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.
For individuals who are feeling back pain, neck pain, or shoulder pain, can using postural techniques help decrease pain and develop strategies to maintain correct posture?
Maintaining Correct Posture
Exercise and postural correction are two of the most important strategies to manage pain. (Robin McKenzie, the great spine guru PT, (May S. and Donelson R. 2008) However, it is not easy to maintain correct posture as the day progresses. While working or driving, most of us forget to be mindful of our posture; we slip back into unhealthy habits of sitting slouched, to the side, forward, etc, which often leads to continued pain and movement limitations. Studies on postural correction and its effect on overall back or neck pain levels are limited. (Lederman E. 2011) However, some studies show that a forward-head posture increases stress and load on the neck. (Hansraj K. K. 2014) If an individual has pain that improves with sitting upright, perhaps checking posture as the day progresses could be beneficial. There are ways to start changing posture and maintain the change. First, visit a physical therapist, spine specialist, or chiropractor to learn how to sit or stand to manage posture problems. They can teach individuals how to attain healthy posture and manage their condition. These strategies can then be used to maintain correct posture.
Lumbar Support
A lumbar roll/support is one of the simplest ways to attain and maintain a healthy sitting posture. These specialized pillows can help maintain the forward curve in the lower back. Maintaining the lumbar lordosis curve is essential for keeping stress off the back muscles, joints, and discs. Lumbar support pillows can be found in various stores, office supply stores, or purchased online. A physical therapist PT can help train individuals to use a lumbar roll properly.
Utilize the Slouch Overcorrect Exercise
The slouch overcorrect exercise is a simple maneuver for training the body to find and maintain its neutral position. It involves slowly shifting from a slouched position to an overcorrected postural position. Once posture is overcorrected, a slight relaxation from a fully erect posture will return to sitting properly. Practicing this exercise daily can help train the body to feel the muscles, listen to the body, and maintain proper posture. The muscles have memory, and the more often the body is placed in optimal posture, the muscles memorize their healthy, pain-free positioning.
Kinesiology Tape
Kinesiology tape is a flexible cotton adhesive that facilitates muscle contractions and inhibits muscle spasms and pain. (Han J. T. et al., 2015) Using the tape is a simple way to help facilitate the postural support muscles. The tape can be applied to the middle trapezius and rhomboid muscles to help support the shoulder blades and spine. Kinesiology tape for postural control also gently pulls on the muscles when slouching to remind the individual to sit up or stand straight.
Scapular Stabilization Exercises
A physical therapist or chiropractor can help improve posture through targeted exercises. Strengthening the muscles attached to the shoulder blades can help individuals better control their posture. (Shiravi S. et al., 2019) Exercises like the prone T, I, or Y can help improve the muscles’ neuromuscular recruitment to maintain correct posture.
Use an Alarm
Setting an alarm while working can help train the body to maintain correct posture. Most of us sit at a computer, desk, or workstation with proper posture, but depending on what we’re working on, we eventually slouch, lean to the side, or have a forward head posture. Pretty much all computers and phones have an alarm setting or app. Use the alarm or timer to go off every 20 to 30 minutes. When the alarm rings, look at your posture to recognize what you’re doing, get up and move around to stretch the body, sit and readjust, reset the alarm, and continue working. As you get better at maintaining appropriate posture, you won’t need the alarm anymore, and readjusting will become automatic.
Chiropractic Team
Sitting and standing with unhealthy posture can significantly cause back, neck, and shoulder pain. By visiting a chiropractic and physical therapy team and learning to attain and maintain correct posture, you can quickly relieve pain, resolve musculoskeletal issues, and prevent future pain symptoms. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized care plan for each patient through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and 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.
Scapular Winging In-Depth
References
May, S., & Donelson, R. (2008). Evidence-informed management of chronic low back pain with the McKenzie method. The spine journal : official journal of the North American Spine Society, 8(1), 134–141. doi.org/10.1016/j.spinee.2007.10.017
Lederman E. (2011). The fall of the postural-structural-biomechanical model in manual and physical therapies: exemplified by lower back pain. Journal of bodywork and movement therapies, 15(2), 131–138. doi.org/10.1016/j.jbmt.2011.01.011
Hansraj K. K. (2014). Assessment of stresses in the cervical spine caused by posture and position of the head. Surgical technology international, 25, 277–279.
Han, J. T., Lee, J. H., & Yoon, C. H. (2015). The mechanical effect of kinesiology tape on rounded shoulder posture in seated male workers: a single-blinded randomized controlled pilot study. Physiotherapy theory and practice, 31(2), 120–125. doi.org/10.3109/09593985.2014.960054
Shiravi, S., Letafatkar, A., Bertozzi, L., Pillastrini, P., & Khaleghi Tazji, M. (2019). Efficacy of Abdominal Control Feedback and Scapula Stabilization Exercises in Participants With Forward Head, Round Shoulder Postures and Neck Movement Impairment. Sports health, 11(3), 272–279. doi.org/10.1177/1941738119835223
For individuals dealing with headaches, can utilizing self-care techniques help ease symptoms?
Headaches Self Care
There are different self-pain-relieving approaches to ease headache-related pain that use non-medication options. While headache self-care pain-relieving techniques can help temporarily, they are recommended to help ease headache symptoms until professional treatment is available. Individuals are encouraged to try multiple strategies to find the right treatment regimen that works for them, which is usually a process of trial and error. Self-care headache relief maneuvers can include temple massages, breathing exercises, exercise, or applying a cold pack to the head.
Self-Care Relief
Commonly used for tension headaches or migraine, a few examples of self-care techniques include (Espí-López G. V. et al., 2016)
Massaging the temples, neck, or scalp with the hand, fingers, or a massage tool.
Applying a cold pack to the affected area.
Heat can be used on the affected area, like a headband or a hot shower.
Compression such as a handkerchief or belt wrapped tightly around the head or pressing firmly on the painful area.
Compression is more commonly utilized in migraineurs versus scalp massage in people with tension headaches. This is often due to the throbbing sensation caused by a migraine versus a tension headache, which feels like a tight grip or band around the head.
Individuals with cluster headaches are more likely to utilize unique approaches, such as covering one ear, rotating the head, shallow breathing, moving around, or closing the nostril on the same side as the head pain.
Various scientific studies support the potential benefit of these complementary therapies. However, individuals should talk with a healthcare provider to choose the best strategy for their headache type and their unique needs/goals. Working with a chiropractic team can help expedite healing. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a customized treatment plan 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. 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.
Tension Headaches and Chiropractic Care
References
Espí-López, G. V., Zurriaga-Llorens, R., Monzani, L., & Falla, D. (2016). The effect of manipulation plus massage therapy versus massage therapy alone in people with tension-type headache. A randomized controlled clinical trial. European journal of physical and rehabilitation medicine, 52(5), 606–617.
Millstine, D., Chen, C. Y., & Bauer, B. (2017). Complementary and integrative medicine in the management of headache. BMJ (Clinical research ed.), 357, j1805. doi.org/10.1136/bmj.j1805
Can understanding the causes and symptoms of potential hip tendonitis help healthcare providers diagnose and treat the condition for individuals experiencing pain in the front of the hip with restricted hip flexibility that worsens during movement?
Hip Tendonitis
Hip tendonitis is inflammation of the iliopsoas tendon. It is most commonly caused by overuse of the hip flexors without adequate rest for recovery. The condition can occur when the hip muscles overpower the tendons attached to the hip bone, causing inflammation and irritation. This can lead to pain, tenderness, and mild swelling near the hip joint. Hip tendonitis can be diagnosed with a physical examination, and treatment can include:
Rest
Ice
NSAIDs
Stretching
Physical therapy
Chronic cases may require a cortisone injection into the iliopsoas tendon to decrease inflammation.
Surgical release of the iliopsoas tendon may be recommended to decrease tightness and pain.
There is a high prognosis for a full recovery.
Tendonitis
Inflammation in a muscle’s tendon leads to pain and tenderness that worsens the more the muscle is used. An overuse injury means the tendon becomes repeatedly stressed through repetitive muscle contractions, causing muscle and tendon fibers to micro-tear. If not enough rest is allowed for the micro-tears to heal, a chronic cycle of pain and inflammation develops within the affected tendon. Other tendons that are prone to developing the condition include:
The tendon of the wrist extensors/tennis elbow.
The tendon of the wrist flexors/golfer’s elbow.
The Achilles’ tendon/Achilles tendonitis.
The patellar tendon/jumper’s knee.
The tendons of the thumb/De Quervain’s tenosynovitis.
Bursitis
Bursae are small fluid-filled sacs that help cushion and decrease friction around joints.
Because the iliopsoas tendon overlays bursae, inflammation of the tendon can also cause bursitis or inflammation of the bursae surrounding the tendon.
Tendonitis and bursitis can and often occur together due to overlapping symptoms.
Causes
The iliopsoas originates in the pelvis and vertebrae of the lower spine and attaches to the top of the femur or thigh bone. It allows the hip joint movement that brings the leg closer to the front of the body, like lifting the leg to step up or jump. It also helps keep the torso stable when standing with one or both feet on the ground and rising from a lying position. Hip tendonitis most often results from physical activities that require repeated leg lifting when stepping, running, kicking, or jumping. This can include:
Running
Dancing
Gymnastics
Martial arts
Cycling
Playing soccer
Iliopsoas tendonitis can also occur after hip arthroscopy, a minimally invasive surgical procedure to repair structures inside the hip joint because of altered joint movement and muscle activation patterns after surgery. (Adib F. et al., 2018)
Symptoms
The primary symptoms of hip tendonitis include a soreness or deep ache in the front of the hip that worsens after physical activity and limits the range of motion because of the pain. Other symptoms include:
Tenderness to touch in the front of the hip.
The pain can feel like a dull ache.
Stiffness may also be present.
Hip flexor tightness.
Altered posture, with the pelvis rotated forward and an exaggerated curve in the lower back.
Lower back pain.
Discomfort after prolonged sitting.
Altered walking pattern characterized by shortened steps.
Diagnosis
Hip tendonitis is diagnosed through a physical examination and medical history reviews of individual symptoms.
Individuals may also have an X-ray of their hip performed to examine the joint alignment and determine if a fracture or arthritis is present.
Treatment
Initial treatment involves rest from physical activities, applying ice, and gentle stretching.
Nonsteroidal anti-inflammatory drugs/NSAIDs can ease pain and swelling, decrease inflammation, and reduce muscle spasms.
If chronic pain persists, individuals may receive a cortisone injection into their iliopsoas tendon. (Zhu Z. et al., 2020)
A personalized physical therapy program focusing on hip flexor stretching and strengthening, as well as strengthening the glutes and core, will help expedite an optimal recovery.
Surgery
For cases that do not improve after three months of treatment, surgery to lengthen the iliopsoas tendon, a procedure known as a tenotomy, may be performed. It involves making a small cut into a portion of the tendon, allowing the tendon to increase in length while decreasing tension as it heals back together. A tenotomy temporarily reduces the strength of the iliopsoas; however, this weakness usually resolves within three to six months after surgery. (Anderson C. N. 2016)
Chiropractic Care
Chiropractic care can be an effective treatment because it can help restore proper alignment and motion in the hip, reduce inflammation, and improve muscle and joint function. Treatments may include:
Spinal adjustments to realign the spine and other joints, reducing pressure on nerves and inflammation.
Non-surgical decompression
Manual therapy – massage, trigger point therapy, or spinal manipulation.
Acupuncture
Graston technique
Rehabilitative exercises like stretching, strengthening, and range of motion exercises.
Tendonitis generally has an excellent prognosis for full recovery as long as thorough rest from activities is taken to allow the inflamed tendon to heal. The postsurgical prognosis is positive for chronic and severe cases of iliopsoas tendonitis that require surgery.
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 to relieve pain and help 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.
Inflammation and Integrative Medicine
References
Adib, F., Johnson, A. J., Hennrikus, W. L., Nasreddine, A., Kocher, M., & Yen, Y. M. (2018). Iliopsoas tendonitis after hip arthroscopy: prevalence, risk factors and treatment algorithm. Journal of hip preservation surgery, 5(4), 362–369. doi.org/10.1093/jhps/hny049
Zhu, Z., Zhang, J., Sheng, J., Zhang, C., & Xie, Z. (2020). Low Back Pain Caused by Iliopsoas Tendinopathy Treated with Ultrasound-Guided Local Injection of Anesthetic and Steroid: A Retrospective Study. Journal of pain research, 13, 3023–3029. doi.org/10.2147/JPR.S281880
Anderson C. N. (2016). Iliopsoas: Pathology, Diagnosis, and Treatment. Clinics in sports medicine, 35(3), 419–433. doi.org/10.1016/j.csm.2016.02.009
Individuals dealing with pain in the buttocks can make life difficult to sit, walk, or perform simple, everyday tasks. Can understanding the anatomy, location, and function of the gluteus maximus muscle help in muscle rehabilitation and avoid potential injuries?
Gluteus Maximus
The gluteus maximus is the largest human body muscle responsible for hip extension, external rotation, adduction, and abduction, as well as the ability to stand upright. The primary muscle extends laterally and keeps the body upright by supporting the bony pelvis and trunk. (Neto W. K. et al., 2020) When the gluteus maximus is strained, injured, or weak, it can lead to pain and inflammation.
Common symptoms can include:
Stiffness in the buttock
Discomfort while sitting
Difficulty standing up from sitting
Difficulty bending over
Pain when walking, especially upstairs or on a hill
Pain in the lower back and/or tailbone
Anatomy and Structure
The muscles that comprise the glutes are the gluteus maximus, gluteus medius, and gluteus minimus. The gluteus medius runs underneath the gluteus maximus, and the gluteus minimus is underneath the gluteus medius.
The gluteus maximus is one of the strongest muscles. Fibers from the muscle connect to different body parts, including the femur/thighbone and the iliotibial band, which comprises connective tissue that runs up the thigh. The superior gluteal artery transports blood from the heart to the glutes.
Nerve Supply
The inferior gluteal nerve, part of the sacral plexus branch, innervates the maximus muscle. The sacral plexus nerves support motor and sensory function in the thighs, lower legs, feet, and pelvis. The sciatic nerve runs under the gluteus maximus, from the lower back down to the leg, and is often the cause of nerve pain in and around the area. (Carro L. P. et al., 2016) The main nerve of the perineum is the pudendal nerve, which runs under the gluteus maximus muscle.
Location
The gluteus maximus muscle defines the buttocks. It can be called a superficial muscle, sometimes referred to muscles that help provide shape. The origin of the gluteus maximus connects to the sacrum, the ilium, or the large upper part of the hip bone, the thoracolumbar fascia tissue, and the sacrotuberous ligaments attached to the posterior superior iliac spine. The gluteus maximus has a 45-degree angle from the pelvis to the buttocks and then inserts at the gluteal tuberosity of the femur and the iliotibial tract.
Variations
Sometimes, a duplicate muscle may originate from the gluteus maximus muscle in rare cases. However, it is more common that the gluteus maximus muscle fibers may be inserted into different body parts than where they are typically inserted. (Taylor, V. G., Geoffrey & Reeves, Rustin. 2015) This can cause a condition called greater trochanteric pain syndrome or GTPS. Inflammation of the gluteus medius, minimum tendons, and bursa inflammation can also cause GTPS. Individuals with GTPS will have tenderness or a pulsing feeling on the outer side of the hip and thigh when lying on the side, along with other symptoms.
Function
The gluteus maximus extends and externally rotates the hip joint, stabilizing the body. It is highly engaged during running and hiking activities. Regular walking does not typically target gluteus maximus strength training. However, the gluteus maximus promotes balance when walking and other activities by helping keep the pelvis and posture upright.
Conditions
The most common condition associated with the gluteus maximus is muscle strain, and deep gluteus maximus syndrome is another condition that can cause pain and involves the muscles.
Muscle Strain
A muscle strain can result from stretching and working the muscle too much that it becomes overstretched or tears. (Falótico G. G. et al., 2015) This can happen from not warming up or cooling down properly, repetitive use injury, and over-exercising. Alternatively, not exercising and not utilizing your gluteus maximus can weaken it, leading to lower back pain, hip pain, and stability and posture issues. (Jeong U. C. et al., 2015)
Deep Gluteus Maximus Syndrome
This syndrome causes pain in the buttocks when the sciatic nerve becomes entrapped. (Martin, H. D. et al., 2015) The location of the pain can help healthcare providers determine where the nerve is trapped. Those with deep gluteus maximus syndrome may experience various types of discomfort, including (Martin, H. D. et al., 2015)
Numbness and tingling in the leg
Pain when sitting
Pain when walking
Pain that radiates down the back and hips and into the thigh
To diagnose the condition, a healthcare provider may perform a physical examination and various tests to rule out other conditions that can cause similar symptoms.
Treatment and Rehabilitation
If there is pain in the buttocks and/or lower extremities, it’s important to consult a primary doctor, chiropractor, or physical therapist. They will evaluate the strength of the gluteus muscles to diagnose any strain or weakness. From there, they will develop a personalized treatment plan to help heal the injury, strengthen the muscles, and restore function. Treatment will include stretches once the strain is rested and improves.
Recommendations can include taking a few days off to rest the muscle or, at the very least, stop performing the work or activity that caused the strain.
Ice and over-the-counter medication like ibuprofen can help reduce inflammation.
For weak gluteus maximus, a physical therapist will strengthen and retrain the muscle with a tailored program of exercises. (Jeong U. C. et al., 2015)
Treatment for deep gluteus maximus syndrome may include conservative treatment, such as chiropractic decompression and realignment, physical therapy, medications for pain and inflammation, and injections.
If conservative treatments do not relieve the pain, a primary healthcare provider may recommend surgery. (Martin, H. D. et al., 2015)
Working with a chiropractic physical therapy team can help individuals return 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 to relieve pain and help 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.
The Science of Motion and Chiropractic Care
References
Neto, W. K., Soares, E. G., Vieira, T. L., Aguiar, R., Chola, T. A., Sampaio, V. L., & Gama, E. F. (2020). Gluteus Maximus Activation during Common Strength and Hypertrophy Exercises: A Systematic Review. Journal of sports science & medicine, 19(1), 195–203.
Carro, L. P., Hernando, M. F., Cerezal, L., Navarro, I. S., Fernandez, A. A., & Castillo, A. O. (2016). Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release. Muscles, ligaments and tendons journal, 6(3), 384–396. doi.org/10.11138/mltj/2016.6.3.384
Taylor, Victor & Guttmann, Geoffrey & Reeves, Rustin. (2015). A variant accessory muscle of the gluteus maximus. International Journal of Anatomical Variations. 8. 10-11.
Falótico, G. G., Torquato, D. F., Roim, T. C., Takata, E. T., de Castro Pochini, A., & Ejnisman, B. (2015). Gluteal pain in athletes: how should it be investigated and treated?. Revista brasileira de ortopedia, 50(4), 462–468. doi.org/10.1016/j.rboe.2015.07.002
Jeong, U. C., Sim, J. H., Kim, C. Y., Hwang-Bo, G., & Nam, C. W. (2015). The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients. Journal of physical therapy science, 27(12), 3813–3816. doi.org/10.1589/jpts.27.3813
Martin, H. D., Reddy, M., & Gómez-Hoyos, J. (2015). Deep gluteal syndrome. Journal of hip preservation surgery, 2(2), 99–107. doi.org/10.1093/jhps/hnv029
Can individuals with stiff person syndrome incorporate non-surgical treatments to reduce muscle stiffness and restore muscle mobility?
Introduction
The musculoskeletal system allows the body’s extremities to be mobile, provides stability to the host, and has an outstanding relationship with the other body systems. The musculoskeletal system’s muscles, tissues, and ligaments help protect the body’s vital organs from environmental factors. However, many individuals often deal with repetitive motions in the upper and lower body extremities that can cause pain and discomfort. Additionally, environmental factors, illnesses, and injuries can affect the musculoskeletal system and play a part in co-morbidities in overlapping risk profiles. These issues can cause the musculoskeletal system to develop a condition known as stiff person syndrome. Today’s articles focus on what stiff person syndrome is, the symptoms it is associated with, and how non-surgical treatments can help alleviate the symptoms of stiff person syndrome. We discuss with certified associated medical providers who consolidate our patients’ information to assess stiff person syndrome and its associated symptoms affecting the musculoskeletal system. We also inform and guide patients while asking their associated medical provider intricate questions to integrate non-surgical treatments to reduce the overlapping symptoms correlating with stiff person syndrome. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
What Is Stiff Person Syndrome
Have you been dealing with muscle stiffness in your lower extremities affecting your mobility? Have you noticed that your posture is rigid due to ongoing muscle spasms in your lower back? Or have you felt tightness in your back muscles? Many pain-like symptoms are associated with back pain, a common musculoskeletal condition; however, they can also correlate with a rare condition known as stiff person syndrome. Stiff person syndrome is a rare autoimmune disorder that is progressive and is characterized by rigidity and stimulus-triggered painful muscle spasms that affect the lower body and extremities. (Muranova & Shanina, 2024) There are three classifications that a person is experiencing with stiff person syndrome, and they are:
Classic Stiff Person Syndrome
Partial Stiff Person Syndrome
Stiff Person Syndrome Plus
Since stiff person syndrome is a rare condition, many individuals may not exhibit any objective findings early on, which then causes a delayed diagnosis that can impact a person’s quality of life (Newsome & Johnson, 2022). At the same time, since stiff person syndrome is a rare autoimmune disease, it can affect the musculoskeletal system with associated pain-like symptoms.
The Symptoms
Some symptoms associated with stiff person syndrome that can develop over time are muscle stiffness and painful muscle spasms. This is because the neuron receptors from the central nervous system can become haywire and cause non-specific somatic symptoms that make the individuals deal with comorbid chronic pain and myofascial tenderness in the muscles. (Chia et al., 2023) This is because stiff person syndrome can spread into different areas of the musculoskeletal system and can gradually develop over time. For muscle stiffness associated with stiff person syndrome, the muscles can become stiff over time, causing pain and discomfort, thus leading to many individuals developing abnormal posture, making it difficult to be mobile. Muscle spasms can affect the entire body itself or in a specific location and cause intense pain that lasts for hours. However, many individuals can incorporate non-surgical treatments to reduce the pain-like symptoms in the musculoskeletal system.
Movement Medicine: Chiropractic Care- Video
Non-Surgical Treatments For Stiff Person Syndrome
When it comes to reducing the musculoskeletal pain symptoms of stiff person syndrome, many individuals can begin to go to their primary doctor for early diagnosis and develop a customized treatment plan to manage the pain-like symptoms and provide a positive impact in creating awareness of this rare condition. (Elsalti et al., 2023) By assessing the pain-like symptoms of stiff person syndrome, many people can incorporate non-surgical treatments to manage the musculoskeletal pain symptoms and improve a person’s quality of life. Non-surgical treatments are cost-effective and can be combined with other therapies to restore mobility. One of the primary goals for managing stiff person syndrome is through pain management, symptom relief, and improved quality of life. (Cirnigliaro et al., 2021)
Chiropractic Care For Stiff Person Syndrome
One of the non-surgical treatments that can help reduce symptoms of muscle spasms and muscle stiffness is chiropractic care. Chiropractic care incorporates mechanical and manual manipulation to stretch and mobilize the joint-muscle function while reducing pain and discomfort. (Coulter et al., 2018) For individuals suffering from stiff person syndrome, chiropractic care can help reduce muscle stiffness and muscle spasms in the upper and lower extremities and relieve the pain. Additionally, incorporating non-surgical treatments like chiropractic care and combined therapies can help manage the musculoskeletal pain associated with stiff person syndrome and improve a person’s quality of life.
References
Chia, N. H., McKeon, A., Dalakas, M. C., Flanagan, E. P., Bower, J. H., Klassen, B. T., Dubey, D., Zalewski, N. L., Duffy, D., Pittock, S. J., & Zekeridou, A. (2023). Stiff person spectrum disorder diagnosis, misdiagnosis, and suggested diagnostic criteria. Ann Clin Transl Neurol, 10(7), 1083-1094. doi.org/10.1002/acn3.51791
Cirnigliaro, F. A., Gauthier, N., & Rush, M. (2021). Management of refractory pain in Stiff-Person syndrome. BMJ Case Rep, 14(1). doi.org/10.1136/bcr-2020-237814
Coulter, I. D., Crawford, C., Hurwitz, E. L., Vernon, H., Khorsan, R., Suttorp Booth, M., & Herman, P. M. (2018). Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. Spine J, 18(5), 866-879. doi.org/10.1016/j.spinee.2018.01.013
Elsalti, A., Darkhabani, M., Alrifaai, M. A., & Mahroum, N. (2023). Celebrities and Medical Awareness-The Case of Celine Dion and Stiff-Person Syndrome. Int J Environ Res Public Health, 20(3). doi.org/10.3390/ijerph20031936
Newsome, S. D., & Johnson, T. (2022). Stiff person syndrome spectrum disorders; more than meets the eye. J Neuroimmunol, 369, 577915. doi.org/10.1016/j.jneuroim.2022.577915
Individuals experiencing pain, numbness, tingling, or a burning sensation in the front and outer thigh could have meralgia paresthetica, a nerve entrapment. Can understanding the condition help healthcare providers develop an effective treatment plan?
Meralgia Paresthetica
Meralgia paresthetica, or MP, is also known as Bernhardt-Roth syndrome, lateral femoral cutaneous nerve syndrome, or lateral femoral cutaneous neuralgia. It occurs when the lateral femoral cutaneous nerve, a sensory nerve that passes over the brim of the pelvis and down the front of the thigh, becomes compressed. The nerve supplies information about sensations over the front and outside of the thigh. This can happen for several reasons, including:
Recent hip injuries, such as from a motor vehicle collision/accident.
Repetitive hip activities, like cycling.
Pregnancy
Weight gain
Wearing tight clothing.
The nerve entrapment condition causes tingling, numbness, and burning pain in the front and/or outer thigh.
Causes
There can be several different causes of this condition, but it is frequently seen in pregnancy, sudden weight gain, wearing tight clothing or belts, and other conditions. (Ivins G. K. 2000) Sometimes, meralgia paresthetica can be caused by medical procedures. For example, the condition can present after an individual has surgery and is in an unusual position for a long period of time, where there is direct external pressure on the nerve. Also, the nerve can become damaged during a surgical procedure. (Cheatham S. W. et al., 2013) This can occur when a bone graft is obtained from the pelvis or anterior hip replacement surgery.
Sensitivity to lightly touching the outside of the thigh.
Worsening of symptoms with certain positions.
Increased symptoms when wearing belts, work belts, or tight-waist clothes.
The symptoms may come and go or be persistent. Some individuals are hardly noticeable and do not impact their lives or activities, while others can be very bothersome and cause significant pain. (Scholz C. et al., 2023)
Treatment
Treatment depends on how long the injury has been present and the frequency and severity of the condition.
Clothing Modifications
If the cause is due to tight clothing, belts, or work belts, then garment modification should alleviate symptoms.
If recent weight gain is thought to contribute to the condition, then a weight loss program may be recommended.
Cortisone Injections
If simple steps do not relieve symptoms, a cortisone injection around the nerve area may be recommended. The goal is to reduce inflammation that contributes to nerve pressure (Houle S. 2012) . Cortisone injections may be a definitive treatment or a temporary treatment.
Chiropractic
Chiropractic care can be an effective, natural, and safe treatment. Adjustments can help relieve pressure on the lateral femoral cutaneous nerve (LFCN) by realigning the spine and restoring nerve function. Chiropractors may also use soft tissue therapies, such as massage, to relieve muscle tension and support the body’s healing process. Other chiropractic techniques that may be used include:
A chiropractic treatment program may include 10–15 treatments over 6–8 weeks, but the number of treatments needed will vary from person to person. If there’s no noticeable progress after 3–4 weeks, it may be time to consult a specialist or surgeon.
Surgery
Surgery is rarely necessary. However, a surgical procedure may be considered when all conservative treatments fail to provide relief. (Schwaiger K. et al., 2018) A surgeon dissects and identifies the nerve, looks for compression locations, and tries to free the nerve from any areas where it may be pinched. Alternatively, some surgeons transect/cut the nerve so it no longer causes problems. If the transection procedure is performed, there will be a permanent area of numbness over the front of the thigh.
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a customized treatment plan to relieve pain, treat injuries, improve flexibility, mobility, and agility, and help individuals return to optimal function. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Chiropractic Care for Leg Instability
References
Ivins G. K. (2000). Meralgia paresthetica, the elusive diagnosis: clinical experience with 14 adult patients. Annals of surgery, 232(2), 281–286. doi.org/10.1097/00000658-200008000-00019
Cheatham, S. W., Kolber, M. J., & Salamh, P. A. (2013). Meralgia paresthetica: a review of the literature. International journal of sports physical therapy, 8(6), 883–893.
Chung, K. H., Lee, J. Y., Ko, T. K., Park, C. H., Chun, D. H., Yang, H. J., Gill, H. J., & Kim, M. K. (2010). Meralgia paresthetica affecting parturient women who underwent cesarean section -A case report-. Korean journal of anesthesiology, 59 Suppl(Suppl), S86–S89. doi.org/10.4097/kjae.2010.59.S.S86
Scholz, C., Hohenhaus, M., Pedro, M. T., Uerschels, A. K., & Dengler, N. F. (2023). Meralgia Paresthetica: Relevance, Diagnosis, and Treatment. Deutsches Arzteblatt international, 120(39), 655–661. doi.org/10.3238/arztebl.m2023.0170
Hosley, C. M., & McCullough, L. D. (2011). Acute neurological issues in pregnancy and the peripartum. The Neurohospitalist, 1(2), 104–116. doi.org/10.1177/1941875211399126
Houle S. (2012). Chiropractic management of chronic idiopathic meralgia paresthetica: a case study. Journal of chiropractic medicine, 11(1), 36–41. doi.org/10.1016/j.jcm.2011.06.008
Schwaiger, K., Panzenbeck, P., Purschke, M., Russe, E., Kaplan, R., Heinrich, K., Mandal, P., & Wechselberger, G. (2018). Surgical decompression of the lateral femoral cutaneous nerve (LFCN) for Meralgia paresthetica treatment: Experimental or state of the art? A single-center outcome analysis. Medicine, 97(33), e11914. doi.org/10.1097/MD.0000000000011914
When muscle pains and aches present from health conditions, work, exercise, housework, etc., many individuals turn to topical sprays, creams, ointments, and gels to bring relief. Can magnesium spray be beneficial in the fight against neuromusculoskeletal pain?
Magnesium Spray
Magnesium spray is a liquid form of magnesium applied externally to the skin that has been marketed to promote muscle relaxation, improve sleep, and manage migraines. However, studies of its effectiveness have had mixed results. Some studies have shown that topical use can:
Improve chronic muscle and joint pain. Example: fibromyalgia.
Decrease the frequency and severity of nerve pain symptoms. Example: peripheral neuropathy.
Reduce the incidence and severity of an intubation-related sore throat after surgery.
Further studies of various groups are necessary to clarify the optimal dose for each condition and to determine how topical magnesium affects magnesium blood levels.
What is It?
Magnesium is a mineral that has an important role in many of the body’s processes and is essential for the following (Gröber U. et al., 2017)
Nerve transmission
Muscle contraction
Blood pressure regulation
Blood sugar regulation
Protein production
DNA and RNA production
Currently, there is no recommended dosage for topical magnesium use. However, some major health institutions have established a recommended daily amount taken by mouth. Listed are the recommended daily magnesium intake based on age and other factors. (National Institutes of Health Office of Dietary Supplements, 2022)
14 to 18 years old: 410 mg for males, 360 mg for females and when lactating, and 400 mg when pregnant.
19 to 30 years old: 400 mg for males, 310 mg for females and when lactating, and 350 mg when pregnant.
31 to 50 years old: 420 mg for males, 320 mg for females and when lactating, and 360 mg when pregnant.
51 years old and above: 420 mg for males and 320 mg for females.
Although self-care is appropriate for minor injuries or exercise, individuals are encouraged to see their healthcare provider for severe musculoskeletal pain symptoms.
Benefits
Though taking oral magnesium supplements is common, there is limited research on using magnesium on the skin to improve magnesium levels. Studies comparing the absorption of magnesium taken by mouth with the spray applied to the skin require further research. However, some studies look at the localized effect of magnesium spray on improving a sore throat after surgery and nerve, muscle, and joint pain.
Intubation-Related Sore Throat
Topical magnesium reduced the severity of sore throat after surgery in individuals undergoing tracheal intubation compared to a placebo. (Kuriyama, A. et al., 2019) However, further studies are necessary to clarify the optimal dose.
Nerve Pain
Peripheral neuropathy is nerve damage that causes a tingling and numbing sensation in the arms or legs. In a study of individuals with chronic kidney disease, the daily application of magnesium sprays to limbs affected by peripheral neuropathy for twelve weeks decreased the frequency and severity of nerve pain symptoms. However, one limitation was that it was performed mostly in females. (Athavale, A. et al., 2023)
Chronic Muscle and Joint Pain
A small study assessed whether applying magnesium to the skin could improve the quality of life of female participants with fibromyalgia – a chronic condition that causes muscle and joint pain, fatigue, and other symptoms. The study found that four sprays of magnesium chloride applied twice daily to the upper and lower limbs for four weeks could benefit those with fibromyalgia. However, further research with larger studies is needed to confirm the results. (Engen D. J. et al., 2015)
Does The Spray Increase Overall Magnesium Levels?
Magnesium is transported into cells through magnesium transporters. The outer layer of the skin does not contain these transporters, so absorption occurs in the small areas of the sweat glands and hair follicles. (Gröber U. et al., 2017) One study suggested that applying magnesium to the skin can help with magnesium deficiency within four to six weeks, compared to four to 12 months in the case of oral magnesium supplementation. However, there is minimal research on topical magnesium and its impact on magnesium levels. Another study suggested that 56 mg of magnesium cream applied daily on the skin for 14 days had no statistically significant effect on magnesium blood levels. Although the results were statistically insignificant, a clinically relevant increase in magnesium blood levels was observed. (Kass, L. et al., 2017) Because it remains unclear if magnesium absorption via the skin is more effective than by mouth, further studies are necessary to confirm the amount of magnesium absorbed into the skin.
Using The Spray
In one study, a magnesium chloride solution was poured into a spray bottle and applied as follows (Engen D. J. et al., 2015)
The solution was sprayed into the palm and applied evenly on the affected area.
There is a four-hour wait time between spray dose applications.
Individuals should wait at least one hour after application before showering or washing the product off.
Leave the product on the skin throughout the day and wash it off before bed.
Rinse the solution off with water if the skin becomes irritated.
Avoid applying to open wounds.
Precautions
Avoid magnesium chloride sprays if you are allergic to them or their components. If you have a severe allergic reaction, such as itching, hives, or shortness of breath, seek immediate medical attention. Topically applied magnesium solution has no known side effects other than skin irritation. (Engen D. J. et al., 2015)
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment plan through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help individuals return to optimal function. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Why Choose Chiropractic?
References
Gröber, U., Werner, T., Vormann, J., & Kisters, K. (2017). Myth or Reality-Transdermal Magnesium?. Nutrients, 9(8), 813. doi.org/10.3390/nu9080813
Kuriyama, A., Maeda, H., & Sun, R. (2019). Topical application of magnesium to prevent intubation-related sore throat in adult surgical patients: a systematic review and meta-analysis. Application topique de magnésium pour prévenir les maux de gorge liés à l’intubation chez les patients chirurgicaux adultes: revue systématique et méta-analyse. Canadian journal of anaesthesia = Journal canadien d’anesthesie, 66(9), 1082–1094. doi.org/10.1007/s12630-019-01396-7
Athavale, A., Miles, N., Pais, R., Snelling, P., & Chadban, S. J. (2023). Transdermal Magnesium for the Treatment of Peripheral Neuropathy in Chronic Kidney Disease: A Single-Arm, Open-Label Pilot Study. Journal of palliative medicine, 26(12), 1654–1661. doi.org/10.1089/jpm.2023.0229
Engen, D. J., McAllister, S. J., Whipple, M. O., Cha, S. S., Dion, L. J., Vincent, A., Bauer, B. A., & Wahner-Roedler, D. L. (2015). Effects of transdermal magnesium chloride on quality of life for patients with fibromyalgia: a feasibility study. Journal of integrative medicine, 13(5), 306–313. doi.org/10.1016/S2095-4964(15)60195-9
Kass, L., Rosanoff, A., Tanner, A., Sullivan, K., McAuley, W., & Plesset, M. (2017). Effect of transdermal magnesium cream on serum and urinary magnesium levels in humans: A pilot study. PloS one, 12(4), e0174817. doi.org/10.1371/journal.pone.0174817
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