Back Clinic Chiropractic. This is a form of alternative treatment that focuses on the diagnosis and treatment of various musculoskeletal injuries and conditions, especially those associated with the spine. Dr. Alex Jimenez discusses how spinal adjustments and manual manipulations regularly can greatly help both improve and eliminate many symptoms that could be causing discomfort to the individual. Chiropractors believe among the main reasons for pain and disease are the vertebrae’s misalignment in the spinal column (this is known as a chiropractic subluxation).
Through the usage of manual detection (or palpation), carefully applied pressure, massage, and manual manipulation of the vertebrae and joints (called adjustments), chiropractors can alleviate pressure and irritation on the nerves, restore joint mobility, and help return the body’s homeostasis. From subluxations, or spinal misalignments, to sciatica, a set of symptoms along the sciatic nerve caused by nerve impingement, chiropractic care can gradually restore the individual’s natural state of being. Dr. Jimenez compiles a group of concepts on chiropractic to best educate individuals on the variety of injuries and conditions affecting the human body.
Can correcting body misalignments and the elements of unhealthy posture help achieve a healthy posture?
Healthy Posture
Maintaining a healthy posture is more important than ever, as individuals from all walks of life realize how practicing awkward and unhealthy postures can wreak havoc on their bodies and quality of life. Unhealthy postures include rounding the upper and lower back, slouching, and forward head posture. Over time, these postures make daily activities more difficult or painful. Mobility, stability, and strengthening exercises can address unhealthy posture problems and issues, along with practicing correct sitting, standing, and resting postural habits to reinforce proper alignment daily. A chiropractic and physical therapy team can treat and train individuals to restore correct and healthy posture.
Body Alignment
Ideal posture involves correct body alignment or how the structural parts, such as the head, trunk, hips, knees, etc., relate to an individual’s form. Whether standing, sitting, lying down, or moving, body parts need to be balanced in relationship to each other to avoid unnecessary stress on the spine and musculoskeletal system. (Bone Health & Osteoporosis Foundation, 2024)
Posture Types
Posture is considered static when sitting or standing still and dynamic when moving. Both are categorized as active postures as they require the activation of stabilizing muscles to deal with gravity and maintain alignment. Lying down and remaining still is considered an inactive posture, as muscle involvement is minimal. However, both have the potential to be healthy or unhealthy.
Proper Body Alignment
An easy way to check proper alignment while standing is to stand against a wall with the base of the head, shoulder blades, and buttocks flush against the wall, with enough space for a hand wide enough to slide in between the wall and the small of the back. This exercise correctly lines up the head, shoulders, and hips to reduce or eliminate undue stress on the spine. Body balance is the foundation for active and inactive postures concerning workstations, industrial ergonomics, daily activities, and sports. (Mayo Clinic, 2023) Healthy alignment is a standard position in which all body joints are centered and balanced and the most mechanically efficient position for static or dynamic activities. Biomechanical efficiency (the ability to use the body’s muscles and joints to perform movements while minimizing energy use and maximizing output) enables the muscles surrounding the joints to work in balance and efficiently activate, which, in turn, helps reduce strain, tension, and injury. Balanced muscles also conserve energy, leading to better daily stamina.
Development of Imbalances
Individuals develop position and movement habits in joint positioning that have led to imbalanced muscles. When this is the case, some muscles can be chronically stretched, and others become chronically tight, all to hold the body up or move around, which can lead to postural conditions like upper crossed (Physiopedia, 2024) or lower crossed syndrome (Physiopedia, 2024) which often leads to pain and/or mobility issues.
Posture Assessment
The recommended way to determine if one’s posture is healthy or poor is by conducting a posture assessment. The examination looks at joint positions and gathers visual information about the planes into which parts of each joint move and the axes around which those movements occur (Singla D. and Veqar Z., 2014) (Debra Coglianese et al., 2006). In a posture assessment, body alignment is compared with the ideal standard, a plumb line, usually a string with a small weight attached to the bottom to help maintain straightness. The other end of the string is affixed to the ceiling to be used as an accurate reference for correct alignment. (Singla D. and Veqar Z. 2014) During a posture assessment, the patient stands next to the plumb line while the doctor or therapist compares the relative positions of the following areas:
Ears
Shoulder joint
Spine
Hip joint
Knee joint
Ankle joint
Feet
Any areas that don’t match the reference can indicate misalignments in one or several regions.
Making Corrections
Chiropractic care can help correct unhealthy posture by realigning the spine and strengthening the musculoskeletal system:
Spinal Adjustments
Chiropractors use their hands or instruments to apply controlled force to the spine to realign the vertebrae. This can help relieve pressure on muscles, ligaments, and nerves, which can improve posture.
Corrective Exercises
Chiropractors can create custom exercises to strengthen postural muscles and maintain proper alignment.
Massage Therapy
Chiropractors can use massage therapy to work on strained ligaments and soft tissue.
Guidance and Training
Chiropractors can teach patients how to move to encourage a neutral spine and provide strategies for maintaining healthy posture.
A posture corrector or brace can also help teach and engage the correct muscles to achieve proper alignment. However, it should not be relied on long-term because promoting and activating one’s stabilizing muscles is important rather than relying on a brace for prolonged periods.
Injury Medical Chiropractic and Functional Medicine Clinic
Achieving and maintaining proper posture requires consistent work and development. Retraining the body and maintaining its optimal health requires daily efforts through exercise, conscious position corrections, and ergonomics. 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.
Singla, D., & Veqar, Z. (2014). Methods of postural assessment used for sports persons. Journal of clinical and diagnostic research: JCDR, 8(4), LE01–LE4. doi.org/10.7860/JCDR/2014/6836.4266
Coglianese, D. (2006). Muscles: Testing and Function With Posture and Pain, ed 5 (with Primal Anatomy CD-ROM). Physical Therapy, 86(2), 304-305. doi.org/https://doi.org/10.1093/ptj/86.2.304
An axillary nerve injury can cause pain, weakness, and shoulder mobility loss. Can physical therapy help restore and maintain shoulder joint flexibility?
Axillary Nerve
The axillary nerve, or the circumflex nerve, is a peripheral nerve that runs through the shoulder and supports movement and sensation in the upper limbs. It originates in the neck at the brachial plexus, a network of nerves that extends from the neck and upper torso to the shoulders and arms. Its primary purpose is to supply nerve function to the shoulder joint and three muscles in the arm and also innervates some skin in the region.
Anatomy
Except for the cranial nerves, all the body’s nerves branch off from the spinal cord, emerge from between vertebrae and continue to branch off as they travel to various muscles and other structures. The axillary nerve is named after the axilla, the medical name for the armpit. Individuals have two, one on each side. After leaving the spinal column, the axillary nerve runs behind the axillary artery and continues to the shoulder blade’s lower edge of the subscapularis muscle. It winds back and travels down the arm along the posterior humeral circumflex artery, which then passes through the quadrangular space (a small area of the shoulder blade just above the armpit where there is a gap in the muscles that allows nerves and blood vessels to pass through to the arm before it divides into terminal branches, which are:
Anterior Division
Supplies motor innervation to the deltoid’s anterior and middle heads, allowing the arm to abduct or move away from the body.
It winds around the neck of the humerus/funny bone, goes beneath the deltoid muscle, and then connects to the forward edge of the deltoid.
A few small cutaneous branches serve the skin in that area.
Posterior Division
Innervates the teres minor muscles and the lower part of the deltoid.
It enters the deep fascia and becomes the superior lateral cutaneous nerve.
It then wraps around the lower edge of the deltoid, connects to the skin over the lower two-thirds of the muscle, and covers the long head of the triceps brachii.
Articular Branch
Comes from the trunk of the axillary nerve and enters the glenohumeral joint, which is in the shoulder, below the subscapularis muscle.
Anatomical Variations
In a case report, healthcare providers noted an incidence of the nerve branching directly off the upper trunk of the brachial plexus rather than the posterior cord. (Subasinghe S. K. and Goonewardene S. 2016) In this case, it innervated the subscapularis muscle, latissimus dorsi, and the deltoid and teres minor muscles and also had a communicating branch to the posterior cord. Another case documented multiple abnormalities in the course of the axillary nerve in an individual with pain and severely limited shoulder mobility. (Pizzo R. A. et al., 2019) During reverse shoulder arthroplasty, the surgeon discovered that the axillary nerve ran beside the coracoid process instead of underneath and stayed close to the subscapularis muscle instead of traveling through the quadrangular space. The case noted earlier reports of axillary nerves not running through the quadrangular space. In those cases, the nerve pierced the subscapularis muscle or split into branches before reaching the quadrangular space.
Function
The axillary nerve functions as a motor nerve that controls movement and a sensory nerve that controls sensations like touch or temperature.
Motor
As a motor nerve, the axillary nerve innervates three muscles in the arm and includes:
Deltoid
Allows flexing of the shoulder joint and rotating the shoulder inward.
Long Head of the Triceps
It runs down the back of the outer arm, allowing straightening, pulling the upper arm toward the body, or extending it backward.
The radial nerve can also innervate this muscle.
Teres Minor
One of the rotator cuff muscles starts outside the shoulder and runs diagonally along the bottom edge of the shoulder blade.
It works with other muscles to allow for the external rotation of the shoulder joint.
Sensory
In its sensory role, the nerve carries information to the brain from the following:
Glenohumeral joint or the ball-and-socket joint in the shoulder.
The skin on the lower two-thirds of the deltoid muscle through the superior lateral cutaneous branch.
Injuries and Conditions
Problems with the axillary nerve can be caused by injuries anywhere along the arm and shoulder and by disease. Common injuries include:
Dislocations
Of the shoulder joint, which can cause axillary nerve palsy.
Fracture
Of the surgical neck of the humerus.
Compression
This stems from walking with crutches, also known as crutch palsy.
Direct Trauma
This can be from an impact sports, work, automobile accident, collision, or laceration.
Added Pressure
This can be from wearing a cast or splint.
Surgical Accidental Injury
An injury or damage can come from shoulder surgery, especially arthroscopic surgery on the inferior glenoid and capsule.
Quadrangular Space Syndrome
This is where the axillary nerve is compressed where it passes through that space, which is most common in athletes who perform frequent overhead motions)
Nerve Root Damage
Between the fifth and sixth cervical vertebrae, where the nerve emerges from the spinal cord, which can be caused by traction, compression, spinal disc prolapse, or a bulging disc.
Systemic Neurological Disorders
Example – multiple sclerosis
Erb’s Palsy
A condition often is the result of a birth injury called shoulder dystocia, in which a baby’s shoulder/s becomes stuck during childbirth.
Axillary Nerve Palsy
Damage can result in a type of peripheral neuropathy that can cause weakness in the deltoid and teres minor muscles.
This can result in losing the ability to lift the arm away from the body and weakness in various shoulder movements.
If the damage is severe enough, it can cause paralysis of the deltoid and other minor muscles, resulting in flat shoulder deformity, in which individuals cannot lay their shoulders flat when lying down.
Axillary nerve damage also can lead to a change, reduction, or loss of sensation in a small part of the arm just below the shoulder.
Nerve Injury Statistics
Three times more common in men than women.
It may be present in as many as 65% of shoulder injuries.
The risk of injury due to dislocation is significantly increased after age 50.
Tests
If a healthcare provider suspects a problem with axillary nerve function, they’ll test the shoulder’s range of motion and skin sensitivity. A difference in the range of motion between the shoulders can indicate a nerve injury. Individuals may be sent for electromyography and a nerve conduction study to verify nerve palsy. In some cases, an MRI and/or X-rays may be ordered, especially if the cause of possible nerve damage is unknown.
Rehabilitation
Depending on the severity and cause of the injury, non-surgical treatments may be recommended, with surgery as a last resort. Non-surgical treatment can include some combination of immobilization, rest, ice, physical therapy, and anti-inflammatory meds. Physical treatment typically lasts about six weeks and focuses on strengthening and stimulating the muscles to prevent joint stiffness, which can impair long-term function.
Surgery
If conservative treatments don’t work, surgery may be recommended, especially if several months have passed without improvement. Surgical outcomes are generally better if surgery is performed within six months of the injury, and regardless of the time frame, the prognosis is considered positive in about 90% of cases. Surgical procedures performed for axillary nerve dysfunction or injury include:
Neurolysis
This procedure involves targeted damage/degeneration of nerve fibers, interrupts the nerve signals, and eliminates pain while the damaged area heals.
Neurorrhaphy
This procedure stitches a severed nerve back together.
Nerve Grafting
Grafting involves transplanting a portion of another nerve, usually the sural nerve, to reconnect severed nerves.
This helps, especially when the damaged portion is too large to be repaired by neurorrhaphy.
It allows a pathway for signals and encourages the regrowth of nerve axons.
Neurotization or Nerve Transfer
Similar to grafting but used when the nerve is too damaged to heal.
This procedure involves transplanting a healthy but less important nerve, or a portion of a nerve, to replace the damaged one and restore function.
Injury Medical Chiropractic and 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.
Shoulder Pain Chiropractic Treatment
References
Subasinghe, S. K., & Goonewardene, S. (2016). A Rare Variation of the Axillary Nerve Formed as Direct Branch of the Upper Trunk. Journal of clinical and diagnostic research : JCDR, 10(8), ND01–ND2. doi.org/10.7860/JCDR/2016/20048.8255
Pizzo, R. A., Lynch, J., Adams, D. M., Yoon, R. S., & Liporace, F. A. (2019). Unusual anatomic variant of the axillary nerve challenging the deltopectoral approach to the shoulder: a case report. Patient safety in surgery, 13, 9. doi.org/10.1186/s13037-019-0189-1
Individuals experiencing persistent pain, weakness, numbness, and tingling in the back could be suffering from nerve root encroachment. Could surgery ease nerve compression and improve symptoms for persistent and severe cases?
Surgical Decompression
The pain, weakness, numbness, and tingling associated with nerve root encroachment are usually first treated with non-surgical therapies that include:
Anti-inflammatory medications
Physical therapy
This can be enough to address the irritation of the spinal nerve root. But when cases become severe, surgical decompression may be recommended and necessary. It can be done in a couple of different ways.
Causes and Symptoms
Vertebrae are bones in the spine. Small openings called foramina allow a spinal nerve root to pass through on each side of the vertebra. When nerve root encroachment is present, the spinal nerve root gets compressed, pinched, and trapped, which can cause peripheral symptoms such as numbness, tingling, pain, or weakness to develop. Nerve root encroachment is typically caused by normal aging degenerative wear and tear changes in the vertebrae. (Choi Y. K. 2019) These degenerative changes can include:
Facet joint hypertrophy
Ligament and bone hypertrophy
Disc disorders
Formation of bone spurs or osteophytes.
If these degenerative changes progress, they can encroach and compress a nerve root, leading to peripheral symptoms. (Choi Y. K. 2019)
When Surgery Is Recommended
When symptoms occur, initial treatment will involve:
Physical therapy
Chiropractic realignment
Massage therapies
Rest
Lifestyle adjustments
Nonsteroidal anti-inflammatories – NSAIDs
Corticosteroid injections into the spine
If conservative therapies don’t fully heal or improve symptoms or there are neurological problems like difficulty with balance or walking, then surgery may be recommended. Severe pain that limits normal function is an indication for surgery, and rapidly progressive weakness of the arms and/or legs or signs of cauda equina syndrome are indications for emergency surgery.
Surgery Options
Different types of spinal surgery may be performed. A neurosurgeon will decide the best procedure for each patient based on their case, age, medical conditions, and other factors. Specific spinal surgical decompression depends on what is causing the nerve compression. In most cases, it involves removing bone or tissue to relieve nerve pressure or provide support to stabilize the joint. The most common types of surgical decompression include: (Mayo Clinic Health System, 2022)
Maintain the stability and alignment of the spine.
Improve the stability and alignment of the spine.
Anterior Surgery
The anterior approach to surgery means that the spine is accessed through the anterior/front of the spine. In this surgery, one or more discs and bone spurs may be removed through an incision in the front of the neck. (American Association of Neurological Surgeons, 2024) For example, an anterior cervical discectomy may alleviate pressure on one or more nerve roots in the neck. With an anterior lumbar interbody fusion, a surgeon removes a degenerative disc in the lower spinal area by going through a patient’s lower abdomen. (American Association of Neurological Surgeons, 2024) After the disc is removed, a structural device, usually made of bone, fills the space where it once was. This device encourages bone healing and helps the vertebrae’s bodies fuse.
Posterior Surgery
Posterior surgery means the spine is accessed through the posterior/back of the spine. An example is removing a thickened ligament, bone spur, or disc material in the neck. To do this, a small incision in the back of the neck may be made to remove part of the back of the vertebrae called the lamina. This is called a posterior cervical laminectomy. (American Association of Neurological Surgeons, 2024) A posterior lumbar interbody fusion removes a degenerative disc by going through the back. (American Association of Neurological Surgeons, 2024) Like the anterior approach, a structural device often contains bone to fill the space where the disc once was to fuse the bones.
Potential Risks
As with any surgery, it’s important that the individual and their healthcare provider carefully discuss the benefits and risks. Spinal surgical decompression includes: (Proietti L. et al., 2013)
Bleeding
Blood clots
Surgical site infection
Urinary tract infection
Lung infection
Intestinal blockage
There are also specific risks to the area of the spine being operated on and how it is surgically approached. For example, a cervical anterior procedure may injure the esophagus, trachea, or carotid artery. Likewise, damage to the C5 nerve root/C5 palsy can occur from cervical spinal decompressive surgery. This complication causes weakness, numbness, and pain in the shoulders. (Thompson S. E. et al., 2017) The spinal cord may also be injured during surgery and result in paralysis, although this is rare. (American Association of Neurological Surgeons, 2024)
Injury Medical Chiropractic and 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 Non-Surgical Solution
References
Choi Y. K. (2019). Lumbar foraminal neuropathy: an update on non-surgical management. The Korean journal of pain, 32(3), 147–159. doi.org/10.3344/kjp.2019.32.3.147
Proietti, L., Scaramuzzo, L., Schiro’, G. R., Sessa, S., & Logroscino, C. A. (2013). Complications in lumbar spine surgery: A retrospective analysis. Indian journal of orthopaedics, 47(4), 340–345. doi.org/10.4103/0019-5413.114909
Thompson, S. E., Smith, Z. A., Hsu, W. K., Nassr, A., Mroz, T. E., Fish, D. E., Wang, J. C., Fehlings, M. G., Tannoury, C. A., Tannoury, T., Tortolani, P. J., Traynelis, V. C., Gokaslan, Z., Hilibrand, A. S., Isaacs, R. E., Mummaneni, P. V., Chou, D., Qureshi, S. A., Cho, S. K., Baird, E. O., … Riew, K. D. (2017). C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases. Global spine journal, 7(1 Suppl), 64S–70S. doi.org/10.1177/2192568216688189
Can individuals maintain proper hydration levels in their bodies to prevent spinal pain and other musculoskeletal conditions?
Introduction
When making small changes to better their health and wellness, many understand that eating nutritional foods, exercising, and finding ways to reduce the pain and stress that environmental factors have affected the body. However, there is also another crucial component to a person’s health and wellness, and that is staying hydrated. Many individuals sometimes don’t realize that the human body contains about 60% of the water, which helps every vital organ, muscle, tissue, and vertebra in the body to function. However, many individuals who do not consume enough water due to a stressful event, exercising, or just wanting to drink sugary drinks will feel pain and discomfort in their bodies. This can range from mild headaches to back pain. Today’s article focuses on what spinal pain correlates with the back, why staying hydrated can reduce spinal pain and ways to stay hydrated. We talk with certified associated medical providers who inform our patients to maintain proper hydration to reduce the chances of spinal pain affecting their bodies. While asking their associated medical provider intricate questions, we advise patients to incorporate daily hydration levels as part of their routine to reduce the chances of spinal pain from returning. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.
Spinal Pain Is Correlated With The Back
Do you feel constant aches or pains after a stressful day? Do you feel like chugging gallons of water but still feel thirsty? Or have you been noticing that you have been dealing with limited mobility that has been causing you pain and discomfort in your lower back? These pain-like scenarios are multifactorial and can correlate with spinal pain affecting the back. Now, many people wonder why spinal pain is associated with back pain. The spine is crucial in allowing the individual to be upright and move around during daily activities. The spinal vertebrae discs are between the bones, which would enable shock absorption when a person twists, bends, or flexes so the bones don’t rub together. However, when the body ages, the spine does, too, which causes the intervertebral disc to gradually fall and change the dynamics of the affected spine segments. (Kos et al., 2019) To that point, when the intervertebral disc becomes compressed due to degeneration, it can lead to the development of back pain.
Since low back pain is a multifactorial musculoskeletal condition, many individuals often develop low back pain from numerous environmental risk factors like physical labor, excessive sitting or standing, poor dieting, andphysical inactivity, which can cause individuals to have a loss of sensation, reduced reflexes, limited range of movements and tenderness can affect a person’s gait and posture. (Kabeer et al., 2023) When the spinal discs are being compressed, the water inside the disc becomes dehydrated and is linked to lower back pain. (Cheung et al., 2023) When the spinal discs are dehydrated in the spine due to improper hydration, it can lead to immobility, cause the disc to degenerate, and cause spinal structural defects that cause the surrounding muscles and tissues to have biomechanical instability and inflammation. (Hauser et al., 2022) When the body starts dehydrating, it retrieves water from the spine and other parts to sustain life and keep the vital organs functioning.
Eating Right To Feel Better- Video
Why Staying Hydrated Can Reduce Spinal Pain
Proper hydration is key to reducing the chances of spinal pain. By staying hydrated with plain, pure water, individuals can stay focused, remove toxins from the body, aid in weight reduction, and reduce muscle and low back pain. (Nsiah-Asamoah & Buxton, 2021) Drinking at least 64 ounces of water a day can rehydrate the body and prevent future issues that can cause pain.Proper hydration allows the body to maintain cell activity and regulate body temperature, reducing the chances of pain affecting the body.
Ways to Stay Hydrated
There are ways to stay hydrated and allow the body to have proper hydration levels. Incorporating hydrating fruits and vegetables can help aid in proper hydration as these fruits and vegetables contain about 90% water and the essential nutrients. Additionally, when individuals try to get their hydration levels back up, they are encouraged to drink more fluids as they prefer, especially if they feel unwell. This is to ensure that the body is hydrated enough so that individuals can receive subcutaneous or intravenous fluid supplements combined with regular fluid intake. (Li et al., 2023) Another way many individuals can stay hydrated is to combine non-surgical treatments like chiropractic care and spinal decompression to help realign and lengthen the spine to reduce unwanted pressure on the spinal discs and rehydrate them. The combination of non-surgical treatments and drinking plenty of hydrating fluids can help many individuals dealing with back pain associated with the spine as they start to make small changes to their routine and can live a life pain-free.
References
Cheung, S. T. Y., Cheung, P. W. H., & Cheung, J. P. Y. (2023). Why Are Some Intervertebral Discs More Prone to Degeneration?: Insights Into Isolated Thoracic “Dysgeneration”. Spine (Phila Pa 1976), 48(12), E177-E187. doi.org/10.1097/BRS.0000000000004632
Hauser, R. A., Matias, D., Woznica, D., Rawlings, B., & Woldin, B. A. (2022). Lumbar instability as an etiology of low back pain and its treatment by prolotherapy: A review. J Back Musculoskelet Rehabil, 35(4), 701-712. doi.org/10.3233/BMR-210097
Kabeer, A. S., Osmani, H. T., Patel, J., Robinson, P., & Ahmed, N. (2023). The adult with low back pain: causes, diagnosis, imaging features and management. Br J Hosp Med (Lond), 84(10), 1-9. doi.org/10.12968/hmed.2023.0063
Kos, N., Gradisnik, L., & Velnar, T. (2019). A Brief Review of the Degenerative Intervertebral Disc Disease. Med Arch, 73(6), 421-424. doi.org/10.5455/medarh.2019.73.421-424
Li, S., Xiao, X., & Zhang, X. (2023). Hydration Status in Older Adults: Current Knowledge and Future Challenges. Nutrients, 15(11). doi.org/10.3390/nu15112609
Nsiah-Asamoah, C. N. A., & Buxton, D. N. B. (2021). Hydration and water intake practices of commercial long-distance drivers in Ghana: what do they know and why does it matter? Heliyon, 7(3), e06512. doi.org/10.1016/j.heliyon.2021.e06512
What type of concussion tests are there to help establish the extent of head injuries and help assess improvement during recovery?
Concussion Tests
A concussion is a temporary change in brain function that occurs from a traumatic brain injury or TBI. It can cause problems with thinking and mood and can take weeks to years to heal. Concussion tests are done after a suspected head injury and are also used after diagnosis to assess healing progress. They are noninvasive tests that measure brain functions. Several tests vary in how they are given and what they measure.
Tests
A mild or moderate traumatic brain injury can cause damage to the brain that is not detectable with brain imaging tests. However, the damage can cause serious symptoms, including headaches, emotional changes, difficulty concentrating, and memory problems. (Haider M. N. et al., 2021) The effects of a concussion can be hard to describe, but concussion testing can help identify and quantify these changes. For individuals who don’t have time to heal or experience further brain injuries while recovering, the effects can be prolonged and worsen. This is one reason why concussion testing is vital to get a diagnosis and follow medical recommendations to avoid further injury to the brain. Diagnosis can help set goals, adjust, and assess how the effects improve over time. With improvement, individuals can participate in rehabilitation and follow their doctor’s instructions for gradually returning to work, school, and other activities.
Measurements
Concussion tests can measure subtle aspects of brain function, like visual or auditory perception and response speed (Joyce A. S. et al., 2015). The damage sustained can impair these abilities, like slow decision-making. A traumatic brain injury can be associated with serious injuries, like a skull fracture, swelling, bruise, or bleeding in the brain. These injuries can be detected with imaging tests and often require surgery or other interventions. Brain damage from bleeding or swelling would cause focal neurological symptoms and signs, including partial vision loss, numbness, and weakness. Individuals can have a concussion along with detectable brain injuries or in the absence of detectable brain injuries.
Types of Tests
There are several types of concussion tests. Individuals may have one or more of these, depending on the standard test that is used in their school, sports league, or by their doctor. These can include:
Online Checklists
Several different online checklists are available for concussion screening.
These tests may include questions about symptoms and are often used as self-tests but are not intended to replace an evaluation by a medical professional.
Baseline and Post-Injury Tests
Many schools and sports leagues conduct preseason skill measurements, including memory tests or tests of speed and accuracy, either in an interview form or with computer testing.
Individuals might be asked to retake the test that is used as a comparison if they have experienced a traumatic brain injury.
Standardized Assessment of Concussion – SAC
This five-minute test can be done on the sidelines after a sports injury or later.
It evaluates orientation, immediate memory, neurologic function, concentration, and delayed recall. (Kaufman M. W. et al., 2021)
King-Devick Concussion Test
This two-minute test can be performed on the sidelines after a sports injury or later to assess language, eye movement, and attention. (Krause D. A. et al., 2022)
Post-Concussion Symptom Scale
This test includes 22 questions involving neurocognitive factors, including difficulty concentrating or remembering, physical symptoms like headaches and dizziness, and emotional symptoms like sadness or irritability. (Langevin P. et al., 2022)
Sport Concussion Assessment Tool – SCAT
This test includes an on-field assessment noting concussion symptoms, memory assessment using Maddocks questions (a short list of specific questions), Glasgow Coma Scale (GCS), and cervical spine assessment.
An off-field assessment involves the evaluation of cognitive, neurological, balance, and delayed recall. (Kaufman M. W. et al., 2021)
Buffalo Concussion Physical Examination – BCPE
A modified physical examination that assesses neck tenderness and range of motion, head, jaw, and face abnormalities, eye movements examination, and coordination. (Haider M. N. et al., 2021)
After a concussion, individuals will also have a physical examination, including a full neurological examination, in a doctor’s office.
Results
A doctor will diagnose based on symptoms, physical examination, and concussion test results. For example, for individuals who have broken several bones and are taking powerful pain medications, concussion test results can be abnormal even if they did not experience a concussion. The results of concussion testing can be compared with results before the head injury. Often, baseline testing is required for participation in certain sports leagues at professional and amateur levels. A low score can indicate that head injury has impaired brain function. Sometimes, testing can be done within a few hours of the head trauma and then again a few days later. Responses of individuals who did not have measurements taken before a head injury can be compared with the average results of people their age.
Injury Medical Chiropractic and 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.
Lumbar Spine Injuries in Sports: Chiropractic Healing
References
Haider, M. N., Cunningham, A., Darling, S., Suffoletto, H. N., Freitas, M. S., Jain, R. K., Willer, B., & Leddy, J. J. (2021). Derivation of the Buffalo Concussion Physical Examination risk of delayed recovery (RDR) score to identify children at risk for persistent postconcussive symptoms. British journal of sports medicine, 55(24), 1427–1433. doi.org/10.1136/bjsports-2020-103690
Joyce, A. S., Labella, C. R., Carl, R. L., Lai, J. S., & Zelko, F. A. (2015). The Postconcussion Symptom Scale: utility of a three-factor structure. Medicine and science in sports and exercise, 47(6), 1119–1123. doi.org/10.1249/MSS.0000000000000534
Kaufman, M. W., Su, C. A., Trivedi, N. N., Lee, M. K., Nelson, G. B., Cupp, S. A., & Voos, J. E. (2021). The Current Status of Concussion Assessment Scales: A Critical Analysis Review. JBJS reviews, 9(6), e20.00108. doi.org/10.2106/JBJS.RVW.20.00108
Krause, D. A., Hollman, J. H., Breuer, L. T., & Stuart, M. J. (2022). Validity Indices of the King-Devick Concussion Test in Hockey Players. Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine, 32(3), e313–e315. doi.org/10.1097/JSM.0000000000000938
Langevin, P., Frémont, P., Fait, P., & Roy, J. S. (2022). Responsiveness of the Post-Concussion Symptom Scale to Monitor Clinical Recovery After Concussion or Mild Traumatic Brain Injury. Orthopaedic journal of sports medicine, 10(10), 23259671221127049. doi.org/10.1177/23259671221127049
For pregnant individuals, dehydration during pregnancy increases the risk of health problems for the individual and the fetus. Is it possible to prevent dehydration by drinking more water and managing morning sickness?
Pregnancy Dehydration
Maintaining proper hydration is an important part of a healthy pregnancy. Dehydration during pregnancy can occur for several reasons. A pregnant body needs more water to support the increased physical demands. Pregnant individuals need more water than non-pregnant ones and risk losing more water throughout the day. (American College of Obstetricians and Gynecologists, 2023) Pregnant individuals need eight to 12 glasses of water daily to prevent dehydration. Risks of dehydration during pregnancy include:
Low amniotic fluid levels and preterm contractions.
Early symptoms can include decreased urination, increased thirst, and dry mouth.
Serious symptoms can include dizziness, confusion, fainting, and low blood pressure.
In severe cases, intravenous/IV intervention may be required to replenish fluids.
The body’s physiological changes during pregnancy cause it to require more water. Pregnant individuals need more water and lose more water throughout the day. Dehydration happens when the body loses more water than it takes in. Factors that contribute to dehydration during pregnancy include: (Song, Y. et al., 2023)
Increased Blood Volume
A pregnant body requires increased blood circulation.
Blood volume increases as much as 30% to 45%.
The body needs more water to keep up with the increased volume.
Changes In The Urinary System
The kidneys often increase slightly in size during pregnancy.
This causes changes in the urinary system, causing the body to lose more water.
Changes In The Respiratory System
The increased demands on the body cause increased breathing.
Each time the body exhales, it loses water through the breath.
Increased Metabolism
Pregnancy causes the adrenal and thyroid functions to become slightly hyperactive.
This leads to increased metabolism and sweating.
When the body loses water through sweat, dehydration risks increase.
Increased Nutrition
A pregnant individual requires 300 extra daily calories, which increases to 450 additional daily calories in late pregnancy.
Eating more means the individual needs added hydration to support digestion and prevent constipation.
Morning Sickness
Nausea and vomiting are common.
Morning sickness causes fluid loss, increasing the risk of dehydration.
If the body does not acquire enough water when mildly dehydrated further symptoms can present and include fatigue, dizziness, feeling overheated, and having Braxton Hicks contractions or tightening and release of the uterus that are not from labor contractions. (Mulyani E. Y. et al., 2021)
Emergency Symptoms
Severe dehydration can lead to serious pregnancy complications and require immediate medical care. Emergency signs and symptoms include: (National Library of Medicine, 2023)
Irritability
Confusion
Sunken eyes
Fainting
Low or no urine
Low blood pressure
Rapid heart and breathing rate
Shock
Risks
Staying hydrated is essential, and hydration status affects health and pregnancy outcomes. When pregnant, the body needs extra water to produce enough amniotic fluid, which fills the amniotic sac with the fetus. When amniotic levels are low, the fetus has little room to grow and move. This can lead to delayed growth and development and potential umbilical cord issues. If the umbilical cord becomes compressed, the baby cannot receive oxygen and nutrients, which can quickly lead to an emergency. (Song, Y. et al., 2023) Chronic, untreated dehydration during pregnancy increases the risk of complications and can include (Aziz M. M. et al., 2018) (Song Y. et al., 2023)
Preterm contractions
Decreased birth weight and length
Reduced head circumference and chest circumference
Neural tube defects – malformations in early development of the brain and spine.
Low milk production
Rehydrating and Adding Electrolytes
Individuals must drink eight to 12 glasses of water daily to prevent dehydration (American College of Obstetricians and Gynecologists, 2020). Rehydration with water and electrolytes, essential minerals the body needs for normal function, may also be recommended. Ask a healthcare provider if they recommend consuming electrolytes through sports drinks, Pedialyte, coconut water, or electrolyte powders.
Drink between meals if drinking water is difficult because of nausea or feeling full.
Always have a water bottle, and drink what is possible when nausea is not manifesting.
Other recommended sources can include milk, natural fruit juices, and broth.
To reduce water loss, avoid high-caffeine or sugar drinks.
Take frequent breaks and drink more water when in the heat.
Minor Dehydration Treatment
Most pregnant individuals can safely treat mild dehydration at home. Call a healthcare provider if there are any concerns about symptoms. To treat minor dehydration, rest in a cool area and replenish fluids. Drink water, a sports drink, or a rehydration solution like Pedialyte. If symptoms do not improve, contact a healthcare provider. (Song Y. et al., 2023)
Injury Medical Chiropractic and Functional Medicine Clinic
Fortunately, treating and preventing dehydration is possible by drinking plenty of water throughout the day, avoiding drinks with caffeine or sugar, and taking frequent breaks. 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 associated medical professionals to integrate a treatment plan to improve the body’s flexibility and mobility and resolve musculoskeletal issues.
Mulyani, E. Y., Hardinsyah, Briawan, D., Santoso, B. I., & Jus’at, I. (2021). Effect of dehydration during pregnancy on birth weight and length in West Jakarta. Journal of nutritional science, 10, e70. doi.org/10.1017/jns.2021.59
Song, Y., Zhang, F., Lin, G., Wang, X., He, L., Li, Y., Zhai, Y., Zhang, N., & Ma, G. (2023). A Study of the Fluid Intake, Hydration Status, and Health Effects among Pregnant Women in Their Second Trimester in China: A Cross-Sectional Study. Nutrients, 15(7), 1739. doi.org/10.3390/nu15071739
Aziz, M. M., Kulkarni, A., Tunde-Agbede, O., Benito, C. W., & Oyelese, Y. (2018). Are Women With Threatened Preterm Labor More Dehydrated Than Women Without It? Journal of obstetric, gynecologic, and neonatal nursing: JOGNN, 47(5), 602–607. doi.org/10.1016/j.jogn.2018.05.006
For individuals that are trying to change up their daily routine, can incorporating the beneficial properties of a HIIT workout reduce pain?
Introduction
When it comes to a person’s health and wellness, they need to exercise for at least 30 minutes. However, many individuals have hectic lifestyles, which correlates to a lack of time to work out, leading to various health conditions that can develop over time and lead to pain and discomfort. Around the world, many adults should get 150 to 300 minutes of exercise to reduce pain in their body system. This can include doing chores, exercising at home, or going to the gym. But people who want to get in a quick workout within their busy schedules can opt for a HIIT workout or high-intensity interval training. In today’s article, we will look at what HIIT is, its beneficial effects on the body, and how important it is to incorporate a HIIT workout as part of a daily routine. We talk with certified associated medical providers who inform our patients to include a HIIT workout in their daily routine. While asking their associated medical provider intricate questions, we advise patients to formulate a customized treatment plan to help with chronic pain affecting their bodies through various exercise routines. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.
What is HIIT?
Do you experience any weight changes that cause difficulty maintaining your ideal weight? How often do you feel stressed and tired after a hectic day that you don’t have time for yourself? Or do you feel unusual aches and pains in your body that make you feel fatigued throughout the day? When it comes to individuals making small changes in their health and well-being, try to work out with the minimum time they have but also achieve the benefits of a full workout, can try HIIT. HIIT, or high-intensity interval training, is defined by exercise activities that target 80% of the individual’s max heart rate with alternative explosive bursts of full-throttle efforts with rest periods. (Coates et al., 2023)
Additionally, a HIIT workout usually involves cardio and resistance training as part of its sub-categories. This is generally incorporated into gyms and fitness centers and still requires both a warm-up, recovery intervals, and cool-down to ensure that the body is getting the full beneficial properties and effects from a HIIT workout. This is because a HIIT workout involves an active, high-intensity training session that is less than 15 minutes long and helps improve cardiometabolic health and cardiovascular endurance. (Atakan et al., 2021)
Optimize Your Wellness- Video
The Beneficial Properties of HIIT
Since HIIT has beneficial properties, many individuals experiencing low back pain from stress, excessive sitting or standing, or lifting heavy objects can utilize HIIT workouts as part of their exercise routine. HIIT workouts for lower back pain can help through general resistance and core strength training, which helps improve muscle strength and decrease the pain and deconditioning of the trunk muscles. (Verbrugghe et al., 2020) The other beneficial properties of HIIT are that it can help improve a person’s cardiorespiratory system or stamina. This helps maintain healthy endurance levels and causes them to increase the length or intensity of a HIIT workout while enjoying the health benefits it can provide. (Martin-Smith et al., 2020)
Since HIIT has beneficial properties, many individuals experiencing low back pain from stress, excessive sitting or standing, or lifting heavy objects can utilize HIIT workouts as part of their exercise routine. HIIT workouts for lower back pain can help through general resistance and core strength training, which helps improve muscle strength and decrease the pain and deconditioning of the trunk muscles. (Verbrugghe et al., 2020) The other beneficial properties of HIIT are that it can help improve a person’s cardiorespiratory system or stamina. This helps maintain healthy endurance levels and causes them to increase the length or intensity of a HIIT workout while enjoying the health benefits it can provide. (Martin-Smith et al., 2020)
Incorporating HIIT As Part of A Routine
Additionally, anyone who wants to do a HIIT workout routine can do it since it is perfect for a quick workout in a short amount of time. Individuals with busy schedules can complete a workout with alternating bursts of exercises and rest periods that can build up a person’s endurance. With a HIIT workout, many individuals will begin to notice that they have more energy throughout the day and start making changes to improve their lives.
References
Atakan, M. M., Li, Y., Kosar, S. N., Turnagol, H. H., & Yan, X. (2021). Evidence-Based Effects of High-Intensity Interval Training on Exercise Capacity and Health: A Review with Historical Perspective. Int J Environ Res Public Health, 18(13). doi.org/10.3390/ijerph18137201
Coates, A. M., Joyner, M. J., Little, J. P., Jones, A. M., & Gibala, M. J. (2023). A Perspective on High-Intensity Interval Training for Performance and Health. Sports Med, 53(Suppl 1), 85-96. doi.org/10.1007/s40279-023-01938-6
Gjellesvik, T. I., Becker, F., Tjonna, A. E., Indredavik, B., Lundgaard, E., Solbakken, H., Brurok, B., Torhaug, T., Lydersen, S., & Askim, T. (2021). Effects of High-Intensity Interval Training After Stroke (The HIIT Stroke Study) on Physical and Cognitive Function: A Multicenter Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 102(9), 1683-1691. doi.org/10.1016/j.apmr.2021.05.008
Guimaraes, G. V., Ciolac, E. G., Carvalho, V. O., D’Avila, V. M., Bortolotto, L. A., & Bocchi, E. A. (2010). Effects of continuous vs. interval exercise training on blood pressure and arterial stiffness in treated hypertension. Hypertens Res, 33(6), 627-632. doi.org/10.1038/hr.2010.42
Martin-Smith, R., Cox, A., Buchan, D. S., Baker, J. S., Grace, F., & Sculthorpe, N. (2020). High Intensity Interval Training (HIIT) Improves Cardiorespiratory Fitness (CRF) in Healthy, Overweight and Obese Adolescents: A Systematic Review and Meta-Analysis of Controlled Studies. Int J Environ Res Public Health, 17(8). doi.org/10.3390/ijerph17082955
Verbrugghe, J., Agten, A., Stevens, S., Hansen, D., Demoulin, C., Eijnde, B. O., Vandenabeele, F., & Timmermans, A. (2020). High Intensity Training to Treat Chronic Nonspecific Low Back Pain: Effectiveness of Various Exercise Modes. J Clin Med, 9(8). doi.org/10.3390/jcm9082401
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