Strengthening the Gluteus Medius After an Injury

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

During single extremity weight bearing exercises, such as stance phase of walking or running, lunging and landing from a jump, amongst others, the lower extremity joints are designed to naturally absorb the impact of gravity being placed against the body. When the force of gravity acts upon the body, the joints move into distinct directions and the muscles need to properly function as to counteract these forces. Generally, these muscles function isometrically and/or eccentrically. For instance, with the absorption movements of a pelvic lateral tilt, the hip abductors work to stabilize the movement. With an anterior pelvic tilt absorption movement, the pelvic posterior tilters such as the gluteals and hamstrings work to stabilize mobility. With hip joint flexion, adduction and internal rotation, the muscles are controlled by the gluteus medius and other hip joint external rotators, such as the gemellus muscles, quadrutus femoris, obturator muscles and the piriformis. And finally, the quadriceps controls the absorption movements of a knee joint flexion, the soleus of an ankle dorsiflexion and the tibialis posterior, FHL and FDL, stabilizes midfoot pronation.

The gluteus medius is a proximal hip muscle which purpose is to control proximal pelvic/hip joint motion that in turn controls lower limb kinetics around the knee and ankle. The gluteus medius attaches to the iliac crest and inserts onto the greater trochanter, functioning as a hip abductor, hip external rotator and stabilizer of the pelvis on the femur during stance phase of gait. It�s most significant role, however, is to compress the femoral head into the acetabulum during the stance phase of gait. The muscle is divided into three equal parts: anterior, middle and posterior.

The fibres which make up the posterior section of the muscle travel parallel with the neck of the femur while the middle and anterior sections travel vertically from the iliac crest to the anterosuperior feature of the greater trochanter. It�s been suggested, that each individual part of the muscle functions independently from each other as each of the three portions contain their own supply of nerves which run through the superior gluteal nerve.

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Lumbar Disc Herniation, Massage and Chiropractic

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

Lumbar spine disc herniation is a well-known type of injury which often causes impairing low back pain, however, it can also compress the nerve roots in the area and generate radicular pain and other symptoms along the lower extremities, such as altered sensations and muscle weakness. Furthermore, this type of injury will not only affect the athlete�s ability to perform during their specific sport or physical activity, it may also become chronic and affect the athlete in the future.

Conservative treatments are frequently utilized when managing lumbar disc herniation in athletes, although surgical options may be considered if the injury is too severe. Many elite athletes often request faster recovery methods for their type of injuries and symptoms in order to minimize their time spent away from training and competition. As a result, a wide number of athletes will seek surgical alternatives earlier than recommended, provided they meet the criteria for lumbar spine surgery. The most popular surgical procedure for athletes with a low back disc herniation is the lumbar disc microdiscectomy.

The intervertebral discs of the lumbar spine perform an essential biomechanical role within the spine. These function to provide mobility between the segments of the spine while distributing compressive, shear and torsional forces. These discs are made up of a thick, outer ring of fibrous cartilage, known as the annulus fibrosis, which surround the gelatinous core of the disc, known as the nucleus pulposus, which is contained within the cartilage end plates.

Each intervertebral disc consists of cells and substances, such as collagen, proteoglycans and scattered fibrochondrocytic cells, which function to absorb and conduct increased forces from body weight and muscle activity. In order to effectively perform its function, the disc depends immensely on the structural condition of the annulus fibrosis, nucleus pulposus and the vertebral end plate. If the disc is healthy, it will evenly spread the forces being applied against the spine. However, disc degeneration caused by cell degradation, loss of hydration or disc collapse, can decrease the disc�s ability to withstand external forces and these will no longer be absorbed and conducted evenly across the spinal structures.

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Chiropractor El Paso | Evaluating Neck Injuries in Athletes

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

The predominance of neck injuries in sports is believed to be rising, mostly due to the increased improvements in injury recording and observation. However, the growth of physical, extreme sports has led to higher risks of injury among unprepared athletes.

For instance, athletes who participate in sports such as skeleton, where individuals sprint on ice and hurtle head first down an icy, often bumpy track at elevated speeds, must learn to understand the importance of properly training their neck to avoid complications to its surrounding structures. Neck injuries are common in skeleton but these can be prevented. Neck training doesn�t simply involve avoiding the risk of suffering a neck complication, in competitive sports, such as skeleton, strengthening the neck can ultimately improve an athlete�s overall physical performance, helping them achieve their goals of triumph.

In order to decrease the chance of injury, the neck needs to be strategically and individually prepared to ensure it has a greater tolerance to the increased loads it�s exposed to. But, before an athlete begins implementing this program, it�s essential for them to receive an accurate evaluation of their cervical spine in a comprehensive assessment and screening process.

Neck injuries occur most frequently in motorsports and high impact, collision sports like rugby. It�s been previously described that acute force exposure through compression and distraction, axial loading and/or direct blows along with sudden acceleration and deceleration of the structures of the body, are the most common reasons for injury in these types of sports.

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Shoulder Pain Caused by Serratus Anterior Injuries

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

Muscular imbalances around the complex structures of the shoulder can develop abnormal activation patterns and inherent myofascial restrictions, both which can cause a significant decrease in the athlete�s scapular control and dyskinesis, leading to glenohumeral joint injuries resulting from instability and impingement.

The serratus anterior, or SA, is one of the muscles of the scapula that functions by providing a connection between the shoulder girdle and the trunk, however, it�s often believed to be a dysfunctional muscle among shoulder pathologies. The serratus anterior is a primarily offers movement to the scapula, contributing to the maintenance of normal scapulo-humeral rhythm and motion. Due to its insertion on the inferior and medial border of the scapula, it can produce upward rotation and posterior tilting. Poor activation of the serratus anterior muscle may result in limited scapular rotation and protraction, causing a relative anterior-superior translation of the humeral head in relation to its glenoid articulation, leading to sub-acromial impingement and rotator cuff tears.

The serratus anterior is characterized as a flat sheet of muscle beginning from the lateral surface of the first nine ribs. Then, it passes behind and around the thoracic wall before inserting into the anterior surface of the medial border of the scapula. The most important function of the serratus anterior, or SA, is to protract and rotate the scapula, helping to maintain it close yet away from the thoracic wall, allowing for the proper positioning of the glenoid fossa to increase the efficiency of upper extremity motion to its maximum state. The anatomy of the SA can be broken down into three anatomical components as follows: Read more.

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Stretches and Exercises for SLAP Lesions

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

Many variations of SLAP lesions can primarily be treated conservatively with methods to initially improve the patho-mechanical factors that affect SLAP lesions, such as glenohumeral internal rotation deficit (GHIRD) and scapular dyskinesis. With a majority of type 1 lesions, this can be significantly effective in eliminating the symptoms of the lesion without the need for surgery. However, once an athlete has surgically treated their SLAP lesions, they can follow a similar rehabilitation process to achieve overall wellness.

Minor type-1 SLAP lesions may only require a simple debridement without disrupting the biceps anchor, whereas type-2 SLAP lesions are the most commonly seen type by many healthcare providers, involving a detachment of the biceps anchor from the labrum. Type-2 lesions can be treated with arthroscopic fixation of the superior labrum to develop biceps anchor stability.

Type 3 SLAP lesions are identified by bucket-handle tears along the superior labrum with intact biceps anchor. This bucket handle fragment can easily be debrided by an arthroscopic shaver, and further treatment may often not be needed. The other types of SLAP lesions are not as common as the type 2 lesions, although if they do occur, these will almost certainly require surgical intervention.

A large database study found that the highest incidence of repair is among the 20-29 years and 40-49 years of age groups. This is believed to occur due to the younger population�s higher participation in sports activities. In the 40-49-year-old group however, the high incidence most likely occurs due to the degeneration of the labrum, which may primarily develop around this age. Also men have a three times higher incidence of repair. This is believed to occur due to how males are more likely to participate in a sport which may cause SLAP lesions. �

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Rehabilitating Acute Hamstring Injuries

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

The semitendinosus, or ST, the semimembranosus, or SM, and the biceps femoris long and short heads (BFLH and BFSH) are part of the hamstring muscle group. They primarily function with the extension of the hip and flexion of the knee as well as providing multi-directional stability of the tibia and pelvis. These three muscles which make up the hamstring muscle group, cross the posterior aspect of both the hip and the knee joints, making them bi-articular. As a result, they are consistently responding to large mechanical forces created by upper limb, trunk and lower limb locomotion as a means of concentric and eccentric mobilization. During sporting activities, these forces will tend to increase, augmenting the frequency of injury.

In a study conducted at the University of Melbourne, biomechanical analysts measured the musculotendinous strain, velocity, force, power, work and other biomechanical loads experienced by the hamstrings throughout the course of over-ground sprinting and compared the biomechanical load across each individual hamstring muscle.

Basically, the hamstrings are subjected to a stretch-shortening cycle when sprinting, with the lengthening phase occurring during the terminal swing and the shortening phase commencing just before each foot strike, continuing throughout the stance. Then, the biomechanical load on the bi-articular hamstring muscles were determined to be stronger during the terminal swing.

BFLH had the greatest musculotendinous strain, ST displayed considerable musculotendinous lengthening velocity, and SM produced the highest musculotendinous force and both absorbed and generated the most musculotendinous power. Similar research also distinguished peak musculotendinous strain as a large contributor to eccentric muscle damage or injury, most commonly acute hamstring injuries, instead of peak muscle strength. This is why eccentric strengthening is often a rehabilitation recommendation for acute hamstring injuries.

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