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.
Finger sprains and dislocations are common hand injuries that can happen during work, physical/sports activities, or in automobile collisions and accidents. Can recognizing the symptoms help in developing an effective treatment strategy?
Finger Sprains and Dislocations
Finger sprains and dislocations are common injuries of the hand that cause pain and swelling.
A sprain happens when the finger tissue that supports a joint gets stretched beyond its limits in a way that stresses the ligaments and tendons.
The ligament tissue can be partially or completely torn. If the damage is bad enough, the joint comes apart.
This is a dislocation – A dislocation happens when the joint in the finger gets shifted out of its normal position.
Both injuries can cause pain and stiffness in the finger and hand.
Finger sprains can happen any time the finger bends in an awkward or unusual way. This can happen from falling on the hand or getting hurt when engaged in physical activities like sports or household chores. Sprains can occur in any of the knuckle joints in the finger. However, most commonly, the joint in the middle of the finger gets sprained. It’s known as the proximal interphalangeal or PIP joint. (John Elfar, Tobias Mann. 2013) Symptoms of a finger sprain can include:
Thumb sprains and finger sprains in children may need to be splinted or taped for longer periods, as the ligament is not fully developed or as strong, which could lead to a tear.
A finger dislocation is a more severe injury involving the ligament, joint capsule, cartilage, and other tissues that causes misalignment of the finger. The ligaments and the joint capsule get torn when a joint is dislocated. The joint needs to be reset, which can be a simple process, or in severe cases, patients may need to be placed under anesthesia or undergo surgery to reset the joint properly.
In these cases, tendons or other tissues might be preventing the joint from getting into position.
Putting the finger back into the right position is known as”reduction.” Once reduced, the finger needs to be splinted.
Individuals suffering from hip, thigh, and/or groin pain could be experiencing iliopsoas syndrome. Could knowing the symptoms and causes help in diagnosis and treatment?
Iliopsoas syndrome encompasses several conditions that affect the inner hip muscle and can cause hip and thigh pain. The muscle helps to bend the leg toward the body.
The condition is usually caused by overuse injuries and commonly affects individuals who perform repeated hip flexion movements, like cyclists, gymnasts, dancers, runners, and soccer players. (Liran Lifshitz, et al., 2020)
The term is often used interchangeably with psoas syndrome, iliopsoas tendonitis, snapping hip syndrome, and iliopsoas bursitis. However, there are clinical differences.
Hip or groin clicking or snapping that can be heard and/or felt during movement.
Pain and/or stiffness in the hip and thigh area.
Pain that worsens when bending the hip – walking, climbing stairs, squatting, sitting.
Movements that involve bringing the knee toward the chest can worsen the pain.
The iliopsoas muscles are hip muscles on the front of the hip. They are made up of the psoas major, the psoas minor, and the iliacus. Small, fluid-filled sacs/bursae are within the hip joint between bones and soft tissues. The bursae reduce friction and provide cushioning to help the tendons, muscles, and other structures move smoothly over the bony prominences.
Lifshitz, L., Bar Sela, S., Gal, N., Martin, R., & Fleitman Klar, M. (2020). Iliopsoas the Hidden Muscle: Anatomy, Diagnosis, and Treatment. Current sports medicine reports, 19(6), 235–243. doi.org/10.1249/JSR.0000000000000723
Hamstring muscle injuries are common, especially in athletes and individuals with physically demanding jobs. Is there a better chance of full recovery with surgical repair and post-op rehabilitation?
Hamstring Muscle Tear
Most often, hamstring muscle injuries are partial tears of the muscle. These types of injuries are muscle strains that occur when the muscle fibers are stretched beyond their normal limits. Complete tears of the hamstring muscle are unusual, but they do occur in both athletes and non-athletes. Determining the optimal treatment plan depends on:
The severity of the tendon tear
The expectations of the injured individual.
Incomplete tears are when the hamstring muscle is stretched too far, but not completely detached.
Basic hamstring strains can be treated with simple steps – rest, ice, anti-inflammatory medications, and conservative therapies.
Symptoms of a hamstring muscle strain can include pain, bruising, swelling, and movement difficulty. (American Academy of Orthopaedic Surgeons. 2021) Individuals who sustain this injury typically experience sudden sharp pain. Signs of a tear can include:
Sharp pain where the buttock and thigh meet.
Sitting can be difficult as the edge of a chair can place pressure directly on the injury.
Spasms and cramping sensations in the back of the thigh.
Weakness in the leg, specifically when bending the knee or lifting the leg behind the body.
Numbness or burning sensations as a result of sciatic nerve irritation.
Swelling and bruising in the back of the thigh – over time it can travel down to the back of the knee and calf and possibly into the foot.
With a complete hamstring tear, there is usually significant swelling and bruising that develops in the back of the thigh.
The symptoms can be difficult to spot in the early stages which is why X-rays of the hip or thigh are usually obtained.
In some situations, a fragment of bone can get pulled off the pelvis along with the hamstring muscle attachment. MRI testing can be performed to evaluate the attachment and can define critical features of a complete hamstring muscle tear, including: (American Academy of Orthopaedic Surgeons. 2021)
The number of tendons involved.
Complete versus incomplete tearing.
The amount of retraction – the amount the tendons have pulled back.
This will guide the development of treatment.
The treatment of a complete tear will depend on different factors. The other variable is the patient and their expectations.
Treatment is more aggressive in younger individuals like high-level athletes.
Treatment is less aggressive in middle-aged individuals.
Often a single tendon tear can be treated non-surgically.
When one tendon is involved, it is typically not pulled very far from its normal attachment and will develop scar tissue in a positive position.
Conversely, when three tendons have been torn, they usually pull more than a few centimeters away from the bone. These cases have better results with surgical repair. (UW Health. 2017)
Surgeons will use patient characteristics – high-level athletes or less physically active individuals – to guide treatment recommendations.
Rehabilitation following surgery can take 3-6 months or longer.
The first six weeks limit weight-bearing with the use of crutches.
Patients may be recommended to wear a brace to reduce tension on the repaired hamstring tendons.
Strengthening does not begin until three months post-op, and even light activities are usually delayed. (UW Health. 2017)
Sometimes these individuals experience symptoms of discomfort from sitting and may exhibit long-term weakness of the hamstring muscle.
Full recovery from a complete hamstring muscle injury takes time. Studies have shown high-level athletes are able to resume competitive sports after the repair and rehabilitation of an acute hamstring muscle injury. (Samuel K. Chu, Monica E. Rho. 2016)
Delaying surgical treatment may not always lead to optimal results.
When the tendon is torn away from its normal attachment, it begins to scar around the surrounding soft tissues.
When there is a delay of more than a few weeks following the initial injury, regaining the full length of the tendon and muscle can be challenging.
Chu, S. K., & Rho, M. E. (2016). Hamstring Injuries in the Athlete: Diagnosis, Treatment, and Return to Play. Current sports medicine reports, 15(3), 184–190. doi.org/10.1249/JSR.0000000000000264
Kwak, H. Y., Bae, S. W., Choi, Y. S., & Jang, M. S. (2011). Early surgical repair of acute complete rupture of the proximal hamstring tendons. Clinics in orthopedic surgery, 3(3), 249–253. doi.org/10.4055/cios.2011.3.3.249
As the body ages, individuals want to stay active and maintain a healthy pain free lifestyle. Can regenerative cells for arthritis and cartilage damage be the future of neuromusculoskeletal medicine and joint healing?
Regenerative Cells For Arthritis and Cartilage Damage
Individuals want to continue to do the physical activities they love, which require healthy joints. Scientists are learning how to harness the abilities of regenerative cells to repair and regrow damaged and deteriorated cartilage. Current stem cell treatment of cartilage problems has not been shown to reverse the effects of arthritis and while studies show clinical improvement, further research is necessary. (Bryan M. Saltzman, et al., 2016)
Cartilage and How It Gets Damaged
Cartilage is a type of connective tissue. In the joints, there are a few types of cartilage. The most commonly referred to is the smooth lining known as articular or hyaline cartilage. This type forms a smooth layer of cushion on the end of a bone at the joint. (Rocky S. Tuan, et al., 2013)
The tissue is very strong and has the ability to compress and absorb energy.
It is very smooth allowing a joint to glide effortlessly through a limb’s range of motion.
When joint cartilage is damaged, the cushioning can wear down.
In traumatic injuries, a sudden force can cause the cartilage to break off and/or suffer damage, that exposes the underlying bone.
In osteoarthritis – degenerative or wear-and-tear arthritis, the smooth layer can wear down thin and unevenly.
Eventually, the cushion wears away, the joints become inflamed and swollen and movements become stiff and painful.
There are treatments for arthritis and cartilage damage, but these treatments are usually focused on relieving symptoms by smoothing down the damaged cartilage or replacing the joint surface with an artificial implant, like knee replacement or hip replacement surgeries. (Robert F. LaPrade, et al., 2016)
Regenerative stem cells are special cells that have the ability to multiply and develop into different types of tissue. In an orthopedic surgery setting for joint problems, stem cells are obtained from adult stem cell primary sources which are bone marrow and fatty tissue. These cells have the ability to develop into cartilage cells, called chondrocytes. (Rocky S. Tuan, et al., 2013)
They also help by stimulating the body to reduce inflammation, stimulate cell repair, and improve blood circulation.
This process is caused by cellular signals and growth factors to stimulate the body to activate the healing processes.
Once stem cells have been obtained, they need to be delivered to the area of cartilage damage.
Cartilage is a complex tissue that is described as a scaffold structure that is composed of collagen, proteoglycans, water, and cells. (Rocky S. Tuan, et al., 2013)
To regenerate cartilage, the complex tissues must also be reconstructed.
There are studies on types of tissue scaffolds engineered to recreate a similar type of cartilage structure.
The stem cells can then be injected into the scaffold, in hopes of restoring a normal type of cartilage.
Non-Surgical Arthritis Treatments
Standard treatments such as cortisone shots or physical therapies work as well and provide benefits that could be utilized in combination with regenerative cells for arthritis and cartilage damage in the near future. Data takes time and therefore how this impacts the long-term health of a joint needs continued research in terms of tissue engineering and cell delivery to determine the best approach to help individuals.
LaPrade, R. F., Dragoo, J. L., Koh, J. L., Murray, I. R., Geeslin, A. G., & Chu, C. R. (2016). AAOS Research Symposium Updates and Consensus: Biologic Treatment of Orthopaedic Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 24(7), e62–e78. doi.org/10.5435/JAAOS-D-16-00086
Saltzman, B. M., Kuhns, B. D., Weber, A. E., Yanke, A., & Nho, S. J. (2016). Stem Cells in Orthopedics: A Comprehensive Guide for the General Orthopedist. American journal of orthopedics (Belle Mead, N.J.), 45(5), 280–326.
Tuan, R. S., Chen, A. F., & Klatt, B. A. (2013). Cartilage regeneration. The Journal of the American Academy of Orthopaedic Surgeons, 21(5), 303–311. doi.org/10.5435/JAAOS-21-05-303
Can combining chiropractic treatment with the common therapies of medication, exercise, and/or physical therapy help relieve sciatic endometriosis pain symptoms?
Sciatic endometriosis is a condition in which endometrial cells (tissue that resembles the lining of the uterus) grow outside of the uterine lining and compress the sciatic nerve. This places stress and pressure on the nerve causing back, pelvic, hip, and leg pain, especially before and during the menstrual cycle. It can also cause pain, irregular periods, and infertility. (The American College of Obstetricians and Gynecologists. 2021)
These areas of endometrial tissue growth are also known as lesions or implants.
The abnormal growth may be caused by higher-than-normal levels of estrogen.
Researchers believe that endometriosis is related to retrograde menstruation, which causes menstrual blood to flow back into the pelvis instead of out through the vagina. (World Health Organization. 2023)
Endometriosis, including sciatic endometriosis, typically cannot be diagnosed with a pelvic examination or ultrasound by themselves. A healthcare provider may need to perform a biopsy using laparoscopy and discuss menstrual cycles, symptoms, and medical history.
The laparoscopy procedure involves making tiny incisions and taking a tissue sample with tools attached to a thin tube with a camera. (MedlinePlus. 2022)
Symptoms can sometimes be temporarily relieved with over-the-counter/OTC pain relievers. Depending on the condition and severity a healthcare provider may prescribe hormonal treatment to prevent new endometrial implants from growing. These can include:
Hormonal birth control.
Progestin – a synthetic form of progesterone.
Gonadotropin-releasing hormone – GnRH agonists.
If pain persists or worsens, individuals may need to undergo surgery to remove the tissue.
The American College of Obstetricians and Gynecologists. Endometriosis.
Seegers, L. M., DeFaria Yeh, D., Yonetsu, T., Sugiyama, T., Minami, Y., Soeda, T., Araki, M., Nakajima, A., Yuki, H., Kinoshita, D., Suzuki, K., Niida, T., Lee, H., McNulty, I., Nakamura, S., Kakuta, T., Fuster, V., & Jang, I. K. (2023). Sex Differences in Coronary Atherosclerotic Phenotype and Healing Pattern on Optical Coherence Tomography Imaging. Circulation. Cardiovascular imaging, 16(8), e015227. doi.org/10.1161/CIRCIMAGING.123.015227
World Health Organization. Endometriosis.
Yahaya, A., Chauhan, G., Idowu, A., Sumathi, V., Botchu, R., & Evans, S. (2021). Carcinoma arising within sciatic nerve endometriosis: a case report. Journal of surgical case reports, 2021(12), rjab512. doi.org/10.1093/jscr/rjab512
Johns Hopkins Medicine. Sciatica.
Yanchun, L., Yunhe, Z., Meng, X., Shuqin, C., Qingtang, Z., & Shuzhong, Y. (2019). Removal of an endometrioma passing through the left greater sciatic foramen using a concomitant laparoscopic and transgluteal approach: case report. BMC women’s health, 19(1), 95. doi.org/10.1186/s12905-019-0796-0
Center for Endometriosis Care. Sciatic endometriosis.
Chen, S., Xie, W., Strong, J. A., Jiang, J., & Zhang, J. M. (2016). Sciatic endometriosis induces mechanical hypersensitivity, segmental nerve damage, and robust local inflammation in rats. European journal of pain (London, England), 20(7), 1044–1057. doi.org/10.1002/ejp.827
Siquara de Sousa, A. C., Capek, S., Howe, B. M., Jentoft, M. E., Amrami, K. K., & Spinner, R. J. (2015). Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases. Neurosurgical focus, 39(3), E15. doi.org/10.3171/2015.6.FOCUS15208
The brachial plexus is a network of nerves that begin in the cervical/neck spinal cord and travel down the cervicoaxillary canal into the armpit. Forming in the area of the shoulder joint at the branch junction of the brachial plexus, the radial nerve extends down the arm, through the elbow joint, into the forearm, across the wrist, and tips of the fingers. The nerves are susceptible to injury that can cause abnormal function leading to unusual sensations and impaired muscle function.
One of the major nerves of the upper extremity.
There is one brachial plexus on each side of the body that carries the nerves to each arm.
The radial nerve has two major functions.
One is to provide sensations in the hands, forearms, arms, and fingers.
The other is to deliver messages to muscles about when to contract.
The radial nerve transmits signals to the muscles of the back of the arm and forearm on when to contract.
Individuals who have abnormal radial nerve function can experience weakness of the muscles and symptoms like wrist drop.
A wrist drop occurs when the back forearm muscles cannot support the wrist, causing the individual to hold the wrist in a flexed posture.
Abnormal radial nerve function can cause symptoms of numbness or tingling in the back of the hand.
Associated conditions to the radial nerve include lacerations, contusions, fractures, and palsies.
A contusion typically occurs through blunt force trauma that can crush and smash the nerve area.
This causes abnormal or no function.
A nerve contusion can occur from a personal, work, or sports injury or other conditions that generate intense pressure on the nerve/s.
A laceration occurs when there is a penetrating injury that cuts and/or severs the nerve.
This injury can occur from stab wounds or sliced by broken glass, metal, etc.
Broken bones of the upper extremity can lead to extended damage to the nerves near the damaged bone.
The most common type of fracture associated with radial nerve malfunction is fractures to the humerus bone.
The nerve wraps tightly around the humerus and can be injured with a fracture.
Most fracture-related radial nerve injuries heal on their own and do not require surgery.
However, the way the injury heals can be the difference between normal function and chronic pain.
Crutch palsy is pressure on the radial nerve in the armpit resulting from using crutches incorrectly.
To use crutches properly, the individual needs to support their body weight through the hands.
However, many tend to place pressure around the armpit at the top of the crutch, causing irritation to the nerve in that area.
Padding the top of crutches and using the proper form can prevent the condition.
Saturday Night Palsy
Saturday night palsy is the abnormal function of the radial nerve after sleeping in a position that causes direct pressure against the nerve.
This often occurs when an individual falls asleep with their arm draped over an armrest on a chair.
The name comes from when individuals are intoxicated and fall asleep in a location other than the bed and in awkward positions.
Nerve injuries often cause symptoms at different locations other than where the nerve damage is, complicating diagnosis. Determining the specific location of nerve damage is the first step in developing an appropriate treatment plan. Once the location has been identified, steps can be taken to prevent worsening damage to the nerve.
The objective is to relieve the pressure from the irritation or compression.
The musculoskeletal system comprises muscles, ligaments, and tissues surrounding the skeletal structure and vital organs. These components have various functions, including transporting blood and nutrients throughout the body and facilitating movement. However, chronic conditions or aging can cause pain-like symptoms, disrupting daily life and leading to disability. There are many available treatments, both surgical and non-surgical, that can help alleviate chronic pain. This article will explore how chronic pain affects individuals and how treatments like Muscle Energy Technique (MET) therapy can help address it. We work with certified medical providers who use our patients’ valuable information to treat individuals suffering from muscle pain while informing them about non-surgical treatments like MET therapy that can help reduce the effects of chronic pain associated with the musculoskeletal system. We encourage patients to ask essential questions and seek education from our associated medical providers about their condition. Dr. Jimenez, D.C., provides this information as an educational service. Disclaimer
How Does Chronic Pain Affect The Individual?
Have you been dealing with shooting pain in your joints or muscles? When you wake up in the morning, do you feel constant stiffness in your joints? Or do you experience muscle pain slowly throughout the entire day? When it comes to chronic pain in the musculoskeletal system, it can be hard to pinpoint where the pain is located in the body. Research studies reveal that chronic musculoskeletal pain is a challenge for the individual and their doctors and a main contributor to disability worldwide. Chronic musculoskeletal pain can be non-specific and specific depending on the severity and factors contributing to its development. For many individuals experiencing chronic pain associated with the musculoskeletal system, the homeostatic and adaptive function in their muscle fibers has been stretched past their limits.
Additional research studies stated that factors like mechanical forces, ischemia, and even inflammation are all primary stimuli for chronic muscle pain. Factors like lifting/carrying heavy objects, persistent sitting, physical inactivities, and dietary habits all correlate to chronic muscle and joint pain, as repetitive motions or prolonged inactivity can either shorten or overstretch the muscle fibers. At the same time, chronic musculoskeletal diseases like fibromyalgia and myofascial pain syndrome can cause the affected muscles to stiffen, contract, and tender to the touch, which then causes the other surrounding muscles to take over and compensate for the pain. To that point, chronic musculoskeletal pain can cause many individuals to decrease their productivity, call off work constantly, and lead a life of disability.
From Consultation To Transformation- Video
Have you been dealing with constant muscle and joint pain throughout your life? Has the pain been unbearable that it is affecting your routine? Or do you feel aches or stiffness in your sides or different body areas? Throughout the entire world, many individuals suffer from chronic musculoskeletal pain at one point in their lives, and it has become a social/economic burden. Research studies reveal that chronic pain associated with musculoskeletal disorders can affect many other aspects of a person’s life. When chronic pain starts to affect a person’s ability to function, it can have a negative effect on the person’s mental health. When chronic pain is associated with musculoskeletal disorders, it also correlates with work, as many individuals with chronic pain have reduced work productivity, lost wages, and lost hours that can take a toll on their income. However, there is hope, as many affordable treatments can reduce the effects of chronic musculoskeletal pain and its associated symptoms. Non-surgical treatments like chiropractic care and MET therapy can help many individuals with chronic musculoskeletal pain find the relief they deserve. The video above explains how non-surgical treatments approach chronic musculoskeletal pain, from assessing patients through consultation to transforming their health and wellness. By taking back their health, many individuals can find relief from their pain and get back to their routines.
MET Therapy’s Approach To Chronic Pain
Non-surgical treatments like MET (muscle energy technique) therapy has a unique approach to reducing chronic pain in the musculoskeletal system. In the book, “Clinical Applications of Neuromuscular Techniques,” Dr. Leon Chaitow, N.D., D.O., and Dr. Judith Walker DeLany, L.M.T., mentioned that the fascia and the characteristics of the connective tissues are relevant for MET by commencing stretching the affected muscles that are in chronic pain and use biomechanical forces to initiate a low intense force to lengthen the tissues and increase their flexibility. MET therapy helps many individuals with chronic pain associated with musculoskeletal disorders, as research studies reveal that MET therapy can help increase the strength of weakened muscles and help increase the spinal ROM. MET therapy is non-surgical, cost-effective, and safe to reduce chronic pain associated with musculoskeletal disorders.
Identifying The Patterns
Many pain specialists who incorporate MET will begin by assessing the individual with chronic pain associated with musculoskeletal disorders. They will get examined by testing their range of motion, spinal and joint mobility, and any additional factors to develop a personalized plan that caters to the individual. Once the pain issue is found, the individual will work with other medical professionals to help strengthen their muscles and help reduce the pain-like symptoms that are causing them. To that point, MET therapy combined with other treatments is beneficial for those with chronic illnesses and needs relief from pain.
Many individuals suffering from chronic musculoskeletal pain often experience limited mobility, shortened muscles, and referred pain in different areas of their bodies. Chronic musculoskeletal pain is a social/economic problem that has affected many individuals and left them missing out on important life events. Treatments like MET (muscle energy technique) therapy can help reduce pain by stretching the muscle fibers to alleviate pain and restore joint mobility to the body. When many individuals start to utilize MET therapy, it can reduce chronic pain and allow them to get back their health and wellness.
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