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Complex Injuries

Back Clinic Complex Injuries Chiropractic Team. Complex injuries happen when people experience severe or catastrophic injuries, or whose cases are more complex due to multiple trauma, psychological effects, and pre-existing medical histories. Complex injuries can be serial injuries of the upper extremity, severe soft tissue trauma, and concomitant (naturally accompanying or associated), injuries to vessels or nerves. These injuries go beyond the common sprain and strain and require a deeper level of assessment that may not be easily apparent.

El Paso, TX’s Injury specialist, chiropractor, Dr. Alexander Jimenez discusses treatment options, as well as rehabilitation, muscle/strength training, nutrition, and getting back to normal body functions. Our programs are natural and use the body’s ability to achieve specific measured goals, rather than introducing harmful chemicals, controversial hormone replacement, unwanted surgeries, or addictive drugs. We want you to live a functional life that is fulfilled with more energy, a positive attitude, better sleep, and less pain. Our goal is to ultimately empower our patients to maintain the healthiest way of living.

Running Piriformis Syndrome: El Paso Back Clinic

Running Piriformis Syndrome: El Paso Back Clinic

The piriformis is a large and powerful muscle beneath the gluteal/buttocks muscles. It runs from the bottom of the sacrum, where the base of the spine and pelvis converge to the top of the femur. This muscle plays a critical role in running motion; it helps externally rotate the hips and upper leg outward, provides hip flexibility and stability, and stabilizes the pelvis. The sciatic nerve passes next to, over, under, or through the piriformis muscle. When the piriformis contracts or spasms, it can irritate, become entangled and compress the nerve, resulting in painful symptoms. This can lead to various problems and is how piriformis syndrome occurs.

Running Piriformis Syndrome: EP's Chiropractic Specialist Team

Running Piriformis Syndrome

The proper function of the piriformis muscle is essential for athletes who participate in running sports. Repetitive activities, like running, can fatigue the muscle and irritate and inflame the nerve.


Piriformis syndrome can be challenging to diagnose because it can be confused for a herniated disc, sciatica, a proximal hamstring strain/high hamstring tendinitis, or lower back problems. A few symptoms that can help determine whether the piriformis is the cause include:

Sitting, Stairs, Squatting Discomfort or Pain

  • Individuals don’t always experience discomfort while running.
  • Instead, it’s sitting, climbing stairs, and squatting where pain symptoms present.
  • Pain while running, specifically an overstretched sensation when going up a hill or increasing speed, is more associated with a proximal hamstring strain.


  • The area around the piriformis is tender.
  • Applying pressure can cause discomfort or pain around the area and radiate down the leg.

Centered Pain

  • Piriformis syndrome is usually felt in the middle of the glutes.
  • A proximal hamstring strain typically causes non-radiating pain at the bottom of the glutes, where the hamstrings connect to the pelvis.


  • Pelvic misalignment.
  • Pelvic misalignments created by other conditions, like a tilted pelvis, functional leg-length discrepancy, or practicing unhealthy posture, make the piriformis work harder to compensate, which leads to tightness and/or spasms.
  • Sudden increases in distance or workout intensity can worsen any weakness in the piriformis and other gluteal muscles.
  • Continuing to run, which is possible, can worsen and prolong the condition.
  • When running, the muscle’s signal transmissions are interrupted by inflammation and/or compression and cannot synchronize with each other.
  • The result is the inability to withstand the repetitive strain of running.
  • Not warming up with glute-activation exercises increases the risk of running piriformis syndrome.

Chiropractic Treatment

Resting may not be enough to alleviate piriformis syndrome. This is especially true if the problem involves spine and pelvic misalignment. Chiropractic can provide significant relief from running piriformis syndrome. A combination of spinal, pelvic, and extremity adjustments, therapeutic massage, MET, decompression, stretches, and anti-inflammatory nutrition will take the pressure off overly tight areas, realign the body, and maintain nervous system function.

  • Running form could be evaluated and checked for leg-length discrepancies and muscle-strength imbalances.
  • Running can continue if the individual can do so without pain or symptoms.
  • But it is recommended to avoid slanted surfaces, which increase the risk of pelvic misalignment.
  • Avoid long runs, which increase the chance of overload and fatigue.
  • The goal is to relax and release the piriformis.
  • If it’s impinging on the sciatic nerve, loosening and releasing the muscle will significantly lessen radiating pain.
  • Orthotics may be recommended for excessive overpronation or inward movement of the foot when landing.

Other treatments to stop piriformis spasms.

  • Ice and take over-the-counter anti-inflammatory medications can be used during acute phases when the area is tender.
  • Work out tight spots using a foam roller or percussive massager.
  • Stretching and loosening the muscle before and after runs can help it relax and increase blood flow.
  • Stretches like pigeon pose and standing figure four and exercises like side planks with a leg lift are recommended.

Building a Stronger Body


Ahmad Siraj, Sidra, and Ragini Dadgal. “Physiotherapy for Piriformis Syndrome Using Sciatic Nerve Mobilization and Piriformis Release.” Cureus vol. 14,12 e32952. 26 Dec. 2022, doi:10.7759/cureus.32952

Chang A, Ly N, Varacallo M. Piriformis Injection. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

Heiderscheit, Bryan, and Shane McClinton. “Evaluation and Management of Hip and Pelvis Injuries.” Physical Medicine and rehabilitation clinics of North America vol. 27,1 (2016): 1-29. doi:10.1016/j.pmr.2015.08.003

Julsrud, M E. “Piriformis syndrome.” Journal of the American Podiatric Medical Association vol. 79,3 (1989): 128-31. doi:10.7547/87507315-79-3-128

Kraus, Emily, et al. “Piriformis Syndrome With Variant Sciatic Nerve Anatomy: A Case Report.” PM & R: the Journal of Injury, Function, and Rehabilitation vol. 8,2 (2016): 176-9. doi:10.1016/j.pmrj.2015.09.005

Lenhart, Rachel, et al. “Hip muscle loads during running at various step rates.” The Journal of Orthopedic and sports physical therapy vol. 44,10 (2014): 766-74, A1-4. doi:10.2519/jospt.2014.5575

Sulowska-Daszyk, Iwona, and Agnieszka Skiba. “The Influence of Self-Myofascial Release on Muscle Flexibility in Long-Distance Runners.” International Journal of environmental research and public health vol. 19,1 457. Jan 1, 2022, doi:10.3390/ijerph19010457

A Modern Epidemic Known As Back Pain

A Modern Epidemic Known As Back Pain


Back pain is a common issue experienced by people all over the world. The human body’s main structure is the back, divided into three sections: cervical, thoracic, and lumbar. These sections help in body movement, including twisting and turning, moving the extremities, and have a relationship with the gut and central nervous system. The surrounding muscles in the back also provide support and protect the spine. However, normal activities like bending down to pick up a heavy object, sitting down for an extended period, or falling can cause changes that lead to back pain, misalignment, and risk profiles in the upper and lower extremities. Today’s article focuses on the causes of back pain and the treatments available to relieve its effects. We utilize and incorporate valuable information about our patients to certified medical providers using non-surgical treatments to reduce the impact of back pain. We encourage and refer patients to associated medical providers based on their findings while supporting that education is a remarkable and fantastic way to ask our providers the essential questions at the patient’s acknowledgment. Dr. Alex Jimenez, D.C., comprises this information as an educational service. Disclaimer


An Overview Of Back Pain


Do you have pain in your upper, middle, or lower back? Do you experience aches and pains in the morning? Did lifting something heavy cause you pain? These symptoms could be signs of back pain, a common and costly reason for emergency room visits. Research studies reveal that back pain can have various causes and affect the entire body, either mechanically or non-specifically. The three sections of the back – cervical, thoracic, and lumbar – can all be impacted, causing referred pain in different parts of the body. For instance, cervical (upper) back pain can cause stiffness in the neck, while thoracic (middle) back pain can lead to shoulder and posture issues. Lumbar (low) back pain, the most common type, can cause hip and sciatic problems. Additional research studies reveal that back pain is a complex issue that can severely affect body function, and environmental factors can also influence it.


Causes Of Back Pain

Various factors can be the cause of back pain, thus resulting in spine misalignment. In their book, “The Ultimate Spinal Decompression,” Dr. Eric Kaplan, D.C., FIAMA, and Dr. Perry Bard, D.C., explain that the back muscles play a significant role in protecting the spine. Environmental factors can also impact the spine, leading to potential back pain. The book further notes that wear and tear and disc protrusion on the spine can result in disc herniation and degeneration, also associated with back pain. Some common causes of back pain include:

  • Disc degeneration
  • Muscle sprains and strains
  • Slipped spinal disc
  • Herniations
  • Musculoskeletal disorders (arthritis, osteoporosis, sciatica, & fibromyalgia)
  • Visceral-somatic/Somato-visceral pain (Affected organ or muscle causes referred pain to different body parts)
  • Pregnancy

Further research indicates that various environmental factors, such as physical activity, lifestyle, stress, and work conditions, are associated with back pain and can overlap as risk factors. If left untreated, these environmental factors can lead to chronic conditions and significantly impact a person’s quality of life.


Chiropractic Secrets Exposed- Video

Have you been feeling numbness or tingling in your arms or legs? Do you experience back muscle pain when you stretch? Or do you feel pain in your low back or other parts of your body? These issues are often associated with back pain and, if left untreated, can lead to disability and loss of function. Fortunately, there are many ways to reduce back pain and its associated symptoms and promote natural healing. The video above explains how non-surgical treatments like chiropractic care can help alleviate back pain through manual manipulation. This treatment can realign the spine, stretch out tight muscles, and restore the body’s range of motion.

Treatments For Back Pain


If you are experiencing back pain, various treatments can help ease your symptoms and improve your mobility. You have two options for treating back pain: surgical and non-surgical. Surgical treatment may be necessary if you are experiencing nerve compression or have sustained an injury that requires spinal fusion. Non-surgical treatments can help relieve pressure on your spine, reduce back pain, and even alleviate pain in other areas of your body. Some non-surgical treatments for back pain include:

  • Physical therapy
  • Exercise
  • Chiropractic care
  • Acupuncture
  • Spinal Decompression

According to research, non-surgical treatments can alleviate pressure on spinal discs, loosen tight muscles, improve joint mobility, and promote natural healing. Many people supplement these treatments with healthy lifestyle choices, making small adjustments to their routine and paying closer attention to their physical well-being.



Since back pain is a widespread problem affecting people globally, it can be caused by various environmental factors that impact the cervical, thoracic, and lumbar back sections, leading to overlapping risk profiles and affecting different body parts. Tight and strained muscles and a compressed spine are common symptoms of this issue. However, treatments available can effectively reduce pain, stretch tight muscles, and relieve pressure off the spinal disc. By incorporating these treatments, individuals can alleviate back pain and allow their bodies to heal naturally.



Allegri, Massimo, et al. “Mechanisms of Low Back Pain: A Guide for Diagnosis and Therapy.” F1000Research, 28 June 2016,

Casiano, Vincent E, et al. “Back Pain.” In: StatPearls [Internet]. Treasure Island (FL), 20 Feb. 2023,

Choi, Jioun, et al. “Influences of Spinal Decompression Therapy and General Traction Therapy on the Pain, Disability, and Straight Leg Raising of Patients with Intervertebral Disc Herniation.” Journal of Physical Therapy Science, Feb. 2015,

Kaplan, Eric, and Perry Bard. The Ultimate Spinal Decompression. JETLAUNCH, 2023.

See, Qin Yong, et al. “Acute Low Back Pain: Diagnosis and Management.” Singapore Medical Journal, June 2021,


Intercostal Muscle Strain: El Paso Back Clinic

Intercostal Muscle Strain: El Paso Back Clinic

Intercostal muscles are the muscles within the rib cage, commonly called the intercostals, which connect the ribs and make up the chest wall. An intercostal muscle strain refers to an injury between two or more ribs. If these muscles become overstretched, restricted, or suffer damage, it can cause inflammation and significant pain in the middle and upper back. Intercostal muscle strain is a common injury in athletes and physically demanding jobs. Chiropractic care and massage therapy can realign the vertebrae with the ribs and loosen and relax the muscles to increase circulation and restore mobility and function.

Intercostal Muscle Strain: EP's Chiropractic Injury Team

Intercostal Muscle Strain

The intercostal muscles have different layers attached to the ribs to help build the chest wall and assist in breathing. There are 11 intercostal muscles on each side of the rib cage. Each set is located between connected ribs in the upper and mid-back and consists of the following:


  • These are the outermost intercostals, responsible for expanding the chest during breathing to help inhale air and allow full deep breaths.
  • The external intercostals originate at the lower edge of a rib and run diagonally to attach to the upper edge of the rib below.
  • They are found in the rib cage’s back, sides, and front.


  • These sit directly underneath the externals and help collapse the chest during breathing to exhale.
  • The muscle fibers run perpendicular to the external intercostals, moving diagonally from front to back along the ribs, and are in the entire rib cage.


  • These sit directly underneath, run parallel to the internal intercostals, and run from the back of the rib cage to each side.
  • The veins, arteries, and nerves lie between the internal and innermost intercostals.

When an intercostal muscle gets twisted, overused, or stretched too far, it can tear, causing muscle strain. Often radiating pain along the rib cage is experienced that extends to the back.


An intercostal muscle strain often occurs as the result of an injury or overexertion of the muscles. Common causes include:

  • Trauma to the rib cage, such as from a fall or automobile collision.
  • Impact trauma from sports or physical activities.
  • Over twisting the torso beyond its normal range of motion from lifting weights, sports, yoga postures, or dance positions.
  • Repeatedly reaching overhead for work or tasks like cleaning or painting.
  • Lifting heavy objects above shoulder height.
  • Repetitive torso movements.
  • A sudden increase in physical activity that the body is not used to can also lead to intercostal muscle strain.
  • This can happen when a lack of conditioning or unhealthy postures weaken muscles.


The signs and symptoms can vary, depending on the severity and cause. Symptoms can include:

  • Intercostal muscle spasms.
  • Mobility difficulties.
  • Inflammation, swelling, and sensitivity in the affected area.
  • Stiffness and tension, causing upper back pain.
  • Upper back and rib pain.
  • Tenderness in the area between the ribs.
  • Muscle rigidity when bending or twisting the upper body.
  • Gradual worsening pain after repetitive movements.
  • Worsening pain when coughing, sneezing, or breathing in deeply.
  • Severe and sudden pain, particularly if caused by direct trauma to the chest or back.


Diagnosis involves the individual’s medical history and a physical exam to check for movement limitations and assess affected and sensitive areas. Once the inflammation is reduced, chiropractic and physical therapy will focus on the following:

  • Pain relief treatment.
  • Breathing exercises.
  • Posture training.
  • Stretching under supervision.
  • Strengthing exercises.
  • Most cases fully heal within 6 to 8 weeks.

Rib Muscle Injury


De Troyer, A et al. “Mechanics of intercostal space and actions of external and internal intercostal muscles.” The Journal of clinical investigation vol. 75,3 (1985): 850-7. doi:10.1172/JCI111782

Lord, Michael J, and William G Carson Jr. “Multiple Rib Stress Fractures.” The Physician and sports medicine vol. 21,5 (1993): 80-91. doi:10.1080/00913847.1993.11947575

Morrison W. What is an intercostal muscle strain? Medical News Today. Jan 2020

Page P. Current Concepts in Muscle Stretching for Exercise and Rehabilitation. International Journal of Sports Physical Therapy. 2012;7(1):109-119.

Park, Kyung-hee, et al. “Difference in selective muscle activity of thoracic erector spinae during prone trunk extension exercise in subjects with slouched thoracic posture.” PM & R: the Journal of Injury, Function, and Rehabilitation vol. 7,5 (2015): 479-84. doi:10.1016/j.pmrj.2014.10.004

Tran H. Causes of Intercostal Muscle Strain. Spine-health. October 2017

Yoo, Won-Gyu. “Effect of a combined thoracic and backward lifting exercise on the thoracic kyphosis angle and intercostal muscle pain.” Journal of physical therapy science vol. 29,8 (2017): 1481-1482. doi:10.1589/jpts.29.1481

Yoo, Won-Gyu. “Effect of thoracic stretching, thoracic extension exercise and exercises for cervical and scapular posture on thoracic kyphosis angle and upper thoracic pain.” Journal of physical therapy science vol. 25,11 (2013): 1509-10. doi:10.1589/jpts.25.1509

High Hamstring Tendinopathy: El Paso Back Clinic

High Hamstring Tendinopathy: El Paso Back Clinic

The hamstring muscles attach, through a tendon called the proximal hamstring tendon, to the ischial tuberosity, the bones used to sit deep in the buttock muscles. When the tendon is subjected to overuse/repetitive stresses and strains, the internal structure can become compromised, leading to weakness and pain symptoms. This is known as proximal hamstring tendinopathy. Tendinopathy is an overuse injury where the tendon is repeatedly strained until microscopic tears form. It is common in athletes that do a lot of running but also in individuals that sit for prolonged periods. If left untreated, high hamstring tendinopathy can lead to progressive degeneration of the tissues, leading to chronic weakness, pain, and dysfunction.

High Hamstring Tendinopathy: EP's Chiropractic Team

High Hamstring Tendinopathy

The hamstrings are a powerful muscle group that extends the hip and flexes the knee. They experience stress and pressure during activity and inactivity/sitting and are susceptible to strain injuries. Tendons attach muscle to bone and are designed to take compressive and tensile weight/loads that stretch or flex. A tendon is made up of fibrous tissue containing organized type 1 collagen. Tendons receive blood; however, the supply is less where the tendon attaches to the bone and is commonly where tendinopathy occurs.


A hamstring injury involves the bruising, irritation, or tearing of the hamstring tendon or muscle tissue. Severity can range from:

  • Microtears that cause stiffness and pain symptoms but heal fast on their own.
  • Severe ruptures that cause debilitating pain, dysfunction and require medical intervention.

The tendon attaches to the ischial tuberosity or sitting buttock bone. Tendons can have a spasm-like reaction to sudden or quick shift changes. A sudden change can cause adverse changes to the tendon. Too much load on the tendon beyond its ability to recover can cause the structure to change and the collagen to break down/tear like a rope tearing and unraveling. High hamstring tendinopathy happens around the hip area and presents as buttock or upper thigh pain. Individuals report deep, dull, radiating buttock pain during walking, running, and prolonged sitting or driving. Sometimes the sciatic nerve can become irritated or entrapped by an affected tendon’s scar tissue, causing sciatica-like symptoms.

Stages of Tendon Pathology

Reactive Phase

  • Caused by an acute overload of physical activity or inactivity.
  • The tendon will thicken temporarily to decrease the stress; however, there may be no inflammation.
  • The tendon can return to normal if the load is reduced or sufficient time for recovery and repair is allowed.


  • Chronically overloaded.
  • Unsuccessful healing.
  • More negative tendon changes occur.
  • Reversibility is possible with load management and targeted exercises to stimulate the tendon and surrounding tissues.


  • Continual progression of adverse tendon changes.
  • More common in older individuals.
  • Continue load management and strength training to maximize the tendon’s tolerance.

Chiropractic Treatment

A chiropractic therapy team will develop a personalized treatment program to improve tendon structure and strengthen the hamstrings, gluteal, and side abdominal muscles. They will begin with tendon symptom-relieving massage to loosen the muscles and get the blood circulating, MET-targeted stretches to lengthen the muscles, and spinal and pelvic adjustments to realign the body.

Sciatica Explained


Buckley, Mark R et al. “Distributions of types I, II and III collagen by region in the human supraspinatus tendon.” Connective tissue research vol. 54,6 (2013): 374-9. doi:10.3109/03008207.2013.847096

Lempainen, Lasse, et al. “Expert opinion: diagnosis and treatment of proximal hamstring tendinopathy.” Muscles, ligaments, and tendons journal vol. 5,1 23-8. 27 Mar. 2015

Mattiussi, Gabriele, and Carlos Moreno. “Treatment of proximal hamstring tendinopathy-related sciatic nerve entrapment: presentation of an ultrasound-guided “Intratissue Percutaneous Electrolysis” application.” Muscles, ligaments, and tendons journal vol. 6,2 248-252. 17 Sep. 2016, doi:10.11138/mltj/2016.6.2.248

Ono, T et al. “Estimation of tensile force in the hamstring muscles during overground sprinting.” International Journal of sports medicine vol. 36,2 (2015): 163-8. doi:10.1055/s-0034-1385865

White, Kristin E. “High hamstring tendinopathy in 3 female long-distance runners.” Journal of chiropractic medicine vol. 10,2 (2011): 93-9. doi:10.1016/j.jcm.2010.10.005

Wilson, Thomas J et al. “Sciatic Nerve Injury After Proximal Hamstring Avulsion and Repair.” Orthopedic Journal of sports medicine vol. 5,7 2325967117713685. 3 Jul. 2017, doi:10.1177/2325967117713685

Vocal Cord Injury: El Paso Back Clinic

Vocal Cord Injury: El Paso Back Clinic

Automobile collisions, work, sports, and personal accidents can cause neck injuries that can affect other areas, leading to long-term health problems. Neck injuries involving soft tissue damage frequently persist after the incident. One of the injuries includes vocal cord damage caused by impact to the larynx. The larynx, or voicebox, is an organ that is behind the Adam’s apple. A neck injury impacting the larynx can affect the ability to speak and breathe and cause vocal cord paralysis. Treatment can involve surgery, voice therapy, physical therapy, and chiropractic.

Vocal Cord Injury: EP Chiropractic Injury Specialists

Vocal Cord Injury

The vocal cords are two flexible bands of muscle tissue at the entrance of the trachea. The vocal cords are normally in a relaxed open position to allow breathing. When talking, the bands combine and vibrate to make a sound. Surgery, viral infections, certain cancers, and neck trauma can cause vocal cord paralysis. In this condition, nerve damage blocks or inhibits impulses from transmitting to the voice box. The muscles, usually one of them, become paralyzed, preventing swallowing and ingesting saliva through the windpipe/trachea. In rare cases, both muscles are unable to move.


Signs and symptoms can include:

  • Difficulty breathing
  • Shortness of breath.
  • Hoarse breathing.
  • Noisy breathing.
  • Speaking problems
  • The need to take frequent breaths while speaking.
  • Loss of vocal pitch.
  • Inability to talk loudly.
  • Trouble Swallowing
  • Choking or coughing when swallowing.
  • Loss of gag reflex.
  • Frequent coughing and throat clearing.


Neck or Chest Injury

  • Trauma to the neck or chest can injure the voice box nerves.


  • Infections like Lyme disease, Epstein-Barr virus, and herpes can cause inflammation and nerve damage.


  • Tumors, cancerous and noncancerous, can grow inside or around the muscles, cartilage, and nerves.


  • Neurological conditions like multiple sclerosis or Parkinson’s disease can lead to vocal cord paralysis.

Surgical Injury

  • Surgical procedure mistakes or complications on or near the neck or upper chest can result in damage to the voice box nerves.
  • Surgeries to the thyroid or parathyroid glands, esophagus, neck, and chest have an increased risk.


  • A stroke chokes blood flow to the brain and can damage the region of the brain that transmits messages to the voice box.


Treatment is determined by a doctor based on the individual medical condition and diagnostic tests. Treatment can involve:

Speech Therapy

Speech therapy is recommended as the laryngeal muscles are strengthened through various exercises, improving breathing function. A speech therapist will begin working with the individual on exercises targeting the weakened vocal folds by enhancing airflow and blood circulation.

Physical Therapy and Chiropractic

Treatment involves performing gentle exercises that work on the vocal cords gradually and progressively but does not stress them. Chiropractors work with the physical therapist performing high-velocity, low-amplitude manipulation targeted at the lower neck and upper thoracic area, the C3/T1 vertebrae. A treatment plan will also use massage, non-surgical decompression, instrument/tool-assisted soft-tissue mobilization, low laser or ultrasound, and at-home stretches and exercises.


Surgery could be necessary for individuals experiencing no improvement despite doing the prescribed speech and physical therapy exercises. Different types of procedures are based on the degree and extent of the paralysis:

  • Injections – Collagen and fillers are injected into the vocal cords to reposition the affected muscles closer to the larynx.
  • Phonosurgery – The vocal cords are repositioned through restructuring.
  • Tracheotomy – If the vocal folds are closing, a surgeon may make an incision in the neck at the opening of the windpipe and insert a breathing tube. This bypasses the air blockage caused by the vocal folds and promotes proper air circulation.

Cervical Spine Instability


Chen, Ching-Chang, et al. “Long-term result of vocal cord paralysis after anterior cervical discectomy.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 23,3 (2014): 622-6. doi:10.1007/s00586-013-3084-y

Dankbaar JW, et al. Vocal cord paralysis: Anatomy, imaging, and pathology. Insights in Imaging. 2014; doi:10.1007/s13244-014-0364-y.

Fitzpatrick, P C, and R H Miller. “Vocal cord paralysis.” The Journal of the Louisiana State Medical Society: official organ of the Louisiana State Medical Society vol. 150,8 (1998): 340-3.

Kriskovich, M D et al. “Vocal fold paralysis after anterior cervical spine surgery: incidence, mechanism, and prevention of injury.” The Laryngoscope vol. 110,9 (2000): 1467-73. doi:10.1097/00005537-200009000-00011

Vocal fold paralysis. National Institute on Deafness and Other Communication Disorders. Accessed May 18, 2022.

Vocal fold paralysis. American Speech-Language-Hearing Association. Accessed May 18, 2022.

Waddell, Roger K. “Chiropractic care for a patient with spasmodic dysphonia associated with cervical spine trauma.” Journal of chiropractic medicine vol. 4,1 (2005): 19-24. doi:10.1016/S0899-3467(07)60108-6

Posterior Cruciate Ligament Injuries: El Paso Back Clinic

Posterior Cruciate Ligament Injuries: El Paso Back Clinic

The body has around 1,000 ligaments that connect bones and joints. Ligaments are strong bands of tissue that support joint mobility and stabilize the muscles and bones. An injury to one or more ligaments can cause inflammation, swelling, discomfort, and instability. The PCL refers to the posterior cruciate ligament that runs along the back of the knee joint. This ligament connects the femur/thigh bone to the tibia/shinbone. Anyone can suffer from an injury to the posterior cruciate ligament. It can be caused by the knee hitting a dashboard in an automobile collision, a worker twisting or falling on a bent knee or a sports contact injury. The Injury Medical Chiropractic and Functional Medicine Clinic Team provide soft tissue work, trigger point therapy, and targeted non-surgical treatment through advanced therapy methods and technologies.

Posterior Cruciate Ligament Injuries: Chiropractic Wellness TeamPosterior Cruciate Ligament

The posterior cruciate ligament – PCL is located inside the knee, just behind the anterior cruciate ligament – ACL. It is one of several ligaments that connect the femur/thighbone to the tibia/shinbone. The posterior cruciate ligament keeps the tibia from moving backward.


Posterior cruciate ligament injuries are far less common than ACL – anterior cruciate tears. PCL injuries make up less than 20% of all knee ligament injuries. It is more common for PCL tears to occur with other ligament injuries. A PCL injury can cause mild, moderate, or severe damage and is rated into four different categories:

Grade I

  • A partial tear is present in the ligament.

Grade II

  • There is a partial tear.
  • The ligament can feel loose.

Grade III

  • The ligament is completely torn.
  • The knee is unstable.

Grade IV

  • The PCL is injured.
  • Other knee ligaments are damaged.

Individuals with posterior cruciate ligament injuries can have short or long-term symptoms. Typically, long-term symptoms occur when an injury slowly develops over time. In mild cases, individuals may still be able to walk, and their symptoms may be less noticeable. Common symptoms associated with PCL injuries include:

  • Difficulty placing weight on the injured knee.
  • Stiffness.
  • Walking difficulties.
  • Difficulty descending stairs.
  • A wobbly sensation inside the knee.
  • Inflammation and swelling can be mild to severe.
  • Knee pain.
  • Pain that worsens over time.
  • Over time, tears could lead to the development of osteoarthritis.

There is an increased risk of extensive damage and chronic pain conditions if left untreated.

Chiropractic Care

The continued participation in work or activity following a mild injury is the primary reason individuals undergo therapy, injections, or surgical repairs. Knee injuries need immediate attention to prevent worsening or further damage. A chiropractor will examine the knee, check the range of motion and ask about symptoms. They may request imaging tests to determine the extent of the damage. These tests may include the following:

  • X-rays.
  • Magnetic resonance imaging.
  • CT scan.

During the physical examination, they will check all the structures of the injured knee and compare them to the non-injured knee. The wounded knee may appear to sag backward when bent or could slide back too far, specifically when beyond a 90-degree angle. Treatment depends on the severity of the injury. Common treatments include:


  • Crutches may be recommended to limit the weight placed on the knee.

Knee Brace

  • A special brace can address instability and help prevent the tibia bone from sagging backward.
  • Gravity tends to pull the bone backward when lying down.

Chiropractic and Physical Therapy

  • As the swelling goes down, a carefully personalized rehabilitation program can begin.
  • A chiropractic regimen will reset and retrain the ligament.
  • Massage therapy will minimize scar tissue and increase circulation.
  • Specific exercises will stabilize the knee, restore function, and strengthen the leg muscles that support it.
  • Strengthening the muscles in the front of the thigh/quadriceps is a key factor in a successful recovery.


  • In severe cases, surgery may be necessary for full rehabilitation.
  • Knee arthroscopy is performed to reconstruct the ligament.
  • This procedure is less invasive compared to traditional surgical methods.

Recovery time varies from person to person. If the injury is mild, it may only take around ten days to heal. If surgery was needed, recovery could take about six to nine months. Full recovery typically requires 6 to 12 months.

Best Knee Injury Chiropractor


American Academy of Orthopaedic Surgeons. Posterior Cruciate Ligament Injuries. (–conditions/posterior-cruciate-ligament-injuries) Accessed 7/26/21.

Bedi A, Musahl V, Cowan JB. Management of Posterior Cruciate Ligament Injuries: An Evidence-Based Review. Journal of the American Academy of Orthopedic Surgery. 2016 May;24(5):277-89. Accessed 7/26/21.

Lu, Cheng-Chang, et al. “Twelve Weeks of a Staged Balance and Strength Training Program Improves Muscle Strength, Proprioception, and Clinical Function in Patients with Isolated Posterior Cruciate Ligament Injuries.” International journal of environmental research and public health vol. 18,23 12849. 6 Dec. 2021, doi:10.3390/ijerph182312849

Pierce, Casey M et al. “Posterior cruciate ligament tears: functional and postoperative rehabilitation.” Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA vol. 21,5 (2013): 1071-84. doi:10.1007/s00167-012-1970-1

Schüttler, K F et al. “Verletzungen des hinteren Kreuzbands” [Posterior cruciate ligament injuries]. Der Unfallchirurg vol. 120,1 (2017): 55-68. doi:10.1007/s00113-016-0292-z

Zsidai, Bálint, et al. “Different injury patterns exist among patients undergoing operative treatment of isolated PCL, combined PCL/ACL, and isolated ACL injuries: a study from the Swedish National Knee Ligament Registry.” Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA vol. 30,10 (2022): 3451-3460. doi:10.1007/s00167-022-06948-x

Trapped Sciatic Nerve In or Around Hamstrings: Back Clinic

Trapped Sciatic Nerve In or Around Hamstrings: Back Clinic

Hamstring syndrome is a condition where the sciatic nerve gets pinched between the hamstring muscles and the pelvic bone or by the tissue bands that connect the hamstring muscles causing compression on and around the nerve. It is seen in individuals that play sports that involve running, kicking, or jumping, in middle-aged individuals engaged in daily activities that have suffered falls, and in individuals that sit for many hours. Chiropractic care, massage, and decompression therapy can relieve the symptoms, release the trapped nerve, relax and stretch the muscles, and restore function. 

Trapped Sciatic Nerve In or Around Hamstrings: Chiropractic Clinic

Hamstring Muscles Trapped Sciatic Nerve

Three muscles make up the hamstrings in the back of the thigh. The sciatic nerve runs from the low back down the leg into the foot. A trapped sciatic nerve can cause various symptoms and sensations in the back of the leg, hip, buttock, and foot. It may hurt to sit down or stretch the legs out, and there is usually tightness in and/or around the buttock and back of the leg. The symptoms typically recede when lying on your back.


  • Regular wear and tear on the back muscles and hamstrings can contribute to the condition.
  • Often the sciatic nerve and/or the sheath surrounding the sciatic nerve gets trapped and irritated as it travels around the ischial tuberosity. The ischial tuberosities are known as the sit bones.
  • The area where the sciatic nerve runs down the back of the leg can become narrowed, leading to nerve irritation and stinging, numbing, and tingling sensations.
  • The injury often happens during sudden, quick, forceful movements that overstretch the tendons and/or muscles but can also happen during slow movements.
  • Movement agitates the pulling and rubbing of the nerve on the muscles.
  • A non-painful pull or pop of the hamstrings can cause the muscles to spasm and wrap around the nerve.


Symptoms usually include the following:

  • Leg pain that worsens when sitting.
  • Intense electrical shooting pain that makes it hard to stand or move.
  • Difficulties moving the leg or foot.
  • Numbness and weakness in and around the leg.
  • Tingling or burning sensations running down the leg.
  • Persistent pain on one side of the lower back.

Chiropractic Care

Chiropractic treatment can relieve the symptoms and release the trapped nerve. Treatment includes:

  • Accurate Diagnosis – A chiropractor will examine and review physical activity, work, and medical history.
  • Ice and Heat therapies will stop the swelling and increase blood flow.
  • Massage therapy relaxes the muscles and increases circulation.
  • Decompression therapy incrementally and gently stretches the body.
  • Chiropractic adjustments realign and reset the body.
  • Targeted stretches and exercises will keep the muscles loose and increase strength.
  • Nutritional recommendations will help reduce inflammation and prevent flare-ups.

Hamstrings and Sciatic Nerve Relationship


Lohrer, Heinz, et al. “Nerve entrapment after a hamstring injury.” Clinical journal of sports medicine: official journal of the Canadian Academy of Sports Medicine vol. 22,5 (2012): 443-5. doi:10.1097/JSM.0b013e318257d76c

Mattiussi, Gabriele, and Carlos Moreno. “Treatment of proximal hamstring tendinopathy-related sciatic nerve entrapment: presentation of an ultrasound-guided “Intratissue Percutaneous Electrolysis” application.” Muscles, ligaments and tendons journal vol. 6,2 248-252. 17 Sep. 2016, doi:10.11138/mltj/2016.6.2.248

McGregor, Catriona, et al. “Traumatic and overuse injuries of the ischial origin of the hamstrings.” Disability and rehabilitation vol. 30,20-22 (2008): 1597-601. doi:10.1080/09638280701786138

Saikku, Kari, et al. “Entrapment of the proximal sciatic nerve by the hamstring tendons.” Acta orthopaedica Belgica vol. 76,3 (2010): 321-4.