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.
How do healthcare professionals provide a clinical approach to recognizing HIV for individuals in pain and providing relief?
Introduction
The human body has dealt with various environmental factors, injuries, and pathogens that can cause issues to the body system. As many individuals are always on the go from one location to another, being healthy is extremely important. Making time to make an appointment for a person’s health and well-being is extremely important, as many people have experienced comorbidities and overlapping risk profiles that are causing them pain. When individuals experience onset issues of fatigue, muscle and joint pain, or immune disorders, many healthcare professionals must assess the situation and ask the individuals when they experienced these overlapping risk profiles and how they affect their daily activities. One of the overlapping risk profiles that seems to affect the body is a viral infection known as Human Immunodeficiency Virus or HIV. This can get many healthcare professionals to come up with a personalized treatment plan to reduce these overlapping risk profiles and educate the individual on what to do to manage HIV symptoms. Today’s article looks at how HIV can impact a person, their symptoms, and non-surgical treatments to manage HIV. We discuss with certified associated medical providers who consolidate our patients’ information to assess the effects of HIV and its associated symptoms. We also inform and guide patients on how to be aware of the impact of HIV and ask their associated medical providers intricate questions to integrate a customized treatment plan to incorporate multiple non-surgical therapies to manage the symptoms. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
What Is HIV?
Do you constantly feel tired even after taking a good night’s rest? Do you feel your throat being sore without the flu symptoms? Or are you experiencing muscle and joint pain in different locations of your body? Worldwide, many individuals have often experienced these symptoms from a viral infection known as Human Immunodeficiency Virus or HIV. HIV belongs to the retroviridae family, which targets the body’s immune system, especially the CD4+ T cells. The CD4+T cells play an important role in the body’s immune response, but when HIV starts to deplete the receptors and terminate the host cells. (Masenga et al., 2023) This causes individuals to have acute stages of HIV and, if not treated immediately, can lead to the progression of severe stages. However, how do individuals contract HIV? Well, the most common mode is through unprotected sexual intercourse, sharing needles, or through maternal-infant exposure, which diminishes the T-helper cell population and, over time, can increasingly weaken the immune system. (van Heuvel et al., 2022) This causes many individuals to develop various symptoms from HIV that can vary, depending on the severity and the progression stages of the virus.
The Symptoms
Now, for the progression of HIV to infect the body’s immune system and cause various symptoms to affect the individual, many healthcare professionals have to look at the process of the host’s exosomes and their correlation role with HIV. The generational process of exosomes causes overlapping risk profiles with the viral assembly of HIV as exosomes can transport the virus from the infected cells to the uninfected cells of the body by helping it regulate the host’s immune response to the virus infection. (Chen et al., 2021) To that point, it can lead to the progression of several stages of HIV and its associated symptoms. When a person is dealing with an HIV infection in its acute stages, the symptoms can be mild and easily mistaken for a common viral infection. Some of the symptoms can include:
Muscle aches
Joint pain
Difficulty falling asleep
Fatigue
Neuropathy
Shortness of breath
Swollen glands
This is because the inflammatory cytokines from the immune system are heightened and influenced by HIV. When inflammatory cytokines become associated with HIV, symptoms have a huge impact on an individual’s life, causing them to be miserable. (Schnall et al., 2020) Additionally, when HIV is in a clinical latency stage, the virus is less active but can still replicate without exhibiting any symptoms in the body. However, when HIV progresses to its severe stage, it can lead to the development of AIDS. Luckily, treatment advancements to treat HIV from its acute stages can help manage the associated symptoms.
The Non-Surgical Approach To Wellness- Video
Non-Surgical Treatments For HIV
When it comes to treating HIV, non-surgical treatments can help manage its associated symptoms while dramatically improving the life expectancy and quality of life of the individual who is affected by the virus. For non-surgical treatments, the main goal is to diagnose HIV as early as possible and to assess the situation by coming up with new and innovative HIV testing initiatives to increase the frequency and prevention of HIV in both clinical and non-clinical settings. (Delaney & DiNenno, 2021) Below are some non-surgical treatments to manage HIV.
Antiretroviral Treatments
Now, some of the non-surgical treatments to manage HIV is by taking antiretroviral therapy. This allows the individual with HIV to be more mindful of taking antiretroviral medications daily, which then helps improve sustained viral suppression of HIV and provides effective strategies of therapeutic approaches to enhance antiretroviral activities. (Huerta, 2020) Additionally, the primary goal of antiretroviral therapy is to reduce the HIV load to an undetectable level, keep the immune system functioning, and prevent the progression development of AIDS.
Lifestyle Adjustments
While living with HIV today is vastly different from decades past, thanks to significant medical advancements. Many individuals can go to their healthcare providers for an early diagnosis and effective treatment to live long and healthy lives. Awareness, education, and staying proactive with health checks remain key in the fight against HIV and its progression. Additionally, proper nutrition, regular exercise, and mental health support are also crucial for people living with HIV, helping to boost the immune system and manage symptoms. At the same time, regular visits to a healthcare provider for blood tests are essential to monitor the effectiveness of ART and adjust the treatment regimen as needed to live a healthier life.
References
Chen, J., Li, C., Li, R., Chen, H., Chen, D., & Li, W. (2021). Exosomes in HIV infection. Curr Opin HIV AIDS, 16(5), 262-270. doi.org/10.1097/COH.0000000000000694
Delaney, K. P., & DiNenno, E. A. (2021). HIV Testing Strategies for Health Departments to End the Epidemic in the U.S. Am J Prev Med, 61(5 Suppl 1), S6-S15. doi.org/10.1016/j.amepre.2021.06.002
Huerta, L. (2020). Editorial: Anti-infective 2020: HIV-From pathogenesis to treatment. Curr Opin Pharmacol, 54, x-xii. doi.org/10.1016/j.coph.2020.12.001
Masenga, S. K., Mweene, B. C., Luwaya, E., Muchaili, L., Chona, M., & Kirabo, A. (2023). HIV-Host Cell Interactions. Cells, 12(10). doi.org/10.3390/cells12101351
Schnall, R., Jia, H., & Reame, N. (2020). Association Between HIV Symptom Burden and Inflammatory Cytokines: An Analysis by Sex and Menopause Stage. J Womens Health (Larchmt), 29(1), 119-127. doi.org/10.1089/jwh.2019.7749
van Heuvel, Y., Schatz, S., Rosengarten, J. F., & Stitz, J. (2022). Infectious RNA: Human Immunodeficiency Virus (HIV) Biology, Therapeutic Intervention, and the Quest for a Vaccine. Toxins (Basel), 14(2). doi.org/10.3390/toxins14020138
Can physical therapies help relieve muscle contractures in individuals who have endured prolonged bed rest, inactivity, or lack of use of certain muscle groups?
Muscle Contracture
A muscle contracture, or contracture deformity, is caused when a muscle loses elasticity. This causes permanent shortening and tightening of muscle fibers, which reduces flexibility and makes movement difficult. Muscles that cannot move and stretch cause the surrounding joints to lose mobility and develop pain symptoms. When trying to stretch the contracted muscle, the individual will feel the muscle become very rigid, which can increase pain. (Lieber, R. L., and Fridén, J. 2019) Delaying treatment can potentially cause irreversible and chronic symptoms.
Commonly Affected Muscles
Flexor muscles bend the joints and are those most affected by contractures. The stiffening and tightening prevent the body parts from moving out and away. The most common include:
Wrist and Finger Flexors
Muscle groups that bend the wrist and fingers.
Biceps
The primary elbow flexor that bends the arm.
Gastrocnemius and Soleus
The calf muscles which allow the ankle to point the foot/plantarflexion.
Hamstrings
A group of three muscles behind the thigh that bend the knee.
Causes
The permanent shortening of muscle fibers and changes in muscle structure cause muscle contractures or stiffer-than-normal tissue that is difficult to stretch. Sarcomeres are structural units of muscles that cause fibers to contract.
With contractures, the sarcomeres overly lengthen when the muscle fibers tighten. This increase in sarcomere length prevents the muscle from contracting normally, resulting in weakness. Muscle fibers are encased in an extracellular matrix, a mesh composed of collagen and other proteins that help transmit force and provide muscle contraction. Muscle contractures cause the amount of collagen within the extracellular matrix to increase, causing a stiffening of fibers that restricts movement. (Lieber, R. L., and Fridén, J. 2019)
Muscle contractures also form from decreased satellite cells. Satellite cells are specialized stem cells that can rebuild muscle and are necessary for muscle regeneration and repair. Without the proper amount of satellite cells, other cells like fibroblasts significantly increase in the muscle tissue, causing the fibers to become stiff and fibrotic or more fibrous. These changes to the sarcomeres, collagen within the extracellular matrix, and decreased satellite cells all result from conditions in which neurological input to the brain and spinal cord muscles becomes reduced. This is caused by lack of use, injury, or neurological and neuromuscular conditions. (Lieber, R. L., and Fridén, J. 2019)
Cerebral Palsy
Contractures often occur from upper motor neuron lesions, which prevent signals from the brain and spinal cord from reaching the motor neurons that control muscle contraction. When these signals are weakened or blocked, muscles become stiff and weak from lack of stimulation. (Lieber, R. L., and Fridén, J. 2019)
Cerebral palsy is a group of disorders affecting mobility caused by an upper motor neuron lesion that is present at birth and is the most common motor disability in children. It causes:
Cognitive impairment
Decreased muscle strength
Problems with movement, coordination, and functional motions.
Because cerebral palsy prevents the muscles of the legs from being sufficiently stimulated, contractures commonly develop in the hips, knees, and ankles. Individuals can have a 75% decrease in satellite cells to repair muscle tissue and prevent muscle fibrosis or stiffening. Specific genes linked to collagen production are also altered, causing irregular changes to the extracellular matrix of muscles. (Lieber, R. L., and Fridén, J. 2019)
Muscular Dystrophy
Muscular dystrophy is a group of inherited neuromuscular disorders characterized by muscle weakness and wasting. Deficient nerve supply to muscles causes them to become stiff and tight, inhibiting the functional range of motion needed to move joints and activate muscles to move. Clinical research suggests that individuals with muscular dystrophy have decreased levels of satellite cells to repair, increasing the risk of developing muscle contracture. (Lieber, R. L., and Fridén, J. 2019)
Disuse-induced Muscle Wasting or Disuse Atrophy
When muscles are not used for some time because of hospitalization, prolonged bed rest, or immobilization from wearing braces, splints, or casts after injuries, the blood circulation and electrical signaling from nerves to muscles decreases. This results in weakness, increased muscle tightness and stiffness, and muscle wasting/atrophy. Over time, stiff and tight muscles can progress to contractures that become extremely difficult to stretch.
Trauma or Injury
Muscle or tendon injuries can cause contractures as scar tissue develops, joining muscle fibers and joints together. This can significantly restrict movement. Large burns can also cause skin, muscles, and joint contractures. The range of motion can become significantly limited, and the changes can become irreversible if not aggressively treated.
Other Causes
Other forms of upper motor neuron lesions that can cause contractures because of weak or blocked electrical input to muscles as a result of brain or spinal cord damage include:
Neuromuscular disorders like spinal muscular atrophy – SMA.
Conditions that cause inflammation and joint stiffening, like juvenile rheumatoid arthritis.
A history of diabetes also increases the risk of developing contractures affecting finger flexors, like Dupuytren’s contractures and stenosing tenosynovitis
or trigger finger. (Lieber, R. L., and Fridén, J. 2019)
Symptoms
Symptoms include:
Extremely stiff and tight muscles resistant to stretching.
Pain from the inability to stretch.
Loss of range of motion.
Impaired joint mobility.
Severe contractures can interfere with the functional range of motion needed to move joints to complete normal tasks and movements, such as standing up from a chair and walking.
Treatment
Physical Therapy
Physical therapies can help reduce the severity through stretching and soft tissue mobilization to decrease tightness. (Lieber, R. L., and Fridén, J. 2019)
Specialized braces or splints can be custom-made to fit different body parts.
These provide a prolonged low-intensity stretch over a period of time to increase muscle length.
Once the muscle has stretched, a new brace or splint may be needed to adjust to the increased range of motion. (Lieber, R. L., and Fridén, J. 2019)
Surgery
In severe cases where muscle contractures limit the functional range of motion needed for activities of daily living or ADLs, surgical release of the contracted tissue may be recommended. This surgery can improve functional movements like walking, getting in and out of bed, and standing up from chairs. The tight muscles can be surgically cut, and the tendons can be lengthened to allow more mobility. (Lieber, R. L., and Fridén, J. 2019)
The causes of muscle contracture are not always avoidable, but various treatment options are available to help loosen up tight muscles and preserve or restore the range of motion. It’s important to move daily and stretch common areas like the fingers, arms, and legs to reduce the risk of muscle tightness and prevent contractures from developing. It is imperative to seek medical treatment for severe contractures resulting from neuromuscular disorders, including physical and occupational therapy, to prevent contractures from worsening and regaining as much functional range as possible.
Injury Medical Chiropractic and Functional Medicine Clinic uses an integrated approach personalized to the individual that focuses on what works for them and treats injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers use an integrated approach to create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Our goal is to relieve pain naturally by restoring health and function to the body. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Chiropractic Treatment for Cerebral Palsy
References
Lieber, R. L., & Fridén, J. (2019). Muscle contracture and passive mechanics in cerebral palsy. Journal of applied physiology (Bethesda, Md. : 1985), 126(5), 1492–1501. doi.org/10.1152/japplphysiol.00278.2018
Can the thoracolumbar fascia cause or contribute to lower back pain and inflammation?
Thoracolumbar Fascia
Tissue behind the spinal column, positioned at both the lower back and mid-back levels, is connected to the thoracolumbar fascia, also called the lumbodorsal fascia or LF. The fascia is a thick connective tissue that covers and supports all the body’s muscles, bones, tendons, ligaments, and organs. The fascia also contains nociceptive nerve endings, also known as free nerve endings, that arise from the central nervous system, i.e., the brain and spinal cord, which may be responsible for some forms of back pain and stiffness caused by injury or inflammation.
Anatomy
The thoracolumbar fascia is divided into three layers:
Many of the back muscles attach to the thoracolumbar fascia. The erector spinae muscle group, known as the paraspinals, runs longitudinally down the spine. They are attached to the thoracolumbar fascia and the bony spine. The lumbar part of the posterior layer of the thoracolumbar fascia extends from the lowest rib to the top of the hip bone or the iliac crest. On the same path, it connects with the transverse abdominal muscle. The thoracolumbar fascia connections help bridge the back muscles to the abdominal wall muscles. The latissimus dorsi, a large back muscle that bears and moves the body’s weight with the arms and shoulders, is also connected to the thoracolumbar fascia, with the fibers extending outward from the fascia. The front part of the thoracolumbar fascia, or anterior layer, covers a muscle called the quadratus lumborum. This muscle bends the trunk to the side, helps maintain a healthy posture, and is often focused on muscle-related lower back pain.
What the Fascia Does
The thoracolumbar fascia, examined from the back of an anatomical drawing or diagram, is diamond-shaped. Its shape, large size, and central location uniquely position it to unify and synchronize the upper body’s movements with the lower body’s. The fascia’s fibers are very strong, enabling the tissue sheath to lend support (Willard, F. H. et al., 2012) . The tissue is also flexible, enabling it to help circulate forces of movement and contralateral movements as the back muscles contract and relax. An example is walking.
Back Pain
Scientists and doctors don’t know for sure, but it’s possible that the thoracolumbar fascia may contribute to lower back pain. A study found that the fascia may generate back pain based on: (Wilke, J. et al., 2017)
Sustaining micro-injuries and/or inflammation, which are often related, may cause signal changes in the free nerve endings in the fascia. Nerve endings acquire information from the outer areas of the body, like skin and other fascia, and relay it back to the central nervous system. The theory is that when the fascia close to the skin becomes injured, damaged, and/or backed up with inflammatory chemicals and substances, it is communicated as pain and other sensations back to the brain and spinal cord.
After a back injury, tissues tighten and stiffen. Some studies of patients with back pain noted alterations in their thoracolumbar fascia.
Injuries tend to stimulate nerves, which can lead to increased sensitivity.
Injury Medical Chiropractic and Functional Medicine Clinic focuses on and treats injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers use an integrated approach to create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Our goal is to relieve pain naturally by restoring health and function to the body. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Sciatica, Causes, Symptoms, and Tips
References
Willard, F. H., Vleeming, A., Schuenke, M. D., Danneels, L., & Schleip, R. (2012). The thoracolumbar fascia: anatomy, function and clinical considerations. Journal of anatomy, 221(6), 507–536. doi.org/10.1111/j.1469-7580.2012.01511.x
Wilke, J., Schleip, R., Klingler, W., & Stecco, C. (2017). The Lumbodorsal Fascia as a Potential Source of Low Back Pain: A Narrative Review. BioMed research international, 2017, 5349620. doi.org/10.1155/2017/5349620
Can various stretches can help relieve individuals with plantar fasciitis to reduce foot pain and restore gait function?
Introduction
As human beings, we are constantly on the move, and our feet are the ones that take a toll after a long day. The feet have various muscles, ligaments, tendons, and soft tissues that help protect the joints and provide stability. The feet are part of the lower body extremities that aid in mobility and strength of the upper body. When many individuals are constantly on their feet, the muscles and ligaments become overworked and can develop into pain-like issues. Most of the time, it is just muscle aches and pain; however, when repetitive motions start to cause more problems on the feet, it can lead to micro tears in the foot’s fascia. This, in turn, can lead to the development of plantar fasciitis, affecting a person’s gait ability. Today’s article looks at how plantar fasciitis affects gait function and how various stretches can help alleviate plantar fasciitis. We discuss with certified associated medical providers who consolidate our patients’ information to assess plantar fasciitis and its associated comorbidities. We also inform and guide patients on various stretches for plantar fasciitis and ask their associated medical providers intricate questions to integrate a customized treatment plan to incorporate multiple stretches to reduce the pain-like symptoms correlated with it. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
How Plantar Fasciitis Affects Gait Function
Do you feel like you are walking crooked from one location to another? Do you feel a stabbing pain when you take your first steps? Or do you feel constant pain in your feet while you are resting? As stated earlier, many individuals are constantly on their feet and have dealt with some pain that can affect their quality of life. Since the feet are part of the lower body extremities, a person experiencing a lot of pain in their heels can lead to a chronic musculoskeletal condition known as plantar fasciitis. The plantar fascia plays a huge part in the human body as it helps with the normal biomechanics of the foot, supports the arch, and provides shock absorption when a person is stepping. (Buchanan et al., 2024) When a person has been doing repetitive motions on their feet, it can lead to the development of plantar fasciitis. Plantar fasciitis is a common musculoskeletal disease that causes chronic degenerative changes in the plantar fascia. This musculoskeletal disease is also associated with mechanical factors such as repetitive stress and weight bearing that can lead to microtears in the muscle fibers. (Tseng et al., 2023) That point causes many individuals to have gait issues and other comorbidities.
Some risk factors correlated with plantar fasciitis are decreased ROM in plantarflexion and increased tensile load, which can cause many individuals to have gait issues while walking. (Hamstra-Wright et al., 2021) Since many individuals rely on walking and are experiencing pain from plantar fasciitis, not only their gait function is being affected, butthe surrounding muscles in the legs are also affected. Pain symptoms like intrinsic muscle weakness, reduced muscle strength on the legs and dorsiflexion, leg length discrepancy, and arch deformity can increase the chances of plantar fasciitis developing. (Khammas et al., 2023) This can cause many individuals to have gait dysfunction since the pain can be unbearable. Additionally, when people deal with plantar fasciitis, they shift their weight to one side of their bodies to reduce the pain and allow their secondary muscles to take on the unnecessary weight load. Luckily, there are ways to minimize the pain-like effects of plantar fasciitis and help restore a person’s gait function.
What is Plantar Fasciitis?-Video
Effective Stretches To Alleviate Plantar Fasciitis
When it comes to reducing plantar fasciitis, many individuals seek various treatments to reduce the pain-like symptoms causing their gait dysfunction. Many individuals seek non-surgical and surgical treatments to find the right solution for their plantar fasciitis. Depending on the severity of the pain affecting their feet, the main objective is to reduce tissue compressive load and provide a personalized treatment plan to educate and treat plantar fasciitis. (Morrissey et al., 2021) One of the best ways to reduce the pain from plantar fasciitis is by incorporating various stretches. Various stretches for plantar fasciitis can be effective as they can help relieve pain and enhance muscle strength in the extrinsic and intrinsic foot muscles. (Boonchum et al., 2020) Below are some stretches that many people dealing with plantar fasciitis can do at home to relieve the pain.
Towel Stretch
This simple stretch is perfect for the morning, especially before taking your first steps.
How to do it:
Sit alongside the bed with your legs straight in front of you.
Loop a towel around the ball of the feet and hold each end with your hands.
Pull the towel towards you while trying to keep the knees straight until you feel a stretch along the bottom of your foot and calf.
Hold the position for 15 to 30 seconds.
Repeat 2-3 times for each foot.
Calf Stretches
Tight calf muscles can exacerbate plantar fasciitis. Stretching your calves can relieve the pressure on your plantar fascia.
How to do it:
Stand near a wall with one foot back and one foot in front of you.
Keep your back heel on the ground and bend your front knee until you feel a stretch in the back leg’s calf muscle.
Hold for about 30 seconds and switch.
Repeat 2-3 times for each leg.
Plantar Fascia Stretch
Directly stretching the plantar fascia can help alleviate pain and improve foot function.
How to do it:
Sit with your affected foot and place it over the opposite side.
Use your hand to pull your toes back towards the shin until you feel a stretch along the arch of your foot.
Hold the stretch for at least 15 seconds and repeat the stretch three times.
Achilles Tendon Stretch
This stretch helps both the calf muscles and the plantar fascia.
How to do it:
Stand with your affected foot behind you.
Keep your heel down and bend your knee slightly.
Hold the position for 15-20 seconds, then relax.
Repeat 2-3 times for each leg.
Marble Pickup
Strengthening the muscles around your foot can also support the healing process.
How to do it:
Sit in a chair
Then, place 20 marbles and a bowl on the floor before your feet.
Use your toes to pick up one marble and place it into a bowl one at a time.
Repeat until you have all the marbles in the bowl.
References
Boonchum, H., Bovonsunthonchai, S., Sinsurin, K., & Kunanusornchai, W. (2020). Effect of a home-based stretching exercise on multi-segmental foot motion and clinical outcomes in patients with plantar fasciitis. J Musculoskelet Neuronal Interact, 20(3), 411-420. www.ncbi.nlm.nih.gov/pubmed/32877978
Hamstra-Wright, K. L., Huxel Bliven, K. C., Bay, R. C., & Aydemir, B. (2021). Risk Factors for Plantar Fasciitis in Physically Active Individuals: A Systematic Review and Meta-analysis. Sports Health, 13(3), 296-303. doi.org/10.1177/1941738120970976
Khammas, A. S. A., Mahmud, R., Hassan, H. A., Ibrahim, I., & Mohammed, S. S. (2023). An assessment of plantar fascia with ultrasound findings in patients with plantar fasciitis: a systematic review. J Ultrasound, 26(1), 13-38. doi.org/10.1007/s40477-022-00712-0
Morrissey, D., Cotchett, M., Said J’Bari, A., Prior, T., Griffiths, I. B., Rathleff, M. S., Gulle, H., Vicenzino, B., & Barton, C. J. (2021). Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. Br J Sports Med, 55(19), 1106-1118. doi.org/10.1136/bjsports-2019-101970
Tseng, W. C., Chen, Y. C., Lee, T. M., & Chen, W. S. (2023). Plantar Fasciitis: An Updated Review. J Med Ultrasound, 31(4), 268-274. doi.org/10.4103/jmu.jmu_2_23
Can physical therapies help treat a high steppage gait from injury or medical conditions and restore normal gait patterns for individuals who have or are developing one?
Walking or gait anthropometric analysis on a treadmill
Neuropathic Gait
Neuropathic gait, aka equine or high steppage gait, is a type of walking abnormality that causes individuals to raise their hips to lift their legs higher than normal. It occurs when individuals have a foot drop or ankle equinus due to loss of dorsiflexion. As a result, the foot hangs with the toes pointing down, causing the toes to drag while walking. The foot may appear floppy when it drops. Foot drop is caused by weakness or paralysis of the anterior tibialis muscle in front of the shin bone. The anterior tibialis muscle contracts to help flex the foot and ankle while walking, ensuring the foot clears the floor and doesn’t drag. Individuals with anterior tibialis weakness or paralysis may have a neuropathic gait and excessively bend the hip and knee while stepping forward, lifting their leg high off the floor to clear the foot to avoid tripping. A physical therapy team can help with a high steppage gait pattern after illness or injury.
Causes
Conditions that can cause anterior tibialis weakness or paralysis and a high steppage gait pattern include:
Sciatica
Pain caused by compression or irritation of the sciatic nerve starts in the lower back and travels down the back of the leg. (McCabe, F. J., McCabe, J. P. 2016)
Peroneal Nerve Injury
Damage to the peroneal nerve branches from the sciatic nerve that help move the lower leg and foot. (Johns Hopkins Medicine. 2024)
Multiple Sclerosis
An autoimmune disease that damages nerve cells in the brain and spinal cord. (Taylor, P. N. et al., 2016)
Balance exercises will help improve overall proprioception, or the sense of the body’s position and movement.
Neuromuscular electrical stimulation, or NMES, can help improve the function of the muscle. (Hollis, S., McClure, P. 2017)
The electrical stimulation artificially contracts the muscle to restore proper function.
For anterior tibialis weakness caused by sciatica, back decompression exercises may be prescribed to relieve pressure off the sciatic nerve.
The exercises release the nerve to restore normal signal transmission up and down the nerve in the lower back.
Neuromuscular electrical stimulation may also be used to help improve muscle function.
Assistive Walking Devices
A therapist may suggest using an assistive device to help the patient walk properly. This could include a wheeled walker or a quad cane. A temporary solution to anterior tibialis weakness is to elevate the foot while walking with an elastic band. Tie a band around the leg below the knee and secure it around the ball of the foot. When swinging the leg forward, the band pulls the foot up. Using it as a temporary solution may help maintain safe mobility. Sometimes, paralysis of the anterior tibialis muscle can become permanent. In this case, individuals may benefit from a special brace called an ankle-foot orthosis. The brace helps to lift the foot and toes off the ground.
For individuals concerned about losing their balance and falling, there are ways to improve walking patterns to stay safe. A healthcare provider may recommend physical therapy to correct gait, strengthen the anterior tibialis muscle, improve balance, and educate on injury prevention. Individuals should discuss symptoms and conditions with a primary physician, healthcare provider, or specialist to guide them in the right direction and determine the best treatment.
Injury Medical Chiropractic and Functional Medicine Clinic uses an integrated approach personalized to the individual that focuses on what works for them and treats injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Control Foot Motion and Posture
References
McCabe, F. J., & McCabe, J. P. (2016). An Unusual Presentation of Right-Sided Sciatica with Foot Drop. Case reports in orthopedics, 2016, 9024368. doi.org/10.1155/2016/9024368
Kaykisiz, E. K., & Unluer, E. E. (2017). An Unexpected Reason for Isolated Foot Drop: Acute Stroke. Pakistan journal of medical sciences, 33(5), 1288–1290. doi.org/10.12669/pjms.335.13593
Taylor, P. N., Wilkinson Hart, I. A., Khan, M. S., & Slade-Sharman, D. E. (2016). Correction of Footdrop Due to Multiple Sclerosis Using the STIMuSTEP Implanted Dropped Foot Stimulator. International journal of MS care, 18(5), 239–247. doi.org/10.7224/1537-2073.2015-038
Hollis, S., & McClure, P. (2017). Intramuscular Electrical Stimulation for Muscle Activation of the Tibialis Anterior After Surgical Repair: A Case Report. The Journal of orthopaedic and sports physical therapy, 47(12), 965–969. doi.org/10.2519/jospt.2017.7368
Can various stretches provide beneficial results for individuals experiencing TMJ pain by providing relief to the jaw?
Introduction
Many individuals use their jaws to communicate with one another, eat delicious food, and express themselves. The jaw is part of the upper extremities as it has five muscles that allow it to function when the mouth is opening or closing, chewing, and moving from side to side. When common motor functions like yawning, chewing, or speaking produce loud pops or clicks, it can become very painful and more often lead to temporomandibular joint dysfunction or TMJ. TMJ is a joint disorder that can affect a person’s ability to use their jaws properly and can lead to visceral-somatic disorders that can affect the upper extremities, causing them to be miserable. Luckily, many individuals can incorporate various stretches to reduce the impact of TMJ and help relax the stiff muscles around the jaw. Today’s article looks at the effects of TMJ, how various stretches can effectively reduce TMJ, and how additional non-surgical treatments can relieve TMJ pain. We discuss with certified associated medical providers who consolidate our patients’ information to assess pain-like issues associated with TMJ. We also inform and guide patients on various stretches for TMJ and ask their associated medical providers intricate questions to integrate a customized treatment plan to reduce the pain-like issues affecting their jaws. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
The Effects of TMJ
Do you feel stiffness in your jaw after clenching for an extended period? Do you hear excessive loud clicks when opening or closing your jaw? Or do you think your jaw is locking up constantly, making it difficult to open or close your mouth? When many individuals start to feel pain around their jaws excessively, many would often think that it could be tooth pain, but in actuality, it is the temporomandibular joint that is causing the issues. Temporomandibular joint disorder, or TMJ, can be developed through various causes that can impact a person’s jaw and can lead to pain and discomfort. Mechanical factors like jaw injuries, arthritis, teeth clenching, and grinding can cause excessive or unbalanced joint loading to the jaw, which can progress the development of TMJ. (Cardoneanu et al., 2022) When dealing with TMJ, pain can lead to symptoms of tenderness around the joint area of the jaw, difficulty chewing, ear pain, and stiffness.
At the same time, the effects of TMJ pain are often characterized by localized discomfort, as TMJ is a multifactorial musculoskeletal and neuromuscular disorder that can be difficult to diagnose. (Alolayan et al., 2022) This is because of how many individuals chew their foods on one side, which can lead to its development. When the masseter muscles of the jaw begin to overload on the TMJ, it can initiate remodeling on the non-working side of the jaw and cause the pain to flourish over time. (Santana-Mora et al., 2013) However, when dealing with TMJ pain, many individuals can seek out various treatment options that can reduce muscular impairment and disc displacement from the jaw and help improve the mandibular range of motion. (Brighenti et al., 2023)
The Science of Motion-Video
Why Stretching Helps With TMJ
When it comes to reducing TMJ pain, many individuals can seek out non-surgical treatments to reduce the overlapping pain symptoms and restore jaw function. Some of the main objectives that many pain specialists can take into account when dealing with TMJ pain are reducing reflex masticatory muscle pain and helping increase TMJ function through various treatments that can have a positive impact on the jaw. (Ferrillo et al., 2022) Some non-surgical treatments include multiple stretches to help relax the surrounding muscles and jaw and alleviate the tension and discomfort associated with TMJ.
Effective Stretches For TMJ Relief
Stretching can be part of a person’s personalized treatment plan to reduce TMJ pain and its associated comorbidities. Stretching and strengthening exercises can positively affect pain while improving the range of TMJ movement and helping many individuals restore their jaw motor function (Byra et al., 2020). Below are some of the stretches that can help reduce TMJ pain and relax the jaw muscles.
Relaxed Jaw Exercise
How to Do It: Place the tongue gently on the roof of the mouth behind the upper front teeth. This allows the teeth to come apart while relaxing the jaw muscles.
Benefits: This exercise helps relax the jaw and ease muscle tension.
Partial Goldfish Exercises
How to Do It: Place the tongue gently on the roof of the mouth and one finger in front of the ear where the TMJ is located. Place your middle finger on your chin. Drop your lower jaw halfway and close. Perform this exercise six times in one set.
Benefits: This stretch helps target the jaw’s range of motion and reduce joint stiffness.
Full Goldfish Exercises
How to Do It: Similar to the partial opening, but open your mouth fully this time.
Benefits: This stretch helps enhance the full range of motion and reduce joint stiffness.
Chin Tucks
How to Do It: Sitting upright in a chair, pulling your chin straight back, creating a “double chin.” Hold for three seconds, and then release.
Benefits: This exercise helps strengthen the neck muscles, improves posture, and reduces strain on the jaw.
Additional Tips To Reduce TMJ
Along with these stretches, additional tips for managing and reducing TMJ by avoiding excessive jaw movements and applying hot/cold packs to reduce any residual inflammation correlating with TMJ. When people with TMJ start incorporating non-surgical treatments and stretches to relieve the pain, it can help increase the mandibular active range of motion and provide beneficial relief. (Urbanski et al., 2021) This, in turn, allows many people with TMJ pain to be more mindful of the body and make small changes in their health and well-being.
References
Alolayan, A., Alsayed, S. S., Salamah, R. M., Ali, K. M., Alsousi, M., & Elsayed, S. (2022). Temporomandibular joint (TMJ) disorders prevalence and awareness of appropriate clinical practices, among Al-Madinah community in Saudi Arabia. F1000Res, 11, 395. doi.org/10.12688/f1000research.104272.2
Brighenti, N., Battaglino, A., Sinatti, P., Abuin-Porras, V., Sanchez Romero, E. A., Pedersini, P., & Villafane, J. H. (2023). Effects of an Interdisciplinary Approach in the Management of Temporomandibular Disorders: A Scoping Review. Int J Environ Res Public Health, 20(4). doi.org/10.3390/ijerph20042777
Byra, J., Kulesa-Mrowiecka, M., & Pihut, M. (2020). Physiotherapy in hypomobility of temporomandibular joints. Folia Med Cracov, 60(2), 123-134. www.ncbi.nlm.nih.gov/pubmed/33252600
Cardoneanu, A., Macovei, L. A., Burlui, A. M., Mihai, I. R., Bratoiu, I., Rezus, II, Richter, P., Tamba, B. I., & Rezus, E. (2022). Temporomandibular Joint Osteoarthritis: Pathogenic Mechanisms Involving the Cartilage and Subchondral Bone, and Potential Therapeutic Strategies for Joint Regeneration. Int J Mol Sci, 24(1). doi.org/10.3390/ijms24010171
Ferrillo, M., Giudice, A., Marotta, N., Fortunato, F., Di Venere, D., Ammendolia, A., Fiore, P., & de Sire, A. (2022). Pain Management and Rehabilitation for Central Sensitization in Temporomandibular Disorders: A Comprehensive Review. Int J Mol Sci, 23(20). doi.org/10.3390/ijms232012164
Santana-Mora, U., Lopez-Cedrun, J., Mora, M. J., Otero, X. L., & Santana-Penin, U. (2013). Temporomandibular disorders: the habitual chewing side syndrome. PLOS ONE, 8(4), e59980. doi.org/10.1371/journal.pone.0059980
Urbanski, P., Trybulec, B., & Pihut, M. (2021). The Application of Manual Techniques in Masticatory Muscles Relaxation as Adjunctive Therapy in the Treatment of Temporomandibular Joint Disorders. Int J Environ Res Public Health, 18(24). doi.org/10.3390/ijerph182412970
Can individuals dealing with musculoskeletal trigger points seek non-surgical treatments to reduce pain in their extremities?
Introduction
The musculoskeletal system has various muscles, tendons, ligaments, and soft tissues that allow the lower and upper extremities to function in multiple tasks that the person is doing. From physical activities to relaxing or just doing errands, the musculoskeletal system has a wonderful relationship with all the various body systems. It helps protect the vital organs from environmental factors and injuries. However, when environmental factors or injuries affect the body, many overlapping risk profiles affect the upper and lower quadrants, thus affecting the muscles and the soft tissues. When the musculoskeletal system starts to feel symptoms of pain and discomfort, it can cause visceral-somatic referred pain in different body locations and cause the development of trigger points in the muscle tissues. This causes the individual to be in excruciating pain and discomfort and is seeking treatment to reduce the pain-like symptoms. Today’s article gives us an understanding of musculoskeletal trigger points and how various non-surgical treatments can alleviate musculoskeletal trigger points in the body. We discuss with certified associated medical providers who consolidate our patients’ information to assess pain-like issues affecting their musculoskeletal system that are correlating to trigger point pain. We also inform and guide patients on various non-surgical treatments and ask their associated medical providers intricate questions to integrate a customized treatment plan to reduce musculoskeletal trigger point pain. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
Understanding Musculoskeletal Trigger Points
Do you often experience pain in your legs, arms, hands, and feet throughout the day? How often do you experience symptoms of stiffness and discomfort in your neck, shoulder, or back? Or do you feel tingling and numbing sensations in your hands and feet? More often than not, many people who are experiencing these overlapping pain issues in their musculoskeletal system might have trigger points in their muscle fibers. Trigger points are part of a painful musculoskeletal condition known as myofascial pain syndrome. This painful musculoskeletal condition constitutes a hyperirritable spot within the taut band of the musculoskeletal system, causing pain when being compressed. (Lavelle et al., 2007) When a person is dealing with musculoskeletal trigger points, they will often experience referred pain and discomfort, motor dysfunction, and autonomic issues. This is because when many individuals experience pain in the upper or lower muscle quadrants, they deal with referred pain from the affected muscles. When the affected muscles have abnormal tender muscle regions, it can lead to impaired movements associated with the affected muscles in any joint area. (Macdonald, 1980)
Additionally, musculoskeletal trigger points can be identified as latent or active based on the development of where the pain originates from within the musculoskeletal system. To that point, when environmental factors or injuries develop trigger points, pain-like symptoms like muscle stiffness, dysfunction, and restricted range of motion show up when a pain specialist is assessing a person. (Shah et al., 2015) Fortunately, musculoskeletal trigger points are not difficult to treat once the pain source is located in the musculoskeletal system. This is because non-surgical treatments help manage the pain-like symptoms by inactivating the trigger points and restoring the affected resistant muscles to their full range of motion. (Rubin, 1981)
The Non-Surgical Approach To Wellness-Video
Non-Surgical Treatments For Musculoskeletal Trigger Points
When it comes to treating musculoskeletal trigger points, many individuals seek out various treatments to reduce pain-like symptoms. Since musculoskeletal trigger points can range from mild discomfort to severe pain, it can affect a person’s daily activities and cause them to be miserable. Luckily, musculoskeletal trigger points can be reduced through non-surgical treatments. Non-surgical treatments can vary depending on the pain severity of the trigger points in the musculoskeletal system. At the same time, many individuals can have numerous non-surgical therapies as they are customizable, cost-effective, and personalized for the person’s treatment. Below are some non-surgical treatments that can help alleviate musculoskeletal trigger points.
Chiropractic Care
Chiropractic care utilizes mechanical and manual manipulation of the musculoskeletal system and can help reduce the overlapping effects of musculoskeletal trigger points. Chiropractors incorporate various techniques and ischemic pressure to relieve the pain and provide relief. (Vernon & Schneider, 2009) Additionally, chiropractors can locate the trigger points by pressing on the muscle tissue or manipulating the muscle fibers. Chiropractors can also combine massage therapy to relieve trigger points and associated pain symptoms to restore the body to optimal function. This combination can incorporate various techniques to increase blood circulation to the affected muscle, help break down the inflexible scar tissue, and help restore muscle function to the extremities.
Acupuncture
Another form of non-surgical treatment to reduce musculoskeletal trigger points is acupuncture. Acupuncture incorporates solid, thin needles placed on various acupoints in the body by a professional. What acupuncture does is that when the needles are placed in the acupoints of the affected muscle, it can help stimulate the nervous system and help facilitate the body’s natural pain-relieving chemicals to kick-start the healing process. Additionally, when people incorporate acupuncture to reduce musculoskeletal trigger points, the sensory input that is causing them pain is reduced and can provide prolonged relief. (Melzack, 1981)
Lifestyle Adjustments
When it comes to reducing trigger points and combining non-surgical treatments, many individuals dealing with overlapping pain profiles from musculoskeletal trigger points can make lifestyle adjustments to prevent its development. Making small adjustments to a person’s work and living environments can reduce stress from being a co-factor to developing trigger points in the muscle fibers. Other small adjustments like improving posture and employing relaxation techniques like yoga, meditation, or deep breathing exercises can help reduce muscle stress and strain from everyday life. Incorporating non-surgical treatments to reduce and manage musculoskeletal triggers can provide a positive, beneficial result to improve muscle function and allow individuals to live healthier lives.
References
Lavelle, E. D., Lavelle, W., & Smith, H. S. (2007). Myofascial trigger points. Anesthesiol Clin, 25(4), 841-851, vii-iii. doi.org/10.1016/j.anclin.2007.07.003
Macdonald, A. J. R. (1980). Abnormally tender muscle regions and associated painful movements. Pain, 8(2), 197-205. doi.org/10.1016/0304-3959(88)90007-3
Melzack, R. (1981). Myofascial trigger points: relation to acupuncture and mechanisms of pain. Archives of Physical Medicine and Rehabilitation, 62(3), 114-117. www.ncbi.nlm.nih.gov/pubmed/6972204
Rubin, D. (1981). Myofascial trigger point syndromes: an approach to management. Archives of Physical Medicine and Rehabilitation, 62(3), 107-110. www.ncbi.nlm.nih.gov/pubmed/6453568
Shah, J. P., Thaker, N., Heimur, J., Aredo, J. V., Sikdar, S., & Gerber, L. (2015). Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM R, 7(7), 746-761. doi.org/10.1016/j.pmrj.2015.01.024
Vernon, H., & Schneider, M. (2009). Chiropractic management of myofascial trigger points and myofascial pain syndrome: a systematic review of the literature. J Manipulative Physiol Ther, 32(1), 14-24. doi.org/10.1016/j.jmpt.2008.06.012
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
With contractures, the sarcomeres overly lengthen when the muscle fibers tighten. This increase in sarcomere length prevents the muscle from contracting normally, resulting in weakness. Muscle fibers are encased in an extracellular matrix, a mesh composed of collagen and other proteins that help transmit force and provide muscle contraction. Muscle contractures cause the amount of collagen within the extracellular matrix to increase, causing a stiffening of fibers that restricts movement. (
What the Fascia Does
Causes
