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.
Can individuals incorporate decompression to reduce spinal disc pressure on their lower backs to restore their quality of life?
Introduction
The spine has a wonderful relationship with the human body as it is part of the musculoskeletal system. The spine has many components allow the body to be mobile and help stabilize the different muscle groups around the upper and lower portions. When the body is in motion, the spine starts to compress the spinal discs between the spinal column, which helps reduce the vertical axial load. Many people with highly demanding jobs will often use repetitive motions that cause the spinal disc to be constantly compressed. When the spinal disc starts to be continuously compressed, it can eventually crack over time from the immense pressure. It can aggravate the surrounding nerves that can cause referred pain-like symptoms in the upper and lower extremities. To that point, it can lead to a life of disability if it is not treated right away. Luckily, numerous treatments can help reduce the immense pressure from the spinal discs and reduce the pain-like symptoms from the upper and lower extremities. Today’s article looks at how spinal pressure affects the lower back and how decompression can help reduce spinal pressure on the lower back. We speak with certified medical providers who incorporate our patients’ information to provide various solutions to relieve spinal pressure on the spine. We also inform patients how treatments like decompression can reduce vertical axial pressure on the lower back. We encourage our patients to ask intricated and educational questions to our associated medical providers about the pain-like symptoms they are experiencing correlating with spinal pressure affecting their lower back. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer.
How Does Spinal Pressure Affect The Lower Back?
Have you felt any muscle aches or stiffness in your lower back after bending down to pick up an object? What about feeling excruciating pain in your lower back that is radiating to your neck or your legs? Or do you feel pain in one location of your back that is not going away after rest? When many individuals are in pain, and home remedies are not providing the relief they deserve, they could be dealing with spinal pressure that is affecting their back. When people start to do repetitive motions to their bodies, the spinal disc will begin to crack and shrink depending on the environmental factor the pain is associated with.
Regarding spinal pressure in the lower back, the disc is thicker and the most susceptible to injury. When it comes to spinal pressure related to disc herniation, it can lead to many individuals dealing with lower back pain and can affect their quality of life. One of the symptoms of disc herniation that are correlated with spinal pressure is that the displacement of the spinal disc can cause pain and disability in the spine as a result of a traumatic injury or degenerative changes due to the natural aging process. (Chu et al., 2023) When working, individuals put constant pressure on their spines, which can speed up the development of lower back pain.
Additionally, when there is immense spinal pressure on the spine, many pain-like issues that individuals don’t normally have will begin to pop up. This is due to a focal displacement of the intervertebral disc material that is beyond the normal limit of the spine and compresses one or more nerve roots, which can cause musculoskeletal issues to arise. (Trager et al., 2022) This, in turn, causes radiating extremity pain on the upper and lower body portions, sensory disturbances, muscle weakness, and even diminished muscle stretch reflexes as pain-like symptoms in the lower back. At the same time, when individuals are experiencing low back pain associated with spinal pressure, their truck muscles have an abnormal tilt when sitting, standing, and walking. (Wang et al., 2022) When this happens, it can cause them to develop poor posture, and when they are in an upright position, they will feel pain in their lower backs due to weak truck muscles. However, there are ways to relieve spinal pressure from aggravating the nerve roots affecting the lower back.
The Non-Surgical Approach To Wellness-Video
When looking for the right treatment, many individuals want to look for something that is cost-effective and relieves their pain. Non-surgical treatments are cost-effective and utilize various techniques to help reduce musculoskeletal pain through mechanical and manual motions to strengthen weakened muscles, relieve spinal pressure off the disc, and help realign the body to promote healing properties. The video above shows how non-surgical treatments like chiropractic care can help many individuals get their foot on the right on their health and wellness journey. At the same time, spinal decompression is another form of non-surgical treatment as it incorporates gentle traction on the spine to reduce intervertebral pressure during active and passive traction. (Andersson et al., 1983) When the spine is gently pulled, the herniated disc starts to return to its original position back to the spine, which then allows the fluids and nutrients to return to the disc and rehydrate them.
Decompression Reducing Spinal Pressure On Lower Back
So, how does spinal decompression help reduce disc pressure off the spine when dealing with low back pain? As stated earlier, spinal decompression incorporates gentle traction on the spine to be gently pulled to stretch weak surrounding muscles in the lower back. This causes an inverse relationship as the pressure within the nucleus pulposus of the herniated disc can help improve posture for many individuals with low back pain. (Ramos & Martin, 1994) Similarly, when many people incorporate decompression and chiropractic, the pain intensity is significantly reduced in all body parts, and many individuals will begin to feel the relief they deserve. (Ljunggren et al., 1984) When many individuals listen to their bodies and get the treatment they deserve, they will start to notice how decompression can help restore their bodies and positively improve their health.
References
Andersson, G. B., Schultz, A. B., & Nachemson, A. L. (1983). Intervertebral disc pressures during traction. Scand J Rehabil Med Suppl, 9, 88-91. https://www.ncbi.nlm.nih.gov/pubmed/6585945
Chu, E. C., Lin, A., Huang, K. H. K., Cheung, G., & Lee, W. T. (2023). A Severe Disc Herniation Mimics Spinal Tumor. Cureus, 15(3), e36545. https://doi.org/10.7759/cureus.36545
Ljunggren, A. E., Weber, H., & Larsen, S. (1984). Autotraction versus manual traction in patients with prolapsed lumbar intervertebral discs. Scand J Rehabil Med, 16(3), 117-124. https://www.ncbi.nlm.nih.gov/pubmed/6494835
Ramos, G., & Martin, W. (1994). Effects of vertebral axial decompression on intradiscal pressure. J Neurosurg, 81(3), 350-353. https://doi.org/10.3171/jns.1994.81.3.0350
Trager, R. J., Daniels, C. J., Perez, J. A., Casselberry, R. M., & Dusek, J. A. (2022). Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States’ data. BMJ Open, 12(12), e068262. https://doi.org/10.1136/bmjopen-2022-068262
Can individuals with herniated pain associated with low back pain find relief through spinal decompression to restore mobility?
Introduction
Many people worldwide have experienced pain in the back region and often complain that it affects their mobility when doing their normal routine. The musculoskeletal system has various muscles, soft tissues, joints, ligaments, and bones that help surround the spine and protect the vital organs. The spine consists of bones, joints, and nerve roots that have an outstanding relationship with the central nervous system and musculoskeletal system as the spinal cord is protected by the spinal joints and discs that have the nerve roots spread out and help provide the sensory-motor function to the upper and lower extremities. When various pathogens or environmental factors start to cause the spine to compress the spinal discs constantly, it can lead to herniation and affect the body’s mobility over time. Individuals, both young and old, will notice that the pain is not going away from home remedies and may have to seek out treatment if the pain is too much. However, it can lead to dealing with unnecessary stress when looking for affordable treatment. Today’s article looks at how herniation can affect low back mobility and how treatments like decompression can help restore the spine. We speak with certified medical providers who incorporate our patients’ information to provide various solutions to restore low back mobility to the spine. We also inform patients how treatments like decompression can restore the spine’s mobility to the body. We encourage our patients to ask intricated and educational questions to our associated medical providers about the pain-like symptoms they are experiencing correlating with disc herniation affecting the spine. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer.
Disc Herniation Affecting Low Back Mobility
Do you often experience stiffness or limited mobility in your lower back that causes you to walk a little slower than usual? Do you feel pain in your lower back muscles from stretching or bending down to pick up an object? Or do you feel numbness or tingling sensations down your legs that feel uncomfortable? When many individuals start to do repetitive motions, that can cause their spinal discs to compress over time and eventually become herniated. When many individuals overwork their bodies, their spinal discs can eventually crack, causing the inner portion to protrude and press on the surrounding nerve root. This causes the disc tissue to have a central ballon-type cyst that causes degenerative changes, leading to low back pain and herniation. (Ge et al., 2019)
At the same time, when many individuals start to deal with lower back pain from herniated discs, they will begin to lose mobility in their lower backs. This could be due to weak abdominal muscles combined with limited mobility. When many individuals do not have strong core muscles to provide support and mobility to their lower backs, it can start with simple muscle aches, leading to constant lower back pain without treatment and negatively impacting their quality of life. (Chu, 2022) However, dealing with low back pain does not have to be tedious as numerous therapies can reduce the effects of low back pain correlated with disc herniation while restoring low back spinal mobility.
The Science Of Motion-Video
Have you ever experienced unquestionable muscle aches that radiate from your lower back and travel down your legs? Do you feel stiffness when bending down to pick up an object that causes muscle strain on your lower back? Or do you feel pain in your lower back from excessive sitting or standing? When many people are dealing with these pain-like issues in their lower backs, it can lead to a life of disability while affecting their quality of life. This is due to a disc herniation that affects a person’s lower back mobility and, when not treated right away, can lead to chronic issues. However, many individuals will seek treatment for their lower back pain and find the relief they need. Many therapeutic exercises combined with non-surgical treatments can help retrain the weakened trunk muscles to stabilize the lower back better and help reduce lower back pain. (Hlaing et al., 2021) When individuals start to think about their health and wellness, especially when they are dealing with low back pain affecting their mobility, they will find that most of the pain is from normal, repetitive factors that cause their spinal disc to be compressed and herniated. Hence, applying traction to the lumbar spine can help reduce lumbar disc protrusion that causes low back pain. (Mathews, 1968) Treatments like chiropractic care, traction therapy, and spinal decompression are all non-surgical treatments that are cost-effective and gentle on the spine. They help realign the body and help kick start the body’s natural healing factor to rehydrate the spinal discs. When many individuals start to do continuous treatment to reduce their lower back pain associated with herniated discs, they will begin to see improvements in their spinal mobility and their pain diminished. Check out the video above to look at how non-surgical treatments can help restore mobility to the body and reduce pain-like symptoms.
Decompression Restoring The Spine
When it comes to reducing pain-like symptoms caused by disc herniation that is causing limited mobility and low back pain, spinal decompression could be the answer that many individuals are looking for to incorporate into their health and wellness routine. Since lumbar herniated spinal discs are a common cause of low back pain and radiculopathy, spinal decompression can help gently pull the herniated disc back to its original position to promote healing. Since spinal decompression and lumbar traction are part of the physiotherapy treatment, they can help decrease the pain intensity from the spine and reduce the size of the herniated disc. (Choi et al., 2022) When many individuals feel relief from the gentle pull from spinal decompression, they will notice that their mobility is back. After consecutive treatment, their pain will be diminished as their spinal disc is completely healed. (Cyriax, 1950) With many individuals who are looking for numerous treatments to reduce their lower back pain and regain their sense of life, incorporating these treatments can provide beneficial results to their musculoskeletal system.
References
Choi, E., Gil, H. Y., Ju, J., Han, W. K., Nahm, F. S., & Lee, P. B. (2022). Effect of Nonsurgical Spinal Decompression on Intensity of Pain and Herniated Disc Volume in Subacute Lumbar Herniated Disc. International Journal of Clinical Practice, 2022, 6343837. https://doi.org/10.1155/2022/6343837
Chu, E. C. (2022). Large abdominal aortic aneurysm presented with concomitant acute lumbar disc herniation – a case report. J Med Life, 15(6), 871-875. https://doi.org/10.25122/jml-2021-0419
Ge, C. Y., Hao, D. J., Yan, L., Shan, L. Q., Zhao, Q. P., He, B. R., & Hui, H. (2019). Intradural Lumbar Disc Herniation: A Case Report and Literature Review. Clin Interv Aging, 14, 2295-2299. https://doi.org/10.2147/CIA.S228717
Hlaing, S. S., Puntumetakul, R., Khine, E. E., & Boucaut, R. (2021). Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial. BMC Musculoskelet Disord, 22(1), 998. https://doi.org/10.1186/s12891-021-04858-6
For individuals trying to maintain a healthy spine, can understanding the causes and prevention of rotated vertebrae help protect the spine from harmful rotation of vertebrae?
Spinal Rotation
Healthy spine rotation is an important aspect of injury prevention, and rotated vertebrae or a twisted spine can result from spine, nerve, or muscle disease or certain movements.
Normal Spine Twisting Capability
The spine can move in several ways. Spine movements include:
Bending – Rounding forward
Extending – Arching backward
Tilting sideways is powered by muscles that aid in twisting.
Although the spine can move in many directions, there are limits to how far it can and should go. (Xinhai Shan et al., 2013). This is especially true with twisting. The spinal column is made of 26 interconnected bones called vertebrae. When moving, each vertebrae bone moves accordingly. Rotated or twisted vertebrae, especially when bending forward like lifting heavy objects, are associated with a risk of back injuries like strain and herniated discs.
How Rotation Works
Rotation is a basic movement in which individuals can turn their spinal column. When twisting, the spine also bends to the side. The muscles involved in spine rotation include:
The internal oblique abdominals and the external oblique abdominals don’t directly attach to the spine but are the primary muscles responsible for powering spinal rotation in the lower back.
Intrinsic muscles, including the multifidus and longissimus, contribute to twisting movement as well.
The multifidus helps the spine twist when one side is contracted/activated and extends the lumbar spine when both sides contract.
The multifidus helps control the movement, and the longissimus provides the movement with some extension.
Age and The Spine
As individuals age, the body accumulates tension and/or weakness in the oblique abdominal and other trunk muscles. Sedentary habits primarily bring on these changes. (Pooriput Waongenngarm et al., 2016)
Chronically tight back and abdominal muscles impair the range of motion of the trunk, as well as twisting ability.
Muscle weakness and tightness affect spinal movements.
Weakened muscles can decrease support for spinal movement and decrease overall trunk stability.
Spinal Rotation and Scoliosis
Scoliosis is a common condition that causes a lateral curve of the spine. Some of the vertebrae become displaced to the side. Often, abnormal vertebral rotation underlies this displacement. Treatment often focuses on controlling vertebral rotation with medical guidance and physical therapy. (John P. Horne et al., 2014)
Over-Rotating The Spine
Many individuals over-rotate their spines with manual work, which can increase the risk of back injuries. (National Institutes of Health. 2020). Over-rotation can happen with activities like digging or shoveling.
Exercise For A Healthy Spine
A recommended way to achieve optimal rotation of the spine is with daily back exercises. (National Spine Health Foundation. 2015). An effective back exercise program will consist of movements in every direction.
Yoga is recommended because it places emphasis on developing flexibility and strength in all directions.
Pilates does the same.
An injury prevention exercise program will work the hip and pelvic muscles as well.
Individuals with a spine condition should consult their healthcare provider or physical therapist about how to exercise the spine safely, as rotation exercises could worsen back problems like bulging or herniated discs.
Core Strength For A Pain-Free Back
References
Shan, X., Ning, X., Chen, Z., Ding, M., Shi, W., & Yang, S. (2013). Low back pain development response to sustained trunk axial twisting. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 22(9), 1972–1978. https://doi.org/10.1007/s00586-013-2784-7
Waongenngarm, P., Rajaratnam, B. S., & Janwantanakul, P. (2016). Internal Oblique and Transversus Abdominis Muscle Fatigue Induced by Slumped Sitting Posture after 1 Hour of Sitting in Office Workers. Safety and health at work, 7(1), 49–54. https://doi.org/10.1016/j.shaw.2015.08.001
For individuals experiencing tightness in the lower back and hamstrings, can utilizing the sit and reach test help determine an individual’s risk for future pain and injury?
Sit and Reach Test
Lower back and hamstring tightness and pain symptoms are usually brought on by muscle stiffness. The sit-and-reach test is one of the most common ways to measure lower back and hamstring flexibility. Exercise physiologists, physical therapists, chiropractors, and fitness trainers use the sit-and-reach test to measure lower back and hamstring flexibility to assess baseline flexibility. The test has been around since 1952 (Katharine F. Wells & Evelyn K. Dillon 2013) and has an extensive database of results across all age groups and genders.
Individuals can use the sit-and-reach test to compare flexibility to the average result for individuals of the same gender and age.
For healthcare providers, the test may be repeated after several weeks to determine flexibility progress.
Measurement
The test can be a valuable measurement of functional flexibility to sit with the legs straight in front and reach the toes. Jobs, sports, and everyday tasks regularly require bending over, reaching, and lifting objects. These are real-life examples of how having a healthy back and hamstring flexibility is vital in preventing pain symptoms and injuries. New flexibility assessments are currently being developed, and many trainers and therapists use their own versions with patients and clients. But even with more advanced specialized flexibility tests, the sit and reach test can be a functional testing tool for tracking general flexibility changes over time. (Daniel Mayorga-Vega et al., 2014)
Performing The Test
A special sit-and-reach testing box is used; however, individuals can make their own testing box by finding a heavy-duty box around 30cm or 11.811 inches tall. Set a measurement ruler/stick on top of the box so that 26 cm or 10.2362 inches of the ruler extends over the front edge toward the individual being tested. The 26cm mark should be at the edge of the box.
Get into position – Remove shoes and sit on the floor with legs stretched out in front with the knees straight and feet flat against the front end of the test box.
Start the movement – In a slow, steady motion, lean forward, keeping the knees straight, and slide the hands up the ruler as far as possible.
Stretch and repeat – Extend as far as possible, record the results, rest, and repeat three times.
Calculate the results – Average the results.
Results
Results compare flexibility over time to norms, or averages, for gender and age. Adequate flexibility is reaching the toes – the 26-cm mark on the ruler while keeping the legs straight.
Adult Women
37cm or 14.5669 inches or above: Excellent
33 to 36cm or 12.9921 inches: Above average
29 to 32cm or 11.4173 inches: Average
23 to 28cm or 9.05512 inches: Below average
Below 23cm or 8.66142 inches: Poor
Adult Men
34cm or 13.3858 inches or above: Excellent
28 to 33cm or 11.0236 inches: Above average
23 to 27cm or 9.05512 inches: Average
16 to 22cm or 6.29921 inches: Below average
Below 16cm or 5.90551 inches: Poor
Alternatives
Individuals can test their own hamstring and lower back flexibility with some easy at-home tests. Use these methods while working on flexibility, and keep a record to see improvements. (Brittany L. Hansberger et al., 2019) One alternative is the V-sit reach test.
To perform this, make a line on the floor with tape, then place a measuring tape perpendicular to the tape, making a cross.
Sit with the feet in a V shape, touching the tape, feet about a foot apart, with the measuring tape between the legs; the 0 end starts where the legs part.
Overlap hands with arms outstretched in front.
Repeat three times, leaning forward and reaching with hands out.
Then, repeat and take note of how far the hands could reach.
Individuals will need someone to measure the distance between their fingertips and the floor.
Warm up with a few practice stretches of standing and bending toward the floor.
Then, measure how far from the floor the fingertips are.
The ability to touch the floor is a good sign.
Improving Flexibility
Individuals with less than adequate flexibility are recommended to work on stretching the major muscle groups in both the upper and lower body on a regular basis to improve and maintain body flexibility.
Individuals can incorporate dynamic stretching, which consists of active movements utilizing a full range of motion as part of warming up for workouts, sports, or other activities.
Static stretching is recommended when cooling down after the muscles are warmed up and joints are lubricated.
The American College of Sports Medicine recommends 2 to 3 sessions a week of flexibility training and learning to stretch daily.
Stretches should be held for 15 to 30 seconds, then released and repeated 2 to 4 times. (Phil Page 2012)
This will take time and dedication, but with the help of trained specialists, regaining flexibility and full range of motion can be accomplished.
Benefits of Stretching
References
Katharine F. Wells & Evelyn K. Dillon (1952) The Sit and Reach—A Test of Back and Leg Flexibility, Research Quarterly. American Association for Health, Physical Education and Recreation, 23:1, 115-118, DOI: 10.1080/10671188.1952.10761965
Mayorga-Vega, D., Merino-Marban, R., & Viciana, J. (2014). Criterion-Related Validity of Sit-and-Reach Tests for Estimating Hamstring and Lumbar Extensibility: a Meta-Analysis. Journal of sports science & medicine, 13(1), 1–14.
Hansberger, B. L., Loutsch, R., Hancock, C., Bonser, R., Zeigel, A., & Baker, R. T. (2019). EVALUATING THE RELATIONSHIP BETWEEN CLINICAL ASSESSMENTS OF APPARENT HAMSTRING TIGHTNESS: A CORRELATIONAL ANALYSIS. International journal of sports physical therapy, 14(2), 253–263.
Page P. (2012). Current concepts in muscle stretching for exercise and rehabilitation. International journal of sports physical therapy, 7(1), 109–119.
Individuals experiencing pain symptoms like shooting, stabbing, or electrical sensations to the latissimus dorsi of the upper back could be caused by a nerve injury to the thoracodorsal nerve. Can knowing the anatomy and symptoms help healthcare providers develop an effective treatment plan?
Thoracodorsal Nerve
Also known as the middle subscapular nerve or the long subscapular nerve, it branches out from a part of the brachial plexus and provides motor innervation/function to the latissimus dorsi muscle.
Anatomy
The brachial plexus is a network of nerves that stem from the spinal cord in the neck. The nerves supply most of the sensation and movement of the arms and hands, with one on each side. Its five roots come from the spaces between the fifth through eighth cervical vertebrae and the first thoracic vertebra. From there, they form a larger structure, then divide, re-combine, and divide again to form smaller nerves and nerve structures as they travel down the armpit. Through the neck and chest, the nerves eventually join and form three cords that include:
Lateral cord
Medial cord
Posterior cord
The posterior cord produces major and minor branches that include:
Axillary nerve
Radial nerve
The minor branches include:
Superior subscapular nerve
Inferior subscapular nerve
Thoracodorsal nerve
Structure and Position
The thoracodorsal nerve branches off the posterior cord in the armpit and travels down, following the subscapular artery, to the latissimus dorsi muscle.
It connects to the upper arm, stretches across the back of the armpit, forming the axillary arch, and then expands into a large triangle that wraps around the ribs and the back.
The thoracodorsal nerve lies deep in the latissimus dorsi, and the lower edge typically reaches close to the waist.
Variations
There is a standard location and course of the thoracodorsal nerve, but individual nerves are not the same in everyone.
The nerve typically branches off the posterior cord of the brachial plexus from three different points.
The lats can have a rare anatomical variation known as a Langer’s arch, which is an extra part that connects to muscles or connective tissue of the upper arm beneath the common connecting point.
In individuals with this abnormality, the thoracodorsal nerve supplies function/innervation) to the arch. (Ahmed M. Al Maksoud et al., 2015)
Function
The latissimus dorsi muscle cannot function without the thoracodorsal nerve. The muscle and nerve help:
Stabilize the back.
Pull the body weight up when climbing, swimming, or doing pull-ups.
Assist with breathing by expanding the rib cage during inhalation and contracting when exhaling. (Encyclopaedia Britannica. 2023)
Rotate the arm inward.
Pull the arm toward the center of the body.
Extend the shoulders by working with the teres major, teres minor, and posterior deltoid muscles.
Bring down the shoulder girdle by arching the spine.
Pain that can be shooting, stabbing, or electrical sensations.
Numbness, tingling.
Weakness and loss of function in the associated muscles and body parts, including wrist and finger drop.
Because of the nerve’s path through the armpit, doctors have to be cautious of the anatomical variants so they don’t inadvertently damage a nerve during breast cancer procedures, including axillary dissection.
The procedure is performed to examine or remove lymph nodes and is used in staging breast cancer and in treatment.
According to a study, 11% of individuals with axillary lymph node dissection suffered damage to the nerve. (Roser Belmonte et al., 2015)
Breast Reconstruction
In breast reconstruction surgery, the lats can be used as a flap over the implant.
Depending on the circumstances, the thoracodorsal nerve can be left intact or severed.
There is some evidence that leaving the nerve intact can cause the muscle to contract and dislocate the implant.
An intact thoracodorsal nerve may also cause atrophy of the muscle, which can lead to shoulder and arm weakness.
Graft Uses
A portion of the thoracodorsal nerve is commonly used in nerve graft reconstruction to restore function after injury, which includes the following:
Musculocutaneous nerve
Accessory nerve
Axillary nerve
The nerve can also be used to restore nerve function to the triceps muscle in the arm.
Rehabilitation
If the thoracodorsal nerve is injured or damaged, treatments can include:
Braces or splints.
Physical therapy to improve range of motion, flexibility, and muscle strength.
If there is compression, surgery may be required to alleviate the pressure.
Exploring Integrative Medicine
References
Chu B, Bordoni B. Anatomy, Thorax, Thoracodorsal Nerves. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539761/
Al Maksoud, A. M., Barsoum, A. K., & Moneer, M. M. (2015). Langer’s arch: a rare anomaly affects axillary lymphadenectomy. Journal of surgical case reports, 2015(12), rjv159. https://doi.org/10.1093/jscr/rjv159
Britannica, The Editors of Encyclopaedia. “latissimus dorsi“. Encyclopedia Britannica, 30 Nov. 2023, https://www.britannica.com/science/latissimus-dorsi. Accessed 2 January 2024.
Belmonte, R., Monleon, S., Bofill, N., Alvarado, M. L., Espadaler, J., & Royo, I. (2015). Long thoracic nerve injury in breast cancer patients treated with axillary lymph node dissection. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 23(1), 169–175. https://doi.org/10.1007/s00520-014-2338-5
Kwon, S. T., Chang, H., & Oh, M. (2011). Anatomic basis of interfascicular nerve splitting of innervated partial latissimus dorsi muscle flap. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 64(5), e109–e114. https://doi.org/10.1016/j.bjps.2010.12.008
Postural orthostatic tachycardia syndrome is a medical condition that causes lightheadedness and palpitations after standing. Can lifestyle adjustments and multidisciplinary strategies help reduce and manage symptoms?
Postural Orthostatic Tachycardia Syndrome – POTS
Postural orthostatic tachycardia syndrome, or POTS, is a condition that varies in severity from relatively mild to incapacitating. With POTS:
The heart rate increases dramatically with body position.
This condition often affects young individuals.
Most individuals with postural orthostatic tachycardia syndrome are women between the ages of 13 and 50.
Some individuals have a family history of POTS; some individuals report POTS began after an illness or stressor, and others report it began gradually.
It usually resolves over time.
Treatment can be beneficial.
Diagnosis is based on assessing blood pressure and pulse/heart rate.
Symptoms
Postural orthostatic tachycardia syndrome can affect young individuals who are otherwise healthy and can begin suddenly. It usually happens between the ages of 15 and 50, and women are more likely to develop it than men. Individuals can experience various symptoms within a few minutes of standing up from a lying or seated position. The symptoms can occur regularly and daily. The most common symptoms include: (National Institutes of Health. National Center for Advancing Translational Sciences. Genetic and Rare Diseases Information Center. 2023)
Anxiety
Lightheadedness
A feeling like you’re about to pass out.
Palpitations – sensing rapid or irregular heart rate.
Dizziness
Headaches
Blurred vision
Legs turn to reddish-purple.
Weakness
Tremors
Fatigue
Sleep problems
Trouble concentrating/brain fog.
Individuals may also experience recurrent episodes of fainting, usually without any trigger/s other than standing up.
Individuals can experience any combination of these symptoms.
Sometimes, individuals cannot handle sports or exercise and may feel light-headed and dizzy in response to mild or moderate physical activity, which can be described as exercise intolerance.
Associated Effects
Postural orthostatic tachycardia syndrome can be associated with other dysautonomia or nervous system syndromes, like neurocardiogenic syncope.
Individuals are often co-diagnosed with other conditions like:
Chronic fatigue syndrome
Ehlers-Danlos syndrome
Fibromyalgia
Migraines
Other autoimmune conditions.
Bowel conditions.
Causes
Usually, standing up causes blood to rush from the torso to the legs. The sudden change means less blood is available for the heart to pump. To compensate, the autonomic nervous system sends signals to the blood vessels to constrict to push more blood to the heart and maintain blood pressure and a normal heart rate. Most individuals do not experience significant changes in blood pressure or pulse when standing up. Sometimes, the body is unable to perform this function correctly.
If blood pressure drops from standing and causes symptoms like lightheadness, it is known as orthostatic hypotension.
If the blood pressure remains normal, but the heart rate gets faster, it is POTS.
The exact factors that cause postural orthostatic tachycardia syndrome are different in individuals but are related to changes in:
The autonomic nervous system, adrenal hormone levels, total blood volume, and poor exercise tolerance. (Robert S. Sheldon et al., 2015)
Autonomic Nervous System
The autonomic nervous system controls blood pressure and heart rate, which are the areas of the nervous system that manage internal bodily functions like digestion, respiration, and heart rate. It is normal for blood pressure to drop slightly and the heart rate to speed up a little when standing. With POTS, these changes are more pronounced.
POTS is considered a type of dysautonomia, which is diminished regulation of the autonomic nervous system.
Several other syndromes are also thought to be related to dysautonomia, like fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome.
It isn’t clear why the syndrome or any of the other types of dysautonomia develop, but there seems to be a familial predisposition.
Sometimes the first episode of POTS manifests after a health event like:
Pregnancy
Acute infectious illness, for example, a severe case of influenza.
An episode of trauma or concussion.
Major surgery
Diagnosis
A diagnostic evaluation will include a medical history, a physical examination, and diagnostic tests.
The healthcare provider will take blood pressure and pulse at least twice. Once while lying down and once while standing.
Blood pressure measurements and pulse rate lying down, sitting, and standing are orthostatic vitals.
Typically, standing up increases the heart rate by 10 beats per minute or less.
With POTS, heart rate increases by 30 beats per minute while blood pressure remains unchanged. (Dysautonomia International. 2019)
The heart rate stays elevated for over a few seconds upon standing/usually 10 minutes or more.
Symptoms happen frequently.
Lasts more than a few days.
Positional pulse changes are not the only diagnostic consideration for postural orthostatic tachycardia syndrome, as individuals can experience this change with other conditions.
During this test, blood pressure and pulse are measured several times when lying on a table and when the table is moved to an upright position.
Differential Diagnosis
There are various causes of dysautonomia, syncope, and orthostatic hypotension.
Throughout the evaluation, the healthcare provider may look at other conditions, like dehydration, deconditioning from prolonged bed rest, and diabetic neuropathy.
Medications like diuretics or blood pressure medication can cause similar effects.
Treatment
Several approaches are used in managing POTS, and individuals may require a multidisciplinary approach. The healthcare provider will advise regularly checking blood pressure and pulse at home to discuss the results when going in for medical checkups.
Fluids and Diet
Drinking non-caffeinated fluids can keep the body hydrated.
A healthcare provider can calculate the right amount of fluids that are needed each day.
Overnight dehydration is common, so it is especially important to drink fluids first thing in the morning, preferably before getting out of bed and standing.
Exercise and physical therapy can help the body learn to adjust to an upright position.
Because it can be challenging to exercise when dealing with POTS, a targeted exercise program under supervision may be required.
An exercise program may begin with swimming or using rowing machines, which do not require upright posture. (Dysautonomia International. 2019)
After a month or two, walking, running, or cycling may be added.
Studies have shown that individuals with POTS, on average, have smaller cardiac chambers than individuals who don’t have the condition.
Regular aerobic exercise has been shown to increase cardiac chamber size, slow heart rate, and improve symptoms. (Qi Fu, Benjamin D. Levine. 2018)
Individuals must continue an exercise program for the long term to keep symptoms from returning.
Medication
Prescription medications to manage POTS include midodrine, beta-blockers, pyridostigmine – Mestinon, and fludrocortisone. (Dysautonomia International. 2019)
Ivabradine, used for the heart condition of sinus tachycardia, has also been used effectively in some individuals.
Conservative Interventions
Other ways to help prevent symptoms include:
Sleeping in the head-up position by elevating the head of the bed off the ground 4 to 6 inches utilizing an adjustable bed, blocks of wood, or risers.
This increases the blood volume in circulation.
Performing countermeasure maneuvers like squatting, squeezing a ball, or crossing the legs. (Qi Fu, Benjamin D. Levine. 2018)
Wearing compression stockings to prevent too much blood from flowing into the legs when standing can help avoid orthostatic hypotension. (Dysautonomia International. 2019)
Conquering Congestive Heart Failure
References
National Institutes of Health. National Center for Advancing Translational Sciences. Genetic and Rare Diseases Information Center (GARD). (2023). Postural orthostatic tachycardia syndrome.
Sheldon, R. S., Grubb, B. P., 2nd, Olshansky, B., Shen, W. K., Calkins, H., Brignole, M., Raj, S. R., Krahn, A. D., Morillo, C. A., Stewart, J. M., Sutton, R., Sandroni, P., Friday, K. J., Hachul, D. T., Cohen, M. I., Lau, D. H., Mayuga, K. A., Moak, J. P., Sandhu, R. K., & Kanjwal, K. (2015). 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart rhythm, 12(6), e41–e63. https://doi.org/10.1016/j.hrthm.2015.03.029
For individuals affected by headaches that occur 15 or more days a month for more than three months, can knowing the signs and symptoms help healthcare providers help treat and prevent chronic tension headaches?
Chronic Tension Headaches
Most individuals have experienced a tension-type headache. The pain is usually described as a dull tightening or pressure on both sides of the head, like having a tightening band around the head. Some individuals experience these headaches frequently, a condition known as chronic tension headaches. Chronic tension headaches are uncommon but can be debilitating, as they can interfere with a healthy quality of life and daily living.
Tension headaches are typically caused by stress, anxiety, dehydration, fasting, or lack of sleep and usually resolve with over-the-counter medications. (Cleveland Clinic. 2023)
This is a primary headache disorder that affects around 3% of the population.
Chronic tension headaches can occur daily and negatively impact the quality of life and daily functioning. (Cleveland Clinic. 2023)
Symptoms
Tension headaches can be referred to as stress headaches or muscle contraction headaches.
They can present with dull, aching pain and include tightness or pressure across the forehead, sides, or back of the head. (Cleveland Clinic. 2023)
Additionally, some individuals experience tenderness on the scalp, neck, and shoulders.
Chronic tension headaches materialize 15 or more days a month on average for more than three months.
The headache can last for several hours or be continuous for several days.
Causes
Tension headaches are typically caused by tight muscles in the shoulders, neck, jaw, and scalp.
Teeth grinding/bruxism and jaw clenching can also contribute to the condition.
Headaches can be brought on by stress, depression, or anxiety and are more common in individuals who:
Individuals experiencing headaches that interfere with daily life or need to take medication more than twice a week are recommended to consult a healthcare provider. Before the appointment, it can be helpful to keep a headache diary:
Record the days
Times
Description of the pain, intensity, and other symptoms.
Some questions the healthcare provider may ask include:
Is the pain pulsating, sharp, or stabbing, or is it constant and dull?
Where is the pain most intense?
Is it all over the head, on one side, on the forehead, or behind the eyes?
Do the headaches interfere with sleep?
Is working or doing tasks difficult or impossible?
A healthcare provider will likely be able to diagnose the condition based on symptoms alone. However, if the headache pattern is unique or different, the provider may order imaging tests, like MRI or CT scans, to rule out other diagnoses. Chronic tension headaches can be confused with other chronic daily headache disorders like chronic migraine, hemicrania continua, temporomandibular joint dysfunction/TMJ, or cluster headaches. (Fayyaz Ahmed. 2012)
Treatment
Pharmacological therapy for chronic tension headaches usually involves preventive medication.
Amitriptyline is one medication that has been found to be beneficial in chronic tension headache prevention.
According to a meta-analysis of 22 published studies in the Journal of General Internal Medicine, these medications are superior to placebo in reducing headache frequency, with an average of 4.8 fewer headache days per month.
Additional preventive medications may include other antidepressants like:
Remeron – mirtazapine.
Anti-seizure medications – like Neurontin – gabapentin, or Topamax – topiramate.
A healthcare provider may also prescribe medication to treat headache episodes, which include:
Prescription non-steroidal anti-inflammatory drugs or NSAIDs, including acetaminophen, naproxen, indomethacin, or ketorolac.
Opiates
Muscle relaxants
Benzodiazepines – Valium
Non-Medication Treatment
Behavioral therapies are sometimes used on their own or in combination with medication to prevent and manage chronic tension headaches. Examples include:
Acupuncture
An alternative therapy that involves using needles to stimulate specific points on the body believed to connect with certain pathways/meridians that carry vital energy/chi throughout the body.
Biofeedback
In Electromyography – EMG biofeedback, electrodes are placed on the scalp, neck, and upper body to detect muscle contraction.
The process can be costly and time-consuming, and there is little evidence to support its effectiveness.
Physical Therapy
A physical therapist can work out stiff and tight muscles.
Train individuals on stretches and targeted exercises for loosening tight head and neck muscles.
Cognitive Behavioral Therapy/CBT
Involves learning how to identify headache triggers and cope in a less stressful and more adaptive way.
Headache specialists often recommend CBT in addition to medication when developing a treatment plan. (Katrin Probyn et al., 2017)
Teeth-grinding and jaw-clenching training/treatment can help when they are contributors.
Regular exercise, as well as practicing healthy sleep hygiene, can be beneficial in prevention.
Supplements
Some individuals with chronic tension headaches may find relief using supplements. The American Academy of Neurology and the American Headache Society report the following supplements can be effective: (National Center for Complementary and Integrative Health. 2021)
Butterbur
Feverfew
Magnesium
Riboflavin
If the headaches come on suddenly, cause waking up from sleep, or last for days, it’s important to consult a healthcare provider to rule out any underlying causes and develop a personalized treatment plan.
Ahmed F. (2012). Headache disorders: differentiating and managing the common subtypes. British journal of pain, 6(3), 124–132. https://doi.org/10.1177/2049463712459691
Jackson, J. L., Mancuso, J. M., Nickoloff, S., Bernstein, R., & Kay, C. (2017). Tricyclic and Tetracyclic Antidepressants for the Prevention of Frequent Episodic or Chronic Tension-Type Headache in Adults: A Systematic Review and Meta-Analysis. Journal of general internal medicine, 32(12), 1351–1358. https://doi.org/10.1007/s11606-017-4121-z
Probyn, K., Bowers, H., Mistry, D., Caldwell, F., Underwood, M., Patel, S., Sandhu, H. K., Matharu, M., Pincus, T., & CHESS team. (2017). Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components. BMJ open, 7(8), e016670. https://doi.org/10.1136/bmjopen-2017-016670
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
