Chiropractic

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.

Injured At Work? How Chiropractic Can Help | El Paso, TX.

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic, Conditions Treated, Injury Care, Personal Injury, Work Related Injuries

Injured: In 2014, there were 2.8 million occupational injuries. This crossed all industries, but 75 percent were in those that provided a service.

These injuries can lead to time lost at work, decrease in production, depression, and temporary (or permanent) disability. These injuries can be caused by slip and fall, vehicle collisions, electrocution, struck by hazards, and caught in or between accidents. However, work related injury can also be caused by sitting at a desk or hunched over a computer for extended periods of time. Chiropractic has been shown to help workers who have been injured on the job, so they can return to work faster.

Injured

Common Occupational Injuries

Occupational injuries are vast and varied with a host of causes and many different symptoms. They can range from minor annoyances to significant damage that can lead to temporary or permanent disability. Some may require surgery while others require extended physical therapy, braces, and intensive medical treatments.

Thoracic outlet syndrome � This injury is caused by flexing the shoulder, carrying loads on your shoulders, and extending your arms above shoulder height for a prolonged period of time. It is marked by swelling, pain, dull ache, weakness, or a burning sensation in the affected area.
Elbow tendonitis (Epicondylitis) � This injury is caused by forceful or repeated forearm rotation while simultaneously bending the wrist. It is marked by swelling, dull ache, pain, burning, and weakness in the affected area.
Carpal tunnel syndrome � This injury can be caused by several things including vibratory tools, repetitive motion, and secondary factors. It is marked by numbness, pain, tingling, wasting of muscles at the thumb base, and burning.
DeQuervain�s disease � This injury is caused by forceful gripping and repetitive hand twisting. It is marked by pain at the thumb base.
Tendonitis/tenosynovitis � This injury is caused by sustained hyperextension of the knee, repetitive motion, and prolonged load overuse. It is marked by numbness, pain, and swelling in the hands.
Back and neck pain � This injury can have a wide variety of causes from repetitive motion to accident to improper equipment. It is the most common work related injury.

Preventing Workplace Injuries

While a few work related injuries are unavoidable, many can be prevented with a little extra attention and care. The American Chiropractic Association recommends the following practices to reduce the risk of a workplace injury.

Get regular exercise. This helps prevent back injuries by keeping your body strong, fit, and flexible.
If you do desk work, get a chair that fits you. This means that there should be two inches between the backs of your knees and the front edge of the seat. Your knees should be level with your hips or slightly below, never higher.
When doing computer work, use a foot rest for support and keep your knees between a 90 degree and 120-degree angle.
If your job requires you to sit for extended periods of time, take breaks at least every two hours to walk and stretch.
When you lift something heavy or awkward, don�t bend over to do it. Bend at your knees and hips, squatting as you pick up the object and let your legs do the work and keeping the object close to your body while your back remains straight. Do not let your body twist while you are trying to lift.

Of course, you should also follow all recommended and required safety guidelines for your workstation and place of employment.

Chiropractic For Workplace Injuries

Chiropractic care can help speed your recovery, improve your posture, and restore your mobility and strength. Through various chiropractic techniques, many of the occupational injuries listed here can be effectively treated. Chiropractic is a proven method for managing pain for the back and neck, but it has also been proven to be very beneficial for conditions like carpal tunnel, elbow tendonitis, and knee injuries.

Chiropractic�s whole body approach helps injured workers not only manage their pain and help heal their injury through adjustments, it can also help with soft tissue rehabilitation and other noninvasive therapies that improve range of motion. In short, chiropractic can help workers get back to work faster so less time is lost from work and the financial impact is greatly decreased.

Injury Medical Clinic: Accident Treatment & Recovery

Sciatica Pain Treatment In El Paso, TX Chiropractic Care | Video

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Clinical Case Reports, Sciatica, Sciatica Nerve Pain, Testimonies, Video

Mr. and Mrs. Dominguez first received chiropractic care with Dr. Alex Jimenez after suffering automobile accident injuries. Martha Dominguez expresses how much their quality of life has changed since receiving chiropractic treatment and physical rehabilitation with Dr. Jimenez along with the trainers and staff at Push. Mr. and Mrs. Domingues are grateful for the services they’ve received for their automobile accident injuries and their sciatica pain.

Sciatica Pain Treatment And Chiropractic Care

Chiropractic care can help alleviate automobile accident injuries. Moreover, chiropractic care is totally non-invasive and drug-free, so there are fewer dangers involved with this holistic treatment. Furthermore, chiropractic techniques concentrate on treating the pain at its source, rather than masking it with prescription painkillers. Chiropractors will begin with an evaluation and appointment. From that point, they can perform a physical evaluation and run any required diagnostics to confirm the identification of the diagnosis. The chiropractor will then work on developing a customized treatment program with the patient’s needs and lifestyle in mind.

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

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

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

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

Thank You & God Bless.

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

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Injury Medical Clinic: Chronic Pain & Treatments

Posture Affects Your Health | El Paso, TX.

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Posture

Your mother always said don�t slouch – turns out she was right. And she has science to back it up. Your posture can have a profound effect on your health. Walking or sitting with a hunched back has been linked to a variety of health issues.

What�s more, poor posture can cause your body�s structure to change, leading to misalignment. While everyone slips a bit in the posture department now and then, the real damage occurs when it becomes a habit. In fact, you could be damaging your health with bad posture and not even realize it. Here are five ways that posture mistakes can harm your health.

Posture

Pain In The Neck, Back & Shoulders

Sitting in a slouched or hunched over position, drooping your shoulders, or rounding out your spine while standing or sitting can cause pain in your neck, back, and shoulders. Many people who work with computers as a regular part of their jobs experience this to some degree.

That is because the majority of workers do not have their computer monitors at the appropriate height, causing them to spend hours a day hunched over their keyboard. People who spend a lot of time on their smartphone and mobile devices experience text neck, which is caused by this type of poor posture.

Increased Depression & Stress

The connection between posture and mood has long been established. People who walk slouched over tend to feel more depressed and have a poorer self-image.

When you are slouched, you are restricting blood flow throughout your body, inhibiting proper oxygenation of your cells, and crowding your organs so that they are not able to function at an optimum level. If your spine or body is out of alignment, it can slow the neural processes that keep your body functioning as it should. When all these things are going on, your mood will definitely be affected, especially if you aren�t as active as you should be.

Pain/Weakness In The Lower Back, Hips, Knees & Ankles

This posture problem is common in people who are obese and pregnant women. The added weight causes the body to shift in unnatural positions in order to support it.

This postural problem can also be the result of inappropriate footwear. Feet are important! Take care of them by wearing shoes with good support. This can cause flat feet and cause the ankles to roll.

The calf muscles will tighten and your knees may even rotate inward. You can experience plantar fasciitis, pain in your toes, heel spurs, bunions, and hip problems. Weight loss can help and pregnant women can benefit from a pregnancy sling or pregnancy girdle to support the added girth.

Digestion Problems

Sitting in a hunched position crunches up everything inside, including your intestines. This will slow things down considerably, leading to constipation and even hemorrhoids.

The human body was designed to remain in a certain position so that all organs can function as they should. When things are out of alignment it can lead to indigestion, heartburn, and even acid reflux. Practicing good posture can make all the difference in a lot of things. Poor digestion can lead to obesity.

Spinal Misalignment Leading To Many Health Issues

When your spine is out of line it can cause headaches, dizziness, and a host of other issues. It puts your body under stress so even the normal processes like blood flow and organ function are thrown off kilter. When your body isn�t working as it should the risk of serious conditions like heart disease, diabetes, and hypertension are increased.

Many people don�t make the connection between good posture with a properly aligned spine and better health, but it is definitely there. Posture may seem simple, like it�s not that big of a deal, but when it is practiced on an ongoing basis, it can be detrimental to your health. It isn�t worth the risk; not when the fix is as simple as sitting up straight.

Injury Medical Clinic: Fibromyalgia Care & Treatment

Pain Modulation Pathway Mechanisms in El Paso, TX

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic, Chronic Pain, Clinical Neurophysiology, Treatments

Most, if not all, ailments of the body trigger pain. Pain is interpreted and sensed in the brain. Pain is modulated by two key types of drugs which operate on the brain: analgesics and anesthetics. The term analgesic refers to a medication that relieves pain without loss of consciousness. The expression central anesthesia refers to a medication that depresses the CNS. It’s distinguished by the lack of all perception of sensory modalities, for instance, loss of consciousness without loss of critical functions.

Opiate Analgesia (OA)

The most successful clinically used drugs for producing temporary analgesia and relief from pain are the opioid family, which includes morphine, and heroin. There are currently no additional powerful pain therapeutic options to opiates. Several side effects caused by opiate use include tolerance and drug dependence or addiction. In general, these drugs modulate the incoming pain information in the spine and central nervous system, in addition to relieve pain temporarily, and can also be called opiate producing analgesia (OA). Opiate antagonist is a drug that antagonizes the opioid effects, such as naloxone or maltroxone, etc.. They are competitive antagonists of opiate receptors. However, the brain has a neuronal circuit and endogenous substances which modulate pain.

Endogenous Opioids

Opioidergic neurotransmission is located throughout the brain and spinal cord and is believed to influence many functions of the central nervous system, or CNS, such as nociception, cardiovascular functions, thermoregulation, respiration, neuroendocrine functions, neuroimmune functions, food consumption, sexual activity, competitive locomotor behaviour as well as memory and learning. Opioids exert marked effects on mood and motivation and produce a sense of euphoria.

Three classes of opioid receptors are identified: ?-mu, ?-delta and ?-kappa. All 3 classes are widely dispersed in the brain. The genes encoding each one of these have been cloned and found to function as members of the G protein receptors. Moreover, three major types of endogenous opioid peptides that interact with the above opiate receptors have been recognized in the central nervous system, including, ?-endorphins, enkephalins and the dynorphins. These 3 opioid peptides are derived from a large protein receptor by three different genes, such as the proopiomelanocortin, or POMC, gene, the proenkephalin gene and the prodynorphin gene.�The opioid peptides modulate nociceptive input in two ways: first, they block neurotransmitter release by inhibiting Ca2+ influx into the presynaptic terminal, or second, they open potassium channels, which hyperpolarizes neurons and inhibits spike activity. They act on various receptors within the brain and spinal cord.

Enkephalins are considered the putative ligands for the ? receptors, ? endorphins for its ?-receptors, and dynorphins for the ? receptors. The various types of opioid receptors are distributed differently within the peripheral and central nervous system, or CNS. There’s evidence for functional differences in these receptors in various structures. This explains why many undesirable side effects occur after opiate treatments. For instance, mu (?) receptors are widespread in the brain stem parabrachial nuclei, where a respiratory center and inhibition of these neurons may cause what’s known as respiratory depression.

Central or peripheral terminals of nociceptive afferent fibers feature opiate receptors in which exogenous and endogenous opioids could act to modulate the capability to transmit nociceptive information. Additionally, high densities of opiate receptors are found in periaqueductal gray, or PAG, nucleus raphe magnus, or NRM, and dorsal raphe, or DR, from the rostral ventral medulla, in the spinal cord, caudate nucleus, or CN, septal nucleus, hypothalamus, habenula and hippocampus.�Systemically administered opioids at analgesic dosages activate spinal and supraspinal mechanisms via ?, ?, and ? type opioid receptors and regulate pain signals to modulate symptoms.

Neuronal Circuits and Pain Modulation

For many decades it was suggested that somewhere in the central nervous system there is a circuit which can modulate incoming pain details. The gate control theory and the ascending/descending pain transmission system are two suggestions of such a circuit. Below, we will discuss both in further detail.

Gate Control Theory

The initial pain modulatory mechanism known as the gate control theory, has been proposed by Melzack and Wall in the mid 1960’s. The notion of the gate control theory is that non-painful input closes the gates to painful input, which results in avoidance of the pain sensation from travel into the CNS, for example, non-noxious input, or stimulation, suppresses pain.

The theory implies that collaterals of the large sensory fibers carrying cutaneous sensory input activate inhibitory interneurons, which inhibit and regulate pain transmission data carried from the pain fibers. Non-noxious input inhibits pain, or sensory input, and closes the gate to noxious input. The gate control theory demonstrates that in the spinal cord level, non-noxious stimulation will create presynaptic inhibition on dorsal root nociceptor fibers that synapse on nociceptors spinal neurons (T). This presynaptic inhibition will also prevent incoming noxious information from reaching the CNS, for example, it will shut the gate to incoming toxic information.

The gate control theory was the rationale for the idea behind the production and utilization of the transcutaneous electrical nerve stimulation, or TENS, for pain relief. In order to be effective, the TENS unit generates two different present frequencies below the pain threshold that can be taken by the patient. This process has found a degree of achievement in chronic pain treatment.

Pain Modulation: Gate Control Theory

Stimulation Produced Analgesia (SPA)

Evidence for an inherent analgesia system was found by intracranial electrical stimulation of certain discrete brain regions. These areas would be the periaqueductal gray, or PAG, and nucleus raphe magnus, or NRM, dorsal raphe, or DR, caudate nucleus, or CN, septal nucleus, or Spt, along with other nuclei. Such stimulation or sensory signals, inhibits pain, making analgesia without behavioral suppression, while the touch, temperature and pressure sensation stays intact. According to research studies, SPA, or stimulation produced analgesia, is more pronounced and continues for a longer period of time after stimulation in humans than in experimental animals. Additionally, during SPA, the subjects, however, still respond to nonpainful stimulation like temperature and touch within the circumscribed region of analgesia. The most effective CNS, or central nervous system regions for SPA to occur, would be in the PAG and the raphe nuclei, or RN.

Electrical stimulation of PAG or NRM inhibits spinal thalamic cells, or spinal neurons that project monosynaptically to the thalamus, in laminae I, II and V to ensure the noxious information from the nociceptors which are ultimately modulated in the level of the spinal cord. Furthermore, PAG has neuronal connections to the nucleus raphe magnus, or NRM.

The activity of the PAG most likely occurs by activation of the descending pathway from NRM and likely also by activation of ascending connections acting on greater subcortical levels of the CNS. In addition, electric stimulation of PAG or NRM produces behavioral analgesia, or stimulation produced analgesia. Stimulation produced analgesia, or SPA causes the release of endorphins which can be blocked by the opiate antagonist naloxone.

During PAG and/or RN stimulation, serotonin, also medically referred to as 5-HT, can also be discharged from ascending and descending axons from subcortical nuclei, in spinal trigeminal nuclei and in the spinal cord. This release of 5-HT modulates and regulates pain transmission by inhibiting or blocking incoming neural action. Depletion of 5-HT by electrical lesion of the raphe nuclei or with a neurotoxic lesion made by local injection of a chemical agent such as parachlorophenylalanine, or PCPA, results in blocking the power of opiate, both intracranial and systemic, as well as that of electrical stimulation in order to produce analgesia.

To confirm if the electric stimulation produced analgesia via the release of opiate and dopamine, then the region is locally microinjected with morphine or 5-HT. All these microinjections ultimately create analgesia. These processes also provide a way of identifying brain areas related to pain suppression and assist to produce a map of pain centers. The most effective way of producing opiate analgesia, or OA, is by intracerebral injection of morphine into the PAG.

The PAG and RN as well as other brain structures in which analgesia is produced, are also rich in opiate receptors. Intracerebral opioid administration produced analgesia and SPA can be blocked by systemic or from local microinjections of naloxone, the morphine antagonist, into the PAG or RN. For that reason, it’s been suggested that the two, both OA and SPA, operate by a frequent mechanism.

If OA and SPA behave through the same intrinsic system, then the hypothesis that opiates activate a pain-suppression mechanism is much more likely. As a matter of fact, current evidence suggests that microinjections of an opiate into the PAG activate an efferent brainstem system which inhibits pain transmission at segmental spinal cord levels. These observations imply that analgesia elicited from the periaqueductal gray, or PAG, demands a descending pathway into the spinal cord.

Dr. Alex Jimenez’s Insight

Pain modulation occurs through the process of electrical brain stimulation which occurs due to the activation of descending inhibitory fibers, which regulate or inhibit the input and output of certain neurons. What has been described as opioid and serotonergic antagonists, is believed to reverse both local opiate analgesia and brain-stimuli generated analgesia. The sensory signals or impulses in the central nervous system are ultimately controlled by both ascending and descending inhibitory systems, utilizing endogenous opioids or other endogenous substances, such as serotonin as inhibitory mediators. Pain is a complex perception which can also be influenced by a variety of other factors, including emotional state.

Mechanisms of Pain Modulation

Ascending and Descending Pain Suppression Mechanism

The primary ascending pain fibers, such as the A ? and C fibers, reach the dorsal horn of the spinal cord from peripheral nerve areas in order to innervate the nociceptor neurons in Rexed laminae I & II. Cells from Rexed lamina II make synaptic connections in Rexed layers IV to VII. Cells, particularly within laminae I and VII of the dorsal horn, give rise to ascending spinothalamic tracts. In the spinal level, opiate receptors are located in the presynaptic endings of their nocineurons and in the interneural level layers IV to VII from the dorsal horn.

Activation of opiate receptors at the interneuronal level produces hyperpolarization of the neurons, which lead to the the inhibition of activation as well as the release of substance P, a neurotransmitter involved in pain transmission, thus preventing pain transmission. The circuit which consists of the periaqueductal gray, or PAG, matter in the upper brain stem, the locus coeruleus, or LC, the nucleus raphe magnus, or the NRM, and the nucleus reticularis gigantocellularis, or Rgc,� leads to the descending pain suppression pathway, which inhibits incoming pain data at the spinal cord level.

As stated before, opioids interact with the opiate receptors in distinct central nervous system levels. These opiate receptors are the normal target regions for hormones and endogenous opiates, such as the endorphins and enkephalins. Due to binding at the receptor in subcortical websites, secondary changes which result in some change in the electrophysiological properties of the neurons and regulation of their ascending pain information.

What activates the PAG to exert its consequences? It was discovered that noxious stimulation triggers neurons in the nucleus reticularis gigantocellularis, or RGC. The nucleus Rgc innervates both PAG and NRM. The PAG sends axons into the NRM, and nerves in the NRM send their axons to the spinal cord. Additionally, bilateral dorsolateral funiculus, or DLF, lesions, referred to as DLFX, block the analgesia produced by both electrical stimulation and by microinjection of opiates directly into the PAG and NRM, but they just attenuate the systemic analgesic effects of opiates. These observations support the hypothesis that discrete descending pathways from the DLF are necessary for both OA and SPA.

The DLF is comprised of fibers originating from several brainstem nuclei, which can be serotonergic, or 5-HT, from nerves located inside the nucleus raphe magnus, or NRM; dopaminergic neurons originating from ventral tegmental area, or VTA, and adrenergic neurons originating from the locus coeruleus, or LC. These descending fibers suppress noxious input in the nociceptive spinal cord neurons in laminae I, II, and V.

Opiate receptors have also been discovered in the dorsal horn of the spinal cord, chiefly in Rexed laminae I, II, and V, and such spinal opiate receptors mediate inhibitory effects on dorsal horn neurons transmitting nociceptive information. The action of morphine seems to be exerted equally in the spinal cord and brainstem nuclei, including the PAG and NRM. Systemic morphine acts on both brain stem and spinal cord opiate receptors to produce analgesia. Morphine binds the brainstem opiate receptors, which triggers the brainstem descending serotonergic pathway into the spinal cord as well as the DLF, and these have an opioid-mediated synapse at the level of the spinal cord.

This observation demonstrates that noxious stimuli, instead of non-noxious stimulus, determine the gate control theory, which are critical for the activation of the descending pain modulation circuit where pain inhibits pain via the descending DLF pathway. In addition, there are ascending connections in the PAG and the raphe nuclei into the PF-CM complex. These thalamic regions are a part of the ascending pain modulation at the diencephalon degree.

Stress Induced Analgesia (SIA)

Analgesia may be produced in certain stressful circumstances. Exposure to many different stressful or painful events generates an analgesic response. This phenomenon is known as stress induced analgesia, or SIA. Stress induced analgesia has been believed to give insight into the physiological and psychological factors that trigger endogenous pain control and opiate systems. By way of instance, soldiers injured in battle or athletes hurt in sports sometimes report that they don’t feel pain or discomfort during the battle or game, nevertheless, they will go through the pain afterwards once the specific situation has stopped. It’s been demonstrated in animals that electrical shocks cause stress-induced analgesia. Based on these experiments, it is assumed that the pressure the soldiers and the athletes experienced suppressed the pain which they would later experience.

It’s believed that endogenous opiates are produced in response to stress and inhibit pain by triggering the midbrain descending system. Furthermore, some SIA exhibited cross tolerance with opiate analgesia, which indicates that this SIA is mediated via opiate receptors. Experiments using different parameters of electrical shock stimulation demonstrate such stress induced analgesia and some of those anxieties that produce analgesia could be blocked by the opioid antagonist naloxone, whereas others were not blocked by naloxone. In conclusion, these observations lead to the decision that both opiate and non-opiate forms of SIA exist.

Somatovisceral Reflex

The somatovisceral reflex is a reflex in which visceral functions are activated or inhibited by somatic sensory stimulation. In experimental animals, both noxious and innocuous stimulation of somatic afferents are proven to evoke reflex changes in sympathetic efferent activity and, consequently, effector organ function. These phenomena have been shown in such regions as the gastrointestinal tract, urinary tract, adrenal medulla, lymphatic cells, heart and vessels of the brain and peripheral nerves.

Most frequently, incisions are elicited experimentally by stimulation of cutaneous afferents, even though some work has also been conducted on muscle and articular afferents, including those of spinal cells. The ultimate responses will represent the integration of multiple tonic and reflex influences and might exhibit laterality and segmental trends as well as variable excitability in line with the afferents involved. Given the complexity and multiplicity of mechanisms involved in the last expression of the reflex response, attempts to extrapolate to clinical situations should most likely be conducted in favor of further systematic physiological studies.

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

Curated by Dr. Alex Jimenez

Additional Topics: Sciatica

Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.

EXTRA IMPORTANT TOPIC: Chiropractor Sciatica Symptoms

MORE TOPICS: EXTRA EXTRA: El Paso Back Clinic | Back Pain Care & Treatments

Gate Control Theory and Pain Management in El Paso, TX

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic, Chronic Pain, Clinical Neurophysiology, Treatments

Pain perception varies across different people based on their mood, psychological condition and previous experience, even when pain is brought on by similar physical stimulation and ends in a similar level of damage. In 1965, Ronald Melzack and Patrick Wall summarized a scientific theory about the psychological influence on pain perception; known as the gate control theory.

If it wasn’t for this theory, pain perception would still be connected to the intensity of the pain stimulation and the degree of damage caused to the affected tissue. But Melzack and Wall made it clear that pain perception is far more complicated than we believe.

Based on the gate control theory, pain signals aren’t free to travel to the brain as soon as they’re generated in the region of the damaged or injured tissues. These first need to encounter specific neural gates found at the level of the spinal cord level, where these gates ascertain whether the pain signals should reach the brain or not. To put it differently, pain is perceived when the gate gives way to the pain signals and it is not as intense or it is not sensed at all when the gate closes for the signs to pass through.

This theory provides the explanation for why people find relief by massaging or rubbing a damage, injured or painful site. Although the gate control theory cannot demonstrate the whole picture of the fundamental system which underlies pain, it’s visualized the mechanism of pain perception and it has created a pathway to various pain management treatment approaches.

Nerve Fibers in Transmission of Sensory Signals

Every organ, or portion of the human body, has its own nerve supply which are in charge of carrying electric impulses generated in reaction to several senses, such as touch, temperature, pressure and pain. These nerves, which make up the peripheral nervous system, transmit these sensory signals, to the central nervous system, or the brain and the spinal cord. These impulses are then translated and perceived as senses. The peripheral nerves send signals to the dorsal horn of the spinal cord and from there, the sensory signals are transmitted into the brain through the spinothalamic tract. Pain is a sensation which alarms a person that a tissue or certain portion of the human body has been damaged or injured.

Due to their axonal diameter and their conduction speed, nerve fibers can be categorized into three different types, nerve fibers A, B and C. The C fibers are considered to be the smallest among the three different types. Moreover, there are four subtypes within the A fibers: A-alpha, A-beta, A-gamma and A-delta. From the A fiber subtypes, the A-alpha fibers are the largest and the A-delta fibers are the smallest.

The A fibers which are larger compared to the A-delta fibers, carry sensations, such as touch, pressure, etc., into the spinal cord. The A-delta fibers as well as the C fibers carry pain signals into the spinal cord. A-delta fibers are faster and carry sharp pain signals while the C fibers are slower and carry diffuse pain signals.

When thinking about that the conduction velocity of nerve fibers, the A-alpha fibers, which are the biggest A nerve fibers, have greater conduction speed compared to A-delta fibers and C fibers, which are considered to be the smallest nerve pathways. When a tissue is damaged or injured, the A-delta fibers are activated first, followed by the activation of the C fibers. These nerve fibers have a tendency to carry the pain signals to the spinal cord and then to the brain. However, the pain signals are transmitted through a much more complex process than what is simply explained above.

Ascending Tracts | Pain Modulation: Gate Control Theory

What is the Gate Control Theory of Pain?

The gate control theory implies that the sensory signals or impulses which are transmitted by the nerve fibers encounter neural gates at the level of the spinal cord and these will need to get cleared through those gates to reach the brain. Various factors determine how the pain signals ought to be treated in the neurological gates, including:

The intensity of the pain signals
The degree of another sensory signal, such as touch, temperature and pressure, if produced at the site of damage or injury
The message from the brain itself to deliver the pain signals or not

As previously mentioned, the nerve fibers, both large and small, carrying the sensory signals, end in the dorsal horn of the spinal cord from where the impulses are transmitted into the brain. According to the original postulate of Melzack and Wall, the nerve fibers project to the substantia gelatinosa, or SG, of the dorsal horn and the initial central transmission (T) cells of the spinal cord. The SG consists of inhibitory interneurons that behave as the gate and ascertain which sensory signals should get to the T cells then go further throughout the spinothalamic tract to finally reach the brain.

When the pain signals carried by the small nerve fibers, or the A-delta fibers and the C fibers, are somewhat less intense compared to another non-pain sensory signal like touch, temperature and pressure, the inhibitory neurons stop the transmission of the pain signals through the T cells. The non-pain signals override the pain signals and therefore the pain is not perceived by the brain. When the pain signals are somewhat more intense compared to the non-pain signals, the inhibitory neurons are inactivated and the gate is opened. The T cells transmit the pain signals into the spinothalamic tract which carries those impulses to the brain. As a result, the neurological gate is influenced by the relative amount of activity from the large and the small nerve fibers.

How Emotions and Thoughts Affect Pain

The gate control theory also suggests that the pain signal transmission could be affected by thoughts and emotions. It’s well known that people do not feel that a chronic pain or, more appropriately, the pain does not disturb them if they concentrate on other activities which interest them. Whereas, people who are depressed or anxious may often feel intense pain and can also find it challenging to cope with. This is due to the fact that the brain sends messages through descending nerve fibers which stop, reduce or enhance the transmission of pain signals through the gate, depending on the emotions and thoughts someone may be going through.

Gate Control Theory in Pain Management

The gate control theory has caused a radical revolution within the field of pain management. The theory suggested that pain management can be accomplished by influencing the larger nerve fibers that carry non-pain stimulation. The concept has also paved way for more research on cognitive and behavioral strategies to achieve pain relief.

Among the most tremendous advances in pain management research is the arrival of Transcutaneous Electrical Nerve Stimulation (TENS). The gate control theory forms the cornerstone of TENS. In this procedure, the selective stimulation of the large diameter nerve fibers taking non-pain sensory stimulation from a particular region nullifies or reduces the impact of pain signals from the region. TENS is a non-invasive and affordable pain control strategy that has been widely used for the treatment of chronic and intractable pain by various healthcare professionals, which may otherwise have been non-responsive to analgesics and surgical interventions. TENS is tremendously advantageous over pain drugs from the aspect that it does not have the problem of medication interactions and toxicity.

For instance, many doctors of chiropractic, or chiropractors, utilize TENS and other electrotherapeutic procedures in their practice. These are generally utilized along with spinal adjustments and manual manipulations to increase circulation as well as to aid in the support of chiropractic care. Several other invasive and noninvasive electrical stimulation techniques are discovered to be helpful in several chronic pain conditions such as arthritic pain, diabetic neuropathy, fibromyalgia, etc.. The theory has also been extensively studied in treating chronic back pain and cancer pain. However, favorable results are not attained in some conditions and the long term efficacy of these techniques based on the theory still remains under consideration.

Dr. Alex Jimenez’s Insight

Chiropractic care is widely utilized to benefit patients with chronic pain. Symptoms of persistent pain and discomfort have become a big health issue in the United States where many years of research have found that drugs and/or medications are not necessarily a solution to the problem. The gate control theory, which was first proposed over half a century ago, has offered healthcare professionals new insights on the perception of pain, providing a variety of pain management treatment methods, such as the use of transcutaneous electrical nerve stimulation, or TENS, as well as other electrotherapeutic procedures. Chiropractors can help with pain management through spinal adjustments and manual manipulations, and through the use of TENS.

Nevertheless, the gate control theory has radically revolutionized the area of pain research and it has achieved to get numerous studies which aim at presenting a pain-free lifestyle into the patients who suffer from chronic pain. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

Curated by Dr. Alex Jimenez

Additional Topics: Sciatica

EXTRA IMPORTANT TOPIC: Chiropractor Sciatica Symptoms

MORE TOPICS: EXTRA EXTRA: El Paso Back Clinic | Back Pain Care & Treatments

What is Central Sensitization? | El Paso, TX Chiropractor

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic, Clinical Neurophysiology

Central sensitization is a state of the nervous system that’s related to the development and maintenance of chronic pain. When central sensitization occurs, the nervous system goes through a procedure known as wind-up and gets regulated in a constant condition of increased reactivity. This persistent, or regulated, state of reactivity decreases the threshold for what causes pain and subsequently learns to keep pain after the initial injury has healed. Central sensitization has two major characteristics. Both have an increased sensitivity to pain and to the feeling of touch. These are referred to as allodynia and hyperalgesia.

Allodynia occurs when an individual experiences pain with circumstances that are normally not supposed to be painful. For instance, chronic pain patients often experience pain even with things as simple as touch or a massage. In these situations, nerves in the region which has been touched sends signals through the nervous system into the brain. Because the nervous system is in a constant condition of heightened reactivity, the brain doesn’t generate a mild feeling of touch as it should, given that the stimulus that initiated it was an easy touch or massage. Instead, the brain produces a feeling of pain and discomfort.

Hyperalgesia occurs when a stimulus that’s usually considered to be somewhat painful is perceived as a much more debilitating pain than it ought to be. For instance, chronic pain patients that experience a simple bump, which generally would be mildly painful, will often feel intense pain. Again, once the nervous system is in a constant condition of high reactivity, it amplifies pain.

Peripheral and Central Sensitization

Chronic pain patients sometimes believe they might be suffering from a mental health issue because they understand from common sense that touch or simple bumps produce tremendous amounts of pain or discomfort. Other times, it’s not the patients themselves who feel this way, but their friends and family members. Individuals who don’t suffer with chronic pain may witness others who have central sensitization experience pain at the slightest touch or cry out at the simplest bump. However, because they don’t have the condition, it may be difficult for them to understand what someone who does is going through.

In addition to allodynia and hyperalgesia, central sensitization has other well-known features, though they may occur less commonly. Central sensitization may lead to heightened sensitivities throughout all senses, not only the feeling of touch. Chronic pain patients can sometimes report sensitivities to light, smell and sound. As such, regular levels of light may seem overly bright or even the perfume aisle in the department shop can produce a headache. Central sensitization can also be associated with cognitive deficits, such as poor concentration and poor short-term memory. Central sensitization also interferes with increased levels of psychological distress, particularly fear and axiety. After all, the nervous system is responsible for not merely senses, like pain, but also emotions. If the nervous system is trapped in a constant condition of reactivity, patients are going to be nervous or anxious. Lastly, central sensitization is also correlated with sick role behaviors, such as resting and malaise, and pain behavior.

Central sensitization has long been known as a potential consequence of stroke and spinal cord injury. However, it is increasingly believed that it plays a part in several different chronic pain disorders. It may happen with chronic low back pain, chronic neck pain, whiplash injuries, chronic tension headaches, migraine headaches, rheumatoid arthritis, osteoarthritis of the knee, endometriosis, injuries sustained in an automobile accident, and even following surgeries. Fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome, all appear to occur due to central sensitization as well.

Central Sensitization and C Fibers

What Causes Central Sensitization?

Central sensitization involves specific changes to the nervous system. Changes in the dorsal horn of the spinal cord and in the brain occur, particularly at the cellular level, such as at the receptor sites. As mentioned previously, it has long been proven that fractures and spinal cord injuries can cause central sensitization. It stands to reason. Strokes and spinal cord injuries cause harm to the central nervous system, including the brain, in the event of strokes, and the spinal cord, in the case of spinal cord injuries. These injuries change the sections of the nervous system which are involved in central sensitization.

However, what about the other, more prevalent, types of chronic pain disorders, recorded above, such as headaches, chronic back pain, or pain in the extremities? The accidents or conditions which lead to these kinds of chronic pain are not direct injuries to the brain or spinal cord. Rather, they include injuries or condition which affect the peripheral nervous system, particularly in that are of the nervous system which lies outside the spinal cord and brain. How can health issues associated with the peripheral nervous system contribute to modifications in the central nervous system and cause chronic pain in the isolated area of the initial injury? In summary, how can isolated migraine headaches eventually become chronic daily headaches? How can an acute low back lifting injury become chronic low back pain? How does an injury to the hand or foot turn into a complex regional pain syndrome?

There are probably multiple factors that cause the development of central sensitization in these ‘peripheral’ chronic pain disorders. These variables may be divided into two classes:

Factors that are associated with the state of the central nervous system before onset of the initial pain or injury condition
Factors that are associated with the central nervous system following onset of the initial pain or injury condition

The first group involves those factors that might predispose individuals to developing central sensitization once an accident occurs and the next group involves antecedent factors that boost central sensitization once pain begins.

Dr. Alex Jimenez’s Insight

Chronic pain can often modify the way the central nervous system itself functions, so much so that a patient may become more sensitive to pain with less provocation. This is what’s referred to as central sensitization and it generally involves changes in the central nervous system, or CNS, more specifically, in the brain and the spinal cord. Central sensitization has been associated with several common diseases and it’s even been reported to develop with something as simple as a muscle ache. Central sensitization has also been documented to persist and worsen even in the absence of obvious provocation. Several factors have also been attributed with the development of central sensitization, although the true cause is still unknown.

Predisposing Factors for Central Sensitization

There are probably biological, emotional, and environmental predisposing factors for central sensitization. Low and higher sensitivity to pain, or pain thresholds, are perhaps in part due to numerous genetic factors. While there’s absolutely no research as of yet to support a causal link between pre-existing pain thresholds and following development of central sensitization after an incident, it’s largely assumed that it will be eventually found.

Psychophysiological factors, like the stress-response, are also apt to play a part in the development of central sensitization. Direct experimental evidence on animals and humans, as well as prospective studies on humans, have demonstrated a connection between stress and the decrease of pain thresholds. Similarly, different kinds of pre-existing anxiety about pain is consistently related to higher pain sensitivities. All these psychophysiological aspects suggest that the preexisting state of the nervous system is also an important determinant of creating central sensitization after the onset of pain. If the stress response has made the nervous system responsive prior to injury, then the nervous system might be more prone to become sensitized once onset of pain happens.

There is considerable indirect evidence for this theory as well. A prior history of anxiety, physical and psychological trauma, and depression are predictive of onset of chronic pain later in life. The most common denominator between chronic pain, anxiety, nervousness, injury, and depression, is the nervous system. They’re all states of the nervous system, especially a persistently changed, or dysregulated, nervous system.

It’s not that such pre-existing health issues make individuals more vulnerable to injury or the onset of illness, as injury or illness is apt to happen on a somewhat random basis across the populace. Instead, these pre-existing health issues are more inclined to make people prone to the development of chronic pain once an injury or disease occurs. The dysregulated nervous system, at the time of injury, for instance, may interfere with the normal trajectory of healing and thereby stop pain from subsiding once tissue damage is healed.

Factors Resulting in Central Sensitization After Onset of Pain

Predisposing factors may also be part of the development of central sensitization. The onset of pain is frequently associated with subsequent development of conditions, such as depression, fear-avoidance, nervousness or anxiety and other phobias. The stress of those responses can, in turn, further exacerbate the reactivity of the nervous system, leading to central sensitization.�Inadequate sleep is also a frequent effect of living with chronic pain. It’s associated with increased sensitivity to pain as well. In what’s technically known as operant learning, interpersonal and environmental reinforcements have long been proven to lead to pain behaviors, however, it is also evident that such reinforcements may lead to the development of central sensitization.

Mayo Clinic Discusses Central Sensitization

Treatments of Central Sensitization

Treatments for chronic pain syndromes that involve fundamental sensitization typically target the central nervous system or the inflammation which corresponds with central sensitization. All these often generally include antidepressants and anticonvulsant medications, and cognitive behavioral treatment. While usually not considered to target the central nervous system, regular mild aerobic exercise changes structures in the central nervous system and contributes to reductions in the pain of many ailments which are mediated by central sensitization. As such, moderate aerobic exercise is used to treat chronic pain syndromes marked by central sensitization. Non-steroidal anti-inflammatories are utilized for the inflammation associated with central sensitization.

Finally, chronic pain rehabilitation programs are a standard, interdisciplinary treatment that employs each of the above-noted therapy strategies in a coordinated manner. They also make the most of the research on the role of operant learning from central sensitization and also have developed behavioral interventions to reduce the pain and discomfort associated with the health issue. Such applications are typically considered the most effective treatment option for chronic pain syndromes.�The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

Curated by Dr. Alex Jimenez

Additional Topics: Sciatica

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Active Release Technique (A.R.T.) for Chronic Neck Pain in El Paso, TX

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic, Treatments

Active Release Technique (A.R.T) is a hands on soft tissue treatment for ligaments, tendons muscles and nerves. It is the leading soft tissue treatment utilized widely in the treatment of soft tissue injuries and conditions among professional athletes and the general population alike. In the instance of chronic neck pain, along with shoulder and subscapularis pain, ART involves guided pressure being applied to a shortened muscle in the top region of the neck or cervical spine. Most commonly, a healthcare professional will move the patient’s head in a direction that lengthens the muscle. During the motion the doctor maintains a strain on the muscle, as it slides out from beneath the doctor’s fingers.

The active release technique hurts a bit (many patients describe it as a”good hurt”), and it feels like a stretch that you need but can’t do yourself. When a muscle is tight the procedure operates by increasing the nervous system’s tolerance to extend the muscle. ART is utilized to take care of repetitive strain injuries, and it is often used in a variety of other medical practices. This is because it can offer quick results in treating ailments like: tennis elbow, frozen shoulder, shoulder rotator cuff injuries and plantar fasciitis. ART permits the physician to isolate treatment to each individual small muscle of the neck, and treat it through its full selection of movement. The neck muscles are layered, and also to isolate them during therapy demands careful attention.

Effects of the Active Release Technique on Pain and Range of Motion in Patients with Chronic Neck Pain

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Abstract

Purpose: To compare the influences of the active release technique (ART) and joint mobilization (JM) on the visual analog scale (VAS) pain score, pressure pain threshold (PPT), and neck range of motion (ROM) of patients with chronic neck pain.
Subjects: Twenty-four individuals with chronic neck pain were randomly and equally assigned to 3 groups: an ART group, a joint mobilization (JM) group, and a control group. Before and after the intervention, the degree of pain, PPT, and ROM of the neck were measured using a VAS, algometer, and goniometer, respectively.
Results: The ART group and JM group demonstrated significant changes in VAS and ROM between pre and post-intervention, while no significant change was observed in the control group. Significant differences in the PPT of all muscles were found in the ART group, while significant differences in all muscles other than the trapezius were found in the JM group. No significant difference in PPT was observed in any muscle of the control group. The posthoc test indicated no statistically significant difference between the ART and JM group, but the differences of variation in VAS, PPT, and ROM were greater in the ART group than in the JM and control groups.
Conclusion: ART for the treatment of chronic neck pain may be beneficial for neck pain and movement.
Key words: Active release technique, Soft tissue, Chronic neck pain

Introduction

People have a 70% likelihood of developing neck pain during their lives; thus, neck pain is an important issue affecting economic productivity in modern society[1]. Neck pain is a work-related musculoskeletal disorder that can occur when a person works for a long time or at a high intensity. An increasing number of patients also visit hospitals complaining of pain occurring not only in the neck but also in the upper extremities and head as a result of sustained excessive tension[2]. Although the issue of neck pain is becoming increasingly common and important, research into optimal treatmentslacking[3].

A common cause of neck pain is mechanical dysfunction, which causes abnormal joint movement, as abnormal cervical joint mobility inside the joint capsule can limit neck movement[4, 5]. Additionally, unbalanced soft tissue around the head and neck structure can place limits on the range of motion (ROM) of the head and cause neck pain[6]. Therefore, many treatments are performed with the aim of restoring soft tissue function or mobility to the joints in patients with chronic neck pain. Joint mobilization (JM) and joint manipulation are the most widely used methods to increase mobility inside the joint capsule. These methods have been reported to increase the ROM and relieve pain[7, 8]. However, JM and joint manipulation performed at the end range of the ROM directly on the joints of the cervical vertebrae can cause tension in the patient�s neck muscles, because the cervical vertebrae are the most sensitive part of the spine and this tension protects the nerves and blood vessels[9].

The active release technique (ART) is a manual therapy for the recovery of soft tissue function that involves the removal of scar tissue, which can cause pain, stiffness, muscle weakness, and abnormal sensations including mechanical dysfunction in the muscles, myofascia, and soft tissue[10]. The effectiveness of ART has been reported for carpal tunnel syndrome, Achilles tendonitis, and tennis elbow, all of which involve soft tissue near joints in the distal parts of the body[11]. ART is also effective at reducing pain and increasing ROM in patients with a partial tear of the supraspinatus tendon[12]. Most patients with chronic neck pain experience pain and movement limitation as a result of soft tissue impairment in the neck[13]. Accordingly, more research on ART for the treatment of the soft tissues of the neck is warranted. However, no previous studies have assessed how ART can improve ROM in patients with neck pain.

Therefore, the purpose of this study was to compare the influence of ART and JM on the visual analog scale (VAS) score, pressure pain threshold (PPT), and neck ROM of patients with chronic neck pain, with the aim of elucidating additional information on their effects and identifying more efficient treatments that can be used in clinical settings.

Subjects and Methods

The study subjects were 24 patients admitted to Hospital A in Gangnamgu who had a 3-month or longer history of neck pain and had mild disability based on the Neck Disability Index (NDI; 5�14 points). The sample size of this study was based on that of Hyun[14], while considering the subject dropout rate, and accounting for significance level (5%), power of the test (0.8), and the effect size (f=0.7). Patients with structural abnormalities involving bone fracture or nerves those who had undergone surgery for hernia or had high blood pressure, spondyloarthritis, lumbar spinal stenosis, or scoliosis were excluded from the study. The participating patients understood the study purpose and associated information and provided their written consent to participation. This study was conducted using a procedure ethically suitable for human research in accordance with the Declaration of Helsinki.

We used the VAS to evaluate the degree of neck pain. The VAS is a subjective scoring method for recording the degree of present pain from 0 (no pain) to 10 (the most severe pain ever experienced) on a 10-cm scale. The VAS is difficult to compare among patients because of the subjective nature of the pain, but its reproducibility has been recognized in individual patients (ICC=0.97)[15].

The PPT measurement was performed by one investigator using an algometer. The right and left upper trapezius and sternocleidomastoideus (SCM) were pressed at a constant speed. The subject was asked to respond immediately when the pressure changed to pain, and the mechanical pressure was recorded. The mean value of two measurements was used; increasing PPT values indicate a higher-pressure pain threshold. An algometer is particularly useful for measuring the trigger point in myofacial pain syndrome, because it can determine the precise location of the source pain and quantify the pressure sensitivity of muscles (ICC=0.78�0.93)[16, 17].

Passive ROM was measured by fixing the subject�s shoulder so that it was not affected by the other parts of the trunk. Then, neck flexion, extension, right side bending, left side bending, right rotation, and left rotation were measured. The range of the angle was measured with a therapist passively assessing the patient�s pain-free neck-joint ROM[18].

The 24 subjects with chronic neck pain included in the study were randomly assigned to one of three groups following an equivalent control group pre-test/post-test design. For 3 weeks, the ART and JM groups received treatment twice per week for 20 minutes. After all the interventions were completed, the VAS score, PPT, and ROM were measured again. In the ART group, ART was used to treat the muscles demonstrating scar tissue, among the muscles involved in neck movement. After shortening based on fiber texture in the longitudinal direction, soft tissue mobilization was performed with active or passive stretching to lengthen the tissue that had been shortened[12].

JM was performed using Kaltenborn�s techniques of traction and gliding. In order to relieve pain with physiological movements including flexion, extension, side bending, and rotation, traction at Grade I or II was performed for 10 seconds. Additionally, in order to recover hypomobility, traction and gliding were performed at level 3 and maintained for 7 seconds. Both treatments included 2�3 seconds of rest and were repeated 10 times[19]. Subjects in the control group did not receive any treatment for chronic neck pain.

SPSS 18.0 for Windows was used to analyze the results. In order to confirm the homogeneity of subjects� general characteristics and dependent variables, descriptive statistics and the Kruskal-Wallis test were used. The Wilcoxon rank test was performed to assess the difference between pre- and post-treatment values in each group, and the Mann-Whitney U test was used to identify significant differences among the groups. The threshold for statistical significance was chosen as 0.05.

Results

The extent of change in VAS score, PPT, and ROM was compared between patients with chronic neck pain who underwent ART or JM. Twenty-four patients with a 3-month or longer history of chronic neck pain participated in this study. The three groups demonstrated no significant differences in NDI scores, ages, heights, or weights (p>0.05) (Table 1).

ART Table 1 | El Paso, TX Chiropractor

The ART and JM groups both demonstrated significant improvements in VAS pain scores (p<0.05), but no significant change was observed in the control group (p>0.05). The PPT significantly increased (p<0.05), in every muscle measured in the ART group, and in all muscles other than the right upper trapezius in the JM group. Muscle PPT demonstrated no significant change in the control group (p>0.05) (Table 2).

ART Table 2 | El Paso, TX Chiropractor

After treatment, the ART and JM groups both demonstrated significant increases (p<0.05) in every neck joint ROM parameter, while no significant changes were observed in the control group (p>0.05) (Table 2).

The extent of change in the VAS pain score and PPT between pre- and post-treatment significantly differed across the three groups (p<0.05). The posthoc test indicated that changes in the VAS scores significantly differed between the ART and control groups, and between the JM and control groups (p<0.05), but not between the ART and JM groups (p>0.05). The changes in PPTs of the right upper trapezius and left SCM significantly differed to between the ART and JM groups (p<0.05); however no significant differences were observed in the other muscles (p>0.05). Between the JM and control groups, the change in right SCM PPT demonstrated a significant difference (p<0.05); however, no difference was observed in other muscles (p>0.05). Between the ART and control group, the change in PPT significantly differed for all the measured muscles (p<0.05). The changes in VAS score and PPT were greater in the ART group than in the JM group, but these differences were not statistically significant (Table 3).

ART Table 3 | El Paso, TX Chiropractor

The extent of change in ROM after the treatments significantly differed across the three groups (p<0.05). The posthoc test indicated that the change in ROM significantly differed between the ART and JM groups only in neck flexion (p<0.05), but not in other ROM measurements (p>0.05). There was no significant difference in neck flexion ROM between the JM and control groups (p>0.05), but all other ROM parameters significantly differed between these groups (p<0.05). The ART and control groups significantly differed in terms of the change in ROM for all the parameters measured (p<0.05). The change in ROM was greater in the ART group than in the JM group, but this difference was not reach statistically significant (Table 3).

Dr. Alex Jimenez’s Insight

The following study compared the use of the active release technique (A.R.T.) to the use of joint mobilization to determine the best method for treating chronic neck pain symptoms. As it will be properly described below, the research study concluded that ART and joint mobilizations are both effective as treatment for patients with chronic neck pain, however, the active release technique demonstrated a greater effectiveness for neck pain associated with soft tissue injury. A.R.T. is believed to be a better treatment option for chronic neck pain mainly because soft tissue injuries are believed to be the cause of painful symptoms in 87.5 percent of cases, where ART is performed directly on the area of damage.

Discussion

Repetitive motions and the use of smart phones and tablets in abnormal head postures can stress the head, neck, and shoulder areas. Additionally, abnormal head posture can cause mechanical dysfunction of the cervical joint, which can lead to pain, fibrosis of soft tissue, adaptive shortening, loss of flexibility, and mechanical deformation reflecting the condition of hypomobility, where there is no movement inside the normal joint capsule[20, 21]. When mechanical dysfunction is present in a vertebra, manual therapy is typically performed, and it can be an effective method of relieving neck pain related to such dysfunction[22]. JM is used to treat joints with hypomobility or progressive limitation of mobility, by identifying a cervical segment with abnormal mobility and irritating the sensory receptors that sense pain, thus eliciting effects on the muscle, which in turn stimulate the muscles to apply force in the appropriate direction[8].

After 3 weeks of JM, the VAS, ROM, and PPT values of muscles other than the right upper trapezius demonstrated significant improvements compared to their pre-test values. The PPT also increased in the right upper trapezius, but the difference was not statistically significant. The trapezius is particularly susceptible to damage by repetitive movements of the hand and arm while performing work such as using a computer[23]. Most of the study participants were right-handed and thus performed more movement of the right upper extremity than the left, which may explain why the improvement of the right upper trapezius PPT was not reach statistically significant.

ART is a method for treating the soft tissues such as the tendon, nerve, and myofascia, and is performed for repetitive strain injury, acute injury, and functional fixation damage due to abnormal posture maintained over the long term. Furthermore, ART is an effective at resolving adhesion of scar tissue and the soft tissue that causes pain, spasm, muscle weakness, tingling, and other symptoms[11].

Robb et al.[24] demonstrated immediate improvement of muscle PPT when ART was used to treat patients with adductor strain. Additionally, in a study by Tak et al.[10], ART treatment for 3 weeks on the gluteus medius of a patient with low back pain for 3 weeks resulted in improvement of the patient�s VAS score and PPT. Although our target area differed from the studies of Tak et al.[10] and Robb et al.[24], significant improvement was observed in the VAS score, PPT, and ROM after using ART to treat the neck muscles in the present study. It is our opinion that these improvements in VAS score and PPT after treatment is the result of decreases in muscle tone after removing scar tissue adherent to soft tissue.

In a study by James[25] involving 20 young men with no injury of the lower extremity, hamstring flexibility increased immediately after ART was applied. Similarly, in the present study, ROM significantly increased after ART was applied on the neck for 3 weeks. This finding indicates that scar tissue, which can limit the mobility of soft tissue, can be removed by ART and thus relieve limitations of movement[12].

Although no statistically significant difference was detected in many cases, the change in the VAS score, PPT, and ROM demonstrated a consistent trend toward being greater in the ART group than in the JM group. This greater effect may be related to the observation that soft tissue injury is the cause of pain in 87.5% of neck pain cases, and ART is performed directly on the injured soft tissue[13], whereas JM treats the limited area of the joint. This study compared the effect of treatment over a short period of 3 weeks, and thus, it remains unclear how long its effectiveness is maintained. Longerterm follow-up surveys are needed after the cessation of treatment. Additionally, it is difficult to generalize our findings, as the sample sizes were small. In order to reinforce these findings, more research is needed.

In conclusion, this study compared the VAS score, PPT, and ROM across 24 subjects with chronic neck pain receiving ART, JM, or no treatment. It revealed that ART and JM both positively affected the VAS score, PPT, and ROM, and that the two methods demonstrated few significant differences in their effects. Thus, ART and JM are both effective for the treatment of patients with chronic neck pain, but ART demonstrated a trend toward greater effectiveness for patients with neck pain involving soft tissue injury. Therefore, ART appears to be a better option for treating patients with chronic neck pain in the clinical setting. Follow-up research involving greater numbers and diversity of subjects with longer terms are needed to expand upon these findings.

The purpose of the article above is to present the effectiveness of the active release technique, or ART, towards the management and improvement of chronic neck pain in a clinical setting. Information referenced from the National Center for Biotechnology Information (NCBI). The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

Curated by Dr. Alex Jimenez

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