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.
Individuals who sit in an office chair for a long period naturally tend to slouch over or slouch down into the chair. This posture can overstretch the spinal ligaments, strain the discs and surrounding structures in the spine, and contribute to or worsen back pain. Can the right office chair settings help relieve and prevent future injuries?
Work Office Chair
Sitting in an office chair for prolonged periods can cause lower back pain or worsen an existing back problem. The main reason behind this is that sitting is a static posture that increases stress in the back, shoulders, arms, and legs, putting pressure on the back muscles and spinal discs. Over time, incorrect sitting posture can damage the spinal structures. Most office chair customers base their decisions on availability, color, style, and price. However, it’s recommended that individuals learn about fitting seating equipment to their height, frame, or any condition, such as back or hip pain. The controls on or under the armrests and at the bottom of the chair seat, including the levers, paddles, and knobs, are there for a reason. Here are some recommendations for adjusting their work office chair to decrease back and hip pain.
Height Adjustment
The chair’s height affects the quadriceps, psoas, and hamstring muscles, which are important in posture-related back pain. Height adjustment is the primary way to change the angle of the hip joint while sitting. This angle affects the position of the pelvis and the degree of curve in the lower back, which can alter the spine’s normal alignment. (De Carvalho D. et al., 2017) Adjusting the chair’s height can provide a reference for other chair and workstation adjustments.
Back Angle
The hip angle is how close (increased hip flexion) or how far away (less hip flexion) the trunk is to the top of the thigh when sitting. Adjusting chair height can control the angle of the hip joint. When adjusting the height, adjust the degree of flexion at the hip joint to ensure ideal alignment for the individual body frame. A recent study measured the load that sitting has on simulated spinal discs. Researchers concluded that pressure on the spine can be relieved with a more open angle between the trunk and the thigh, that is, the hip joint angle. (Rohlmann A. et al., 2011) The backrest, seat tilt, and lumbar support features help maintain a pain-free back and relieve pressure and tension in the lower back and should be utilized.
Seat Depth
A kitchen chair, for example, may have no back supports or armrests to assist with posture and angle. (Holzgreve F. et al., 2022) When sitting, the individual’s back should be against the back of the work office chair for the best support and a healthy posture. Individuals will want to check and see how concave the seat surface is. If there is a prominent curve, this will cause the back to be rounded when sitting, which can become uncomfortable and lead to back pain. A chair with built-in support or a pillow can help adjust the depth. This means that chair size matters, as different people will need seats of varying depths to match their musculoskeletal structure.
Seat Height
Another way to understand the hip joint angle is to compare the height of the knees to the height of the hips. This is usually the easiest way to assess whether the chair height is right while adjusting. When the seat is right, the feet will be flat on the floor. The feet should reach the floor without causing pressure on the back of the thighs. Individuals with dangling feet, which may be because of their height, should place a footrest or thick book under them. The knees should be approximately level with or lower than the hips. In this case, the level is a 90-degree angle between the hip and trunk, which is stress-free on the hips and back.
Risks
Chair Too High
For individuals who can’t reach their feet to the floor, the chair is probably too high. The Occupational Safety and Health Administration (OSHA) says this is potentially hazardous because it can lead to scooting forward and forgoing the backrest’s support (United States Department of Labor, N.D.) Sitting like this is considered an awkward posture and a risk factor for work-related musculoskeletal disorders (MSD). Musculoskeletal disorders and symptoms caused by awkward sitting posture include muscle fatigue, swelling, pain, numbness, or decreased circulation. (Ng, P. K., Jee, K. S. and Lim, S. Y. 2016)
Chair Too Low
If the knees are higher than the hips, the chair is probably too low, causing extreme flexion in the hip joints. Most individuals’ backs can’t handle this well because their hip muscles are not flexible enough. If sitting with knees higher than hips, the position can cause lower back pain.
Taking Breaks
No matter how comfortable a work office chair is, prolonged static posture is unhealthy for the spine and is a common contributor to back problems and muscle strain. Remember to stand, stretch, and walk for at least a minute or two every half hour to prevent the back from staying in one position for a long period. A quick stretch or minimal movement, like a quick walk, will help. A longer walk will help even more, promoting blood circulation to supply nutrients to all the spinal structures.
Moving and stretching regularly throughout the day will help keep the joints, ligaments, muscles, and tendons loose and promote comfort, relaxation, and the ability to focus productively.
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. An integrated approach to treating injuries and chronic pain syndromes improves 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.
Low Back Pain: Impact and Chiropractic Solutions
References
De Carvalho, D., Grondin, D., & Callaghan, J. (2017). The impact of office chair features on lumbar lordosis, intervertebral joint and sacral tilt angles: a radiographic assessment. Ergonomics, 60(10), 1393–1404. doi.org/10.1080/00140139.2016.1265670
Rohlmann, A., Zander, T., Graichen, F., Dreischarf, M., & Bergmann, G. (2011). Measured loads on a vertebral body replacement during sitting. The spine journal : official journal of the North American Spine Society, 11(9), 870–875. doi.org/10.1016/j.spinee.2011.06.017
Holzgreve, F., Maurer-Grubinger, C., Fraeulin, L., Bausch, J., Groneberg, D. A., & Ohlendorf, D. (2022). Home office versus ergonomic workstation – is the ergonomic risk increased when working at the dining table? An inertial motion capture based pilot study. BMC musculoskeletal disorders, 23(1), 745. doi.org/10.1186/s12891-022-05704-z
Ng, P. K., Jee, K. S. & Lim, S. Y. (2016). Development of Ergonomics Guidelines for Improved Sitting Postures in the Classroom among Malaysian University Students. American Journal of Applied Sciences, 13(8), 907-912. doi.org/10.3844/ajassp.2016.907.912
For individuals dealing with stress, back and neck pain, and wanting to improve overall health, can trying a Hatha yoga class help?
Hatha Yoga Class
A yoga class is great for moms, athletes, or anyone interested in low-impact exercise. Today, many practice yoga for its mind and body, health and wellness benefits. Research shows that hatha yoga helps to reduce stress, relieve back and arthritis pain, support healthy habits, and improve emotional health. (National Center for Complementary and Integrative Health, 2023) Hatha classes stretch, unwind, and release tension, providing a healthy outlet for hectic lifestyles.
What Is It?
In Sanskrit, Hatha translates to force. Hatha yoga focuses on posture and breathing techniques to channel energy. Classes last 45 to 90 minutes and consist of breathing, poses, and meditation.
Yoga can help relieve everyday anxiety and depressive symptoms.
However, it may not be effective for clinically diagnosed mental health conditions.
The reviews and published studies on yoga did not find conclusive evidence to support its effectiveness in managing anxiety disorder, depression, or PTSD.
Arthritis and Fibromyalgia
According to the NCCIH, there is limited evidence to support yoga’s benefits for osteoarthritis, rheumatoid arthritis, and fibromyalgia.
Back Pain
The American College of Physicians recommends yoga as a non-pharmacological back pain treatment. (Qaseem A. et al., 2017)
A review of studies found that yoga improves low-back pain and function with both short-term and intermediate-term benefits, and its effects are similar to those of other types of exercise. (Skelly A. C. et al., 2020)
Balance
According to 11 out of 15 reviewed studies, yoga helps to improve balance in generally healthy individuals.
Emotional Health
Yoga has a positive impact on mental health. Ten out of 14 studies reviewed showed benefits in improving resilience or general mental well-being.
Menopause
Yoga can relieve physical and psychological symptoms of menopause, including hot flashes, according to the review of 1,300 study participants.
Mindfulness
In a survey of 1,820 young adults, participants attributed increased mindfulness, motivation to participate in other forms of activity, and eating healthier. (Watts A. W. et al., 2018)
Multiple Sclerosis
The NCCIH reports showed that yoga had short-term benefits on mood and fatigue in individuals with multiple sclerosis.
However, it did not affect muscle function, cognitive function, or quality of life.
Neck Pain
A 2019 meta-analysis, including ten studies and a total of 686 subjects, found that yoga can reduce neck pain intensity and disability pain while also improving the range of motion. (Li Y. et al., 2019)
Sleep
Several studies have found yoga can improve sleep quality and duration.
Populations found to experience sleep benefits include cancer patients, older adults, individuals with arthritis, pregnant women, and women experiencing menopause symptoms.
Stress Management
Yoga improved physical or psychological stress-related measures in 12 of 17 studies reviewed.
What to Expect
There are several different styles of yoga to choose from. Classes labeled yoga are likely the Hatha variety. Hatha is a gentle style that focuses on static poses and is great for beginners. However, it can still be physically and mentally challenging. Practitioners should wear athletic clothes and sports bras for maximum comfort and ease of movement. Each class varies depending on the instructor, but most last between 45 and 90 minutes.
Class Breakdown
Classes typically start with a gentle warm-up, advance to more physical poses, and end with a short meditation.
Breathing
Most Hatha classes start with a period of focus on breathing.
As you perform the poses, the instructor will continue to remind everyone to focus on breathing and may suggest different breathing exercises.
Poses
Yoga poses, also called postures or asanas, are a series of movements that help improve balance, flexibility, and strength.
Poses range in difficulty from laying flat on the floor to physically challenging positions.
If, during a class, a pose is too difficult, the instructor can provide a modified posture.
Meditation
Most classes end with a short period of meditation.
If you go into a Hatha class and it feels too slow or inactive, there are faster-paced, more athletic yoga classes, including flow, vinyasa, or power yoga classes. See if it’s more your speed.
Injury Medical Chiropractic Clinic
At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for you and strive to create fitness and better the body through research methods and total wellness programs. These programs use the body’s ability to achieve health and fitness goals, and athletes can condition themselves to excel in their sport through proper fitness and nutrition. Our providers use an integrated approach to create personalized programs, often including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.
Qaseem, A., Wilt, T. J., McLean, R. M., Forciea, M. A., Clinical Guidelines Committee of the American College of Physicians, Denberg, T. D., Barry, M. J., Boyd, C., Chow, R. D., Fitterman, N., Harris, R. P., Humphrey, L. L., & Vijan, S. (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine, 166(7), 514–530. doi.org/10.7326/M16-2367
Skelly, A. C., Chou, R., Dettori, J. R., Turner, J. A., Friedly, J. L., Rundell, S. D., Fu, R., Brodt, E. D., Wasson, N., Kantner, S., & Ferguson, A. J. R. (2020). Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Agency for Healthcare Research and Quality (US).
Watts, A. W., Rydell, S. A., Eisenberg, M. E., Laska, M. N., & Neumark-Sztainer, D. (2018). Yoga’s potential for promoting healthy eating and physical activity behaviors among young adults: a mixed-methods study. The international journal of behavioral nutrition and physical activity, 15(1), 42. doi.org/10.1186/s12966-018-0674-4
Li, Y., Li, S., Jiang, J., & Yuan, S. (2019). Effects of yoga on patients with chronic nonspecific neck pain: A PRISMA systematic review and meta-analysis. Medicine, 98(8), e14649. doi.org/10.1097/MD.0000000000014649
Individuals with inflammation, pain, and swelling on the tops of their feet or hands could be experiencing extensor tendonitis. What treatment options are available?
Extensor Tendonitis
These tendons attach to muscles that straighten the fingers and lift the toes and the top of the foot. Extensor tendonitis is a condition characterized by inflammation of the tendons on the tops of the hands and feet. It often results from overuse of the muscles and from wearing tight shoes. Symptoms tend to worsen with activity and improve with rest. The condition does not usually require surgery; treatments include medications, home remedies/activity modification, and physical therapy.
Types
Tendonitis can develop in any tendon of the extensor muscles. These tendons are long, thin bands of tissue that can be felt on the tops of the hands and feet. The structures attach to muscles on one end and bones of the fingers and toes on the other. The extensor tendons in the hands include: (American Society for Surgery of the Hand, 2024)
The extensor digitorum communis straightens the index, middle, ring, and small fingers.
The extensor digiti minimi straightens the small finger.
The extensor indicis proprius straightens the index finger.
The extensor pollicis longus and extensor pollicis brevis muscles move the thumb into the thumb-up position.
The extensor digitorum longus and extensor digitorum brevis muscles lift the second, third, fourth, and fifth toes.
The extensor hallucis longus lifts the big toe.
Tendonitis vs Tendinopathy
Chronic tendon pain can lead to a condition known as tendinopathy.
Tendonitis results from inflammation.
Tendinopathy is the degeneration/micro-tearing of a tendon that occurs with long-term overuse.
Knowing which condition you are dealing with is important because it requires different treatments.
Symptoms
The primary symptom is pain in the affected tendon/s. Individuals may also experience swelling, and the skin can become red or warm to the touch. Extensor tendonitis can cause pain when using the affected muscles, moving the hand or foot in the opposite direction, and stretching the tendons. Usually, the pain worsens when using the affected muscles and improves with rest.
Causes
Extensor tendonitis in the hands usually results from overuse, which causes inflammation. However, it can also result from trauma, such as falling on the hand or an injury during physical or sports activities. Common activities include: (Hanson Z. C., and Lourie G. M. 2022)
Manual labor work
Typing
Computer mouse use
Weightlifting
Gymnastics
Playing a musical instrument
Extensor tendonitis in the foot can also result from overuse activities like running, especially uphill. However, it can also occur from wearing overly tight or tightly laced shoes for physical activities like running or dancing. Less common causes include: (Arthritis Foundation, N.D.)
Medical conditions like diabetes or arthritis
Medication side effects
Infection
Joint deformities
Treatment
Extensor tendonitis usually improves with conservative treatment, which includes self-care, activity modification, physical therapy, and medication.
Medications
Individuals can treat inflammation with non-steroidal anti-inflammatory drugs NSAIDs like:
Ibuprofen
Naproxen
Aspirin
Acetaminophen can help reduce pain.
In some cases, individuals may need prescription anti-inflammatory medications like corticosteroids or pain relievers for short-term use.
Self-Care and Activity Adjustments
Self-care includes:
Rest and avoid any activities that increase pain symptoms. If you can’t avoid them completely, take frequent breaks to allow the muscles to relax.
Apply ice to the hand or foot several times daily for up to 20 minutes.
Compression wraps should be applied on the foot or hand using an elastic bandage or soft splint to help support the injured tendons and reduce swelling.
Elevate the hand or foot if swollen above the heart level when resting.
Activity Adjustments
Modifying activities can help address the underlying cause/s.
Hand extensor tendonitis can develop from poor positioning.
Setting up an ergonomic workstation can help.
Consult a coach or trainer if the tendonitis is related to sports or exercise.
Individuals might need to adjust their technique or training schedule to decrease pressure on the tendons.
Physical Therapy
Physical therapy is an effective treatment. A therapy team can help determine the condition’s underlying cause and provide a personalized treatment program. Interventions can include:
Pain-reducing treatments like ultrasound, electrical stimulation, electroacupuncture, and laser therapy.
Extensor tendonitis can take weeks or even months to fully heal. Early diagnosis and determining the condition’s underlying cause rather than just treating symptoms are recommended for a faster and optimal recovery. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility, relieving pain, and helping individuals return to normal activities. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers if other treatments are needed.
Hanson, Z. C., & Lourie, G. M. (2022). Middorsal Wrist Pain in the High-Level Athlete: Causes, Treatment, and Early Return to Play. Orthopaedic journal of sports medicine, 10(4), 23259671221088610. doi.org/10.1177/23259671221088610
Bronner, S., Ojofeitimi, S., & Rose, D. (2008). Repair and rehabilitation of extensor hallucis longus and brevis tendon lacerations in a professional dancer. The Journal of orthopaedic and sports physical therapy, 38(6), 362–370. doi.org/10.2519/jospt.2008.2749
The levator scapulae muscles could be overstretched for individuals experiencing upper back, shoulder, and neck pain. Can physical therapies help relieve pain and retrain the muscles to function properly?
Levator Scapulae Muscles
The levator scapulae muscles stretch along the spine across the upper back and neck. They originate from the cervical vertebrae C1 to C4 and attach to the inside top edge of the scapula. (Chotai P. N. et al., 2015) They elevate the shoulder blades, tilt the head, and work with other muscles to stabilize the spine and influence neck motion and upper back posture. The shoulder blade/scapula is the flat, triangular-shaped bone that sits on top of the upper part of the rib cage. Where the levator scapulae attaches, the muscles raise the shoulder blade, a movement called elevation, and indirectly rotates the scapula’s bottom tip downward towards the spine. These shoulder blade movements are part of the shoulder joint’s larger flexion and abduction movements.
Flexion occurs when moving the arm forward and up, and abduction occurs when moving the arm out to the side.
The levator scapulae muscles contract during flexion and/or abduction,
The muscles also contract when moving the neck in side bending, lateral flexion, rotation, or twisting.
Symptoms
Neck and shoulder pain are common problems for office workers, truck drivers, and others who sit most of the day for their jobs. It can worsen when there is no spinal support for maintaining correct alignment. Poorly designed work chairs may contribute to chronic muscle tension and spasms, plus they may contribute to muscle weakness. One of the primary functions of the levator scapulae muscles is to keep the shoulder blade in a position that supports a vertical alignment of the head and to prevent forward head posture. (Yoo W. G. 2018)
However, the shoulder blade is an extremely movable bone. Maintaining stability and correct neck posture is not easy. The levator scapulae muscles may not be strong enough to keep the shoulder blade where it’s supposed to be for healthy posture, and instead, they become overstretched. When muscles are overstretched, they often become taut to try to maintain some form of stability. It can feel like muscle tension because the muscles shorten, but there is a difference. The situation can worsen if one slouches, has no lumbar support, and/or the desk or steering wheel is too high or too low, which may force the shoulder blade upward or downward.
Pain Relief
The levator scapulae muscles are two of several shoulder muscles that may contribute when neck pain presents. This is why a qualified, licensed health professional should diagnose any pain or dysfunction in the area. Physical therapy can help get the body back on track. (Yoo W. G. 2018) Treatment may consist of restoring muscle strength and flexibility in the shoulder, neck, and upper back muscles and developing better posture habits. Physical therapy exercises, particularly those that address upper back posture, can help reduce the stress placed on the levator scapulae muscles and can help decrease kyphosis, often a precursor to forward head posture. Stretching, strengthening, and posture lessons will help relieve pain and increase the physical functioning of the upper body. Other tips for avoiding and relieving muscle pain include:
Stretching regularly by gently rotating the neck and shoulders.
Applying heat to promote relaxation.
Regular massage therapy.
Adjusting chairs and/or monitor height to align with a straight line of sight.
Not carrying heavy bags, especially on one shoulder.
Avoiding side sleeping without proper head support.
Injury Medical Chiropractic Clinic
Visiting a chiropractic and physical therapy team can help treat injuries and chronic pain syndromes, relieve pain, resolve musculoskeletal issues, and prevent future symptoms. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized care program for each patient through an integrated approach to help return to normal and 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.
The Natural Way to Heal: Non-Surgical Chiropractic Care for Pain Relief
References
Chotai, P. N., Loukas, M., & Tubbs, R. S. (2015). Unusual origin of the levator scapulae muscle from mastoid process. Surgical and radiologic anatomy : SRA, 37(10), 1277–1281. doi.org/10.1007/s00276-015-1508-6
Yoo W. G. (2018). Effects of thoracic posture correction exercises on scapular position. Journal of physical therapy science, 30(3), 411–412. doi.org/10.1589/jpts.30.411
For individuals experiencing piriformis syndrome. Can knowing the causes and what it feels like help in diagnosis and treatment?
Managing Piriformis Syndrome
Piriformis syndrome is where spasms occur in the piriformis muscle located in the buttocks. These muscle spasms can cause pain and numbness in the buttocks and the back of the leg. (Cedars Sinai, 2022)
What Is It?
Piriformis syndrome is an irritation of the sciatic nerve from the piriformis muscle. Although the piriformis muscle is small compared to other muscles around the hip and thigh, it supports the hip joint’s external rotation or turning out. The sciatic nerve supplies the lower extremities with motor and sensory functions. The piriformis tendon and sciatic nerve cross each other behind the hip joint in the deep buttock. Both are about one centimeter in diameter. The piriformis muscle spasms can irritate the sciatic nerve, causing sciatica symptoms. (Cedars Sinai, 2022)
Triggers
A piriformis syndrome diagnosis means the piriformis tendon binds or spasms around the sciatic nerve, causing irritation and symptoms. Many doctors and specialists support the theory that when the piriformis muscle and its tendon tighten, this can cause compression and pinch the nerve. This can decrease blood circulation and irritate the nerve due to pressure. (Cass S. P. 2015) Many doctors also believe that piriformis syndrome occurs from anatomic variation of the muscle and tendon. It is thought this muscle-tendon variation irritates the nerve in some, leading to sciatica symptoms.
How It Feels
Common signs and symptoms experienced include (Cass S. P. 2015)
Pain in the buttocks.
Pain behind the hip.
Electric shock pains traveling down the back of the lower extremity.
Numbness in the lower extremity.
Tenderness with pressure that often causes pain when sitting.
Some develop symptoms abruptly, while others gradually increase in symptoms in the back of their thighs.
Most who are diagnosed with piriformis syndrome are generally active individuals who experience increasing difficulty with certain types of physical activity.
Testing
There are no specific tests that accurately diagnose piriformis syndrome. Doctors will order tests, including MRI and nerve conduction studies. Because it can be difficult to diagnose, there are likely many misdiagnosis cases. This means that some with the condition don’t have a piriformis diagnosis. In addition, some with vague hip pain may receive this diagnosis even if they don’t have the condition. (Cass S. P. 2015) An injection is often administered into the piriformis muscle when the diagnosis is uncertain. (Jankovic D. et al., 2013) Performing an injection can help determine the specific location of the discomfort. When an injection is given into the piriformis muscle or tendon, it is administered by ultrasound guidance to ensure the needle delivers medication to the correct location. (Bardowski E. A., and Byrd J. W. T. 2019)
Differential Diagnosis
Some other conditions with buttock pain can have similar symptoms. Other causes can include:
Radiculopathy/Sciatica
Herniated discs
Hip bursitis
Spinal stenosis
The diagnosis of piriformis syndrome is given when these diagnoses are eliminated as possible causes of pain.
Treatment
Managing piriformis syndrome is quite general, and it is often difficult to recover from. Common treatment and management suggestions include the following. (Jankovic D. et al., 2013)
Rest
Avoiding activities that cause symptoms for at least a few weeks.
Physical Therapy
Focuses on stretching and strengthening the hip rotator muscles.
Anti-inflammatory Medication
To decrease inflammation around the tendon.
Deep Massage
Used to relax the piriformis muscle and help release the compressed nerve.
Cortisone Injections
It can help decrease inflammation and swelling.
Botulinum Toxin Injection
It can paralyze the piriformis muscle to reduce pain and discomfort.
In severe cases, surgery can be performed to loosen the piriformis tendon, known as a piriformis release (Cass S. P. 2015). This surgical procedure is recommended when conservative treatments have been tried for at least six months and other causes of pain have been evaluated and ruled out. Recovery takes several months.
The goal of managing piriformis syndrome is to improve the range of motion and flexibility around the hip and diminish inflammation around the sciatic nerve. Working with a professional chiropractic team can help relieve pain, return individuals to normal function, and expedite healing. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a customized treatment program through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility. 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.
Cass S. P. (2015). Piriformis syndrome: a cause of nondiscogenic sciatica. Current sports medicine reports, 14(1), 41–44. doi.org/10.1249/JSR.0000000000000110
Jankovic, D., Peng, P., & van Zundert, A. (2013). Brief review: piriformis syndrome: etiology, diagnosis, and management. Canadian journal of anaesthesia = Journal canadien d’anesthesie, 60(10), 1003–1012. doi.org/10.1007/s12630-013-0009-5
Bardowski, E. A., & Byrd, J. W. T. (2019). Piriformis Injection: An Ultrasound-Guided Technique. Arthroscopy techniques, 8(12), e1457–e1461. doi.org/10.1016/j.eats.2019.07.033
An annular fissure is caused by age-related changes to the spine, which often do not cause symptoms but can cause back pain. Can understanding the causes help individuals manage lower back pain and help healthcare providers develop an effective treatment program?
Annular Fissure
An annular fissure is a discogenic condition that affects the spine and can cause lower back pain. Also called an annular tear, it’s usually a wear-and-tear condition that happens over time rather than a condition caused by trauma. It usually happens when the fibers that make up the annulus or the tough outer covering of the intervertebral disc break or separate. To manage it, healthcare providers may recommend:
Making lifestyle changes.
Staying aware of how you go about daily activities and take steps to make adjustments, such as being mindful of unhealthy posture.
Start doing exercises that help make the back stronger.
Medical care if pain and other symptoms need to be managed.
Symptoms
Lower back pain may be a sign of an annular fissure, or there may be no symptoms. Symptoms can include:
Pain
Weakness
Numbness
Electrical sensations travel down one leg or arm if a cervical/neck tear is present.
Numbness and weakness may be caused by the nerves getting irritated or compressed near an annular tear. (Stadnik, T. W. et al., 1998)
These symptoms can also be similar to a herniated disc, which can be a complication of an annular fissure.
However, studies have shown that annular tears and herniated discs often go unnoticed because they have few obvious symptoms. (Jarvik, J. G. et al., 2005)
Annulus Function
The annulus comprises several layers of tough fibers/fibrocartilage that surround, contain, and protect the soft, liquid nucleus inside the disc. The layers of the annulus fibrosus crisscross to provide support. The nucleus is a shock absorber cushions the body’s weight on the spinal joints when sitting, standing, or moving. Its strength also allows the disc to buffer the jolts and jars it experiences. It also helps maintain the integrity of the intervertebral joint by supporting the space between the two vertebrae. When an annular fissure occurs, the fibers separate or tear off from insertion on the nearby spinal bone. A fissure can also be a break in the fibers of one or more layers. (Jarvik, J. G. et al., 2005)
Causes
An annular tear is not the standard term medical professionals use to describe or diagnose a fissure because the word tear suggests that trauma has led to the separation or break in the fibers. While an injury can cause an annular fissure, it’s usually caused by long-term wear and tear. (Guterl, C. C. et al., 2013) The tears are typically caused by age-related degenerative changes in the disc, which can also lead to degeneration in other areas of the spine. Wear and tear are caused by annular fissures due to an individual’s daily living habits, such as sitting, standing, walking, climbing stairs, and performing other routine movements.
Treatment
While a large annular fissure is not likely to improve without treatment, a small one could heal independently. However, once an area has torn, it becomes more likely to continue tearing. (Virginia Spine Institute, N.D.) Conservative treatment is usually enough to control pain and symptoms. Physical therapy and anti-inflammatory medication are the first line of treatment. (Cheng, J. et al., 2019) Medication can be over-the-counter or prescription. Physical therapy treatment includes exercises, traction, and other therapies. If these do not help with the symptoms, the provider may suggest a steroid injection to reduce inflammation and pain. It can take three to six months to recover from degenerative disc problems if doing a standard treatment plan that includes rest, low-impact therapy exercises, and anti-inflammatory treatments. (Cheng, J. et al., 2019)
In severe cases, surgery may be recommended, including disc replacement surgery. An annular tear is not a reason to have disc replacement surgery alone; it is only when there are degenerative changes in the vertebral disc that surgery might be necessary. (Yue, J. J. et al., 2012)
Improving Body Alignment
Not paying attention and being aware of how the body performs everyday activities can, over time, set the stage for an annular fissure and other musculoskeletal injuries. However, fixing daily movement and posture habits to prevent injuries can be done through simple adjustments. For example, strengthening the core and back muscles can reduce pressure on the spine and help prevent injuries. (Camp, C. L. et al., 2016) The idea is to improve joint and overall body alignment. Activities can include:
Strength training
Walking
Pilates classes
Yoga
Tai chi
Somatic exercises
These activities help with muscle balance and joint alignment, which are recommended prevention strategies that physical therapists use when working with individuals who need help with spinal problems.
Visiting a chiropractic and physical therapy team can help treat injuries and chronic pain syndromes, relieve pain, resolve musculoskeletal issues, and prevent future symptoms. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized care program for each patient through an integrated approach to treating injuries, improving flexibility, mobility, and agility to help return to normal and 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.
Back Pain Specialist
References
Stadnik, T. W., Lee, R. R., Coen, H. L., Neirynck, E. C., Buisseret, T. S., & Osteaux, M. J. (1998). Annular tears and disk herniation: prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica. Radiology, 206(1), 49–55. doi.org/10.1148/radiology.206.1.9423651
Jarvik, J. G., Hollingworth, W., Heagerty, P. J., Haynor, D. R., Boyko, E. J., & Deyo, R. A. (2005). Three-year incidence of low back pain in an initially asymptomatic cohort: clinical and imaging risk factors. Spine, 30(13), 1541–1549. doi.org/10.1097/01.brs.0000167536.60002.87
Guterl, C. C., See, E. Y., Blanquer, S. B., Pandit, A., Ferguson, S. J., Benneker, L. M., Grijpma, D. W., Sakai, D., Eglin, D., Alini, M., Iatridis, J. C., & Grad, S. (2013). Challenges and strategies in the repair of ruptured annulus fibrosus. European cells & materials, 25, 1–21. doi.org/10.22203/ecm.v025a01
Cheng, J., Santiago, K. A., Nguyen, J. T., Solomon, J. L., & Lutz, G. E. (2019). Treatment of symptomatic degenerative intervertebral discs with autologous platelet-rich plasma: follow-up at 5-9 years. Regenerative medicine, 14(9), 831–840. doi.org/10.2217/rme-2019-0040
Yue, J. J., Telles, C., Schlösser, T. P., Hermenau, S., Ramachandran, R., & Long, W. D., 3rd (2012). Do presence and location of annular tear influence clinical outcome after lumbar total disc arthroplasty? A prospective 1-year follow-up study. International journal of spine surgery, 6, 13–17. doi.org/10.1016/j.ijsp.2011.09.001
Camp, C. L., Conti, M. S., Sgroi, T., Cammisa, F. P., & Dines, J. S. (2016). Epidemiology, Treatment, and Prevention of Lumbar Spine Injuries in Major League Baseball Players. American journal of orthopedics (Belle Mead, N.J.), 45(3), 137–143.
Can neurological physical therapy help individuals diagnosed with a recently acquired or chronic neurological condition gain strength and functioning?
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.
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Extensor Tendonitis
