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Neuropathy

Back Clinic Neuropathy Treatment Team. Peripheral neuropathy is a result of damage to peripheral nerves. This often causes weakness, numbness, and pain, usually in the hands and feet. It can also affect other areas of your body. The peripheral nervous system sends information from the brain and spinal cord (central nervous system) to the body. It can result from traumatic injuries, infections, metabolic problems, inherited causes, and exposure to toxins. One of the most common causes is diabetes mellitus.

People generally describe the pain as stabbing, burning, or tingling. Symptoms can improve, especially if caused by a treatable condition. Medications can reduce the pain of peripheral neuropathy. It can affect one nerve (mononeuropathy), two or more nerves in different areas (multiple mononeuropathies), or many nerves (polyneuropathy). Carpal tunnel syndrome is an example of mononeuropathy. Most people with peripheral neuropathy have polyneuropathy. Seek medical attention right away if there is unusual tingling, weakness, or pain in your hands or feet. Early diagnosis and treatment offer the best chance for controlling your symptoms and preventing further damage to the peripheral nerves. Testimonies http://bit.ly/elpasoneuropathy

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

 


Nerve Conduction Velocity: Key Insights on Nerve Health

Nerve Conduction Velocity: Key Insights on Nerve Health

Should individuals experiencing nerve pain or various sensations get a nerve conduction velocity study to examine nerve health and function?

Nerve Conduction Velocity: Key Insights on Nerve Health

Nerve Conduction Velocity

A nerve conduction velocity (NCV) is a noninvasive test that measures the speed and strength of nerve stimulation using electrical probes placed on the skin. It’s used to diagnose nerve damage or disease, often alongside an EMG (electromyogram) to differentiate between nerve and muscle problems. It can also evaluate sensory issues, pain, and weakness of the extremities.

  • This test involves safe electrical shocks that can be slightly uncomfortable but not painful.
  • Nerve conduction velocity (NCV) measures the speed at which electrical impulses travel along a nerve fiber, which measures how quickly electrical signals travel through a nerve.
  • This information indicates nerve health and function.
  • Electromyography (EMG) is a nerve test that involves placing tiny needles into the muscles.
  • A slower NCV can indicate nerve injury or dysfunction.

Test Uses

Generally, the test is ordered to assess peripheral nerve diseases, those that connect from the muscles, organs, and skin to the spinal cord or brain. It can help identify the type and location of nerve damage.

  • Peripheral nerve conditions typically cause pain, sensory loss, tingling, or burning.
  • Mild weakness and diminished reflexes can be detected during a neurological examination.

Conditions

Nerve conduction studies are performed to help diagnose conditions.

  • Herniated disc disease
  • Sciatic nerve problems
  • Carpal tunnel syndrome
  • Guillain-Barré syndrome
  • Nerve damage (neuropathy), such as from diabetes, chemotherapy, or autoimmune disorders
  • Charcot-Marie-Tooth disease

Nerve compression

  • Many different conditions, including trauma, inflammation, and tumors, can compress one or more nerves.

Radiculopathy

  • Often described as a pinched nerve, radiculopathy can affect an arm or a leg, causing pain and weakness.

Peripheral Neuropathy

  • This nerve damage begins in the most distal nerves, those farthest from the center of the body, such as the toes and fingers. It is often due to chronic alcohol misuse, uncontrolled diabetes, nutritional deficits, and inflammatory diseases. (Ferdousi M. et al., 2020)

Carpal Tunnel Syndrome

  • Commonly caused by inflammatory diseases or overuse of the wrists, such as from assembly line work, carpal tunnel syndrome causes numbness, pain, and weakness of the fingers and hands. (Tada K. et al., 2022)

Ulnar neuropathy

  • This common condition causes arm pain and sensory changes, usually due to repetitive movements or a prolonged position that causes pressure on the ulnar nerve.

Guillain-Barré syndrome (GBS)

  • This inflammatory condition causes demyelination, or loss of the insulating covering around nerves, which results in leg weakness.
  • It begins in the motor nerves, which send signals to muscles in the legs. (Shibuya K. et al., 2022)
  • The inflammation travels to nerves of the upper body, often affecting the muscles that control breathing.
  • Respiratory support is necessary until the condition improves.

Chronic Demyelinating Polyneuropathy (CIDP)

  • This condition is a chronic, recurrent form of GBS that usually affects the legs and causes episodes of weakness.

ICU neuropathy

  • Metabolic changes, severe illness, and not moving enough can cause nerves to develop a pattern of weakness and sensory loss.

Myasthenia gravis (MG)

  • This autoimmune condition affects the junction between the nerves and the muscles.
  • Myasthenia gravis causes drooping eyelids and weakness of the arms and shoulders.

Amyotrophic lateral sclerosis (ALS)

  • ALS is a serious, degenerative disease affecting the spinal cord’s motor neurons.
  • Amyotrophic lateral sclerosis progresses rapidly, resulting in substantial weakness of muscles throughout the body.

How it’s Done

  • Surface electrodes are placed on the skin over nerves, and a small electrical current is applied to stimulate the nerve.
  • The time it takes for the electrical signal to travel between the electrodes is measured, and this time is used to calculate the NCV.

Values

Normal NCV values are generally between 50 and 70 meters per second. However, these values can vary depending on the nerve and the individual.

NCV Factors

Various factors can influence NCV.

  • Age
  • Sex
  • Medical conditions like diabetes

Interpretation

  • A slower NCV can indicate nerve damage or demyelination (loss of the myelin sheath, which insulates nerve fibers), while an EMG can help determine if the problem is with the nerve or the muscle.

Results

The results of NCV testing can be used to determine the type, severity, and location of nerve damage. The results will be ready in report form about a week after the test.

  • The test measures velocity (how fast a nerve transmits signals) and amplitude (how many nerve fibers were activated). (Tavee J. 2019)
  • The measurements are transmitted to a computer and shown as waves and numerical values.
  • The values are compared to a standard measurement based on the tested nerve.
  • The distance between the electrodes.
  • The person’s age.

Compared to the standard, the NCV results can identify certain patterns of nerve damage. (Tada K. et al., 2022) Outcomes include: (Tavee J. 2019)

  • If one or more nerves are affected.
  • If motor nerves (control movement), sensory nerves (transmit sensory signals), or both are affected.
  • Whether a nerve is blocked or damaged.
  • The severity of the damage.
  • The type of nerve damage
  • Axonal (damage to the nerve itself)
  • Demyelination (damage to the protective fatty layer around the nerve)

The results can help point to certain diagnoses.

Preparation Before the Test

Individuals will not need to change their diet before having an NCV. However, patients will be asked to avoid lotions or creams on their skin before the test. Individuals who are also having an EMG at the time of their NCV might be asked to stop taking medications or supplements that increase the risk of bleeding and bruising. If a healthcare provider says not to stop taking the medicines for health reasons, the patient might be warned that they could have some bruising after the EMG test.

  • NCV may advise against getting the test for those with electrical device implants.
  • Make sure your healthcare providers are aware of your whole medical history.

Injury Medical Chiropractic & Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.


Peripheral Neuropathy and Chiropractic Care


References

Ferdousi, M., Kalteniece, A., Azmi, S., Petropoulos, I. N., Worthington, A., D’Onofrio, L., Dhage, S., Ponirakis, G., Alam, U., Marshall, A., Faber, C. G., Lauria, G., Soran, H., & Malik, R. A. (2020). Corneal confocal microscopy compared with quantitative sensory testing and nerve conduction for diagnosing and stratifying the severity of diabetic peripheral neuropathy. BMJ open diabetes research & care, 8(2), e001801. https://doi.org/10.1136/bmjdrc-2020-001801

Tada, K., Murai, A., Nakamura, Y., Nakade, Y., & Tsuchiya, H. (2022). In Carpal Tunnel Syndrome, Sensory Nerve Conduction Velocities Are Worst in the Middle Finger Than in the Index Finger. Frontiers in Neurology, 13, 851108. https://doi.org/10.3389/fneur.2022.851108

Shibuya, K., Tsuneyama, A., Misawa, S., Suzuki, Y. I., Suichi, T., Kojima, Y., Nakamura, K., Kano, H., Ohtani, R., Aotsuka, Y., Morooka, M., Prado, M., & Kuwabara, S. (2022). Different patterns of sensory nerve involvement in chronic inflammatory demyelinating polyneuropathy subtypes. Muscle & Nerve, 66(2), 131–135. https://doi.org/10.1002/mus.27530

Tavee J. (2019). Nerve conduction studies: Basic concepts. Handbook of Clinical Neurology, 160, 217–224. https://doi.org/10.1016/B978-0-444-64032-1.00014-X

Complex Regional Pain Syndrome Explained and Treated

Complex Regional Pain Syndrome Explained and Treated

Individuals dealing with chronic pain following a minor injury, surgery, or trauma could be experiencing complex regional pain syndrome. What are the symptoms, diagnosis, and treatments available?

Complex Regional Pain Syndrome Explained and Treated

Complex Regional Pain Syndrome

Reflex sympathetic dystrophy syndrome (RSDS), more commonly known as complex regional pain syndrome (CRPS), is a chronic pain condition where a person experiences severe, persistent pain in a limb, usually following an injury, that is significantly more profound than from the initial trauma. It is considered a neuroinflammatory disorder in which the body’s response to injury is dysregulated. The condition is characterized by severe burning pain, often in an arm or leg, that can occur following a minor injury, surgery, or trauma. It is associated with abnormal changes in skin temperature, swelling, and sensitivity to touch, usually affecting the affected area’s nerves, skin, muscles, blood vessels, and bones. Other names it is known by include:

  • Causalgia
  • Shoulder-Hand Syndrome
  • Sudeck’s Atrophy

Causes

CRPS is a chronic pain condition believed to result from dysfunction in the central or peripheral nervous systems (National Institute of Neurological Disorders and Stroke, 2017). It involves irritation and abnormal excitation of nervous tissue, leading to abnormal impulses along nerves that affect blood vessels and skin. Animal studies indicate that norepinephrine, a catecholamine released from sympathetic nerves, acquires the ability to activate pain pathways after tissue or nerve injury, resulting in CRPS. Another theory is that CRPS, which follows an injury, is caused by triggering an immune response and continuous inflammation symptoms (swelling, redness, warmth). (Goh E. L., Chidambaram S., & Ma, D. 2017) It is believed to have multiple causes producing similar symptoms.

Triggers

There can be numerous triggers, including:

Symptoms

CRPS usually affects one of the extremities (arm, leg, hand, or foot). The primary symptom is intense, continuous pain. (National Institute of Neurological Disorders and Stroke, 2017) Other symptoms can include

  • Burning pain
  • Swelling
  • Increased skin sensitivity
  • Extreme sensitivity to touch, often causing significant disability in the affected limb.
  • Stiffness and swelling in affected joints
  • Skin color changes – blotchy, purple, pale, red.
  • Skin temperature changes – warmer or cooler than the opposing extremity.
  • Skin texture changes – shiny, thin, sweaty.
  • Changes in nail and hair growth patterns.
  • Pain can spread, for example, from the finger to the entire arm and the opposite extremity or from the left to the right arm.
  • Emotional stress can cause symptoms to worsen.

Some experts suggest three stages during which progressive changes occur in the affected area’s skin, muscles, joints, ligaments, and bones (Harvard Health Publishing, 2023). However, further research is needed.

Stages

Stage One

  • Lasts 1 to 3 months
  • Severe, burning pain
  • Muscle spasm
  • Joint stiffness
  • Rapid hair growth
  • Skin color and temperature changes (Stanford Medicine, 2025)

Stage Two

  • Lasts from 3 to 6 months
  • Pain becomes more intense
  • Swelling
  • Decreased hair growth
  • Nails are cracked, brittle, grooved, spotty
  • Softened bones
  • Stiff joints
  • Weak muscle tone

Stage Three

  • Pain is continuous
  • Muscle atrophy
  • Severely limited mobility
  • Irreversible changes to skin and bone
  • Contractions of muscles and tendons – limbs may be twisted

Diagnosis

  • A patient’s clinical history – signs and symptoms are the major factor in diagnosis.
  • The diagnosis is difficult because many symptoms overlap with other conditions. (Goh E. L., Chidambaram S., & Ma, D. 2017)
  • There is no specific blood test or other diagnostic tests.
  • X-rays may show osteoporosis, and nuclear bone scans may show characteristic uptake patterns that help diagnose.

Treatments

Treatment focuses on relieving painful symptoms and can include: (Goh E. L., Chidambaram S., & Ma, D. 2017)

  • Physical therapy and exercise
  • Psychotherapy to alleviate stress, anxiety, and depression
  • Sympathetic nerve blocks
  • Surgery
  • Spinal cord stimulation
  • Intrathecal drug pumps

Medications

These can include:

  • Topical analgesics
  • Anti-seizure drugs
  • Antidepressants
  • Corticosteroids
  • Opioids

It is estimated that there are 50,000 new cases every year in the United States. (Tajerian M., & Clark J. D. 2016)

Injury Medical Chiropractic & Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.


The Root Causes of Pain


References

National Institute of Neurological Disorders and Stroke. (2017). Complex regional pain syndrome fact sheet. Retrieved from https://www.ninds.nih.gov/sites/default/files/migrate-documents/CRPS_FactSheet-E_508C.pdf

Goh, E. L., Chidambaram, S., & Ma, D. (2017). Complex regional pain syndrome: a recent update. Burns & Trauma, 5, 2. https://doi.org/10.1186/s41038-016-0066-4

Bruehl S. (2015). Complex regional pain syndrome. BMJ (Clinical research ed.), 351, h2730. https://doi.org/10.1136/bmj.h2730

Harvard Health Publishing. (2023). Complex Regional Pain Syndrome (CRPS). https://www.health.harvard.edu/a_to_z/complex-regional-pain-syndrome-crps-a-to-z

Stanford Medicine. (2025). Complex Regional Pain Syndrome (CRPS). https://med.stanford.edu/pain/about/chronic-pain/crps.html

Tajerian, M., & Clark, J. D. (2016). New Concepts in Complex Regional Pain Syndrome. Hand Clinics, 32(1), 41–49. https://doi.org/10.1016/j.hcl.2015.08.003

Managing Alcoholic Peripheral Neuropathy: Treatment Options

Managing Alcoholic Peripheral Neuropathy: Treatment Options

Excessive alcohol consumption: what is alcoholic peripheral neuropathy?

Managing Alcoholic Peripheral Neuropathy: Treatment Options

Alcoholic Peripheral Neuropathy

Alcoholic peripheral neuropathy (ALN) is a condition that damages the nerves in the body due to chronic alcohol consumption. It can cause sensory, motor, and autonomic dysfunction, which can lead to disability. This damage prevents the nerves from communicating information. Most symptoms generally start as mild but typically worsen over time as the neuropathy progresses. The most common symptoms are: (National Library of Medicine, 2023)

  • Numbness or tingling sensation in the extremities
  • Pain or a burning sensation in the extremities
  • Difficulty walking
  • Difficulty urinating
  • Difficulty talking or swallowing

Affected nerves include the peripheral and autonomic nerves, which help regulate internal body functions. Around 46% of chronic alcohol users will eventually develop the condition. (Julian T., Glascow N., Syeed R., & Zis P. 2019)

Causes

The exact cause of alcoholic neuropathy is unclear. But it is directly related to heavy and long-term alcohol consumption. (Julian T., Glascow N., Syeed R., & Zis P. 2019) It is believed overconsumption of alcohol can directly harm and hinder the nerves’ ability to communicate information. Unhealthy nutritional habits are often associated with it as well. Research shows that decreased thiamine/B vitamin plays a role, while others suggest an overall dietary deficiency may play a role. (Julian T., Glascow N., Syeed R., & Zis P. 2019) However, alcoholic neuropathy can also occur without the presence of malnutrition. (Julian T., Glascow N., Syeed R., & Zis P. 2019)

Neuropathy Development and Progression

Alcoholic peripheral neuropathy develops depending on many factors, including the amount of daily/nightly alcohol consumed, age and overall health, nutritional intake, and other individual factors. In most cases, the neuropathy takes several years or decades to develop, depending on the amount of alcohol consumed.

Symptoms

Symptoms are usually related to nerve dysfunction and include: (National Library of Medicine, 2023)

  • A tingling or pins-and-needles sensation in the extremities.
  • Numbness of the extremities, most commonly in the legs or feet. (Julian T., Glascow N., Syeed R., & Zis P. 2019)
  • Pain or burning sensation in the arms, legs, or feet.
  • Symptoms that occur in the arms and legs typically affect both sides.
  • Cramps, aches, or weakness of the muscles.
  • Constipation or diarrhea.
  • Nausea and vomiting.
  • Difficulty urinating or incontinence.
  • Difficulty walking.
  • Difficulty talking or swallowing.
  • Heat intolerance.
  • Erection difficulties.

Most symptoms begin as mild and usually worsen over time as the neuropathy progresses. Alcoholic neuropathy affects individuals who consume excessive amounts of alcohol over a long time. (Julian T., Glascow N., Syeed R., & Zis P. 2019)

Diagnosis

Symptoms can vary significantly so that a diagnosis may take time. It usually involves a combination of the following (National Institute of Neurological Disorders and Stroke, 2024)

Medical History

  • Healthcare providers will collect data involving past medical history and all current symptoms.

Physical Exam

  • This exam looks at other medical conditions contributing to symptoms, like diabetes or high blood pressure.

Neurological Exam

  • This is a noninvasive exam to determine the location and extent of neurological damage.
  • Healthcare providers may ask patients several questions and have them complete a series of small movements to check neurological function.

Blood and Urine Tests

  • These tests can detect diabetes, liver and kidney problems, infections, vitamin deficiencies, and other conditions that can cause neuropathic conditions.

Chronic alcohol use can also affect how the body stores and uses vitamins necessary for healthy nerve function. Vitamin levels that a healthcare provider may check include: (National Library of Medicine, 2023)

  • Vitamin A
  • Biotin
  • Folic acid
  • Niacin, or vitamin B3
  • Pyridoxine, or vitamin B6
  • Pantothenic acid

Liver Disease

Individuals with chronic liver disease often have neuropathy. The severity and stage are associated with a higher incidence of neuropathy. (Pasha MB, Ather MM, Tanveer MA, et al. 2019)

Treatment

Alcoholic neuropathy is not reversible, even when quitting drinking. However, individuals with the condition can make healthy changes to minimize symptoms and receive help for chronic alcohol use. The first step is stopping alcohol consumption. (Chopra K., & Tiwari V. 2012) Talk to a healthcare provider about what options are available. Treatment can include:

  • In-patient or outpatient rehab
  • Therapy
  • Medication
  • Social support from groups like Alcoholics Anonymous

A combination of treatments will likely be utilized. Other treatment options involve symptom management and preventing further injuries and may include:

  • Physical therapy
  • Keeping the head elevated while sleeping.
  • Orthopedic splints to maintain limb function and positioning.
  • Wearing compression stockings.
  • Adding vitamins and supplements.
  • Eating extra salt for those without hypertension
  • Medications to reduce pain and discomfort.
  • Intermittent catheterization or manual expression of urine for those with difficulty urinating.

Individuals with neuropathy may have reduced sensitivity in the arms and legs. If this occurs, additional steps need to be taken to prevent other injuries, that include (National Library of Medicine, 2023)

  • Wear special footwear to prevent foot injuries.
  • Checking feet daily for wounds.
  • Prevent burns by ensuring that bath and shower water is not too hot.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.


Peripheral Neuropathy Myths and Facts


References

National Library of Medicine. (2023). Alcoholic neuropathy. Retrieved from https://medlineplus.gov/ency/article/000714.htm

Julian, T., Glascow, N., Syeed, R., & Zis, P. (2019). Alcohol-related peripheral neuropathy: a systematic review and meta-analysis. Journal of Neurology, 266(12), 2907–2919. https://doi.org/10.1007/s00415-018-9123-1

National Institute of Neurological Disorders and Stroke. (2024). Peripheral neuropathy. Retrieved from https://www.ninds.nih.gov/health-information/disorders/peripheral-neuropathy

Pasha MB, A. M., Tanveer MA, et al. (2019). Frequency of peripheral neuropathy in chronic liver disease. Med Forum Monthly, 30(8), 23-26. https://medicalforummonthly.com/index.php/mfm/article/view/3761

Chopra, K., & Tiwari, V. (2012). Alcoholic neuropathy: possible mechanisms and future treatment possibilities. British journal of clinical pharmacology, 73(3), 348–362. https://doi.org/10.1111/j.1365-2125.2011.04111.x

The Role of Nociceptors in Sensing and Responding to Pain

The Role of Nociceptors in Sensing and Responding to Pain

Can understanding how nociceptors function and their role in processing pain signals help individuals who are managing injuries and/or living with chronic pain conditions?

The Role of Nociceptors in Sensing and Responding to Pain

Nociceptors

Nociceptors are nerve endings that detect harmful stimuli, such as extreme temperatures, pressure, and chemicals, and signal pain. They are the body’s first defense against potentially damaging environmental inputs.

  • Nociceptors are in the skin, muscles, joints, bones, internal organs, deep tissues, and cornea.
  • They detect harmful stimuli and convert them into electrical signals.
  • These signals are sent to the brain’s higher centers.
  • The brain interprets the signals as pain, which prompts the body to avoid the harmful stimulus.

Nociceptors, often called pain receptors, are free nerve endings all over the body. They play a pivotal role in how the body feels and reacts to pain. The main purpose of a nociceptor is to respond to damage to the body by transmitting signals to the spinal cord and brain. (Purves D, Augustine GJ, Fitzpatrick D, et al., editors. 2001) If you bang your foot, the nociceptors on the skin are activated, sending a signal to the brain via the peripheral nerves to the spinal cord. Pain resulting from any cause is transmitted this way. Pain signals are complex, carrying information about the stimuli’s location and intensity. This causes the brain to fully process the pain and send communication back to block further pain signals.

Classification

There are different classes of nociceptors, which are based on which type of stimuli they respond to (University of Texas McGovern Medical School, 2020)

Thermal

  • Thermal nociceptors respond to extreme hot or cold temperatures.
  • For instance, when touching a hot stove, the nociceptors, which signal pain, are activated immediately, sometimes before you know what you’ve done.

Mechanical

  • Mechanical nociceptors respond to intense stretching or strain, such as pulling a hamstring or straining a tendon.
  • The muscles or tendons are stretched beyond their ability, stimulating nociceptors and sending pain signals to the brain.

Chemical

  • Chemical nociceptors respond to chemicals released from tissue damage.
  • For example, prostaglandins and substance P or external chemicals like topical capsaicin pain creams.

Silent

  • Silent nociceptors must be first activated by tissue inflammation before responding to a mechanical, thermal, or chemical stimulus.
  • Most visceral nociceptors are located on organs in the body.

Polymodal

  • Polymodal nociceptors respond to mechanical, thermal, and chemical stimuli.

Mechano-thermal

  • Mechano-thermal nociceptors respond to mechanical and thermal stimuli.

Pain Transmission

Nociceptors are also classified by how fast they transmit pain signals. Transmission speed is determined by the type of nerve fiber known as an axon a nociceptor has. There are two main types.

  • The first type is A fiber axon, fibers surrounded by a fatty, protective sheath called myelin.
  • Myelin allows nerve signals/action potentials to travel rapidly.
  • The second type is C fiber axons, which are not surrounded by myelin and transmit slower. (University of Texas McGovern Medical School, 2020)

Because of the difference in transmission speed, the pain signals from the A fibers reach the spinal cord first. As a result, after an acute injury, an individual experiences pain in two phases, one from the A fibers and one from the C fibers. (Ngassapa D. N. 1996)

Pain Perception Phases

When an injury occurs, the stimulated nociceptors activate the A fibers, causing a person to experience sharp, prickling pain.

  1. This is the first phase of pain, known as fast pain, because it is not especially intense but comes right after the stimulus.
  2. During the second phase of pain, the C fibers are activated, causing an intense, burning pain that persists even after the stimulus has stopped.
  3. The fact that the C fibers carry burning pain explains why there is a short delay before feeling the sensation.
  4. The C fibers also carry aching, sore pain caused by organs within the body, such as a sore muscle or stomachache. (Ngassapa D. N. 1996)

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.


From Injury To Recovery With Chiropractic Care


References

Purves D, A. G., Fitzpatrick D, et al., editors. (2001). Nociceptors. In Neuroscience. 2nd edition. (2nd ed.). Sunderland (MA): Sinauer Associates. https://www.ncbi.nlm.nih.gov/books/NBK10965/

University of Texas McGovern Medical School. (2020). Chapter 6: Pain Principles. https://nba.uth.tmc.edu/neuroscience/m/s2/chapter06.html

Ngassapa D. N. (1996). Comparison of functional characteristics of intradental A- and C-nerve fibres in dental pain. East African medical journal, 73(3), 207–209.

Dealing with Arm Numbness: Causes and Remedies

Dealing with Arm Numbness: Causes and Remedies

Can determining whether arm numbness occurs suddenly or gradually and whether there are other symptoms help healthcare providers diagnose and treat the condition?

Dealing with Arm Numbness: Causes and Remedies

Arm Numbness

Arm numbness or tingling are common symptoms that various medical conditions can cause. Numbness can be caused by a sudden health emergency, nerve disorder, or nutritional deficiency. (National Institute of Neurological Disorders and Stroke, 2024) Sometimes, this symptom results from an arm falling asleep and could resolve after just a few minutes. The sensation may be temporary, caused by something like sleeping in the wrong position. However, arm numbness and tingling may also be caused by neuropathy and chronic and progressive nerve damage and can also suddenly occur due to serious conditions, such as a heart attack or a stroke.

Circulation Issues

Deficient blood circulation in the arm could cause numbness and tingling as the nerves cannot receive enough oxygen. Conditions can interfere with normal blood flow and include: (Bryan L. and Singh A. 2024)

  • Atherosclerosis – plaque buildup in the arteries that may require medication or surgery.
  • Severe frostbite can damage the blood vessels but can be resolved with proper warming and wound care.
  • Vasculitis – is inflammation of the blood vessels that can be treated with medication.

Sleeping Position

A common example of sudden numbness and tingling is the feeling that the arm has fallen asleep. This usually occurs after sleeping awkwardly or leaning on the arm for a long time. Known as paresthesia, this sensation is related to the compression or irritation of nerves. (Bryan L. and Singh A. 2024) Sleeping in certain positions has been associated with nerve compression, especially when the hands or wrists are tucked or curled under the body, as well as maintaining proper spine alignment when sleeping, is the best way to prevent arm numbness.

Nerve Injuries and Conditions

Numbness that persists may be related to an injury or underlying health problem that affects the brachial plexus, a group of nerves that runs from the lower neck to the upper shoulders and controls movement and sensation in the arms. (Mount Sinai, 2022) Possible injuries that affect these nerves include: (Smith, S. M. et al., 2021)

  • A herniated disc caused by aging or trauma causes the disc to leak out and press on the nerve root.
  • Burner or stinger injuries that affect the neck and shoulders.
  • Backpacker’s palsy is caused by pressure on the shoulders.
  • Birth injuries such as Erb-Duchenne’s palsy and Klumpke’s palsy.
  • Traumatic nerve root avulsion injury in which spinal nerves are damaged.

Diseases and disorders that can cause numbness in the arms include conditions that affect the nervous system, like multiple sclerosis, fibromyalgia, Raynaud phenomenon, and shingles. (National Heart, Lung, and Blood Institute, 2023) (Smith, S. M. et al., 2021)

Numbness and Serious Health Conditions

Stroke

  • This is a medical emergency in which a blockage prevents blood from getting to the brain.
  • One sign of a stroke is a tingling sensation on one side of the body.
  • Individuals may also be unable to move one or more limbs. (Centers for Disease Control and Prevention, 2024)
  • Seek emergency medical care.

Heart Disease

  • When the heart is damaged, blood cannot circulate and can lead to a minor or major heart attack.
  • Signs of a heart attack include numbness in one or both arms, and it is not always the left arm. (National Heart, Lung, and Blood Institute, 2022)
  • Pressure pain in the chest and shortness of breath are other signs that require immediate medical attention.

Spinal Osteoarthritis

Cancer

  • Neoplasm tumors can affect the brachial plexus nerves, causing loss of feeling in the arms.
  • Breast and lung cancers are the most likely. (Smith, S. M. et al., 2021)

Diabetes

  • Loss of feeling in the arms can be a sign of peripheral neuropathy, which can be caused by uncontrolled diabetes. (Johns Hopkins Medicine, 2024)
  • Treatment requires managing blood sugar and oral and topical medications.

Medication Numbness

The relationship between arm numbness and medication usage can be complex. (Senderovich H. and Jeyapragasan G. 2018)

  • Many medications, like gabapentin, can be used to alleviate the sensations of arm numbness.
  • Some medications can cause numbness as a side effect.
  • Some medications can cause complications, and arm numbness could be a symptom of those complications.

Inform healthcare providers about medications being taken to determine the relationship between them and any sensory changes.

Vitamin Deficiency

Peripheral neuropathy can also be caused by nutritional deficiencies and vitamin imbalances, which can damage nerves and cause sensation loss in the left or right arm. The most common sources are vitamin B12 deficiency and excess vitamin B6. (National Institute of Neurological Disorders and Stroke, 2024) Excessive alcohol consumption and other disorders that affect nutritional intake can also lead to nerve damage.

Injury Medical Chiropractic and Functional Medicine Clinic

At Injury Medical Chiropractic and Functional Medicine Clinic, our areas of practice include Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Wellness & Nutrition, Functional Medicine Treatments, and in-scope care protocols. We focus on what works for you to relieve pain and restore function. If other treatment is needed, individuals will be referred to a clinic or physician best suited to their injury, condition, and/or ailment.


Chiropractic Care: The Natural Way to Recover From Injuries


References

National Institute of Neurological Disorders and Stroke. (2024). Paresthesia. Retrieved from https://www.ninds.nih.gov/health-information/disorders/glossary-neurological-terms#paresthesia

Bryan, L., Singh, A. Sleep Foundation. (2024). Numbness in Hands While Sleeping: Causes and Remedies. https://www.sleepfoundation.org/physical-health/numbness-in-hands-while-sleeping

Mount Sinai. (2022). Brachial plexopathy. https://www.mountsinai.org/health-library/diseases-conditions/brachial-plexopathy

Smith, S. M., McMullen, C. W., & Herring, S. A. (2021). Differential Diagnosis for the Painful Tingling Arm. Current sports medicine reports, 20(9), 462–469. https://doi.org/10.1249/JSR.0000000000000877

National Heart, Lung, and Blood Institute. (2023). Vasculitis. Retrieved from https://www.nhlbi.nih.gov/health/vasculitis/symptoms#:~:text=Nerve%20problems%2C%20including%20numbness%2C%20tingling,can%20also%20occur%20with%20vasculitis.

Centers for Disease Control and Prevention. (2024). Stroke signs and symptoms. Retrieved from https://www.cdc.gov/stroke/signs-symptoms/?CDC_AAref_Val=https://www.cdc.gov/stroke/signs_symptoms.htm

National Heart, Lung, and Blood Institute. (2022). What Is a Heart Attack? Retrieved from https://www.nhlbi.nih.gov/health/heart-attack

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2023). Spinal Stenosis Basics. Retrieved from https://www.niams.nih.gov/health-topics/spinal-stenosis/basics/symptoms-causes

Johns Hopkins Medicine. (2024). Peripheral Neuropathy. https://www.hopkinsmedicine.org/health/conditions-and-diseases/peripheral-neuropathy

Senderovich, H., & Jeyapragasan, G. (2018). Is there a role for combined use of gabapentin and pregabalin in pain control? Too good to be true?. Current medical research and opinion, 34(4), 677–682. https://doi.org/10.1080/03007995.2017.1391756

National Institute of Neurological Disorders and Stroke. (2024). Peripheral Neuropathy. Retrieved from https://www.ninds.nih.gov/health-information/disorders/peripheral-neuropathy

Enhancing Quality of Life with Neurological Physical Therapy

Enhancing Quality of Life with Neurological Physical Therapy

Can neurological physical therapy help individuals diagnosed with a recently acquired or chronic neurological condition gain strength and functioning?

Enhancing Quality of Life with Neurological Physical Therapy

Neurological Physical Therapy

Neurological physical therapy can be extremely beneficial. It aims to restore functional mobility, strength, balance, and coordination in those with neurological conditions that affect their quality of life and ability to move around. It also helps recover from neurological injuries or prevent the progression and worsening of chronic neurological conditions. Depending on the severity of the condition, individuals may receive this therapy as an inpatient or outpatient. Exercise can help improve mobility, increase independence, and decrease the need for assistance, all of which can improve one’s quality of life.

Process

Neurological physical therapy is geared toward treating individuals with conditions affecting the brain and spinal cord, such as stroke, spinal cord injury, and Parkinson’s disease, to help restore mobility and function. The therapy is performed in hospitals, private practice physical therapy clinics, doctors’ offices, rehabilitation facilities, or at a patient’s home. Whether an individual needs inpatient or outpatient physical therapy will depend on the severity of the neurological condition.

  • Newly acquired neurological conditions such as strokes or traumas like spinal cord injuries and traumatic brain injuries or TBIs often require inpatient rehabilitation.
  • Once the patient gains enough strength, coordination, and independence with movements like standing and walking, they can progress to outpatient physical therapy.
  • The patient will undergo a physical exam after a physical therapist has gathered enough information about medical history during the initial evaluation.
  • The therapist will check muscle strength, coordination, range of motion, reflexes, and the muscle tone of the arms and legs. They may also perform neurological tests to examine coordination, such as following moving objects with the eyes, touching the finger to the nose, and rapidly alternating movements.
  • The individual general level of attention, cognition, and sensation will also be assessed to determine if these areas have been affected by the neurological condition. (Cleveland Clinic, 2022)
  • The therapist will then assess the patient’s ability to perform movements called transfers, which are transitions to and from positions such as lying down to sitting up or standing up to sitting.
  • They will note if the patient can perform these movements independently or if they need assistance.
  • The initial evaluation will also include an assessment of balance, quality of gait, and whether the therapist needs to assist.
  • Depending on the severity of the neurological condition, the therapist may provide the patient with or recommend purchasing an assistive device to help walk.

Treatment Sessions

During therapy sessions, patients may receive the following interventions:

Gait Training

  • To improve walking ability, proper instruction on using assistive devices such as canes, walkers, and crutches.

Balance Training

  • To improve static/stationary and dynamic/while moving balance, both sitting unsupported to improve core control and standing upright with or without handheld support.

Therapeutic Activities

  • To improve independence with bed mobility skills like rolling and sitting up from lying down and transfers on and off beds, chairs, and toilets.
  • Therapeutic exercises for stretching and strengthening muscles and improving coordination and motor control.

Endurance Training

  • This can be done with cardiovascular equipment like treadmills, stationary bicycles, and ellipticals.

Vestibular Therapy Interventions

  • Balance exercises with head movements and exercises to treat a common cause of dizziness are used to improve eye movement control.
  • Examples are the Dix-Hallpike and Epley maneuvers.

Conditions

Neurological physical therapy can treat various conditions. Some neurological conditions are progressive, worsening over time, and require regular physical therapy and at-home exercises to maintain optimal health and wellness. Neurological conditions that can be treated with physical therapy include: (Cleveland Clinic, 2022)

  • Strokes – loss of blood supply to the brain.
  • Spinal cord injuries – damage to part of the central nervous system resulting in loss of movement and control.
  • Polyneuropathies –  damage to the peripheral nerves.
  • Traumatic brain injuries – for example, concussions.
  • Cerebral palsy – a group of disorders affecting movement, balance, and posture.
  • Multiple sclerosis – a disabling disease of the brain and spinal cord.
  • Parkinson’s disease – a progressive nervous system disorder.
  • Guillain-Barre syndrome – an autoimmune disease attacking the nerves.
  • Amyotrophic lateral sclerosis/ALS, also known as Lou Gehrig’s disease.
  • Vertigo, including benign paroxysmal positional vertigo or BPPV.

Neurological conditions, like an automobile collision, can occur suddenly or be progressive, such as Parkinson’s. Physical therapy helps those individuals by increasing their use of weakened muscles, improving their motor control, coordination, and balance, and facilitating their independence with daily tasks and movements. Always seek immediate medical attention for any sudden, unexplained muscle weakness. Individuals who experience skeletal muscle weakness should discuss the type and duration of symptoms with their doctor, specialist, physical therapist, or chiropractor, as this might be a sign of a medical condition such as a neuromuscular disorder. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment program through an integrated approach to treat injuries and chronic pain syndromes, improving flexibility, mobility, and agility, relieving pain, and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.


Personal Injury Rehabilitation


References

Cleveland Clinic. (2022). Neurological Exam. https://my.clevelandclinic.org/health/diagnostics/22664-neurological-exam

Unlocking the Potential of Magnesium Spray: A Guide

Unlocking the Potential of Magnesium Spray: A Guide

When muscle pains and aches present from health conditions, work, exercise, housework, etc., many individuals turn to topical sprays, creams, ointments, and gels to bring relief. Can magnesium spray be beneficial in the fight against neuromusculoskeletal pain?

Unlocking the Potential of Magnesium Spray: A Guide

Magnesium Spray

Magnesium spray is a liquid form of magnesium applied externally to the skin that has been marketed to promote muscle relaxation, improve sleep, and manage migraines. However, studies of its effectiveness have had mixed results. Some studies have shown that topical use can:

  • Improve chronic muscle and joint pain. Example: fibromyalgia.
  • Decrease the frequency and severity of nerve pain symptoms. Example: peripheral neuropathy.
  • Reduce the incidence and severity of an intubation-related sore throat after surgery.
  • Further studies of various groups are necessary to clarify the optimal dose for each condition and to determine how topical magnesium affects magnesium blood levels.

What is It?

Magnesium is a mineral that has an important role in many of the body’s processes and is essential for the following (Gröber U. et al., 2017)

  • Nerve transmission
  • Muscle contraction
  • Blood pressure regulation
  • Blood sugar regulation
  • Protein production
  • DNA and RNA production

Currently, there is no recommended dosage for topical magnesium use. However, some major health institutions have established a recommended daily amount taken by mouth. Listed are the recommended daily magnesium intake based on age and other factors. (National Institutes of Health Office of Dietary Supplements, 2022)

  • 14 to 18 years old: 410 mg for males, 360 mg for females and when lactating, and 400 mg when pregnant.
  • 19 to 30 years old: 400 mg for males, 310 mg for females and when lactating, and 350 mg when pregnant.
  • 31 to 50 years old: 420 mg for males, 320 mg for females and when lactating, and 360 mg when pregnant.
  • 51 years old and above: 420 mg for males and 320 mg for females.

Although self-care is appropriate for minor injuries or exercise, individuals are encouraged to see their healthcare provider for severe musculoskeletal pain symptoms.

Benefits

Though taking oral magnesium supplements is common, there is limited research on using magnesium on the skin to improve magnesium levels. Studies comparing the absorption of magnesium taken by mouth with the spray applied to the skin require further research. However, some studies look at the localized effect of magnesium spray on improving a sore throat after surgery and nerve, muscle, and joint pain.

Intubation-Related Sore Throat

Topical magnesium reduced the severity of sore throat after surgery in individuals undergoing tracheal intubation compared to a placebo. (Kuriyama, A. et al., 2019) However, further studies are necessary to clarify the optimal dose.

Nerve Pain

Peripheral neuropathy is nerve damage that causes a tingling and numbing sensation in the arms or legs. In a study of individuals with chronic kidney disease, the daily application of magnesium sprays to limbs affected by peripheral neuropathy for twelve weeks decreased the frequency and severity of nerve pain symptoms. However, one limitation was that it was performed mostly in females. (Athavale, A. et al., 2023)

Chronic Muscle and Joint Pain

A small study assessed whether applying magnesium to the skin could improve the quality of life of female participants with fibromyalgia – a chronic condition that causes muscle and joint pain, fatigue, and other symptoms. The study found that four sprays of magnesium chloride applied twice daily to the upper and lower limbs for four weeks could benefit those with fibromyalgia. However, further research with larger studies is needed to confirm the results. (Engen D. J. et al., 2015)

Does The Spray Increase Overall Magnesium Levels?

Magnesium is transported into cells through magnesium transporters. The outer layer of the skin does not contain these transporters, so absorption occurs in the small areas of the sweat glands and hair follicles. (Gröber U. et al., 2017) One study suggested that applying magnesium to the skin can help with magnesium deficiency within four to six weeks, compared to four to 12 months in the case of oral magnesium supplementation. However, there is minimal research on topical magnesium and its impact on magnesium levels. Another study suggested that 56 mg of magnesium cream applied daily on the skin for 14 days had no statistically significant effect on magnesium blood levels. Although the results were statistically insignificant, a clinically relevant increase in magnesium blood levels was observed. (Kass, L. et al., 2017) Because it remains unclear if magnesium absorption via the skin is more effective than by mouth, further studies are necessary to confirm the amount of magnesium absorbed into the skin.

Using The Spray

In one study, a magnesium chloride solution was poured into a spray bottle and applied as follows (Engen D. J. et al., 2015)

  • The solution was sprayed into the palm and applied evenly on the affected area.
  • There is a four-hour wait time between spray dose applications.
  • Individuals should wait at least one hour after application before showering or washing the product off.
  • Leave the product on the skin throughout the day and wash it off before bed.
  • Rinse the solution off with water if the skin becomes irritated.
  • Avoid applying to open wounds.

Precautions

Avoid magnesium chloride sprays if you are allergic to them or their components. If you have a severe allergic reaction, such as itching, hives, or shortness of breath, seek immediate medical attention. Topically applied magnesium solution has no known side effects other than skin irritation. (Engen D. J. et al., 2015)

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment plan through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help individuals return to optimal function. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.


Why Choose Chiropractic?


References

Gröber, U., Werner, T., Vormann, J., & Kisters, K. (2017). Myth or Reality-Transdermal Magnesium?. Nutrients, 9(8), 813. https://doi.org/10.3390/nu9080813

National Institutes of Health Office of Dietary Supplements. (2022). Magnesium. Retrieved from https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/#h2

Kuriyama, A., Maeda, H., & Sun, R. (2019). Topical application of magnesium to prevent intubation-related sore throat in adult surgical patients: a systematic review and meta-analysis. Application topique de magnésium pour prévenir les maux de gorge liés à l’intubation chez les patients chirurgicaux adultes: revue systématique et méta-analyse. Canadian journal of anaesthesia = Journal canadien d’anesthesie, 66(9), 1082–1094. https://doi.org/10.1007/s12630-019-01396-7

Athavale, A., Miles, N., Pais, R., Snelling, P., & Chadban, S. J. (2023). Transdermal Magnesium for the Treatment of Peripheral Neuropathy in Chronic Kidney Disease: A Single-Arm, Open-Label Pilot Study. Journal of palliative medicine, 26(12), 1654–1661. https://doi.org/10.1089/jpm.2023.0229

Engen, D. J., McAllister, S. J., Whipple, M. O., Cha, S. S., Dion, L. J., Vincent, A., Bauer, B. A., & Wahner-Roedler, D. L. (2015). Effects of transdermal magnesium chloride on quality of life for patients with fibromyalgia: a feasibility study. Journal of integrative medicine, 13(5), 306–313. https://doi.org/10.1016/S2095-4964(15)60195-9

Kass, L., Rosanoff, A., Tanner, A., Sullivan, K., McAuley, W., & Plesset, M. (2017). Effect of transdermal magnesium cream on serum and urinary magnesium levels in humans: A pilot study. PloS one, 12(4), e0174817. https://doi.org/10.1371/journal.pone.0174817

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