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Viscerosomatic Reflex

Dr. Jimenez DC presents clinical implications of the viscerosomatic reflex.

In today’s big data informational era, there are many disorders, diseases, and clinical presentations that demonstrate concomitant associations, coincidences, correlations, causations, overlapping profiles, overlapping risk profiles, co-morbidities, and risks of associated disorders that clinically intermingle in presentations and outcomes.

To this point, assessing the viscerosomatic dysfunction and somatovisceral disorders is of paramount importance in order to get a full clinical picture affecting patients.

The clinician is mandated by the depth of our present clinical understandings and our oath to our patients to see the complete clinical picture within these integrated clinical paradigms and to treat accordingly.

Somatic dysfunction is defined as the “impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements.”

A viscerosomatic reflex is the resultant of the effect of afferent stimuli arising from a visceral disorder on the somatic tissues. The reflex is initiated by afferent impulses from visceral receptors; these impulses are transmitted to the dorsal horn of the spinal cord, where they synapse with interconnecting neurons. These, in turn, convey the stimulus to sympathetic and peripheral motor efferents, thus resulting in sensory and motor changes in somatic tissues of skeletal muscle, viscera, blood vessels, and skin.

As an example only, visceral afferents play an important part in the maintenance of internal equilibrium and the related mutual adjustments of visceral function. They are also responsible for the conduction of pain impulses that may be caused by distention of a viscus, anoxia (particularly of muscle), irritating metabolites, stretching or crushing of blood vessels, irritation of the peritoneum, contraction of muscular walls, and distention of the capsule of a solid organ.” Because pain-sensitive nerve end- ings are not numerous in viscera, pain sensation or a visceral reflex response may result from the combined input of several different types of receptors rather than as a specific response to a particular receptor. A variety of visceral receptors have been mucosal and epithelial receptors, which respond to mechanical and epithelial stimuli; tension receptors in the visceral muscle layers, which respond to mechanical distention, such as the degree of filling; serosal receptors, which are slow adapting mechanoreceptors in mesentery or
serosa and which monitor visceral fullness; Pacinian corpuscles in mesentery and pain receptors; and free nerve endings in viscera and blood vessels.

https://pubmed.ncbi.nlm.nih.gov/?term=Viscerosomatic+pathophysiology

https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=32644644

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own healthcare decisions based on your research and partnership with a qualified healthcare professional.

Blog Information & Scope Discussions

Our information scope is limited to Chiropractic, musculoskeletal, physical medicines, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somatovisceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and/or functional medicine articles, topics, and discussions.

We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system.

Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez DC or contact us at 915-850-0900.

We are here to help you and your family.

Blessings

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

Dr. Alex Jimenez DC, MSACP, CIFM*, IFMCP*, ATN*, CCST
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Preventing and Treating Plantar Fasciitis with Various Stretches

Preventing and Treating Plantar Fasciitis with Various Stretches

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, but the 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

www.ncbi.nlm.nih.gov/pmc/articles/PMC7493445/pdf/JMNI-20-411.pdf

Buchanan, B. K., Sina, R. E., & Kushner, D. (2024). Plantar Fasciitis. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/28613727

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

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Managing TMJ with Targeted Stretching Exercises

Managing TMJ with Targeted Stretching Exercises

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

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Innovative Non-Surgical Treatments for Musculoskeletal Trigger Points

Innovative Non-Surgical Treatments for Musculoskeletal Trigger Points

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

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Strategies for Recognizing Impairment in a Chiropractic Clinic

Strategies for Recognizing Impairment in a Chiropractic Clinic

How do healthcare professionals in a chiropractic clinic provide a clinical approach to recognizing impairment for individuals in pain?

Introduction

 

Any article you read about substance abuse among nurses will almost certainly repeat the claims made by the American Nurses Association, which states that, in line with the general public, 10% of nurses, or one in ten or about 300,000 Registered Nurses in the United States, are dependent on drugs of some kind. Impairment of any kind at work, particularly if it stems from substance misuse or usage, can have serious repercussions for the nurse and the nursing profession for several reasons. Preciseness, correctness, the capacity for critical thought, and observation are essential in the nursing profession. Because errors or accidents may occur, any inability to deliver these abilities puts patients, coworkers, and the nurse at risk. Additionally, people view nurses as trustworthy, dependable, and honest. Impairment can damage that perception, particularly if it is brought on by alcohol or drugs. In the following sections, we’ll examine impairment, its reasons, and your ethical and legal obligations if you believe a coworker is impaired. Today’s article focuses on the clinical approach to recognizing impairment in a clinical setting. We discuss with certified associated medical providers who consolidate our patients’ information to assess pain-like issues they are experiencing. We also inform and guide patients on various treatments and ask intricate questions to their associated medical providers to integrate a customized treatment plan. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

A Definition of Impairment

The fundamental definition of impairment is “The state of being decreased, weakened or harmed, especially mentally or physically” (“Impairment,” n.d.”) You’ll see that this is merely a description of a state of being and that no reason is given. This is a result of the abundance of possible reasons. While some causes might be simple to prove, others might not. Consequently, it is important to identify and consider the context and cause, if known, while talking about impairment. The impaired populace that surrounds us as nurses is: They are patients of ours. They are in a reduced, weakened, or damaged state, albeit they may be compromised by disease or injury. Similarly, you are compromised by illness if you have worked a shift with a bad cold. Symptoms of feeling slower, impaired thinking, and reviewing your work more frequently are examples of impairment in a clinical setting.

 

A disease or injury may have different consequences and affect how well you execute your job to varied degrees, but as the degree of impairment increases, so does the chance that you will make a mistake. The safety of both you and those around you, including your patients and coworkers, is inversely correlated with your degree of impairment. You, your patients, and your coworkers are less safe the more your performance is negatively impacted. Even though nurses know that the patients are vulnerable because they are compromised in some way. We also know that impairments can make it more likely for you to make mistakes. You are a responsible person and would never work if your impairment was severe enough to put your patients in danger. However, what if a coworker has a disability? Even worse, what if you think it was somehow self-inflicted? How do you proceed? Do you talk to them? Do you inform someone else about it? Do you hope nothing bad happens and ignore it?

 

Preserving patient safety is a top priority for nurses in their line of work. It is your responsibility to know what to do and how to do it if a colleague appears to be affected. But to achieve that, you must be able to spot potential impairment in both you and other people. Administrative and required reporting requirements must be known to you. You also need to be aware of the possible consequences for yourself if you do nothing.

 

Causes of Impairment

You might assume that we are discussing drug usage the moment you hear or read the phrase impairment in the workplace. However, there are other potential causes besides alcohol or drug abuse, and drawing the wrong conclusions can frequently have unanticipated results. You are not required to look into or determine what’s causing your colleague’s apparent disability. That is the task of others. You must identify impairment indicators and take the proper action. One of the things you should consider before reporting a coworker for drug addiction is whether or not you are witnessing real impairment. Everyone has occasional feelings of illness, irritability, or tension. Even if we might not be as effective as usual, nothing about our performance puts anyone at risk, and it doesn’t happen often. “Impairment in the healthcare system is defined as the inability or impending inability to practice, which is divided into two categories that can affect both the professional and the patient” (Baldisseri, 2007). This statement dismisses the previous scenario in which you might move more slowly than usual due to a severe cold.

 


Functional Medicine Influence Beyond Joints- Video


The Difference Between Impairment & A Bad Day

“Impairment is characterized by the inability to carry out the professional duties and responsibilities reasonably consistent with nursing standards.” Having a bad day can affect the individual’s mood and workflow. Sometimes, a faint impression that someone is not quite themselves leads to this discovery. Colleagues could experience unease or feel intimidated. Supervisors may notice a rise in the number of grievances lodged against an employee or by coworkers against that individual. Behavioral patterns suggest issues exist and can lead to the development of causing medical errors. Medical errors in healthcare organizations can create a serious health problem that can substantially threaten the patient’s safety. (Rodziewicz et al., 2024). Before examining these patterns, let’s consider some of the potential reasons other than drug or substance misuse that could be contributing to the decline in risky practices in nursing tasks.

 

Training & Education Deficits

A coworker’s risky activities could result from inadequate training, knowledge, or orientation to the current workplace. This is particularly valid for recently licensed nurses and nurses transitioning from one practice area to another. Nurses in refresher training may need to be more confident in how things have traditionally been done or need to be taught suggested modifications to policy or procedures. Refresher training may also encounter opposition or change and need to be successful. If the nurse is unwilling to acknowledge that their knowledge or abilities are not up to par, these educational deficiencies may appear as impairment. They might take much longer than other nurses to do jobs, among other indicators. Erroneous assumptions about which process is the most reasonable or accurate way to complete a task might lead to mistakes on the part of the nurse. Alternatively, they could be overly sensitive to criticism and try to maintain their composure by insisting they are competent.

 

Physical Illness

We have already discussed the issue of trying to work when you have a bad cold. For most of us, the experience of having a little illness or infection holding us back is probably known. Yet, increased chronic conditions could also lead to compromised performance days. Like many other ailments, diabetes, and arthritis can cause someone to feel less than 100% of themselves on certain days. It’s important to remember that you might not even be aware that your coworker has these ailments. For want of a better or more appropriate title to put this under, be sure the person you are about to accuse of abusing drugs is not pregnant before moving forward. Naturally, this is a partial list of all potential physical explanations. It’s merely a friendly reminder to consider the chance the incompetent nurse could be physically unwell.

 

Physical Injury

Like medical conditions, injuries can also hinder one’s ability to perform at work. Although it is more likely that there may be some overt signs of an injury—such as a limp or other unnatural movement, bandaged regions, or the use of a walking stick or other mechanical aid—this isn’t always the case. A person with a back strain or some different type of nerve entrapment could try to disguise their discomfort and their limits.

 

Stress & Fatigue

Since it is common for these causes to occur together or for one to manifest as a symptom of the other, they might be seen as a collective cause. They may also be the outcome of events outside the workplace, inside the workplace, or both. Someone who has recently gone through a divorce or someone who is the primary caregiver for a critically ill relative at home are two examples. Both scenarios are unpleasant, but what if these factors were secondary to financial difficulties? Both worrying about this and attempting to work more shifts due to their economic challenges may hurt their ability to sleep. Someone in these situations can easily get psychologically and physically fatigued very fast. Depending on their personality, it would also be unheard of for their colleagues to be unconscious of these difficulties. Alternatively, the cause might be as straightforward as stress at work, resulting in burnout and decreased motivation. Burnout and work dissatisfaction are, in fact, “common within the nursing profession” (Van Bogaert et al., 2017)

 

Mental Illness

Even though nurses like to think of themselves as resilient and unaffected by situations that others would see as weakness, the truth is that we are vulnerable to mental health issues like anxiety and depression, as well as drug use disorders, for many of the same reasons. In certain nursing specialties, we work with patients who are dying all the time—possibly even infant deaths—or we witness horrifying results from violent or accidental incidents. Circumstances like these may serve as antecedents to illnesses like Post Traumatic Stress Disorder (PTSD). Nurses are not superwomen or supermen—again, these are only a few examples. Healthcare professionals may be impacted if it impacts the broader public.

 

Substance Use

Substance addiction is perhaps the most chronic and damaging to the individual, the facility, and even the profession, even if it isn’t necessarily more common than the previously described causes of impairment. Substance abuse is not likely to go away on its own over time without assistance from coworkers and superiors, unlike medical conditions or injuries. This does not imply that interventions for other impairment causes are unnecessary or should be avoided. If you don’t act when something like low back pain is the cause of the impairment, you can end up addicted to painkillers in the first place. Included in the collection under this subject is disability brought on by the misuse or overuse of pharmaceuticals that have been prescribed to them or others. The impairment is frequently associated with the side effects of overuse or acute overdose. At the same time, it can also occasionally arise from adverse events associated with normal doses, such as nausea, sleepiness, or dizziness. The usage or misuse of “street drugs” or non-prescription substances like methamphetamine, ecstasy, or cannabis. The acute or chronic misuse or overuse of alcohol. The nurse may be severely intoxicated or experiencing a severe hangover, but both conditions would impede her abilities. Chronic use can also result in physical ailments or cognitive impairments that make it difficult for a nurse to perform at a high enough level. Since a nurse’s whole self-definition frequently centers around their work as a nurse, the entry of their abuse or addiction into their place of employment is often a sign of how far along their illness has evolved.

 

Because health workers identify with their line of work, evidence of disease sometimes points to a late stage of illness. Workplace issues are typically the last stage of a downhill spiral, and when a disease is discovered, coworkers are frequently astonished “(Washington State Department of Health, 2016, p.6). When the impairment is initially seen at work, coworkers and bosses may even deny or minimize the issue, offering justifications or avoiding confrontation in the hopes that the issue will magically disappear.

 

Unique Risk Factors For Nurses

The likelihood of having a drug use disorder is influenced by a variety of factors, including heredity, upbringing, parental and peer pressure, and so on. However, working as a nurse presents a few unique risk factors that are not present in other occupations. The main hour risk factors that nurses deal with in a healthcare facility are:

  • Access
  • Attitude
  • Stress
  • Lack of education (Hakim, 2023)

 

Acess & Attitude

Drugs that are lawful to obtain by prescription are more likely to be used by nurses than by the general public, even though substance use disorders do not affect nurses more frequently than the general population. The explanation is that nurses handle these medications daily, even without a prescription. To this, we add our knowledge of medicine administration, usage, and dosage and work in a setting where the benefits of medication use are evident. This indicates that we are self-assured in our capacity to diagnose and treat ourselves and in our ability to handle these medications.

 

Stress

Some of the indications that all nurses are sometimes a part of the stress factors that have caused them to be impaired include:

  • Extended shifts
  • Heavy workload
  • Absence of personnel
  • Extremely urgent patients while retaining composure under intensely sentimental circumstances. 

These are presumably well-known to all nurses and can occasionally be attributed to role strain. They are all a necessary component of a very demanding line of work. Work schedules alone have demonstrated a beneficial relationship with substance usage. Pain or insomnia following a demanding shift are common and often serve as the primary justification for taking medication to help with aches and pains, promote relaxation, or fall asleep.

 

Lack of Education

Here, the term “lack of education” does not mean ignorance of drugs. As we’ve already mentioned, there is no shortage of schooling there. No. In this context, ignorance of substance use problems and associated warning signs and symptoms is meant. Many times, healthcare professionals are unable to identify these symptoms and indicators in both themselves and other people. Even if they do identify them, stigmatization results from a lack of information about these disorders—especially if the sufferer is a fellow healthcare worker—because we tend to hold healthcare professionals—including ourselves—to higher standards than we do non-healthcare workers.

 

Recognizing The Signs

When a nurse is caught using drugs or alcohol at work, the ideal course of action these days is assistance and therapy rather than immediate termination. The idea is that the nurse will eventually be able to go back to work following treatment and rehabilitation. However, early intervention is a key component of this strategy. As we’ve already mentioned, substance use may need to continue for a while before signs of impairment at work become apparent. Therefore, in pursuing a successful result, time itself becomes a threat. It is appropriate to remind ourselves that substance abuse may not be the only explanation for the impairment as we examine some of the indicators that substance use may cause. For the sake of the patients’ and the staff’s safety, intervention is required regardless of the cause. Searching for behavioral changes or changes from a baseline rather than specific activities is perhaps more beneficial. After all, we all know that a nurse who is not incompetent but has always appeared messy or moves a little more slowly than others when completing tasks. Perhaps it’s just a personal preference, but if a nurse who used to appear well-groomed and productive suddenly starts to act sluggish and careless, there may be a deeper issue at hand.

 

On the other hand, it is also noteworthy if the nurse, who has always been sluggish and sloppy but has always stayed within acceptable parameters, suddenly became unacceptable or extremely slow and messy. However, the noticeable shift might be outside the condition of their attire. Even someone who is usually upbeat can seem depressed, nervous, or afraid. A typically quiet individual can appear animated, talkative, and gregarious. It’s also possible that the shy person isolates themselves more than usual, or the ordinarily talkative and active person becomes even more talkative and active than normal. Recall that the behavior is less important in many cases than the change in pointing out a problem. It is similar to checking for deviations from normal blood pressure or temperature as a sign of an issue. Additional indicators of a change to watch out for include: 

  • Mood swings 
  • Irritability
  • Drowsiness
  • Crying or inappropriate laughing
  • Suspicion or being extremely sensitive to criticism.
  • Inflexibility or excessive adherence to procedures when they are not required.
  • Bewilderment, or bad memory

When it comes to work performance, you could observe the following:

  • A rise in tardiness and absences, particularly when they follow a pattern.
  • Strange explanations for absences
  • Longer or more regular pauses 
  • Uncharacteristic absences from the workplace, 
  • Previously, ordinary tasks required more time.
  • Unusual or dubious “shortcuts” used in operations do not uphold the anticipated level of care. 
  • When the quality or content of the charting becomes shoddy or unique, there are greater inaccuracies and negligence. 
  • A rise in the nurse’s complaints or grievances. 

Each of them points to a possible issue. They could be overtly apparent or strange enough to give you the impression that something is off. You may notice that they are using breath fresheners, mints, or chewing gum more frequently than they used to. They may mumble more than usual or exhibit more subtly stopped speech with longer silence while considering their response. “Were their pupils constricted (or dilated)?” or “Was that alcohol I smelled?” are some questions to ask yourself as you leave. As nurses, we may acquire hunches or intuition. Our innate ability to observe results from our extensive training and these instincts are frequently founded on observations we make unconsciously. Thus, please don’t ignore them. While you shouldn’t ignore them, you shouldn’t accept them as gospel.

 

Drug Diversion

Access to the drug of choice may be restricted for a nurse with a substance use disorder when they are not working. This could be for various reasons, such as the fact that their family is no longer prescribed that particular drug, their doctor or pharmacist becoming suspicious, or other reasons. They frequently attempt to supplement that access from the job in this kind of circumstance. And the nurse will need to be creative in hiding this behavior due to the precautions in place, particularly when it comes to banned substances.

Among the warning indicators to look out for are:

  • Regularly or eagerly offering to be a pharmaceutical nurse. 
  • Patients continue to complain about discomfort even after receiving painkillers.
  • Documents reveal that the patient was given more painkillers than necessary for their condition. 
  • There are more and more reports of drug spills and waste. 
  • When this nurse performs medication rounds relative to other nurses, an abnormally high number of controlled drugs are administered. 

Drug counts are inaccurate; If you have yet to witness a drug given or dispensed, the nurse may ask you to co-sign for it. This is a partial list, just like the others. As with the other lists, nurses are very wise due to our education, training, and experiences, so sometimes it’s just a gut instinct that warns you of a possible issue. However, as a general guideline, anything that feels off should be looked into further. Your obligations to your patients and your coworkers require this. 

 

Interventions

The Florida Nurse Practice Act is broken when a nurse practices while intoxicated. Both illness and substance use are listed as potential causes of this impairment in the paragraph that defines this as a violation and could result in disciplinary action. It would also be illegal to fail to disclose a nurse’s impairment or to put a patient’s safety in peril by permitting them to work while impaired. It is preferable for everyone if there is no attempt to cover for the nurse or if the issue is ignored in the hopes that it will go away. As an employee, you should be fully conversant with the regulations and procedures each facility has likely designed for just these scenarios. These will have been created to guarantee compliance with all legal and regulatory obligations. It is never appropriate for you to approach a coworker who is impaired. Always ask a supervisor or nursing manager for assistance. The manager or supervisor will probably contact the impaired nurse first; however, having multiple people present during the intervention will:

  • Give the evidence given to the nurse more weight because she is likely to dispute impairment. 
  • Present witnesses for incidents that might be needed in hearings or meetings later.
  • Provide strength to the message, emotional support, and uphold safety if the nurse exhibits agitation or aggression when contacted. 
  • Never should the initial intervention be accusatory or involve attempting to identify the nurse’s issue. 

It should be fact-based and provide written evidence of observations and concerns to make the nurse realize why you are requesting them to stop working now. The impairment and any subsequent intervention might be reported in one of two ways. The Florida State Board of Nursing is the first of them. More precisely, the Department of Health would receive the report, investigate the complaints, and take appropriate action. The second action would be to send the report to the Intervention Project for Nurses (IPN). The IPN was created in 1983 by legislative action to protect the public’s health and safety (Chan et al., 2019). It does this by offering close supervision to nurses who are deemed unsafe to practice because of impairments brought on by drug or alcohol abuse, misuse, or both, or because of a physical or mental illness that may impair the licensee’s capacity to practice safely and skillfully. 

 

These alternative-to-discipline programs have been developed across the nation, and in Florida, they are part of the Integrated Patient Network (IPN) because of the recognition that a nurse with a substance use disorder should receive the same care and treatment as anyone else. Through its programs, nurses can obtain non-punitive treatment and rehabilitation. The IPN will assist the nurse’s successful return to practice if she consents to step away from the profession and finish the program while maintaining confidentiality—even from the Board of Nursing. The IPN will send the file to the Department of Health if a nurse accepts these terms but then changes their mind. Certain cases might be reported to the Department of Health and the IPN, where treatment AND disciplinary action might be started. The Department of Health’s participation might lead to the nurse’s license being suspended or revoked, making it more difficult for her to return to work. It is envisaged that by offering non-punitive routes, nurses will be encouraged to seek assistance before facing disciplinary action and may eventually be able to return to practice.

 

Conclusion

Because of the unique circumstances surrounding our education and training, the way we are perceived, and the fact that we perceive ourselves as somehow stronger than others, the issue of disability in the workplace for nurses is particularly complicated. In the past, if an employee was impaired at work, disciplinary action might have been taken because of the impairment itself or the mistakes made. This was particularly valid in cases where it was discovered that the nurse was intoxicated or impaired by another substance. You were out the door and never came back after that. You would also lose your license, preventing you from ever returning to work as a nurse. Thankfully, non-disciplinary initiatives have been sparked by recognizing that we are not immune to the same stressors as others. The idea behind these initiatives is to identify problems, including substance use disorders, early on so that the best possible outcome may be achieved for all parties.

 


References

Baldisseri, M. R. (2007). Impaired healthcare professional. Crit Care Med, 35(2 Suppl), S106-116. doi.org/10.1097/01.CCM.0000252918.87746.96

Chan, C. W. H., Ng, N. H. Y., Chan, H. Y. L., Wong, M. M. H., & Chow, K. M. (2019). A systematic review of the effects of advance care planning facilitators training programs. BMC Health Serv Res, 19(1), 362. doi.org/10.1186/s12913-019-4192-0

Hakim, A. (2023). Investigating the challenges of clinical education from the viewpoint of nursing educators and students: A cross-sectional study. SAGE Open Med, 11, 20503121221143578. doi.org/10.1177/20503121221143578

Impairment. (n.d.). In Dictionary.com Unabridged. Retrieved from www.dictionary.com/browse/impairment

Rodziewicz, T. L., Houseman, B., & Hipskind, J. E. (2024). Medical Error Reduction and Prevention. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/29763131

Van Bogaert, P., Peremans, L., Van Heusden, D., Verspuy, M., Kureckova, V., Van de Cruys, Z., & Franck, E. (2017). Predictors of burnout, work engagement and nurse reported job outcomes and quality of care: a mixed method study. BMC Nurs, 16, 5. doi.org/10.1186/s12912-016-0200-4

Washington State Department of Health. (2016). A guide for assisting colleagues who demonstrate impairment in the workplace. Retrieved from www.doh.wa.gov/portals/1/Documents/Pubs/600006.pdf

 

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Relieving Adductor Muscle Strain with Incorporating MET Therapy

Relieving Adductor Muscle Strain with Incorporating MET Therapy

Can athletic individuals incorporate MET (muscle energy techniques) therapy to reduce the pain-like effects of adductor strain?

Introduction

The body’s lower extremities have an important role as they provide stability and mobility to the individual. Many athletes utilize their lower extremities by adding much power to exert the energy to win matches or competitions. The various muscles, soft tissues, ligaments, and joints help support the body’s skeletal structure and can succumb to injuries from repetitive motions or environmental factors. One of the muscles that can be affected by constant repetitive motions and environmental factors is the adductor muscles, which can cause many athletes to be in continuous pain and affect their performance during competitions. Luckily, there is a technique that many treatments offer to reduce muscle strain in the adductors and provide relief to the lower extremities. Today’s article looks at how adductor strain can affect many individuals, how MET therapy can help with an adductor strain, and its positive effect on athletic individuals. We discuss with certified medical providers who consolidate our patients’ information to assess the pain-like effects of an adductor strain in the lower extremities. We also inform and guide patients on how MET therapy can help stretch and strengthen tight adductor muscles to reduce strain and provide relief. We also encourage our patients to ask their associated medical providers many intricate and important questions about incorporating MET and other non-surgical therapies into their personalized treatment plan for a healthier lifestyle. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

How Does Adductor Strain Affect Individuals?

Do you feel tightness along your thighs and legs after a long day at work? Do you experience instability when walking from one location to another? Or do you feel pain when stretching your thighs that causes temporary relief? Many individuals experiencing pain in their lower extremities will often think it is hip pain, but their adductor muscles are in pain. The adductor muscles consist of three muscles that provide torque to the lower extremities by allowing them to move inward when a person is walking and help keep the trunk muscles steady. So, when many athletes begin to make constant repetitive motions while performing, it can cause issues for the adductors. As a common injury to many athletes, adductor strain can put exaggerated stress on the actual tendon, leading to biomechanical abnormalities affecting the musculoskeletal system. (Kiel & Kaiser, 2024a) Also, when athletes start to use constant repetitive motions during an increased volume or intensity of the training workload, it can cause stress factors in the lower extremities. (Kiel & Kaiser, 2024b) This, in turn, can have many individuals feel like they are experiencing hip and groin pain when it is, in fact, stress fractures in the adductor muscles causing myofascial pain. 

 

 

So, for athletic individuals dealing with adductor strain, primary doctors need to differentiate between adductor strain and regular muscle strain in the lower extremities, as the pain symptoms sometimes have overlapping risk profiles with acute onset pain symptoms associated with distinct injury mechanisms. (McHugh et al., 2023) This is because when athletes overuse their adductor muscles, it causes pain, as many injuries within the adductors are associated with the hips and groin region. (Koscso et al., 2022) However, there are ways for athletes to find the relief they seek to reduce adductor strain and return to their routine. 

 


Movement Medicine- Video


How MET Therapy Helps With Adductor Strain

For athletes and individuals engaged in physical activity, MET therapy can be a valuable part of the recovery process for adductor strain. MET (muscle energy technique) therapy, a form of osteopathic manipulative medicine, is used by pain specialists such as chiropractors, massage therapists, and sports physicians to alleviate pain symptoms in the musculoskeletal system. By using gentle, controlled muscle contractions, these specialists can improve musculoskeletal function by mobilizing joints, stretching tight muscles and fascia, and improving circulation and lymphatic flow. (Waxenbaum et al., 2024) Many pain specialists, including chiropractors and massage therapists, incorporate MET therapy into their practices due to its effectiveness in addressing muscular imbalances and alignment issues that contribute to pain and limited mobility in the lower extremities. 

 

The Positive Effect Of MET Therapy

One of the positive effects of MET therapy for adductor strain is that when athletes and individuals start to utilize it as part of their recovery, their pain is reduced, and muscle mobility is increased since there are changes in the viscoelastic properties in the soft tissue. (Thomas et al., 2019) For the adductor muscles, MET therapy helps with:

  • Increasing muscle length & flexibility
  • Reduce muscle tension
  • Improving blood flow and promoting healing
  • Enhance joint function

MET therapy, when incorporated for pain relief for adductor strain, can put many individuals at ease as it actively focuses on muscle relaxation, lengthening, and strengthening the affected muscles. MET therapy can be combined with other therapies in a person’s personalized treatment plan to enhance mobility, be mindful of what is causing pain and discomfort to their bodies, and live a healthier lifestyle. 

 


References

Kiel, J., & Kaiser, K. (2024a). Adductor Strain. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/29630218

Kiel, J., & Kaiser, K. (2024b). Stress Reaction and Fractures. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/29939612

Koscso, J. M., McElheny, K., Carr, J. B., 2nd, & Hippensteel, K. J. (2022). Lower Extremity Muscle Injuries in the Overhead Athlete. Curr Rev Musculoskelet Med, 15(6), 500-512. doi.org/10.1007/s12178-022-09786-z

McHugh, M. P., Nicholas, S. J., & Tyler, T. F. (2023). Adductor Strains in Athletes. Int J Sports Phys Ther, 18(2), 288-292. doi.org/10.26603/001c.72626

Thomas, E., Cavallaro, A. R., Mani, D., Bianco, A., & Palma, A. (2019). The efficacy of muscle energy techniques in symptomatic and asymptomatic subjects: a systematic review. Chiropr Man Therap, 27, 35. doi.org/10.1186/s12998-019-0258-7

Waxenbaum, J. A., Woo, M. J., & Lu, M. (2024). Physiology, Muscle Energy. In StatPearls. www.ncbi.nlm.nih.gov/pubmed/32644455

 

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Unlock Relief: Stretches for Wrist and Hand Pain

Unlock Relief: Stretches for Wrist and Hand Pain

Can various stretches be beneficial for individuals dealing with wrist and hand pain by reducing pain and discomfort to the extremities?

Introduction

In a technological-driven world, it is common for people to experience wrist and hand pain at some point in their lives. The hands are part of the body’s upper extremities and are used for various tasks and chores throughout the entire day. The forearms provide a causal relationship with the hands and wrists for the upper extremities since they offer very important motor functions to the body. The hands support the body when carrying something; the various muscles, ligaments, tendons, and joints help the wrist with mobility and flexibility. However, when injuries or everyday movements begin to affect the forearms and cause issues with the hands and wrist, it can be difficult to do simple tasks and negatively impact a person’s way of life. Fortunately, numerous ways exist to reduce the pain and discomfort of the wrist and hands. Today’s article focuses on what causes wrist and hand pain, how to prevent wrist and hand pain from returning, and how incorporating various can help reduce the pain-like effects. We discuss with certified medical providers who consolidate our patients’ information to assess the multiple causes that lead to the development of wrist and hand pain. We also inform and guide patients on how various stretches and techniques can help reduce the chances of wrist and hand pain from returning. We also encourage our patients to ask their associated medical providers many intricate and important questions about incorporating these stretches and techniques into their daily routines to live healthier lives. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

What Causes Hand and Wrist Pain?

Do you often feel pain or stiffness in your wrist after typing all day on the computer or phone? Do you have trouble gripping items in your hands? Or how often do your hands ache that massaging them causes temporary relief? Many people, including older adults, have experienced pain at some point, and most of the time, it affects the hands and wrists. Since everyone uses their hands and wrists when performing various tasks, when injuries or repetitive movements start to affect the hands and wrists, it can have a huge impact on simple tasks. When dealing with wrist and hand pain, it can make life unbearable for the person. Since pain is a normal protective response to any injuries and potentially harmful stimuli in its acute form, when prolonged or dysfunctional neuromuscular issues start to affect the body, it may contribute to disability and pain. (Merkle et al., 2020) For wrist and hand pain, many occurrences that lead to its development result from micro-stress or repetitive tear usage. 

 

 

This is because since the world is technological-driven, many people are using computers or smartphones to communicate with each other, which can be one of the causes of the development of wrist and hand pain. When many people frequently use electronic devices, the frequent movements and uses of the thumbs will increase their load and become a higher prevalence of musculoskeletal disorders. (Baabdullah et al., 2020) Other studies stated that when many individuals begin to do repetitive movements constantly and have different positions of their wrist joints while using their electronic devices continually, it can cause pain to their wrist joints and affect the structure. (Amjad et al., 2020) Additionally, when repetitive vibration exposures or forceful angular motions affect the hands and wrists, it can lead to carpal tunnel syndrome and affect the hands. (Osiak et al., 2022) The various joints, tendons, and muscles also become affected in the hands and wrist as trigger points in the forearm. Fortunately, there are multiple ways that many people can reduce the pain-like effects of wrist and hand pain.

 


The Benefits of Stretching-Video


How To Prevent Wrist & Hand Pain From Returning

There are numerous ways to reduce wrist and hand pain, and many people try to find therapeutic solutions to mitigate the pain. Non-surgical treatments like manual therapy can help with wrist and hand pain by using mobilization forces to allow wrist flexion and extension to improve motor function. (Gutierrez-Espinoza et al., 2022) Another non-surgical treatment that can help with wrist and hand pain is acupuncture. Acupuncture utilizes small, solid, thin needles to be placed in various acupoints in the forearm to reduce the pain intensity and bring back the mobility function to the hands and wrist. (Trinh et al., 2022)

 

Various Stretches For Wrist & Hand Pain

 

Fortunately, there’s a simple and accessible way for many individuals to reduce the effects of wrist and hand pain-stretching and incorporating yoga into their routine. Yoga stretches for the hands and wrists can help decompress and reduce stiffness, and these stretches can be done for just a few minutes, providing beneficial results. (Gandolfi et al., 2023Below are some of these stretches that can be easily incorporated into anyone’s routine, making it easier for you to take control of your wrist and hand health.

 

Wrist Flexor Stretch

  • How to Do It:
    • Extend your arm in front of you with your palm up.
    • Use your other hand to gently pull the fingers back toward the body until you feel a stretch in your forearm.
    • Hold this position for about 15 to 30 seconds.
    • Repeat 2-3 times with each wrist.

 

Wrist Extensor Stretch

  • How to Do It:
    • Extend your arm in front of your body with your palm facing down.
    • Gently pull the fingers towards your body with your other hand until you feel a stretch on the outside of your forearm.
    • Hold for 15 to 30 seconds.
    • Do this 2-3 times per wrist.

 

Prayer Stretch

  • How to Do It:
    • Put the palms together in a prayer position in front of the chest, below the chin.
    • Slowly lower the conjoined hands towards the waistline, keeping the hands close to your stomach and your palms together until you feel a stretch under your forearms.
    • Hold for at least 30 seconds and repeat a few times.

 

Tendon Glides

  • How to Do It:
    • Start with your fingers extended straight out.
    • Then, bend your fingers to form a hook fist; you should feel a stretch but no pain.
    • Return to the starting position and bend your fingers to touch the top of your palm, keeping your fingers straight.
    • Finally, bend your fingers into a full fist.
    • Repeat the sequence ten times.

 

Thumb Stretch

  • How to Do It:
    • Extend your hand with your fingers together.
    • Pull your thumb away from your fingers as far as comfortable.
    • Hold for 15 to 30 seconds.
    • Repeat 2-3 times with each thumb.

 

Shake It Out

  • How to Do It:
    • After stretching, shake your hands lightly as if trying to dry them off. This helps reduce tension and promote circulation.

References

Amjad, F., Farooq, M. N., Batool, R., & Irshad, A. (2020). Frequency of wrist pain and its associated risk factors in students using mobile phones. Pak J Med Sci, 36(4), 746-749. doi.org/10.12669/pjms.36.4.1797

Baabdullah, A., Bokhary, D., Kabli, Y., Saggaf, O., Daiwali, M., & Hamdi, A. (2020). The association between smartphone addiction and thumb/wrist pain: A cross-sectional study. Medicine (Baltimore), 99(10), e19124. doi.org/10.1097/MD.0000000000019124

Gandolfi, M. G., Zamparini, F., Spinelli, A., & Prati, C. (2023). Asana for Neck, Shoulders, and Wrists to Prevent Musculoskeletal Disorders among Dental Professionals: In-Office Yoga Protocol. J Funct Morphol Kinesiol, 8(1). doi.org/10.3390/jfmk8010026

Gutierrez-Espinoza, H., Araya-Quintanilla, F., Olguin-Huerta, C., Valenzuela-Fuenzalida, J., Gutierrez-Monclus, R., & Moncada-Ramirez, V. (2022). Effectiveness of manual therapy in patients with distal radius fracture: a systematic review and meta-analysis. J Man Manip Ther, 30(1), 33-45. doi.org/10.1080/10669817.2021.1992090

Merkle, S. L., Sluka, K. A., & Frey-Law, L. A. (2020). The interaction between pain and movement. J Hand Ther, 33(1), 60-66. doi.org/10.1016/j.jht.2018.05.001

Osiak, K., Elnazir, P., Walocha, J. A., & Pasternak, A. (2022). Carpal tunnel syndrome: state-of-the-art review. Folia Morphol (Warsz), 81(4), 851-862. doi.org/10.5603/FM.a2021.0121

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Banish Neck Pain with Yoga: Poses and Strategies

Banish Neck Pain with Yoga: Poses and Strategies

Can incorporating various yoga poses help reduce neck tension and provide pain relief for individuals dealing with neck pain?

Introduction

Within the hustling and bustling of modern life, it is common for many individuals to carry stress in their bodies. When the body deals with everyday stressors, tension, discomfort, and pain can often manifest in the upper and lower portions of the body. When the body’s upper and lower portions deal with these issues, they can cause overlapping risk profiles in the musculoskeletal system. One of the most common musculoskeletal issues is neck pain. It can cause many problems to the cervical portion of the spine and cause the surrounding muscles to become tense and in pain from the stress of everyday responsibilities. Luckily, there are numerous ways to reduce stress from the neck and help relax the affected muscles from discomfort, including yoga. In today’s article, we will look at how neck pain affects the upper body, the benefits of yoga for neck pain, and various yoga poses to reduce the overlapping effects of neck pain. We discuss with certified medical providers who consolidate our patients’ information to assess how neck pain is correlated with everyday stressors that affect the upper body. We also inform and guide patients on how yoga and the various poses can benefit the body and provide pain relief to the surrounding muscles. We also encourage our patients to ask their associated medical providers many intricate and important questions about incorporating yoga into their daily routine to reduce muscle tension and provide clarity to their bodies. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

How Does Neck Pain Affect The Upper Body?

Do you feel discomfort or pain in your neck and shoulders after a long, hard workday? Do you notice you hunched more than usual when doing your daily routine? Or do you see yourself developing a hunched posture from looking at the computer screen or phone for an extended period? Many of these normal motions are often correlated with the upper body, especially in the neck and shoulder regions, which causes neck pain. As one of the most common problems affecting many people worldwide, neck pain is a multifactorial disease with numerous risk factors contributing to its development. (Kazeminasab et al., 2022) Like back pain, neck pain can have acute and chronic stages depending on the severity and environmental factors leading to its development. The various muscles, ligaments, and tissues surrounding the neck and shoulders keep the neck stable and mobile. When many individuals overuse these muscles in the neck and shoulders repetitively, it can increase neck pain in the upper body in adulthood. (Ben Ayed et al., 2019

 

 

When acute neck pain turns chronic, it can cause the individual to be in constant discomfort, pain, and misery, so they start to look for various solutions to reduce the correlating symptoms when speaking to their primary doctors. When many individuals begin to explain to their doctors what their daily routine looks like, many doctors will start to assess and formulate a plan that focuses on any specific description of any injuries, including potential mechanisms, inciting and relieving factors, and pain patterns they have encountered throughout the day to come up with a personalized treatment plan to not only reduce neck pain but also provide relief to tension and discomfort to the body. (Childress & Stuek, 2020

 


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The Benefits Of Yoga For Neck Pain

Many primary doctors will work with associated medical providers to develop a personalized plan to relieve neck pain and its associated symptoms in many individuals. Many of these customized treatment plans include spinal manipulation, acupuncture, massage, decompression therapy, and therapeutic exercises. One of the therapeutic exercises that many individuals have utilized is yoga. Yoga is a holistic practice encompassing breathing control, meditation, and various poses to stretch and strengthen the affected upper muscles. Yoga is excellent for reducing neck pain and helping with upper cervical spine mobility, stretching the neck musculature to help the individual improve mobility and flexibility. (Raja et al., 2021) Additionally, the effects of yoga and its many poses can reduce tension, give clarity to the mind, and allow the nutrients and oxygen to the musculo-articular system to naturally heal the body itself. (Gandolfi et al., 2023)

 

Yoga Poses For Neck Pain

At the same time, many individuals with sedentary jobs that correlate to neck pain have implemented yoga as part of their routine. Yoga improves their range of joint motion and cognitive function and helps relieve musculoskeletal discomfort in the neck and shoulder regions. (Thanasilungkoon et al., 2023) Below are some of the various yoga poses that can help reduce the pain-like symptoms of neck pain and ease the surrounding muscles. 

 

Seated Neck Stretches

 

For seated neck stretches, this yoga pose helps stretch and release the neck muscles that carry tension and stress in the cervical region of the body. 

  • In a seated upright position, turn the head to the right and gently lift the chin.
  • You should feel a stretch along the left side of the neck and shoulders.
  • Hold the position for three to five breaths and repeat on the left side.

 

Camel Pose

 

For the camel pose, this yoga pose helps strengthen the front neck muscles while easing tension on the shoulders and back of the neck.

  • You can kneel on a yoga mat by keeping your knees and feet hip-distance apart while keeping the pelvis neutral. 
  • Lift the chest while arching your back and pressing the pelvis slightly forward.
  • Bring the fingertips to the heels or yoga blocks beside the ankles.
  • Focus on drawing the chin close to the neck while pressing the feet to the mat.
  • Hold the position for three to five breaths before releasing and lifting the sternum to rise back up.

 

Sphinx Pose

 

The sphinx pose allows you to lengthen and strengthen the spine while stretching the shoulders and releasing tension. 

  • On a yoga mat, lie on your stomach with the elbows under the shoulders.
  • Press your palms and forearms on the mat and tighten the lower half to support you as you lift your upper torso and head.
  • Keep looking straight ahead as you are being mindful of lengthening the spine.
  • Hold this position for three to five breaths.

 

Thread The Needle Pose

 

The thread-the-needle pose helps release tension stored in the neck, shoulders, and back.

  • On a yoga mat, start in an all-fours position with the wrist under the shoulders and the knees under the hips.
  • Lift the right hand and move it to the left along the floor with the palm facing up.
  • Hold the position for three to five breaths for thirty seconds and release.
  • Return to the all-fours position and repeat to the left side.

 

Conclusion

Overall, incorporating yoga as part of a daily routine can provide beneficial results in reducing neck pain and its associated comorbidities. Yoga does not require hours of practice or even contorting into various poses, as just a few minutes of gentle stretching and mindful breathing each day can provide positive results. When people start to utilize yoga as part of their daily activities, they will notice their posture improving, their minds clearer than ever, and live a happier, healthier life without dealing with neck pain.


References

Ben Ayed, H., Yaich, S., Trigui, M., Ben Hmida, M., Ben Jemaa, M., Ammar, A., Jedidi, J., Karray, R., Feki, H., Mejdoub, Y., Kassis, M., & Damak, J. (2019). Prevalence, Risk Factors and Outcomes of Neck, Shoulders and Low-Back Pain in Secondary-School Children. J Res Health Sci, 19(1), e00440. www.ncbi.nlm.nih.gov/pubmed/31133629

www.ncbi.nlm.nih.gov/pmc/articles/PMC6941626/pdf/jrhs-19-e00440.pdf

Childress, M. A., & Stuek, S. J. (2020). Neck Pain: Initial Evaluation and Management. American Family Physician, 102(3), 150-156. www.ncbi.nlm.nih.gov/pubmed/32735440

www.aafp.org/pubs/afp/issues/2020/0801/p150.pdf

Gandolfi, M. G., Zamparini, F., Spinelli, A., & Prati, C. (2023). Asana for Neck, Shoulders, and Wrists to Prevent Musculoskeletal Disorders among Dental Professionals: In-Office Yoga Protocol. J Funct Morphol Kinesiol, 8(1). doi.org/10.3390/jfmk8010026

Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M. J. M., Kolahi, A. A., & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord, 23(1), 26. doi.org/10.1186/s12891-021-04957-4

Raja, G. P., Bhat, N. S., Fernandez-de-Las-Penas, C., Gangavelli, R., Davis, F., Shankar, R., & Prabhu, A. (2021). Effectiveness of deep cervical fascial manipulation and yoga postures on pain, function, and oculomotor control in patients with mechanical neck pain: study protocol of a pragmatic, parallel-group, randomized, controlled trial. Trials, 22(1), 574. doi.org/10.1186/s13063-021-05533-w

Thanasilungkoon, B., Niempoog, S., Sriyakul, K., Tungsukruthai, P., Kamalashiran, C., & Kietinun, S. (2023). The Efficacy of Ruesi Dadton and Yoga on Reducing Neck and Shoulder Pain in Office Workers. Int J Exerc Sci, 16(7), 1113-1130. www.ncbi.nlm.nih.gov/pubmed/38287934

www.ncbi.nlm.nih.gov/pmc/articles/PMC10824298/pdf/ijes-16-7-1113.pdf

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