t involve steroids or medications that could have harmful side effects � chiropractic.

Chiropractic For Sacroiliac Joint Pain

There are two chiropractic treatments that are typically used to treat SI joint pain:

  • Spinal manipulation � This is the traditional chiropractic adjustment that is also known as high-velocity, low-amplitude (HVLA) thrust.
  • Spinal mobilization � This is a less forceful, gentle chiropractic adjustment also known as low-velocity, low-amplitude thrust.

Chiropractic is proven to be an effective, non-invasive, gentle method for relieving the pain and inflammation of SI joint dysfunction. No medication, no surgery, just relief.

So if you�ve been suffering from sacroiliac joint dysfunction, give us a call! Our Doctor of Chiropractic is here to help!

Injury Medical Clinic: Sciatica Treatments & Recoveries

Shoulder Pain Chiropractic Rehab | Video

Shoulder Pain Chiropractic Rehab | Video

Bobby Gomez describes how each visit with Dr. Alex Jimenez and to PUSH Fitness with Daniel Alvarado has resulted in great improvements in the stability of his shoulders as well as in the placement of his hips. Although Bobby Gomez’s recovery has been progressing gradually, he discusses the tremendous changes he has experienced mentally, emotionally and physically. Bobby Gomez highly recommends Dr. Alex Jimenez as the non-surgical choice for neck and back pain, as well as shoulder and hip pain.

Shoulder Pain Treatment


Cerebral palsy (commonly known as CP) affects ordinary motion in various areas of the human body and has many degrees of severity. CP causes problems with posture, gait, muscle tone and coordination of movement. Some children with CP have coexisting conditions, such as eyesight and hearing impairment. These disorders are brought on by brain damage and aren’t a direct result of cerebral palsy. Cerebral palsy does not affect life expectancy. Based on the way in which the condition is handled, motor abilities can improve or decrease over time. While severity and symptoms vary, most individuals with this condition go on to direct a rich, fulfilling life.

shoulder pain rehab el paso tx.

We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.

Our services are specialized and focused on injuries and the complete recovery process.�Our areas of practice include:Wellness & Nutrition, Chronic Pain,�Personal Injury,�Auto Accident Care, Work Injuries, Back Injury, Low�Back Pain, Neck Pain, Migraine Headaches, Sport Injuries,�Severe Sciatica, Scoliosis, Complex Herniated Discs,�Fibromyalgia, Chronic Pain, Stress Management, and Complex Injuries.

As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.

If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and share us.

Thank You & God Bless.

Dr. Alex Jimenez DC, C.C.S.T

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Hip Labral Tear Treatment | El Paso, TX. | Video

Hip Labral Tear Treatment | El Paso, TX. | Video

Hip Labral Tear: Andrew Hutchinson turned to chiropractic care and crossfit rehabilitation after suffering a high ankle sprain and a hip labrum tear for which he went through with surgery to repair it. After being bedridden for months in order to properly recover, Andrew Hutchinson transitioned to chiropractic care and crossfit rehabilitation to regain his strength, mobility and flexibility before returning to play. Although he has suffered other sports injuries, Andrew Hutchinson continues to trust in chiropractic care and crossfit rehabilitation to keep his spine properly aligned and maintain overall health and wellness.

Hip Labral Tear Treatment

Labrum tears in athletes can occur from a single event or recurring trauma. Running may cause labrum tears due to the labrum being utilized more for weight bearing and taking excess forces while at the end-range motion of the leg. Sporting activities are probable causes, specifically those that require frequent hip rotation or pivoting to a loaded femur as in ballet or hockey. Constant hip rotation places increased strain on the capsular tissue and harm to the iliofemoral ligament. This subsequently causes hip instability putting increased stress on the labrum and causing a hip labrum tear.

hip labral tear el paso tx.

We focus on what works for you. We also strive to create fitness and better the body through researched methods and total wellness programs. These programs are natural, and use the body�s own ability to achieve goals of improvement, rather than introducing harmful chemicals, controversial hormone replacement, surgery, or addictive drugs.

We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and educated on how to maintain this way of life. I have made a life of taking care of each and every one of my patients.

I assure you, I will only accept the best for you�

God Bless You & Your Health�?

If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and share us.

Thank You & God Bless.

Dr. Alex Jimenez DC, C.C.S.T

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Injury Medical Chiropractic Clinic: Stress Management Care & Treatments

Chiropractic Relieves Sacroiliac Joint Pain

Chiropractic Relieves Sacroiliac Joint Pain

Chiropractic Relieves: How can a body part you have probably never heard of hurt so BAD? This is a common question we hear from individuals suffering from sacroiliac joint pain.

The sacroiliac�joint is formed by the sacrum and the ilium where they meet on either side of the lower back, with the purpose of connecting the spine to the pelvis. This small joint is one of the most durable parts of the human body, and it is responsible for a big job.

chiropractic relieves

The unassuming little sacroiliac joint withstands the pressure of the upper body’s weight pushing down on it, as well as pressure from the pelvis. It’s basically the cushion between the torso and the legs. As such, it handles force from pretty much every angle.

While immensely strong and durable, this joint is not indestructible. Sacroiliac joint pain usually crops up as lower back pain, or pain in the legs or buttocks.

Weakness in these areas may also be present. The typical culprits in causing the sacroiliac joint to exhibit pain are traumatic injuries to the lower back, but more frequently develops over a longer period of time.

Sacroiliac joint pain is often misdiagnosed as soft tissue issues instead of the joint itself. Doctors may rule out other medical conditions before settling on a diagnosis that includes a sacroiliac joint problem.

If you have suffered an injury, a degenerative disease, or otherwise damaged the sacroiliac joint, there are treatments available to help manage pain, promote healing, and lessen the chances of recurrence. Here are a four helpful guidelines to assist in effectively handling sacroiliac joint pain.

chiropractic relieves

Chiropractic Relieves:

First, rest and ice the area. Avoid exaggerated movements of your lower back in order to relieve some of the body’s pressure on the sacroiliac joint. Also apply ice wrapped in a towel periodically to soothe the area and minimize the pain.

A second way to handle sacroiliac pain is with therapeutic massage. Tightness around the joint is a common cause of discomfort and pain. Professional massage serves to loosen and relax the lower back, buttocks, and leg areas, offering relief from pain.

Third, consider chiropractic and seeing a chiropractor. Chiropractic relieves pain, treatment known as adjustments, not only provides great options for pain relief but also helps promote the healing process of this joint.

A chiropractor is specifically trained to guide you through several phases of care. They don�t focus just on pain relief but are primarily interested in helping you fix the problem.

They�re also very well trained in rehabilitation of the spine. This approach will help loosen the muscles surrounding the joint as well as strengthen them. This will decrease the risk of pain returning down the road.

Finally, in very rare cases, doctors will choose to apply an injection to the area to alleviate pain and inflamed tissue. Obviously, the injection won�t fix the problem but may give the patient relief temporarily. Surgery is rarely a viable option.

If you show symptoms of sacroiliac pain, it’s important to see a Doctor of Chiropractic so he or she can perform tests to correctly diagnose your condition. It could very well be another type of lower back problem. Remember chiropractic relieves, so quit suffering and give us a call!

Pregnancy & Chiropractic Care

Hips Positioning And MRI Anatomy

Hips Positioning And MRI Anatomy

Hips Positioning & MRI Anatomy

hipsMRI may be requested for:

  • Bone tumor
  • Osteoarthritis
  • Aseptic or avascular necrosis
  • Bursitis
  • Pain

Bones & Cartilage Of The Hips

The hips joints join the legs to the trunk of the body, and are formed by the femurs and pelvic bones. The hips are ball-and-socket type joints, where the femoral head (ball) fits into the cup-shaped acetabulum (socket) of the pelvis (Figure 1). When compared to the shoulder, which is also a ball-and-socket joint, the acetabulum is a deeper socket, and encompasses a greater area of the ball, or femoral head. This accommodation is necessary to provide stability for the hip, as it is a major weight-bearing joint, and one of the largest joints in the body. When not weight-bearing, the ball and socket of the hip joint are not perfectly fitted. However, as the hip joint bears more weight, the surface area contact increases, and the joint becomes more stable. When in a standing position, the body�s center of gravity passes through the center of the acetabula. While walking, weight-bearing stresses on the hips can be five times a person�s body weight. Healthy hips can support your weight and allow for pain-free movement. Hip injuries or disease can cause changes that affect your gait, as well as changes that affect the ability of the hips to distribute weight bearing. Abnormal stress is then placed on the joints that are above and below the hips.


The three fused hips or innominate bones that form the acetabulum include the ilium, pubis, and ischium. The ilium forms the superior aspect, the pubis forms the inferior and anterior aspect, and the ischium forms the inferior and posterior aspect. The depth of the acetabulum socket is further increased by the attached fibrocartilaginous labrum (Figure 2). In addition to providing stability to the hip joint, the labrum allows flexibility and motion. Hip joint stability can be hampered by injuries resulting from playing sports, running, overuse, or falling, as well as by disease or tumor. MRI of the hips may be ordered to assess the joint(s) for internal derangement, fracture, or degenerative joint disease. A blow to the hip joint or a fall can result in dislocation of the hip, or a hip fracture. Osteoporosis or low bone density can also lead to hip fractures. Successful prevention and/or treatment of osteoporosis may be achieved through nutrition (adequate amounts of calcium, vitamin D and phosphorus), exercise, safety measures, and medications.



Articular cartilage covers the femoral head and the acetabulum (Figure 3). This cartilage is thin but tough, flexible, smooth and slippery, with a rubbery consistency. It absorbs shock, and allows the bones to move against each other easily and without pain. It is kept lubricated by synovial fluid, which is made in the synovial membrane (joint lining). Synovial fluid is both viscous and sticky. This fluid is what allows us to flex our joints under great pressure without wear. The articular cartilage of the hip is typically about � inch thick, except in the posterior aspect of the hip socket (Figure 4). Here, the cartilage is thicker, as this area absorbs most of the force during walking, running, and jumping. MRI of the hip joint can detect problems involving both the articular cartilage and the fibrocartilaginous ring, or labrum. Cartilage has minimal blood vessels, so it is not good at repairing itself. Fraying, fissuring, and other abnormalities or defects of the cartilage can lead to arthritis in the hip joint. Contrast can be directly injected in the hip joint for a detailed look at the cartilage and labrum.


The femurs are the longest bones in the body, with large round heads that rotate and glide within the acetabula of the pelvis. The femoral head is particularly subject to pathologic changes if there is any significant alteration of blood supply (avascular necrosis). The femoral neck connects the head of the femur to the shaft. The neck ends at the greater and lesser trochanters, which are sites of muscle and tendon attachments. A disease characterized by an inadequate blood supply to the femoral head is Legg-Calve-Perthes disease, also known as LCP or simply Perthes disease. This is a degenerative disease of the hip joint that affects children, most commonly seen in boys ages two through twelve. One of the growth plates of the femoral head, the capital femoral epiphysis, is inside the joint capsule of the hip. Blood vessels that feed this epiphysis run along the side of the femoral neck, and are in danger of being torn or �pinched off� if the growth plate is damaged. This can result in a loss of blood supply to the epiphysis, leading to a deformity of the femoral head (Figure 5). The femoral head may become unstable and break easily, which can lead to incorrect healing and deformities of the entire hip joint (Figure 6). Treatment of Perthes disease is centered on the goal of returning the femoral head to a normal shape. Surgical and non-surgical treatments are used, based on the idea of �containment�- holding the femoral head in the acetabulum as much as possible, while still allowing motion of the hip joint for cartilage nutrition and healthy growth of the joint.



High level athletes and active individuals may be susceptible to a hip condition known as Femoro-Acetabular Impingement, or FAI. FAI is characterized by excessive friction in the hip joint. The femoral head and acetabulum rub abnormally, and can create damage to the articular or labral cartilage. FAI is also associated with labral tears, early hip arthritis, hyperlaxity and low back pain. FAI generally occurs in two forms: Cam and Pincer. The Cam form results in abnormal contact between the femoral head and the socket of the hip because the femoral head and neck relationship is aspherical (Figure 7). Males and those involved in significant contact sports typically display Cam impingement. Pincer impingement occurs when the acetabulum covers too much of the femoral head, resulting in the labral cartilage being pinched between the rim of the socket and the anterior femoral head-neck junction (Figure 8). Pincer impingement may be more common in women. Typically, these two forms exist together, and are labeled as �mixed impingement� (Figure 9).



Ewing�s sarcoma is a malignant bone tumor that may affect the pelvis and/or femur, thereby also affecting the stability of the hips. Like Perthes disease, Ewing�s sarcoma is more common in males, typically presenting in childhood or early adulthood. MRI is routinely used in the work-up of these malignant tumors to show bony and soft tissue extent of the tumor, and its relation to nearby anatomic structures (Figure 10). Contrast may be used to help determine the amount of necrosis within the tumor, which aids in determining the response to treatment before surgery.



Figure 10. MRI demonstrating Ewing�s sarcoma.

Ligaments Of The Hips

Hip stability is further increased by three strong ligaments that encompass the hip joint and form the joint capsule. These ligaments connect the femoral head to the acetabulum, with names suggestive of the bones they connect. They include the pubofemoral and iliofemoral ligaments anteriorly, and the ischiofemoral ligament posteriorly (Figure 11). The iliofemoral ligament is the strongest ligament in the body. However, sports and overuse can still result in sprains of these sturdy ligaments of the joint capsules of the hips. A smaller ligament, the ligamentum teres, is an intracapsular ligament that connects the tip of the femoral head to the acetabulum (Figure 12). A small artery within this ligament brings some of the blood supply to the femoral head. Damage to the ligamentum teres, and its enclosed artery, can result in avascular necrosis.



Muscles & Tendons Of The Hips

The muscles of the thigh and lower back work together to keep the hip stable, in alignment, and able to move. The hip gains stability because the hip muscles do not attach right at the joint. Hip muscles allow the movements of flexion, extension, abduction, adduction, and medial and lateral rotation. To better understand the functions of the muscles surrounding the hip, they can be divided into groups based on their locations- anterior, posterior, and medial.

The anterior thigh muscles are the main hip flexors, and are located anterior to the hip joint. Seventy percent of the thigh�s muscle mass is made up of the quadriceps femoris muscle, so named because it arises from four muscle heads- the rectus femoris, vastus medialis, vastus intermedius, and vastus lateralis (Figures 13, 14). The rectus femoris is the only one of the �quad� muscles to cross the hip joint. The sartorius muscle is found anterior to the quadriceps, and also serves as an abductor and lateral rotator of the hip. The most powerful of the anterior thigh hip flexors is the iliopsoas, which originates in the low back and pelvis and attaches at the lesser trochanter.



Posterior hip muscles include those of both the thigh and gluteal regions. The posterior thigh muscles are also known as the hamstrings- semimembranosus, semitendinosus, and biceps femoris (Figure 15). These muscles originate at the inferior pelvis, and are the extensors for the hip. They are active in normal walking motions. When the hamstrings are �tight�, they limit hip flexion when the knee joint is extended (bending forward from the waist with knees straight), and can limit lumbar movement, leading to back pain. The gluteal muscles include the gluteus maximus, medius, and minimus, six deep muscles that serve as lateral rotators, and the tensor fasciae latae. The three gluteals and the anterior sartorius muscle are all involved in abduction. The gluteus maximus is the main hip extensor, and is the most superficial of the gluteal muscles. It is involved in running and walking uphill, and assists with normal tone of the iliotibial band, which lies lateral to it. The gluteus medius and minimus both insert at the greater trochanter of the femur. The minimus is the deepest of the three gluteal muscles. Anterior to the gluteus minimus is the tensor fasciae latae muscle. It is a flexor and medial rotator of the hip, originating from the anterior superior iliac spine (ASIS) and inserting on the iliotibial band. The term �tensor fasciae latae� defines this muscle�s job- �muscle that stretches the band on the side�. This muscle helps the iliopsoas, gluteus medius, and gluteus minimus muscles during flexion, abduction and medial rotation of the thigh by making the iliotibial band taut, thereby steadying the trunk and stabilizing the hip (Figure 16). The iliotibial band or tract is not a muscle, but a thickened, fibrous band of deep fascia, or connective tissue. It is found at the lateral aspect of the thigh, and runs from the ilium to the tibia. It encloses the muscles and helps with lateral stabilization of the knee joint, as well as helping to maintain both hip and knee extension. Tightening of the iliotibial (IT) band typically causes more problems at the knee as opposed to the hip, but hip pain can result from the IT band rubbing as it passes over the greater trochanter.


The medial thigh (groin) muscles include five muscles of adduction, and one lateral rotator (Figures 17, 18). The lone lateral rotator is the obturator externus, which covers the external surface of the obturator foramen in the deep upper medial thigh. The adductors include the gracilis, the pectineus, and the adductor brevis, longus and magnus. The gracilis is the longest adductor, extending from the medial inferior aspect of the pubic bone, to the medial aspect of the tibia. The adductor magnus is the most massive of the medial muscles of the thigh.



The tendons and muscles of the hips are very powerful and create great forces, making them prone to inflammation and irritation. Tendonitis of the hip can result from repetitive movements involving the soft tissues surrounding the hip joint. Overuse of the hip joint in fitness workouts can lead to tendonitis. Tendons lose their elasticity as we age, resulting in swelling and irritation when the tendons are no longer �gliding� on their normal paths. Iliopsoas tendonitis plays a major role in snapping hip syndrome, or dancer�s hip. A snapping sensation when the hip is flexed and extended may be accompanied by an audible snapping or popping noise, as well as pain. This can be both an extra-articular and an intra-articular occurrence. Extra-articular snapping is often found in those patients with a leg length difference (the longer leg is symptomatic), those with tightness of the iliotibial band on the involved side, and those with weak hip abductors and external rotators. Lateral extra-articular snapping can be caused by the iliotibial band, tensor fascia latae or gluteus medius tendon as they slide back and forth across the greater trochanter (Figure 19). If any of these connective tissue bands thickens, they can �catch� on the greater trochanter during the motion of hip extension, thereby creating the �snapping� sensation and sound. Medial extra-articular snapping, which is less common, can occur when the iliopsoas tendon catches on the anterior inferior iliac spine, lesser trochanter, or iliopectineal ridge during hip extension. Intra-articular snapping hip syndrome is similar in many ways to the extra-articular type, but often involves an underlying mechanical problem in the lower extremity, and more intense pain. Intra-articular snapping may be indicative of a torn acetabular labrum, recurrent hip subluxation, a tear of the ligamentum teres, loose bodies, articular cartilage damage, or synovial chondromatosis (cartilage formations in the synovial membrane of the joint). Snapping hip syndrome is usually found in those ages 15-40, often in those in training for the military. It can also affect athletes, especially those involved in dance, gymnastics, soccer, and track and field. These athletes will all be performing repeated hip flexions, which can lead to tendonitis in the hip area. The repetitive motions of those involved in weightlifting and running generally lead to a thickening of the tendons in the hip region, rather than snapping hip syndrome. Prevention, or at least a lessening, of this syndrome may be found with increased stretching of the iliopsosas muscle or the iliotibial band. Surgery is usually not required, unless intra-articular pathology is present.



Figure 19. Hip muscles.

Tendon or muscle strains can occur suddenly, as in sports injuries, or they can develop over time, with symptoms including pain, swelling, muscle spasms, and difficulty moving certain muscles. MRI can be used to detect tendon and muscle tears and strains, as well as bone tumors and infection. MRI has shown good accuracy for the diagnosis of tears of the gluteus medius and gluteus minimus tendons, which are both abductor tendons of the hip. An association was found between these tears and areas of high signal intensity superior or lateral to the greater trochanter on T2-weighted images, tendon elongation in the gluteus medius, and tendon discontinuity (Figure 20). STIR and fat-suppressed T2-weighted coronal images are very sensitive for detection of areas of high signal intensity superior to the greater trochanter. Coronal T1-weighted images demonstrate tendon elongation in the gluteus medius (Figure 21). Axial images may prove superior for localizing involvement to individual abductor tendons and confirming tendon discontinuity (Figure 22). Tears of the abductor tendons may be the leading cause of greater trochanteric pain syndrome.


Figure 20. Sag. T2 shows high signal intensity superior to greater trochanter (gt) corresponding to swollen bursa (*).


Figure 21. Coronal STIR shows high signal intensity superior to greater trochanter in bursa (*) between gluteus medius (me) and gluteus minimus (mi) tendons.


Figure 22. Axial T2 shows high signal intensity corresponding to fluid replacing distal rt. gluteus medius tendon (black arrow); normal left tendon (white arrow).

Nerves Of The Hips

The nerves of the hip supply the various muscles in the hip area. The major nerves include the femoral, obturator, and lateral femoral cutaneous nerves anteriorly, and the large sciatic nerve posteriorly (Figure 23). The femoral nerve innervates the quadriceps femoris and sartorius, and is the sensory nerve to the anterior thigh. Trauma to this nerve usually occurs in the pelvis, as it passes through or near the psoas muscle. The obturator nerve passes along the lateral pelvic wall and through the obturator foramen, then splits into branches that supply the adductor muscle group. This nerve can also be subject to trauma in the pelvis due to its passage through the obturator foramen. The lateral femoral cutaneous nerve is a sensory nerve that travels along the anterolateral aspect of the thigh. It supplies sensation to the skin surface of the thigh. This is the single nerve involved in a painful condition called meralgia paresthetica, which is characterized by tingling, numbness, and burning pain in the outer part of the thigh. Meralgia paresthetica results from focal entrapment of the lateral femoral cutaneous nerve as it passes through the tunnel formed by the lateral attachment of the inguinal ligament and the ASIS. The posterior sciatic nerve passes deep to the gluteus maximus into the posterior thigh, where it innervates the hamstring muscles, on its way down to the lower leg and foot. The sciatic nerve is approximately as big around as the thumb, and is the largest single nerve in the human body. It can be injured in cases of posterior hip dislocation. Pressure on this nerve can cause nerve pain, numbness, tingling and weakness (sciatica symptoms) in the buttocks, leg, or foot, depending on the site of origin of the sciatic nerve compression.


Figure 23. Anterior and posterior views of the nerves of the hip.

Arteries & Veins Of The Hips

The arterial blood vessels that supply the hips are branches of the internal and external iliacs. The internal iliac artery gives off the superior and inferior gluteals, and the obturator artery. The inferior gluteal flows to the posterior aspect of the hip joint and proximal femur, where it joins a branch of the femoral artery. The obturator artery runs through the obturator foramen, and sends its acetabular branch to the ligamentum teres as part of the blood supply to the femoral head. The external iliac becomes the femoral artery, which has numerous branches that supply the hip and proximal femur. The largest femoral branch is the profunda femoris, which branches superiorly into the medial and lateral circumflex femorals (Figure 24). The circumflex femorals and the inferior gluteal artery contribute to the anastomoses to supply the femoral head, femoral neck, and the hip joint. The medial circumflex also has an acetabular branch to the ligamentum teres. Congenital anomalies in the hip anastomoses, degenerative processes, and trauma can all compromise the blood supply to the hip joint area.


Figure 24. Anterior and posterior views of the arteries of the hip.

Venous flow in the hip and proximal femur typically follows the arterial flow, including the same names for the vessels. The deep veins of the hip and thigh can be the origination of a deep vein thrombosis, which can result in a pulmonary embolus. This can be caused by immobility after hip surgery, sitting in cars or airplanes for extended trips, being overweight, or slow or low blood flow. These blood clots can break off, travel through the larger veins of the thigh and hip, continue through the heart, and become lodged in the smaller vessels of the lung. MRI is being used more frequently to diagnose this very serious condition.

Bursae Of The Hips

The hip joint is surrounded by bursae, similar to the shoulder. These fluid-filled sacs are lined with a synovial membrane, which produces synovial fluid. Their function is to lessen the friction between tendon and bone, ligament and bone, tendons and ligaments, and between muscles. There may be as many as 20 bursae around the hip. If they become infected or inflamed, the result is a painful condition called bursitis. Common hip bursae that may become inflamed include the greater trochanteric bursa, the iliopsoas bursa, and the ischial bursa (Figure 25). The greater trochanteric bursa is sandwiched between the greater trochanter of the femur, and the muscles and tendons that cross over it. If this bursal sac becomes inflamed, patients experience pain with every step they take, as each step requires the tendon to move over the femur at the hip joint. A tight iliotibial band can also cause irritation of the greater trochanteric bursa. Iliopsoas bursitis can result from irritation of the bursa found between the hip joint and the iliopsoas muscle that passes in front of it. Another common site for bursitis is the ischial bursa, which acts as a lubricating pad between tendons and the ischial tuberosity, which is the bony prominence of the pelvis that you sit on. The ischial bursa acts to prevent destruction of the tendons as they move over the ischial tuberosity. Prolonged sitting can cause ischial bursitis. Inflammation around the ischial tuberosity can irritate the sciatic nerve, and trigger symptoms similar to sciatica. Hip bursitis is seen in runners and athletes in sports that involve excessive running (soccer, football, etc.). It can also be caused by an injury (traumatic bursitis), and is seen in post-op hip replacement and hip surgery patients. Treatment for hip bursitis typically includes rest, anti-inflammatory medications, and ice. It may become necessary to aspirate the bursa, which can be combined with a cortisone injection. MRI may be needed if the diagnosis is unclear, or if the problem does not resolve with normal treatments.


Figure 25. Bursae of the hip.


Axial Scans

When positioning unilateral axial slices for the hip, a coronal image can be used to ensure inclusion of all pertinent anatomy. The slices should extend superiorly to include the entire femoral head and acetabulum, and inferiorly to include anatomy below the lesser trochanter. The slices should be aligned perpendicular to the shaft of the femur, as seen in the coronal image in Figure 39.


Figure 39. Axial slice setup using sagittal and coronal images.

For bilateral axial hip slice setup, parameters may have to be altered to maintain adequate resolution with the larger FOV that is required (Figure 40). The slice group may require angulation to maintain alignment of the femoral heads on the resultant images.


Figure 40. Bilateral axial slice setup using a coronal image.

Coronal Scans

Coronal slices of the hip should cover the area from the posterior margin to the anterior margin of the femoral head. The area from the proximal margin of the femoral shaft to the greater sciatic notch should be included in the image (Figure 41). Slices may be angled so that they are parallel to the femoral neck. Thinner slices may be requested for coronal scanning.


Figure 41. Coronal slice setup using axial and sagittal images.

Sagittal Scans

Sagittal slices of the hip should extend past the greater trochanter laterally, and through the acetabulum medially. The slices should be aligned along the long axis of the femur, and perpendicular to the coronal slices, as seen in the coronal image in Figure 42. Two different slice groups will be necessary when performing bilateral sagittal scans.


Figure 42. Sagittal slice setup using coronal and axial images.

Hips Arthrography

MR hip arthrography is often times referred to as the gold standard for assessment of the labrum of the hip. The most clinically significant abnormal findings that result from hip arthrography are labral detachments and tears. Detachment of the labrum, which is more common than a labral tear, can be diagnosed from the appearance of the injected contrast at the acetabular-labral interface (Figure 43). A labral tear can result in injected contrast appearing within the substance of the labrum (Figure 44). Contrast injection is necessary to differentiate torn or detached labra from other pathologic conditions, which may have separate signal intensities. The sensitivity and accuracy for the diagnosis of labral tears and detachment with MR arthrography vs. nonarthrographic MR is 90%. Hip arthrography with MR can also depict intrarticular loose bodies, osteochondral abnormalities, and abnormalities of soft-tissue structures.

Hip arthrography can be performed under fluoro in the x-ray dept., with the patient being moved to the MRI dept. for further imaging, or the entire procedure can be performed in the MRI suite, if MR compatible supplies are available for interventional techniques. The patient should be securely positioned with the hips in internal rotation.

T1-weighted imaging is performed post-contrast to visualize the high signal of the intraarticular contrast. T1 gradient echo sequences offer the benefits of thin sections, elimination of partial volume averaging, and increased detection of small tears. Fatsat sequences are helpful in increasing the contrast between the injected contrast and the adjacent soft tissue. STIR or fatsat T2 sequences performed in the coronal plane may help to detect unsuspected pathologic conditions in the soft tissue and adjacent osseous structures.

Post-contrast axial oblique images have been shown to optimize the detection of the most common sports-related acetabular labral tears, which are anterior or anterosuperior in location. Using a mid-coronal localizer, the axial oblique slices should be prescribed parallel to the long axis of the femoral neck.


Figure 43. Labral detachment as seen in a fat-suppressed T1-wtd. sag. image; arrowheads indicate involvement of anterior and anterosuperior labrum.


Figure 44. Labral tear as seen in a T1-wtd. image; arrowheads indicate enlarged labrum; short arrow indicates linear intralabral collection of contrast material; long arrow indicates communication between the joint and the iliopsoas bursa.


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Get A Deep Piriformis Stretch For Sciatica, Hip & Lower Back Pain

Get A Deep Piriformis Stretch For Sciatica, Hip & Lower Back Pain

Many people suffer from lower back pain that spreads downward to the limbs and feet. This can often be alleviated by doing a deep piriformis stretch � a stretch that releases tight piriformis muscles, and relaxes the sciatic nerve.

Constriction of the piriformis muscle can irritate the sciatic nerve because they lay in close proximity to each other. By irritating the sciatic nerve, the result is pain (either in the lower back or thigh), numbness and tingling along the back of the leg and into the foot.

What Is The Piriformis?

The piriformis muscle is a small muscle located deep in the buttock, behind the gluteus maximus. It connects the spine to the top of the femur and allows incredible flexibility in the hip region (it�s the main muscle that allows for outward movement of the hip, upper leg and foot from the body).

The sciatic nerve passes underneath this muscle on its route to the posterior thigh. However, in some individuals, the sciatic nerve can actually pass right through the muscle, leading to sciatica symptoms caused by a condition known as piriformis syndrome.

Unfortunately, for a lot of individuals, their sciatic nerve passes through the piriformis muscle, leaving them with pain that just won�t go away (as well as poor mobility and balance).

Causes Of Piriformis Syndrome

The exact causes of piriformis syndrome are unknown. The truth is, is that many medical professionals can�t determine a cause, so they cannot really diagnose it. Even with modern imaging techniques, the piriformis is difficult to identify.

Lower back pain caused by an impinged piriformis muscle accounts for 6-8% of those experiencing back pain (1).

Suspected causes of piriformis syndrome include (2):

� Tightening of the muscle, in response to injury or spasm � Swelling of the piriformis muscle, due to injury or spasm � Irritation in the piriformis muscle itself � Irritation of a nearby structure such as the sacroiliac joint or hip � Bleeding in the area of the piriformis muscle

Any one of the above can affect the piriformis muscle, as well as the adjacent sciatic nerve.

Also, a misaligned or inflamed piriformis can cause difficult and pain while sitting and when changing positions (from sitting to standing). I actually stretched too far in a yoga pose once, and irritated my piriformis muscle � this took about 1-2 years to fully heal. I had major pain while sitting, and when changing positions from sitting to standing. I remember it being a huge pain in the butt (pardon the bun), but I just stuck with stretching and trigger point release and eventually it went away.

10 Deep Piriformis Stretches

These piriformis stretches are great for alleviating pain and a triggered sciatic nerve.

It is important to note, too, that over-stretching can actually make the condition worse. Light, gentle stretching is best. �No pain, no gain� does NOT apply here. I over-stretched my piriformis and that�s what made it inflamed for 1-2 years (because I was still doing yoga daily, and over-doing it in stretches).

Make sure you warm up your muscles before you stretch, because you can create a different injury. To warm up, simply walk or march in place or climb up and down a flight of stairs slowly for a few minutes before stretching.

Exercising and stretching the piriformis is well worth it � try it now with these 10 stretches:

1. Supine Piriformis Stretch

1. Lie on your back with your legs flat.
2. Pull the affected leg toward the chest, holding the knee with the hand on the same side of the body and grabbing the ankle with the other hand.
3. Pull the knee towards the opposite shoulder�until stretch is felt.
4. Hold for 30 seconds, then slowly return to starting position.

There are many variations of this stretch, but here is a good video to demonstrate:


2. Standing Piriformis Stretch

1. If you have trouble balancing, stand with your back against a wall, and walk your feet forward 24 inches. Position your knees over your ankles, then lower your hips 45 degrees toward the floor.
2. Lift your right foot off the ground and place the outside of your right ankle on your left knee.
3. Lean forward and lower your chest toward your knees while keeping your back straight. 4. Stop when you feel the glute stretch. 5. Hold for 30-60 seconds, then switch legs and do the same.


3. Outer Hip Piriformis Stretch

1. Lie on your back and bend the right knee.
2. Use the left hand to pull the knee over to the left side. Keep your back on the ground, and as you do so, you should feel the stretch in the hip and buttocks.
3. Hold for 20-30 seconds, and repeat on the other side.

4. Long Adductor (Groin) Stretch

1. Sitting on the floor, stretch your legs straight out, as far apart as you can.
2. Tilt your upper body slightly forward at the hips and place your hands next to each other on the floor.
3. Lean forward and drop your elbows to the floor if you can. You will feel the pelvis stretching.
4. Hold for 10-20 seconds, and release.


5. Short Adductor (Inner Thigh) Stretch

1. For this exercise, sit on the floor and put the soles of your feet together.
2. Use your elbows to apply downward pressure to your knees to increase the stretch.
3. You should feel the stretch on the inner thighs. For a deeper stretch, bend your upper torso forward with a straight back.
4. Hold for 30 seconds, release, and flutter your legs in the same position for 30 seconds.


6. Side Lying Clam Exercise

1. Lay on your side with the hip that needs help on top.
2. Bend your knees and position them forward so that your feet are in line with your spine. 3. Make sure your top hip is directly on top of the other and your back is straight.
4. Keeping your ankles together, raise the top knee away from the bottom one. Do not move your back or tilt your pelvis while doing so, otherwise the movement is not coming from your hip.
5. Slowly return the knee to the starting position. Repeat 15 times.


7. Hip Extension Exercise

1. Position yourself on all fours with your shoulders directly over your hands. Shift your weight a little off the leg to be worked.
2. Keeping the knee bent, raise the knee off the floor so that the sole of the foot moves towards the ceiling.
3. Slowly lower the leg, almost back to the starting position and repeat 15 times.


8. Supine Piriformis Side Stretch

1. Lie on the floor with the legs flat, and raise the affected leg by placing that foot on the floor outside the opposite knee.
2. Pull the knee of the bent leg directly across the midline of the body using the opposite hand or towel until a stretch is felt. Do not force anything and be gentle.
3. Hold the piriformis stretch for 30 seconds, then return to starting position and switch legs.
4. Aim for a total of 3 repetitions.


9. Buttocks Stretch for the Piriformis Muscle

1. Laying with your stomach on the ground, place the affected foot across and underneath the trunk of the body so that the affected knee is on the outside.
2. Extend the non-affected leg straight back behind the body and keep the pelvis straight. 3. Keeping the affected leg in place, move your hips back toward the floor and lean forward on the forearms until a deep stretch it felt.
4. Hold for 30 seconds, and then slowly return to starting position. Aim for a total of 3 stretches.


10. Seated Stretch

1. In seated position, cross your right leg over your left knee.
2. Bend slightly forward, making sure to keep your back straight.
3. Hold for 3-60 seconds and repeat on the other side.


Trigger Points &�The Piriformis Muscle

There are many other natural and highly effective remedies for sciatic nerve pain. Trigger point therapy is one of them, and truly one of the best.

According to Myofascial Pain and Dysfunction: The Trigger Point Manual, written by doctors Janet Travell and David Simons, myofascial trigger points (tiny knot contractions) in overworked gluteus minimus and piriformis muscles in the buttocks are the main cause of sciatica and all the symptoms that come with it.

Picking up a copy of the book, or even following instruction in the video below can help release these knot contractions.


Recovering at Home After Knee or Hip Replacement Surgery

Recovering at Home After Knee or Hip Replacement Surgery

Patients who go straight home from the hospital following hip or knee replacement surgery recover as well as, or better than, those who first go to a rehabilitation center, new research indicates.

And that includes those who live alone without family or friends, one of three studies shows.

“We can say with confidence that recovering independently at home does not put patients at increased risk for complications or hardship, and the vast majority of patients were satisfied,” said that study’s co-author, Dr. William Hozack. He is an orthopaedic surgery professor with the Rothman Institute at the Thomas Jefferson University Medical School in Philadelphia.

Hozack noted that while in the past it was “not uncommon for patients to enter a rehabilitation facility in order to receive additional physical therapy,” most patients today do not end up going to a secondary facility. In fact, roughly 90 percent of Hozack’s joint replacement patients are discharged directly home following surgery, he said. “Considerable evidence has now shown that most patients do just as well at home,” he noted.

Hozack and his colleagues are scheduled to present their findings in San Diego at a meeting of the American Academy of Orthopaedic Surgeons (AAOS).

Home Recovery Following Surgery

Two other studies being presented at the meeting also found that recovering at home may be the better option.

One study found that patients who are discharged directly home following a total knee replacement face a lower risk for complications and hospital readmission than those who first go to an inpatient rehab facility. The study was led by Dr. Alexander McLawhorn, an orthopaedic hip and knee surgeon at the Hospital for Special Surgery in New York City.

McLawhorn was also part of a second Hospital for Special Surgery study, led by Michael Fu. That study found that hip replacement patients admitted to an inpatient facility rather than being sent home faced a higher risk for respiratory, wound and urinary complications, and a higher risk for hospital readmission and death.

Dr. Claudette Lajam is chief orthopaedic safety officer with NYU Langone Orthopaedics in New York City. She was not involved with the studies, but agrees that home recovery is the best option for most patients.

“The home setting is the single best way to get people back into their routines as quickly as possible after surgery,” she said. “In some cases, this cannot be done,” Lajam acknowledged. “Some patients live in settings that are inaccessible, [such as] a 5th-floor walk-up apartment where the patient would need to go downstairs to let the visiting nurse and therapist in the door.” For some patients, anxiety about the recovery process could also pose a challenge, she added. But “being in an institutional setting after surgery only reinforces the idea that the patient is ‘sick,’ ” Lajam added. “We have learned that this type of thinking slows down recovery. We want our total joint patients to start using their new joints as quickly as possible, and staying in bed at a nursing facility is not the way to do this.”

Hozack and his colleagues set out to see whether patients who live alone fare as well as those who live with others. All 769 patients enrolled in the study by Hozack’s team went home following either a total hip replacement or a total knee replacement. Of those, 138 lived alone (about 18 percent). Once home, all were assessed on multiple levels, including functionality (ability to move); pain levels; hospital readmissions; emergency department visits; unscheduled doctor visits; dependency on assisted-walking devices; and time before returning to work or being able to drive again.

Hozack’s team observed no differences by any measure. And while those who lived with others indicated relatively higher satisfaction levels at the two-week mark, by the three-month point there was no appreciable difference between the two groups.

“We feel that giving patients back their independence early on is the best way to promote a safe and effective recovery,” said Hozack. His team concluded that single-household patients who go straight home can expect to fare as well as those who have live-in support.

A recent Mayo Clinic study calculated that between 2000 and 2010, the number of Americans who underwent hip replacement surgery more than doubled, rising from just under 140,000 to more than 310,000 per year.

Meanwhile, AAOS figures indicate that in 2010 more than 650,000 knee replacement procedures were performed, with about 90 percent involving total knee replacement. AAOS estimates from 2014 show that 4.7 million Americans now live with an artificial knee and 2.5 million have an artificial hip.

Findings presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.

SOURCES: William J. Hozack, M.D., professor of orthopaedic surgery, Rothman Institute, Thomas Jefferson University Medical School, Philadelphia; Claudette Lajam, M.D. assistant professor and chief orthopedic safety officer, NYU Langone Orthopedics, New York City; March 14-18, 2017 presentations, American Academy of Orthopaedic Surgeons meeting, San Diego

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900

Additional Topics: What is Chiropractic?

Chiropractic care is a safe and effective, alternative treatment option utilized to diagnose, treat and prevent a variety of injuries and conditions associated with the musculoskeletal and nervous system. A chiropractor, or doctor of chiropractic, commonly uses spinal adjustments or manual manipulations to help correct the spine and it’s surrounding structures, improving and maintaining the patient’s strength, mobility and flexibility.


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Orthotics Can Help With Sports Hip Injuries

Orthotics Can Help With Sports Hip Injuries

Injuries to the muscles and ligaments around the hip affect both competitive and recreational athletes. These injuries can interfere significantly with sports enjoyment and performance levels, and they occasionally will end participation completely. Excessive pronation and poor shock absorption have been found to be an underlying cause or a contributing factor for many leg injuries. Functional orthotics which have been custom-fitted to improve the biomechanics of the feet and reduce the extent of pronation can help to prevent many sport-related leg injuries.

Lower Extremity Problems in Athletes

One study looked at the foot biomechanics of athletes who reported a recent foot or leg injury and compared them to an uninjured control group. The researchers determined that those athletes with more foot pronation had a much greater statistical probability of sustaining one of five leg injuries, including iliotibial band syndrome (which is due to excessive tightness of the hip abductor muscles).
This study helps us understand how providing appropriate functional foot orthotic support to patients who are involved in sports or recreational activities lowers their likelihood of developing both traumatic and overuse hip injuries.

blog illustration of anatomical body in running motion focusing on the ililotibial band

In this paper, sixty-six injured athletes who ran at least once a week, and who had no history of traumatic or metabolic factors, were the study group. Another control group of 216 athletes were matched who did not have any symptoms of lower extremity injuries. The amount of pronation during standing and while running at �regular speed� was determined by measuring the angles of their footprints. The investigators found a significant correlation: Those athletes with more pronation had a much greater likelihood of having sustained one of the overuse athletic injuries.

Hip and Thigh Injuries

Many injuries experienced at the hip develop from poor biomechanics and gait asymmetry, especially when running. Smooth coordination of the muscles that provide balance and support for the pelvis is needed for optimum bipedal sports performance. This includes the hamstring muscles and the hip abductor muscles, especially the tensor fascia lata (the iliotibial band). When there is a biomechanical deficit from the feet and ankles, abnormal motions (such as excessive internal rotation of the entire leg) will predispose to pulls and strains of these important support muscles. The hamstrings (comprised of the biceps femoris, semimembranosus, and semitendinosus muscles) are a good example.


blog picture of multicolor illustration of runners


During running, the hamstrings are most active during the last 25% of the swing phase, and the first 50% of the stance phase. This initial 50% of stance phase consists of heel strike and maximum pronation. The hamstring muscles function to control the knee and ankle at heel strike and to help absorb some of the impact. A recent study has shown a significant decrease in electromyographic activity in the hamstrings when wearing orthotics. In fact, these investigators found that the biceps femoris (which is the most frequently injured of the three hamstring muscles) had the greatest decrease in activity of all muscles tested, including the tibialis anterior, the medial gastrocnemius, and the medial and lateral vastus muscles. The scientists in this study theorized that the additional support from the orthotics helped the hamstrings to control the position of the calcaneus and knee, so there was much less stress into the hip joint and pelvis.

Excessive Pronation and Hip Injuries

Using functional orthotics to correct excessive pronation and to treat hip problems requires an awareness of the various problems that can develop. The following is a list of the pathologies that are seen in the hip and pelvis secondary to pronation and foot hypermobility:

Iliotibial band syndrome����������������� Tensor fascia lata strain

Trochanteric bursitis����������������������� Hip flexor muscle strain

Piriformis muscle strain������������������ Hip adductor muscle strain

Hip joint capsulitis��������������������������� Anterior pelvic tilt

These conditions will develop much more easily in athletes, who push their musculoskeletal systems, and who seek more efficient and effective functional performances.

In 2002, researchers at Logan College of Chiropractic recruited a total of 40 male subjects that demonstrated bilateral pes planus or hyperpronation syndrome. Subjects were cast for custom made orthotics; their right and left Q-angles were measured with and without the orthotic in place. Thirty-nine of 40 test subjects showed reduced Q-angle, which was in the direction of correction, suggesting that wearing orthotics can improve stability and levelness of the pelvis, thus protecting the body to some degree from hip injury.


blog picture of lady running with a close up of intense active orthotic inserts


Excessive pronation and/or poor shock absorption have been shown to be an associated or causative factor in many leg injuries � from the foot itself, up the lower leg to the knee, thigh, and into the hip joint. The good news is that many of these conditions can be prevented with custom-fitted functional orthotics. Evaluation of foot biomechanics is a good idea in all patients, but is especially necessary for those who are recreationally active, or for anyone who has experienced hip problems.

To avoid potentially disabling hip injuries, competitive athletes must have regular evaluations of the alignment and function of their feet. Additional preventive measures include wearing well-designed and solidly-constructed shoes. When athletes are provided with custom-fitted functional orthotics, it can help prevent arch breakdown and biomechanical foot problems, and also treat numerous injuries of the lower extremities, including the hip joints.

Sourced through from: Dr. Alex Jimenez

Many injuries experienced at the hip develop from poor biomechanics and gait asymmetry, especially when running. Smooth coordination of the muscles that provide balance and support for the pelvis is needed for optimum bipedal sports performance. For Answers to any questions you may have please call Dr. Jimenez at 915-850-0900

Pregnant Women Can Use Kinesiotape 5 Ways

Pregnant Women Can Use Kinesiotape 5 Ways

5 Ways to Use Kinesiotape for Pregnant�Women

Women often seek out chiropractic care during their pregnancies. One of the main reasons for this is that if they are having musculoskeletal pain, their Obstetrician or Midwife generally has very limited options for conventional medical treatment. They are less likely to prescribe medication, which presents an amazing opportunity for us as chiropractors. What initially began as a strange combination of a sports certification and a prenatal/pediatric certification has created a successful and in-demand niche for us. For the most part, I cannot imagine treating prenatal patients without having the sports background. First, most women at some point in their lives have been or currently are an athlete. And second, one of the most common complaints women have during pregnancy is myofascial pain, and who better to treat that than a sports chiropractor? Here are 5 common and easy-to-treat complaints during pregnancy:

blog infographic of how to use kinesiotape during pregnancy

One: Pubic Bone Pain

This pain is very common during the second and third trimesters of pregnancy. Women will often describe it as exquisitely tender, worse with rolling over in bed at night, walking or climbing stairs. Conventional medical opinion is that the ligaments during pregnancy are much more relaxed (due to the hormone, relaxin) causing separation of the pubic symphysis and thus inflammation and pain. Sports chiropractors are uniquely qualified to assess this joint, and the common causes of pain can include:

1. Adductor hypertonicity easily addressed with myofascial release or techniques such as Graston, which can be done over leggings or on skin.

2. SI Joint fixation or Pubic Symphysis fixation. While I am generally a diversified adjuster, an activator adjustment to the superior or more-tender pubic rami will go a long way in terms of providing relief. I strongly discourage any audible manipulation of the pubic symphysis.

3.�Kinesiology taping�of a �RockTape Baby Belt� or modified version of this can provide significant relief and is much more comfortable than a pelvic support belt.

4. Using an ice pack for 15 minutes prior to going to bed at night will decrease pain and inflammation while sleeping.

Two: Rib Pain

Rib pain, especially in the lower and floating ribs, is common as the weight of the abdomen is pulling on the oblique abdominal muscles and their attachments at the ribs. Adjusting the ribs at the thoracic spine and incorporating myofascial release or Graston Technique will work quickly (often in just 1 treatment). Finish up with a few strips of kinesiology tape and your patient will feel significantly better.

Three: Upper Abdominal Numbness

Upper abdominal numbness is a common symptom during the later stage of pregnancy. It often presents as numbness but can also be painful and worse with sitting. One of the easiest ways to provide relief is with one simple strip of kinesiology tape over the top of the abdomen directly under the rib cage.

Four: Swelling in the arms and legs

Swelling in the arms and legs is very common and can lead to numbness, tingling or pain. Before beginning treatment, be sure to assess if the swelling in the feet is significant and test for pitting edema which can be a warning sign of preeclampsia. This can be corroborated with a high blood pressure reading and is very dangerous. Two very effective sports techniques for use with lower extremity swelling include 1.�NormaTec PULSE Recovery System�which is not contraindicated in pregnancy. Patients can do a few 20-30 minutes sessions per week to promote circulation and decrease swelling. 2. Kinesiology taping for edema on the ankles.

Five: Lower Back Pain

Lower back pain in pregnancy is very common. Evaluating a pregnant patient prone is very easy if you have pregnancy cushion that sits on top of your table. If you do not, you can evaluate the lower back in the seated or side lying position. Lower back pain can generally be addressed with diversified adjustments (without any rotation as to not stress the abdomen). In addition, the Webster Technique for pregnancy is a valuable tool for assessing and treating lower back pain during all stages of pregnancy. There are also valuable kinesiology tape applications for lower back pain,�RockTape features a pregnancy taping pdf online. In addition, there are no contraindications to using the Graston Technique to address myofascial pain in the lower back.�blog picture of pregnant lady's stomach with kinesiotape strips around belly

Most of the taping techniques discussed above can be done by patients themselves after a one-time demonstration. Have an assistant or patient�s family member take a video of the application for reference at home. Many sports chiropractic techniques can be used very effectively on prenatal patients.

Sourced through from: Dr. Alex Jimenez

Hip Injuries Due to Improper Running Mechanics

Hip Injuries Due to Improper Running Mechanics

Hip injuries are often uncommon types of injuries among athletes, as these don�t generally occur immediately, rather, the accumulated hours of training may progressively cause a series of worsening symptoms.

Approximately 3.3 percent to 11.5 percent of long distance runners suffer sports injuries as a result of overtraining, where hip complications are believed to contribute for up to 14 percent of all athletic issues. In fact, hip injuries make up nearly a sixth of all injuries sustained by athletes. Moreover, because of the complexity of the hip and its surrounding structures, about 30 percent of hip injuries are undiagnosed. Without correcting the initial problem, recurrence or ongoing impairment may often follow.

Anatomy of the Hip

The hip can be described as a ball and socket joint, the ball constitutes from the head of the femur and the socket from the acetabulum of the pelvis. The depth of the socket is increased due to a specific type of tissue best known at the fibrocartilage lining of the labrum, which is almost identical to the cartilage found in the knee. The extra added depth to the acetabulum adheres the ball within the socket to allow the necessary stability to support the hip joint as well as its surrounding muscles and ligaments. The labrum is made up of multiple nerve endings which assist with the perception of pain and the awareness and balance of the joint within the body, referred to as proprioception. The structure provides forward, backward, and side to side movement to the hip, also allowing it to rotate inwards and outwards. This intricate mobility of the hip, together with the speed and power of running, is the main cause behind the different forms of hip injuries among athletes.


Hip Joint Anatomy Diagram - El Paso Chiropractor


Running Biomechanics

To understand the mechanics of running and the process of impact which transfers through the body, the cycle of running can be explained into two phases. The first phase is called the stance phase, where the foot lands on the ground, and the second phase is called the swing phase, were the foot moves through the air. The stance phase initiates when the heel is in contact with the ground. Referred to as the mid-stance, this middle phase occurs when the rest of the foot follows, also referred to as the absorption phase. At this point, the knee and ankle are fully flexed in order to be able to absorb the impact against the ground, functioning as a brake to control the landing. The leg then saves this elastic energy within the muscles. The hip, knee and ankle subsequently extend using the recoil from the muscles to complete the toe-off phase and propel the body forward and upward.

During longer distance running, the stance phase generally lasts longer due to a runner�s longer stride. The stance phase also exposes the hip joint to about five times the individual�s body weight in comparison to three times the individual�s body weight during the swing phase. When athletes run faster, they spend less time on the ground, subjecting them to lesser forces being transmitted up their lower extremities.

The muscles and tissues of the hip, knee and ankle function together to control the movements of the joints and well as restrict the forces being placed against them. They are exposed to reaction forces from the ground which force the structures to contract accordingly. The harder and athlete lands or the greater the distance they run, the more activation is usually required by the structures to offload the joints and absorb the force of the additional load. As every runner possesses their unique running style, over a period of time, a constant pattern of running and the impact they receive from the above mentioned forces eventually exceeds an individual�s limit. This combination of factors is generally the leading cause of hip injuries among many athletes.


Running Biomechanics - El Paso Chiropractor


The Effects of Running on the Hip

Running impact occurs through the heel strike of the running phase. Depending on the duration of contact, the frequency and how heavy an athlete lands on their heel, the extent of impact will vary. Runners who impact on the midfoot are believed to experience far less impact force than other athletes.

As often described by many healthcare professionals, a single load can damage or injure the articular cartilage and tear the labrum, most commonly occurring after an unexpected trip or fall. Most often than not, however, the repetitive load from running or similar activities can gradually develop small micro trauma to the hip joint, an accumulation of damage which can thin out this layer of cartilage and cause tearing and shearing of the tissues. The hip consists of flexor muscles, such as the iliopsoas, the sartorius, the rectus femoris, the tensor fasciae latae and the pectineus, which are designed to flex in order to absorb the shock of impact. The pelvis will then follow by rotating back, providing more space for flexion to occur. It will then adduct, using the adductor longus, adductor brevis, adductor magnus and pectineus, which will then follow into abduction, primarily utilizing the gluteus medius, for a terminal swing and take off. The hip will then subsequently move into extension, where the leg extends backwards, to propel the body forward, mainly utilizing the gluteus maximus as the pelvis shifts forward to adjust the functions of the hip joint.

If any of these movements are altered during physical performance, the forces of impact being placed against the body will be transmitted incorrectly, causing the pelvis to become unstable and adding tremendous strain against the hip joints and muscles. Repetitive and constant loads of weight and force can then create an accumulation of trauma, leading to several forms of hip injuries and complications.

Hip Pathologies

A wide variety of hip injuries can affect running athletes as well as those involved in other types of sports and physical activities. The most common complications are as follows:

Muscle strains, can develop and affect any of the muscles and tissues involved in the natural biomechanics of the hip, specially if these become overloaded due to poor alignment and mechanics. The most common muscle strains causing hip injuries occur to the iliopsoas due to over flexing of the hip joint or from a heavy impact while the hip is flexed and an excessive amount of load is placed against the muscles. The gluteus medius can also suffer damage or injury if the runner or athlete over-adducts, described as an inwards movement of the hip, during their running pattern and the gluteus medius tendons become irritated with direct compression from the hip bone.

Trochanteric Bursitis, is characterized by swelling and inflammation of the fluid-filled sac known as the bursa, located within the greater trochanter on the side of the hip. The bursa provides the appropriate mobility to the iliotibial band found over the hip bone, however, constant shearing can often lead to irritation and inflammation.

Femoroacetabular impingement, or FAI, occurs when the femur compresses the acetabulum, primarily during the flexion of the hip where the bones and other structures collide. A pincer impingement where the acetabulum rim develops an extra lip of bone can often cause hip injuries or a CAM impingement can cause the femoral neck to grow an extra ridge of bone, resulting in other types of complications. Untreated FAI can progressively lead to labral tears because the additional bone can repeatedly grind down the labrum.

Labral tears, are medically defined as a tearing of the labrum which surrounds the joint of the hip and the acetabulum. These generally occur after a traumatic event or injury or due to cumulative microtraumas over a period of time.

Rehabilitation and Prevention

Because of the wide variety of hip injuries which can affect the modern athlete, a proper diagnosis performed by a qualified healthcare professional, such as a chiropractor or physical therapist, is absolutely essential towards developing an appropriate treatment plan. Foremost, athletes with already diagnosed hip injuries should avoid repeated or regular flexions of the hip to prevent further complications. If flexion cannot be avoided, for instance, when sitting, then the individual can lean back or stand up into extension. Cycling and treadmill running are not appropriate cross-training methods for hip injuries as these promote hip flexion and internal rotation, causing further impingement to the acetabulum. Swimming is permitted in these cases as it is a non-impact sport and it avoids these irritable positions.

The following three stages of rehabilitation can be followed in sequence or may be combined to prevent aggravating hip injuries.

First, the individual can proceed to strengthen the gluteal muscles, primarily the gluteus medius and maximus in isolation by performing the next exercise. The individual must bridge lie on their back while keeping their knees bent and placing their arms by their sides. Then, placing a resistance band around their thighs will help draw the knees in together. The individual may attempt to keep them apart by pushing against the band, activating the gluteus medius. Subsequently, the athlete can carefully push up through the heels to lift their buttocks and back off the floor, holding the position for five seconds before slowly returning to the initial position. This exercises should be repeated in sets of 10.


Bridging Exercise - El Paso Chiropractor


Also, the individual can perform another strengthening exercise by clam lying on their side with the specified hip on top. Keeping their feet together, the affected individual should then lift the top knee upwards into external rotation, activating the gluteus medius and preventing the hip from adducting. It�s important for the athlete to control their knee on the return to start position to maintain eccentric muscle control and improve greater hip stability. This exercise should be repeated for three sets of 10 repetitions.


Clam Exercise - El Paso Chiropractor


Second, to strengthen the whole lower extremities, the individual must combine movements to incorporate other muscle groups and improve core stability. To achieve this, the individual must perform a lunge with twist by taking a step forward with their specified leg and proceed to bend both knees and hips simultaneously, making sure not to bend the hip to more than 60 degrees. Once in this particular position, the affected athlete can proceed to rotate their body from right to left, slowly returning to the starting position to strengthen the core and improve pelvic stability. This exercise should be repeated for sets of 10 as the participant is capable to do so.


Lunge with Twist - El Paso Chiropractor


Also, the individual can perform another exercise to strengthen the lower extremities known as the single leg squat with twist. Standing on the specified leg while the pelvis is in a neutral position, the athlete can proceed with this exercise by bending at the hip and knee into a squatting position. Keeping the knee behind the toes, the athlete must then rotate their body to the right and left while keeping their back straight, further activating the the gluteus maximus and challenging the core muscles. This exercise can be repeated in sets of 10 as able.


Single Leg Squat with Twist - El Paso Chiropractor


And finally, to strengthen the hip and improve the functional movements of running patterns, athletes with hip injuries can proceed to perform the following exercises. The standing hip hike can be completed by having the athlete stand upright with their feet kept hip distance apart. The individual must then hitch up their specified hip while maintaining neutral pelvic stability, making sure the hips do not twist or move around. Repeat for three sets of 10 repetitions.

Then, the individual can also perform forward step ups by standing in front of a high step or stair, holding on to a pole at one side to activate the latissimus dorsi back muscles, associated with the gluteal muscles. Leading with the chosen hip, the athlete can then proceed to step upwards and then return to the starting position. Repeat leading with the same leg each time for three sets of 10 repetitions.

Furthermore, to continue strengthening their hip and improve function, hip swings can be utilized to help those athletes with hip injuries throughout their rehabilitation process. Using a similar setup as the forward step ups, the individual can perform this exercise by resting their good knee on a bench. Holding on to the pole, the athlete can proceed to bring the specified hip forward into hip flexion, returning to the original position. The static leg should maintain good pelvic stability and will be brought into extension, activating the gluteus maximus rather than the hamstrings. This exercise must be repeated for three sets of 10 repetitions.


Hip Swings - El Paso Chiropractor


Return to Play

The athlete can participate in an appropriately developed return to play program following the variety of hip injuries they may experience, alongside the strength training regimen mentioned above once the complications begin to improve. Runners should aim to begin this specific program at approximately 60 percent pre-injury intensity. Athletes can begin running on soft surfaces to limit the amount of impact, they may include a comprehensive dynamic warm-up. Subsequently, athletes can begin progressively increase the speed, only running on alternate days for the first 3 to 4 weeks, continuing to strengthen through training. Sprints, hills, accelerations, and decelerations can be introduced slowly, choosing one element at a time.

As with any type of rehabilitating programs, the affected athletes must first seek medical attention from a qualified healthcare professional to receive a proper diagnosis of their injuries before attempting any form of stretches or exercises as to avoid further injuries. A chiropractor, is a specialized doctor who focuses on a variety of spinal injuries or conditions and its surrounding structures, including various types of sports injuries. Through chiropractic care, a chiropractor can perform a series of spinal adjustments and manual manipulations to provide mobilization therapy and improve an athlete�s symptoms, strength, flexibility and overall health. Doctors of chiropractic, or DCs, may also recommend a series of additional exercises different from the ones mentioned above to accordingly help speed up the individual�s recovery process.

Tips for Preventing Overuse and Traumatic Injuries

Hip injuries can be debilitating to runners as well as athletes from other sports. Hip flexibility and strength is essential for optimal performance. The hip joint is a complex structure that moves in multiple directions and is stabilized and supported by those specific structures. When an individual is faced with debilitating hip injuries, getting the appropriate medical attention is essential and following through with the right rehabilitation exercises can be crucial towards the athlete�s overall recovery and return to play.

For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900�.

Sourced through from:

By Dr. Alex Jimenez