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.
The iliacus muscle is a triangle-shaped muscle in the pelvic bone that flexes and rotates the thigh bone. It works with the other muscles in the hip and thigh to help bend, run, walk, sit, and maintain correct posture. Injuries and common medical conditions can affect its function, causing pain and stiffness. Can physical therapy help?
The Iliacus Muscle
The iliacus is one of the body’s most important hip flexor muscles. The iliacus and surrounding muscles work together to produce the stability and range of motion required for bending, dancing, sitting, and walking.
Anatomy
The iliacus muscle is part of a complex muscle system in the hip and pelvis. Two iliacus muscles on each side of the pelvic bone enable the thigh to flex and rotate. They are innervated by the femoral nerve, which provides movement and sensation to the lower limbs. (Bordoni B. and Varacallo M. 2023) The iliacus muscle sits on the wing-shaped ilium and fits into the curved surface of the ilium, called the iliac fossa. The top of the muscle is attached to the upper wings of the ilium or iliac crest. It extends past the hip joint, which connects to the upper thigh bone/femur at the lesser trochanter protrusion. The iliacus is part of a major trio of muscles called the iliopsoas, including the major psoas and minor psoas muscles. These muscles are also attached to the upper femur but extend upward, connecting to the lumbar/lower spine at several attachment points. The iliopsoas also interact with the quadratus lumborum muscle, the deepest muscle of the lower back that starts at the iliac crest and attaches to the lumbar spine at several points. The quadratus lumborum enables flexion and elevation of the spine, while the iliopsoas enable the flexion and rotation of the hip and thigh.
Functions
The iliacus muscle has many functions that include: (Physiopedia, 2024)
Flexing and rotating the femur.
Helps maintain proper body posture while standing and sitting.
Produces hip movement that enables walking, running, and climbing stairs.
Provides hip flexion – bringing the knee to the chest.
Enables the forward tilt of the pelvis and side-bending.
Conditions
Several conditions can affect the iliacus muscle, specifically from under and/or overuse injuries. These conditions, collectively known as Iliopsoas syndrome, are typically the result of overuse/repetitive strain or injuries. These include:
Iliopsoas tendinopathy – which affects tendons.
Iliopsoas bursitis – which affects cushioning sacs known as bursae.
Iliopsoas syndrome can affect anyone but is common in:
Individuals and athletes who repeatedly use movements that flex the hips.
Track-and-field athletes
Gymnasts
Dancers
Iliopsoas Bursitis
This is the inflammation of the cushioning sac or bursa under the iliacus muscle, which helps the muscle slide over the pelvic bone. Symptoms can range from mild discomfort to pain that radiates through parts of the leg and hips. Runners, skiers, and swimmers are commonly affected, and individuals who regularly have tight hips and individuals with different forms of arthritis can also be affected. Early treatment can prevent the symptoms from worsening. Mild cases can be treated with self-care and stretching to help relieve tightness, rest, ice application, and over-the-counter nonsteroidal anti-inflammatory drugs. In severe cases, treatment options that may be recommended include: (Physiopedia, 2024)
Physical therapy
Assistant walking devices to relieve pressure – for example, a cane.
Corticosteroid steroid injections
Prescription anti-inflammatory medications
Iliopsoas Tendinopathy
Another condition affecting the iliacus muscles is iliopsoas tendinopathy, sometimes called snapping hip syndrome, because individuals can hear an audible snapping sound (Davenport KL. 2019). The condition is often experienced by dancers who repeatedly flex and hyperextend their hips and can result in hip and groin pain that gets worse with kicking or rotation. Treatment of iliopsoas tendinopathy can include:
Retraining muscle imbalances with strengthening and stretching exercises.
If these fail to provide relief, corticosteroid injections may be used. A saline hydro dissection can relieve stress around the tendon by injecting fluids that cushion and release trapped tissues.
Tendon release surgery may be recommended when all other options have failed. The surgical release involves severing the tendon to reduce pain and improve the range of motion.
Rehabilitation
Core muscle strengthening is essential to the rehabilitation of iliacus muscle injuries. The iliopsoas is an integral component of the core group and can benefit from stretching and strengthening exercises (Yogateket, 2019)
Lunge stretches
Straight leg raises
Knee-to-chest stretches
Standing hip flexion with resistance bands
Certain yoga poses can also help and include variations on the bridge pose that encourage hip flexion. (Yoga International, 2024)
Injury Medical Chiropractic and Functional Medicine Clinic
Iliopsoas pain is often felt at the front of the hips, thigh, mid-back, and lower back. Chiropractic care can help with iliacus muscle injuries through:
Evaluation
A chiropractor can evaluate the condition and determine if the iliacus muscle is causing pain.
Treatment plan
A chiropractor can create a personalized treatment plan that may include exercise instructions, manipulation, and other therapies.
Rehabilitation
A chiropractor can create a rehabilitation program to expedite healing.
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Hip Labral Tear and Chiropractic Care
References
Bordoni, B., & Varacallo, M. (2024). Anatomy, Bony Pelvis, and Lower Limb, Iliopsoas Muscle. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/30285403
Incorrect manual handling and lifting is a leading cause of workplace injuries. Can health and safety training help reduce injuries and lost workdays?
Correct Manual Lifting Technique
Manually lifting objects using incorrect techniques can lead to acute back injuries, herniated discs, sciatica, and long-term issues like increased risk of reinjury, body misalignment, and chronic back pain. Individuals can prevent spinal disc compression and/or lower back muscle strain by learning to use correct manual lifting techniques. (CDC. The National Institute for Occupational Safety and Health (NIOSH). 2007)
Lifting Guide
Individuals can protect their backs and prevent injury by following simple steps when lifting objects.
Support Base
Ensure there is a healthy support base from which to lift.
Keep feet shoulder-width apart with one foot slightly in front of the other.
Ask For Help
If coworkers or colleagues are available, ask for assistance.
If the load is too heavy, ask for help lifting and moving the object/s.
Use Mechanical Assistant Devices
Use hand trucks, dollies, or pushcarts whenever possible for uneven and heavy loads.
Squat To Lift Object
Bend at the hips and knees only, not the back.
Put one knee on the ground to ensure stability before lifting.
Check Posture
Looking straight ahead, maintain posture upright with the chest out, shoulders back, and lower back slightly arched.
Lift Slowly
Lift with the knees and hips only, gradually straightening the lower back.
Load Positioning
Once upright, hold the load close to the body around the stomach.
Move and Maintain Alertness
Always take small steps.
Maintain alertness as to where you are going.
Keep the shoulders square with the hips when changing directions to avoid twisting and losing or shifting balance.
Rest
If you are fatigued, set the load/object down and rest for a few minutes until you can fully engage in the task.
Squat To Set Object Down
Squat with the knees and hips and set the load down slowly.
Avoid quickly rising and jerking movements, and allow the legs, hips, and back muscles to reset.
Planning and Tips
Lifting anything heavy takes planning to prevent muscle spasms, back strain, and other musculoskeletal injuries. Considerations to keep in mind:
Make a Plan Before Lifting
Knowing what object/s are being lifted and where they are going will prevent individuals from making awkward movements while holding and carrying something heavy.
Set and clear a path.
If lifting something with another person, ensure both agree and understand the plan.
Lift Close to The Body
Individuals are stronger and more stable lifters if the object is held close to their body rather than at the end of their reach.
Make sure there is a firm hold on the object.
It is easier to maintain balance close to the body.
Maintain Feet Shoulder-Width Apart
Keep the feet about shoulder-width apart.
Having a solid base of support is important while lifting.
Placing the feet too close together will cause instability while placing them too far apart will hinder movement.
Take short steps.
Visualize The Motions Involved and Practice The Motions Before Lifting
Think about the motion before lifting.
Practice the lifting motion before lifting the object.
Focus on keeping the spine straight.
Raise and lower to the ground by bending the knees.
Avoid bending at the waist or hips.
Tighten the Stomach Muscles
Tightening the abdominal muscles will hold the back in a healthy lifting position and help prevent excessive force on the spine.
Lift With the Legs
The legs are stronger than the back muscles, so let the leg strength do the work.
Lower yourself to the ground by bending the knees, not the back.
Keep Eyes Up
Looking slightly upwards will help maintain a better spine position and help keep the back straight.
Avoid Twisting or Bending
Face in the direction you are walking.
Stop, take small steps, and continue walking if turning is required.
Back Belts
It has become common for many who work in jobs requiring manual lifting to wear back belts or support. However, research does not show that they decrease the risk of a lifting injury. (CDC and The National Institute for Occupational Safety and Health, 2023) Instead, it is recommended that the belt be thought of as a reminder of where the back muscles are positioned to keep the individual aligned, combined with the correct lifting techniques.
Injury Medical Chiropractic and Functional Medicine Clinic
Training the body and maintaining its optimal health for correct manual lifting techniques requires daily efforts through practice, conscious position corrections, and ergonomics. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Chiropractic Care For Injury Recovery
References
CDC. The National Institute for Occupational Safety and Health (NIOSH). (2007). Ergonomic Guidelines for Manual Material Handling. (No. 2007-131). Retrieved from www.cdc.gov/niosh/docs/2007-131/pdfs/2007-131.pdf
CDC. The National Institute for Occupational Safety and Health (NIOSH) (2023). Back Belts – Do They Prevent Injury? (No. 94-127). Retrieved from www.cdc.gov/niosh/docs/94-127/
Can correcting body misalignments and the elements of unhealthy posture help achieve a healthy posture?
Healthy Posture
Maintaining a healthy posture is more important than ever, as individuals from all walks of life realize how practicing awkward and unhealthy postures can wreak havoc on their bodies and quality of life. Unhealthy postures include rounding the upper and lower back, slouching, and forward head posture. Over time, these postures make daily activities more difficult or painful. Mobility, stability, and strengthening exercises can address unhealthy posture problems and issues, along with practicing correct sitting, standing, and resting postural habits to reinforce proper alignment daily. A chiropractic and physical therapy team can treat and train individuals to restore correct and healthy posture.
Body Alignment
Ideal posture involves correct body alignment or how the structural parts, such as the head, trunk, hips, knees, etc., relate to an individual’s form. Whether standing, sitting, lying down, or moving, body parts need to be balanced in relationship to each other to avoid unnecessary stress on the spine and musculoskeletal system. (Bone Health & Osteoporosis Foundation, 2024)
Posture Types
Posture is considered static when sitting or standing still and dynamic when moving. Both are categorized as active postures as they require the activation of stabilizing muscles to deal with gravity and maintain alignment. Lying down and remaining still is considered an inactive posture, as muscle involvement is minimal. However, both have the potential to be healthy or unhealthy.
Proper Body Alignment
An easy way to check proper alignment while standing is to stand against a wall with the base of the head, shoulder blades, and buttocks flush against the wall, with enough space for a hand wide enough to slide in between the wall and the small of the back. This exercise correctly lines up the head, shoulders, and hips to reduce or eliminate undue stress on the spine. Body balance is the foundation for active and inactive postures concerning workstations, industrial ergonomics, daily activities, and sports. (Mayo Clinic, 2023) Healthy alignment is a standard position in which all body joints are centered and balanced and the most mechanically efficient position for static or dynamic activities. Biomechanical efficiency (the ability to use the body’s muscles and joints to perform movements while minimizing energy use and maximizing output) enables the muscles surrounding the joints to work in balance and efficiently activate, which, in turn, helps reduce strain, tension, and injury. Balanced muscles also conserve energy, leading to better daily stamina.
Development of Imbalances
Individuals develop position and movement habits in joint positioning that have led to imbalanced muscles. When this is the case, some muscles can be chronically stretched, and others become chronically tight, all to hold the body up or move around, which can lead to postural conditions like upper crossed (Physiopedia, 2024) or lower crossed syndrome (Physiopedia, 2024) which often leads to pain and/or mobility issues.
Posture Assessment
The recommended way to determine if one’s posture is healthy or poor is by conducting a posture assessment. The examination looks at joint positions and gathers visual information about the planes into which parts of each joint move and the axes around which those movements occur (Singla D. and Veqar Z., 2014) (Debra Coglianese et al., 2006). In a posture assessment, body alignment is compared with the ideal standard, a plumb line, usually a string with a small weight attached to the bottom to help maintain straightness. The other end of the string is affixed to the ceiling to be used as an accurate reference for correct alignment. (Singla D. and Veqar Z. 2014) During a posture assessment, the patient stands next to the plumb line while the doctor or therapist compares the relative positions of the following areas:
Ears
Shoulder joint
Spine
Hip joint
Knee joint
Ankle joint
Feet
Any areas that don’t match the reference can indicate misalignments in one or several regions.
Making Corrections
Chiropractic care can help correct unhealthy posture by realigning the spine and strengthening the musculoskeletal system:
Spinal Adjustments
Chiropractors use their hands or instruments to apply controlled force to the spine to realign the vertebrae. This can help relieve pressure on muscles, ligaments, and nerves, which can improve posture.
Corrective Exercises
Chiropractors can create custom exercises to strengthen postural muscles and maintain proper alignment.
Massage Therapy
Chiropractors can use massage therapy to work on strained ligaments and soft tissue.
Guidance and Training
Chiropractors can teach patients how to move to encourage a neutral spine and provide strategies for maintaining healthy posture.
A posture corrector or brace can also help teach and engage the correct muscles to achieve proper alignment. However, it should not be relied on long-term because promoting and activating one’s stabilizing muscles is important rather than relying on a brace for prolonged periods.
Injury Medical Chiropractic and Functional Medicine Clinic
Achieving and maintaining proper posture requires consistent work and development. Retraining the body and maintaining its optimal health requires daily efforts through exercise, conscious position corrections, and ergonomics. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Singla, D., & Veqar, Z. (2014). Methods of postural assessment used for sports persons. Journal of clinical and diagnostic research: JCDR, 8(4), LE01–LE4. doi.org/10.7860/JCDR/2014/6836.4266
Coglianese, D. (2006). Muscles: Testing and Function With Posture and Pain, ed 5 (with Primal Anatomy CD-ROM). Physical Therapy, 86(2), 304-305. doi.org/https://doi.org/10.1093/ptj/86.2.304
An axillary nerve injury can cause pain, weakness, and shoulder mobility loss. Can physical therapy help restore and maintain shoulder joint flexibility?
Axillary Nerve
The axillary nerve, or the circumflex nerve, is a peripheral nerve that runs through the shoulder and supports movement and sensation in the upper limbs. It originates in the neck at the brachial plexus, a network of nerves that extends from the neck and upper torso to the shoulders and arms. Its primary purpose is to supply nerve function to the shoulder joint and three muscles in the arm and also innervates some skin in the region.
Anatomy
Except for the cranial nerves, all the body’s nerves branch off from the spinal cord, emerge from between vertebrae and continue to branch off as they travel to various muscles and other structures. The axillary nerve is named after the axilla, the medical name for the armpit. Individuals have two, one on each side. After leaving the spinal column, the axillary nerve runs behind the axillary artery and continues to the shoulder blade’s lower edge of the subscapularis muscle. It winds back and travels down the arm along the posterior humeral circumflex artery, which then passes through the quadrangular space (a small area of the shoulder blade just above the armpit where there is a gap in the muscles that allows nerves and blood vessels to pass through to the arm before it divides into terminal branches, which are:
Anterior Division
Supplies motor innervation to the deltoid’s anterior and middle heads, allowing the arm to abduct or move away from the body.
It winds around the neck of the humerus/funny bone, goes beneath the deltoid muscle, and then connects to the forward edge of the deltoid.
A few small cutaneous branches serve the skin in that area.
Posterior Division
Innervates the teres minor muscles and the lower part of the deltoid.
It enters the deep fascia and becomes the superior lateral cutaneous nerve.
It then wraps around the lower edge of the deltoid, connects to the skin over the lower two-thirds of the muscle, and covers the long head of the triceps brachii.
Articular Branch
Comes from the trunk of the axillary nerve and enters the glenohumeral joint, which is in the shoulder, below the subscapularis muscle.
Anatomical Variations
In a case report, healthcare providers noted an incidence of the nerve branching directly off the upper trunk of the brachial plexus rather than the posterior cord. (Subasinghe S. K. and Goonewardene S. 2016) In this case, it innervated the subscapularis muscle, latissimus dorsi, and the deltoid and teres minor muscles and also had a communicating branch to the posterior cord. Another case documented multiple abnormalities in the course of the axillary nerve in an individual with pain and severely limited shoulder mobility. (Pizzo R. A. et al., 2019) During reverse shoulder arthroplasty, the surgeon discovered that the axillary nerve ran beside the coracoid process instead of underneath and stayed close to the subscapularis muscle instead of traveling through the quadrangular space. The case noted earlier reports of axillary nerves not running through the quadrangular space. In those cases, the nerve pierced the subscapularis muscle or split into branches before reaching the quadrangular space.
Function
The axillary nerve functions as a motor nerve that controls movement and a sensory nerve that controls sensations like touch or temperature.
Motor
As a motor nerve, the axillary nerve innervates three muscles in the arm and includes:
Deltoid
Allows flexing of the shoulder joint and rotating the shoulder inward.
Long Head of the Triceps
It runs down the back of the outer arm, allowing straightening, pulling the upper arm toward the body, or extending it backward.
The radial nerve can also innervate this muscle.
Teres Minor
One of the rotator cuff muscles starts outside the shoulder and runs diagonally along the bottom edge of the shoulder blade.
It works with other muscles to allow for the external rotation of the shoulder joint.
Sensory
In its sensory role, the nerve carries information to the brain from the following:
Glenohumeral joint or the ball-and-socket joint in the shoulder.
The skin on the lower two-thirds of the deltoid muscle through the superior lateral cutaneous branch.
Injuries and Conditions
Problems with the axillary nerve can be caused by injuries anywhere along the arm and shoulder and by disease. Common injuries include:
Dislocations
Of the shoulder joint, which can cause axillary nerve palsy.
Fracture
Of the surgical neck of the humerus.
Compression
This stems from walking with crutches, also known as crutch palsy.
Direct Trauma
This can be from an impact sports, work, automobile accident, collision, or laceration.
Added Pressure
This can be from wearing a cast or splint.
Surgical Accidental Injury
An injury or damage can come from shoulder surgery, especially arthroscopic surgery on the inferior glenoid and capsule.
Quadrangular Space Syndrome
This is where the axillary nerve is compressed where it passes through that space, which is most common in athletes who perform frequent overhead motions)
Nerve Root Damage
Between the fifth and sixth cervical vertebrae, where the nerve emerges from the spinal cord, which can be caused by traction, compression, spinal disc prolapse, or a bulging disc.
Systemic Neurological Disorders
Example – multiple sclerosis
Erb’s Palsy
A condition often is the result of a birth injury called shoulder dystocia, in which a baby’s shoulder/s becomes stuck during childbirth.
Axillary Nerve Palsy
Damage can result in a type of peripheral neuropathy that can cause weakness in the deltoid and teres minor muscles.
This can result in losing the ability to lift the arm away from the body and weakness in various shoulder movements.
If the damage is severe enough, it can cause paralysis of the deltoid and other minor muscles, resulting in flat shoulder deformity, in which individuals cannot lay their shoulders flat when lying down.
Axillary nerve damage also can lead to a change, reduction, or loss of sensation in a small part of the arm just below the shoulder.
Nerve Injury Statistics
Three times more common in men than women.
It may be present in as many as 65% of shoulder injuries.
The risk of injury due to dislocation is significantly increased after age 50.
Tests
If a healthcare provider suspects a problem with axillary nerve function, they’ll test the shoulder’s range of motion and skin sensitivity. A difference in the range of motion between the shoulders can indicate a nerve injury. Individuals may be sent for electromyography and a nerve conduction study to verify nerve palsy. In some cases, an MRI and/or X-rays may be ordered, especially if the cause of possible nerve damage is unknown.
Rehabilitation
Depending on the severity and cause of the injury, non-surgical treatments may be recommended, with surgery as a last resort. Non-surgical treatment can include some combination of immobilization, rest, ice, physical therapy, and anti-inflammatory meds. Physical treatment typically lasts about six weeks and focuses on strengthening and stimulating the muscles to prevent joint stiffness, which can impair long-term function.
Surgery
If conservative treatments don’t work, surgery may be recommended, especially if several months have passed without improvement. Surgical outcomes are generally better if surgery is performed within six months of the injury, and regardless of the time frame, the prognosis is considered positive in about 90% of cases. Surgical procedures performed for axillary nerve dysfunction or injury include:
Neurolysis
This procedure involves targeted damage/degeneration of nerve fibers, interrupts the nerve signals, and eliminates pain while the damaged area heals.
Neurorrhaphy
This procedure stitches a severed nerve back together.
Nerve Grafting
Grafting involves transplanting a portion of another nerve, usually the sural nerve, to reconnect severed nerves.
This helps, especially when the damaged portion is too large to be repaired by neurorrhaphy.
It allows a pathway for signals and encourages the regrowth of nerve axons.
Neurotization or Nerve Transfer
Similar to grafting but used when the nerve is too damaged to heal.
This procedure involves transplanting a healthy but less important nerve, or a portion of a nerve, to replace the damaged one and restore function.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Shoulder Pain Chiropractic Treatment
References
Subasinghe, S. K., & Goonewardene, S. (2016). A Rare Variation of the Axillary Nerve Formed as Direct Branch of the Upper Trunk. Journal of clinical and diagnostic research : JCDR, 10(8), ND01–ND2. doi.org/10.7860/JCDR/2016/20048.8255
Pizzo, R. A., Lynch, J., Adams, D. M., Yoon, R. S., & Liporace, F. A. (2019). Unusual anatomic variant of the axillary nerve challenging the deltopectoral approach to the shoulder: a case report. Patient safety in surgery, 13, 9. doi.org/10.1186/s13037-019-0189-1
Individuals experiencing persistent pain, weakness, numbness, and tingling in the back could be suffering from nerve root encroachment. Could surgery ease nerve compression and improve symptoms for persistent and severe cases?
Surgical Decompression
The pain, weakness, numbness, and tingling associated with nerve root encroachment are usually first treated with non-surgical therapies that include:
Anti-inflammatory medications
Physical therapy
This can be enough to address the irritation of the spinal nerve root. But when cases become severe, surgical decompression may be recommended and necessary. It can be done in a couple of different ways.
Causes and Symptoms
Vertebrae are bones in the spine. Small openings called foramina allow a spinal nerve root to pass through on each side of the vertebra. When nerve root encroachment is present, the spinal nerve root gets compressed, pinched, and trapped, which can cause peripheral symptoms such as numbness, tingling, pain, or weakness to develop. Nerve root encroachment is typically caused by normal aging degenerative wear and tear changes in the vertebrae. (Choi Y. K. 2019) These degenerative changes can include:
Facet joint hypertrophy
Ligament and bone hypertrophy
Disc disorders
Formation of bone spurs or osteophytes.
If these degenerative changes progress, they can encroach and compress a nerve root, leading to peripheral symptoms. (Choi Y. K. 2019)
When Surgery Is Recommended
When symptoms occur, initial treatment will involve:
Physical therapy
Chiropractic realignment
Massage therapies
Rest
Lifestyle adjustments
Nonsteroidal anti-inflammatories – NSAIDs
Corticosteroid injections into the spine
If conservative therapies don’t fully heal or improve symptoms or there are neurological problems like difficulty with balance or walking, then surgery may be recommended. Severe pain that limits normal function is an indication for surgery, and rapidly progressive weakness of the arms and/or legs or signs of cauda equina syndrome are indications for emergency surgery.
Surgery Options
Different types of spinal surgery may be performed. A neurosurgeon will decide the best procedure for each patient based on their case, age, medical conditions, and other factors. Specific spinal surgical decompression depends on what is causing the nerve compression. In most cases, it involves removing bone or tissue to relieve nerve pressure or provide support to stabilize the joint. The most common types of surgical decompression include: (Mayo Clinic Health System, 2022)
Maintain the stability and alignment of the spine.
Improve the stability and alignment of the spine.
Anterior Surgery
The anterior approach to surgery means that the spine is accessed through the anterior/front of the spine. In this surgery, one or more discs and bone spurs may be removed through an incision in the front of the neck. (American Association of Neurological Surgeons, 2024) For example, an anterior cervical discectomy may alleviate pressure on one or more nerve roots in the neck. With an anterior lumbar interbody fusion, a surgeon removes a degenerative disc in the lower spinal area by going through a patient’s lower abdomen. (American Association of Neurological Surgeons, 2024) After the disc is removed, a structural device, usually made of bone, fills the space where it once was. This device encourages bone healing and helps the vertebrae’s bodies fuse.
Posterior Surgery
Posterior surgery means the spine is accessed through the posterior/back of the spine. An example is removing a thickened ligament, bone spur, or disc material in the neck. To do this, a small incision in the back of the neck may be made to remove part of the back of the vertebrae called the lamina. This is called a posterior cervical laminectomy. (American Association of Neurological Surgeons, 2024) A posterior lumbar interbody fusion removes a degenerative disc by going through the back. (American Association of Neurological Surgeons, 2024) Like the anterior approach, a structural device often contains bone to fill the space where the disc once was to fuse the bones.
Potential Risks
As with any surgery, it’s important that the individual and their healthcare provider carefully discuss the benefits and risks. Spinal surgical decompression includes: (Proietti L. et al., 2013)
Bleeding
Blood clots
Surgical site infection
Urinary tract infection
Lung infection
Intestinal blockage
There are also specific risks to the area of the spine being operated on and how it is surgically approached. For example, a cervical anterior procedure may injure the esophagus, trachea, or carotid artery. Likewise, damage to the C5 nerve root/C5 palsy can occur from cervical spinal decompressive surgery. This complication causes weakness, numbness, and pain in the shoulders. (Thompson S. E. et al., 2017) The spinal cord may also be injured during surgery and result in paralysis, although this is rare. (American Association of Neurological Surgeons, 2024)
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
The Non-Surgical Solution
References
Choi Y. K. (2019). Lumbar foraminal neuropathy: an update on non-surgical management. The Korean journal of pain, 32(3), 147–159. doi.org/10.3344/kjp.2019.32.3.147
Proietti, L., Scaramuzzo, L., Schiro’, G. R., Sessa, S., & Logroscino, C. A. (2013). Complications in lumbar spine surgery: A retrospective analysis. Indian journal of orthopaedics, 47(4), 340–345. doi.org/10.4103/0019-5413.114909
Thompson, S. E., Smith, Z. A., Hsu, W. K., Nassr, A., Mroz, T. E., Fish, D. E., Wang, J. C., Fehlings, M. G., Tannoury, C. A., Tannoury, T., Tortolani, P. J., Traynelis, V. C., Gokaslan, Z., Hilibrand, A. S., Isaacs, R. E., Mummaneni, P. V., Chou, D., Qureshi, S. A., Cho, S. K., Baird, E. O., … Riew, K. D. (2017). C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases. Global spine journal, 7(1 Suppl), 64S–70S. doi.org/10.1177/2192568216688189
Can individuals maintain proper hydration levels in their bodies to prevent spinal pain and other musculoskeletal conditions?
Introduction
When making small changes to better their health and wellness, many understand that eating nutritional foods, exercising, and finding ways to reduce the pain and stress that environmental factors have affected the body. However, there is also another crucial component to a person’s health and wellness, and that is staying hydrated. Many individuals sometimes don’t realize that the human body contains about 60% of the water, which helps every vital organ, muscle, tissue, and vertebra in the body to function. However, many individuals who do not consume enough water due to a stressful event, exercising, or just wanting to drink sugary drinks will feel pain and discomfort in their bodies. This can range from mild headaches to back pain. Today’s article focuses on what spinal pain correlates with the back, why staying hydrated can reduce spinal pain and ways to stay hydrated. We talk with certified associated medical providers who inform our patients to maintain proper hydration to reduce the chances of spinal pain affecting their bodies. While asking their associated medical provider intricate questions, we advise patients to incorporate daily hydration levels as part of their routine to reduce the chances of spinal pain from returning. Dr. Alex Jimenez, D.C., includes this information as an academic service. Disclaimer.
Spinal Pain Is Correlated With The Back
Do you feel constant aches or pains after a stressful day? Do you feel like chugging gallons of water but still feel thirsty? Or have you been noticing that you have been dealing with limited mobility that has been causing you pain and discomfort in your lower back? These pain-like scenarios are multifactorial and can correlate with spinal pain affecting the back. Now, many people wonder why spinal pain is associated with back pain. The spine is crucial in allowing the individual to be upright and move around during daily activities. The spinal vertebrae discs are between the bones, which would enable shock absorption when a person twists, bends, or flexes so the bones don’t rub together. However, when the body ages, the spine does, too, which causes the intervertebral disc to gradually fall and change the dynamics of the affected spine segments. (Kos et al., 2019) To that point, when the intervertebral disc becomes compressed due to degeneration, it can lead to the development of back pain.
Since low back pain is a multifactorial musculoskeletal condition, many individuals often develop low back pain from numerous environmental risk factors like physical labor, excessive sitting or standing, poor dieting, andphysical inactivity, which can cause individuals to have a loss of sensation, reduced reflexes, limited range of movements and tenderness can affect a person’s gait and posture. (Kabeer et al., 2023) When the spinal discs are being compressed, the water inside the disc becomes dehydrated and is linked to lower back pain. (Cheung et al., 2023) When the spinal discs are dehydrated in the spine due to improper hydration, it can lead to immobility, cause the disc to degenerate, and cause spinal structural defects that cause the surrounding muscles and tissues to have biomechanical instability and inflammation. (Hauser et al., 2022) When the body starts dehydrating, it retrieves water from the spine and other parts to sustain life and keep the vital organs functioning.
Eating Right To Feel Better- Video
Why Staying Hydrated Can Reduce Spinal Pain
Proper hydration is key to reducing the chances of spinal pain. By staying hydrated with plain, pure water, individuals can stay focused, remove toxins from the body, aid in weight reduction, and reduce muscle and low back pain. (Nsiah-Asamoah & Buxton, 2021) Drinking at least 64 ounces of water a day can rehydrate the body and prevent future issues that can cause pain.Proper hydration allows the body to maintain cell activity and regulate body temperature, reducing the chances of pain affecting the body.
Ways to Stay Hydrated
There are ways to stay hydrated and allow the body to have proper hydration levels. Incorporating hydrating fruits and vegetables can help aid in proper hydration as these fruits and vegetables contain about 90% water and the essential nutrients. Additionally, when individuals try to get their hydration levels back up, they are encouraged to drink more fluids as they prefer, especially if they feel unwell. This is to ensure that the body is hydrated enough so that individuals can receive subcutaneous or intravenous fluid supplements combined with regular fluid intake. (Li et al., 2023) Another way many individuals can stay hydrated is to combine non-surgical treatments like chiropractic care and spinal decompression to help realign and lengthen the spine to reduce unwanted pressure on the spinal discs and rehydrate them. The combination of non-surgical treatments and drinking plenty of hydrating fluids can help many individuals dealing with back pain associated with the spine as they start to make small changes to their routine and can live a life pain-free.
References
Cheung, S. T. Y., Cheung, P. W. H., & Cheung, J. P. Y. (2023). Why Are Some Intervertebral Discs More Prone to Degeneration?: Insights Into Isolated Thoracic “Dysgeneration”. Spine (Phila Pa 1976), 48(12), E177-E187. doi.org/10.1097/BRS.0000000000004632
Hauser, R. A., Matias, D., Woznica, D., Rawlings, B., & Woldin, B. A. (2022). Lumbar instability as an etiology of low back pain and its treatment by prolotherapy: A review. J Back Musculoskelet Rehabil, 35(4), 701-712. doi.org/10.3233/BMR-210097
Kabeer, A. S., Osmani, H. T., Patel, J., Robinson, P., & Ahmed, N. (2023). The adult with low back pain: causes, diagnosis, imaging features and management. Br J Hosp Med (Lond), 84(10), 1-9. doi.org/10.12968/hmed.2023.0063
Kos, N., Gradisnik, L., & Velnar, T. (2019). A Brief Review of the Degenerative Intervertebral Disc Disease. Med Arch, 73(6), 421-424. doi.org/10.5455/medarh.2019.73.421-424
Li, S., Xiao, X., & Zhang, X. (2023). Hydration Status in Older Adults: Current Knowledge and Future Challenges. Nutrients, 15(11). doi.org/10.3390/nu15112609
Nsiah-Asamoah, C. N. A., & Buxton, D. N. B. (2021). Hydration and water intake practices of commercial long-distance drivers in Ghana: what do they know and why does it matter? Heliyon, 7(3), e06512. doi.org/10.1016/j.heliyon.2021.e06512
What type of concussion tests are there to help establish the extent of head injuries and help assess improvement during recovery?
Concussion Tests
A concussion is a temporary change in brain function that occurs from a traumatic brain injury or TBI. It can cause problems with thinking and mood and can take weeks to years to heal. Concussion tests are done after a suspected head injury and are also used after diagnosis to assess healing progress. They are noninvasive tests that measure brain functions. Several tests vary in how they are given and what they measure.
Tests
A mild or moderate traumatic brain injury can cause damage to the brain that is not detectable with brain imaging tests. However, the damage can cause serious symptoms, including headaches, emotional changes, difficulty concentrating, and memory problems. (Haider M. N. et al., 2021) The effects of a concussion can be hard to describe, but concussion testing can help identify and quantify these changes. For individuals who don’t have time to heal or experience further brain injuries while recovering, the effects can be prolonged and worsen. This is one reason why concussion testing is vital to get a diagnosis and follow medical recommendations to avoid further injury to the brain. Diagnosis can help set goals, adjust, and assess how the effects improve over time. With improvement, individuals can participate in rehabilitation and follow their doctor’s instructions for gradually returning to work, school, and other activities.
Measurements
Concussion tests can measure subtle aspects of brain function, like visual or auditory perception and response speed (Joyce A. S. et al., 2015). The damage sustained can impair these abilities, like slow decision-making. A traumatic brain injury can be associated with serious injuries, like a skull fracture, swelling, bruise, or bleeding in the brain. These injuries can be detected with imaging tests and often require surgery or other interventions. Brain damage from bleeding or swelling would cause focal neurological symptoms and signs, including partial vision loss, numbness, and weakness. Individuals can have a concussion along with detectable brain injuries or in the absence of detectable brain injuries.
Types of Tests
There are several types of concussion tests. Individuals may have one or more of these, depending on the standard test that is used in their school, sports league, or by their doctor. These can include:
Online Checklists
Several different online checklists are available for concussion screening.
These tests may include questions about symptoms and are often used as self-tests but are not intended to replace an evaluation by a medical professional.
Baseline and Post-Injury Tests
Many schools and sports leagues conduct preseason skill measurements, including memory tests or tests of speed and accuracy, either in an interview form or with computer testing.
Individuals might be asked to retake the test that is used as a comparison if they have experienced a traumatic brain injury.
Standardized Assessment of Concussion – SAC
This five-minute test can be done on the sidelines after a sports injury or later.
It evaluates orientation, immediate memory, neurologic function, concentration, and delayed recall. (Kaufman M. W. et al., 2021)
King-Devick Concussion Test
This two-minute test can be performed on the sidelines after a sports injury or later to assess language, eye movement, and attention. (Krause D. A. et al., 2022)
Post-Concussion Symptom Scale
This test includes 22 questions involving neurocognitive factors, including difficulty concentrating or remembering, physical symptoms like headaches and dizziness, and emotional symptoms like sadness or irritability. (Langevin P. et al., 2022)
Sport Concussion Assessment Tool – SCAT
This test includes an on-field assessment noting concussion symptoms, memory assessment using Maddocks questions (a short list of specific questions), Glasgow Coma Scale (GCS), and cervical spine assessment.
An off-field assessment involves the evaluation of cognitive, neurological, balance, and delayed recall. (Kaufman M. W. et al., 2021)
Buffalo Concussion Physical Examination – BCPE
A modified physical examination that assesses neck tenderness and range of motion, head, jaw, and face abnormalities, eye movements examination, and coordination. (Haider M. N. et al., 2021)
After a concussion, individuals will also have a physical examination, including a full neurological examination, in a doctor’s office.
Results
A doctor will diagnose based on symptoms, physical examination, and concussion test results. For example, for individuals who have broken several bones and are taking powerful pain medications, concussion test results can be abnormal even if they did not experience a concussion. The results of concussion testing can be compared with results before the head injury. Often, baseline testing is required for participation in certain sports leagues at professional and amateur levels. A low score can indicate that head injury has impaired brain function. Sometimes, testing can be done within a few hours of the head trauma and then again a few days later. Responses of individuals who did not have measurements taken before a head injury can be compared with the average results of people their age.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Lumbar Spine Injuries in Sports: Chiropractic Healing
References
Haider, M. N., Cunningham, A., Darling, S., Suffoletto, H. N., Freitas, M. S., Jain, R. K., Willer, B., & Leddy, J. J. (2021). Derivation of the Buffalo Concussion Physical Examination risk of delayed recovery (RDR) score to identify children at risk for persistent postconcussive symptoms. British journal of sports medicine, 55(24), 1427–1433. doi.org/10.1136/bjsports-2020-103690
Joyce, A. S., Labella, C. R., Carl, R. L., Lai, J. S., & Zelko, F. A. (2015). The Postconcussion Symptom Scale: utility of a three-factor structure. Medicine and science in sports and exercise, 47(6), 1119–1123. doi.org/10.1249/MSS.0000000000000534
Kaufman, M. W., Su, C. A., Trivedi, N. N., Lee, M. K., Nelson, G. B., Cupp, S. A., & Voos, J. E. (2021). The Current Status of Concussion Assessment Scales: A Critical Analysis Review. JBJS reviews, 9(6), e20.00108. doi.org/10.2106/JBJS.RVW.20.00108
Krause, D. A., Hollman, J. H., Breuer, L. T., & Stuart, M. J. (2022). Validity Indices of the King-Devick Concussion Test in Hockey Players. Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine, 32(3), e313–e315. doi.org/10.1097/JSM.0000000000000938
Langevin, P., Frémont, P., Fait, P., & Roy, J. S. (2022). Responsiveness of the Post-Concussion Symptom Scale to Monitor Clinical Recovery After Concussion or Mild Traumatic Brain Injury. Orthopaedic journal of sports medicine, 10(10), 23259671221127049. doi.org/10.1177/23259671221127049
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