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 pulley injuries are unique digital injuries distinct from sprains or dislocations. They occur specifically in rock climbers and occasionally in baseball pitchers. What are the symptoms, diagnoses, and treatments available?
Finger Pulley Injury
A finger pulley injury, common in activities like climbing, involves damage to the fibrous bands (pulleys) that hold tendons against bones. This causes pain, swelling, and potentially bowstringing of the tendons.
Finger pulleys are structures that hold tendons against the bones of the fingers.
Injury symptoms include pain, swelling, and a popping sound heard at the time of the injury.
Finger pulley injuries, or ruptures of the digital pulley, are seen almost exclusively in rock climbers. (Miro P. H. et al., 2021)
This activity stresses the digits when maneuvering along uneven surfaces while supporting the entire body’s weight. The injuries result from the mechanics of the finger tendons and joints and the position the fingers hold while rock climbing. Rock climbing has grown in popularity. The only other sport in which this injury has been described is baseball, in pitchers. The forces acting on the finger are very different in these activities, but both place high stress on the finger pulleys.
Digital Pulleys
Everyone has structures in their fingers called digital pulleys. These pulleys hold the tendons against the bones of the fingers. Each finger has eight pulleys, but only two are considered critical to prevent the finger tendons’ bowstringing (when one pulley gives out or ruptures). This can result in various injury outcomes, from a simple strain of the pulley to ruptures of multiple pulleys in a single digit. Pain, stiffness, and an inability to fully flex the finger can occur. (Carruthers K. H., Skie M., & Jain M. 2016) In severe situations, when the tendons are bowstringing, the tendon may lift away from the finger when making a fist.
Symptoms
Pain and Tenderness
Localized pain and tenderness at the finger’s base, particularly when gripping or bending. Pain on the palm side of finger and tenderness with pressure
Swelling
Swelling and bruising around the affected finger joint, especially on the palm side.
Stiffness and pain when bending the fingers or difficulty gripping. Difficulty forming a fist
Bowstringing
Visible displacement of the tendon from its normal position, causing a bulge at the finger’s base.
Most commonly, the middle or index digit is the injured finger. The two critical pulleys in the finger are designated the A2 and A4. (Carruthers K. H., Skie M., & Jain M. 2016) Individuals may see swelling, redness, and inflammation at the base of the finger (A2) and/or in the space between the two finger joints closest to the tip of the finger (A4). In rock climbers, either or both of those pulleys may be injured. In baseball pitchers, the injury is typically isolated to the A4 pulley.
Causes
Overuse and Repetitive Strain: Frequent or intense gripping or crimping, common in rock climbing and other activities, can cause pulley injuries.
Dynamic or Sudden Movements: Desperate or dynamic moves or poor technique can lead to injury.
Excessive Force: Pulleys can rupture when the force exerted on them is too great.
Mechanism of injury: The A2 pulley is the most commonly injured, followed by the A4 pulley.
Diagnosis
Emergency treatment is generally unnecessary. However, it is important to have suspected digital pulley injuries examined by a specialist within several days to a week after the injury. The most important aspect of an evaluation is determining whether the injury has caused the bowstringing of the tendons. Imaging tests may be performed to help with the diagnosis and plan treatment. An ultrasound is recommended as the initial imaging technique. (Miro P. H. et al., 2021)
If an ultrasound is inconclusive, an MRI may be advised. Sometimes, an MRI is performed with the finger held straight and then bent to see if the tendons are bowstringing. An X-ray can also help exclude other causes of finger pain, including sprains and fractures.
Treatment
Conservative Care
Immobilization, physical therapy, and pulley-protective measures, such as splints or taped fingers, are often used.
Surgery
Surgery may be necessary for severe grade IV injuries where conservative care fails.
Only in situations where there are multiple pulley ruptures or if there is delayed treatment should surgery be necessary.
Rehabilitation
Focuses on regaining flexibility, strength, and grip function through exercises and physical therapy.
If the tendons do not bowstring, treatment usually protects the injured finger until swelling and pain subside. If there is bowstringing of the tendons, more careful management of the injury is needed. Individuals who suspect a pulley injury rest or splint the finger and use nonsteroidal anti-inflammatory drugs as necessary for pain until they can get a medical evaluation. (Carruthers K. H., Skie M., & Jain M. 2016) Physical therapy, along with immobilization, the H-tape method, and a protective pulley splint, are recommended for most injuries. (Miro P. H. et al., 2021) Specialized splints and therapy techniques can allow the pulleys to heal properly.
Returning to activity varies significantly with the severity of the injury. With mild pulley strains, full activity can be resumed as soon as swelling and pain have subsided. Treatment for full ruptures being treated non-surgically is typically between one and three months. For individuals requiring surgical reconstruction of a pulley injury, restrictions may apply up to a year after the surgery.
Injury Medical Chiropractic & Functional Medicine Clinic
To prevent complications, a healthcare provider should evaluate pulley injuries as soon as possible. Treatment most often consists of physical therapy, but surgery may be necessary. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Sports Injury Treatments
References
Miro, P. H., vanSonnenberg, E., Sabb, D. M., & Schöffl, V. (2021). Finger Flexor Pulley Injuries in Rock Climbers. Wilderness & environmental medicine, 32(2), 247–258. doi.org/10.1016/j.wem.2021.01.011
Carruthers, K. H., Skie, M., & Jain, M. (2016). Jam Injuries of the Finger: Diagnosis and Management of Injuries to the Interphalangeal Joints Across Multiple Sports and Levels of Experience. Sports Health, 8(5), 469–478. doi.org/10.1177/1941738116658643
In females, hernia symptoms are often smaller and deeper without a noticeable lump and can mimic gynecological issues, with misdiagnoses being common. Can knowing the risk factors and how female hernias are treated help women get relief?
Female Hernia
A hernia occurs when an internal structure pushes through a weak spot in the abdominal wall, the muscles, and the tissue covering the front of the torso. The more common include:
Groin hernia, known as an inguinal hernia.
Upper thigh or femoral hernia.
However, a hernia can develop anywhere from the ribcage to the upper thigh. Hernias are less common in women, have different symptoms than in men, and are often misdiagnosed. Lower abdominal and pelvic hernias present differently in women than men, who typically have a visible bulge. Instead, female hernias tend to be smaller, deeper, and less noticeable. They can also cause chronic pelvic pressure or pain that can be mistaken for gynecological problems.
Hernia Symptoms For a Woman
Hernias in women tend to be smaller and deeper than male hernias, with no lump showing. Instead, female hernias can cause chronic, deep pelvic pain and occasional sharp, stabbing pain that comes on fast and lingers. (Köckerling F., Koch A., & Lorenz R. 2019) Hernia pain worsens with exercise, laughing, coughing, or straining to evacuate the bowels. The pain is often described as:
Dull
Aching
Pinching
Sharp
Shooting
Burning
Inguinal hernia pain is usually felt at or above the groin and may radiate to the hip, lower back, vulva, or thigh. Many women find the pain increases during their menstrual cycle. The pain can also be exacerbated by any activity that generates extra pressure on the pelvic floor, including:
Prolonged sitting or standing.
Bending
Getting in or out of bed.
Getting in or out of a car.
Sexual intercourse
Emergency
Hernias in the pelvic area are at risk of becoming incarcerated hernias. An incarcerated hernia occurs when a portion of the intestine or other abdominal tissue becomes trapped in the hernial sac, making it impossible to push it back into place. If this gets trapped or strangulated, it can cause tissue death. Strangulated hernias are a medical emergency. Symptoms include:
Deep red or purple tissues.
The hernia bulge does not shrink when you lie down.
Contact a healthcare provider or the emergency room if experiencing any of the above symptoms.
Types
Hernias can occur anywhere on the abdominal wall. They may be caused by:
Internal pressure, such as during pregnancy.
A sports injury
Tissue weakness
Hernias in the lower abdomen or groin are typically indirect inguinal hernias. The inguinal canal comprises multiple layers of muscles and fascia that the thin round ligament threads through. Other groin and pelvic hernias include:
A direct inguinal hernia
A femoral hernia at the top of the inner thigh.
An obturator hernia in the front upper thigh, although this type is rare.
Other common hernias in women are:
Incisional hernia – at the site of a surgical incision
Pregnancy and repeated pregnancies are linked to an increased risk of hernia. Types that are more common in pregnancy include:
Umbilical hernia
Ventral hernia
Inguinal hernia
Umbilical hernias are the most common. However, only a small percentage of pregnant individuals get them. (Kulacoglu H. 2018)
Diagnosis
A hernia diagnosis is made with a physical examination and, if needed, imaging studies. Patients are asked to describe their symptoms precisely, where the pain is located, and any activities that exacerbate it. To check for a hernia, the healthcare provider will palpate for a hernia while the patient sits, stands, or coughs. Imaging tests can include:
Ultrasound
CT scan
Endoscopy – a camera is used to see inside the esophagus and stomach.
Misdiagnoses
Female hernia symptoms can be vague, which often points healthcare providers in the wrong direction. Female hernias are commonly misdiagnosed as: (Köckerling F., Koch A., & Lorenz R. 2019)
Cysts in the reproductive organs
Endometriosis
Fibroid tumors
Treatment
A small hernia that does not cause problems or pain may be treated with a wait-and-evaluate protocol. A hernia often worsens over time and could eventually require surgery. (University of Michigan Health, 2024) Self-care treatments include:
Medical treatments usually start with conservative measures, including physical therapy, stretching, exercise, and rest. Physical therapists often use myofascial release techniques to relieve muscle spasms. Surgery may be needed to repair the weak area of the abdominal wall to relieve symptoms. (University of Michigan Health, 2024) Hernia repair surgery is typically performed as a laparoscopic surgery. (Köckerling F., Koch A., & Lorenz R. 2019) Most patients heal quickly from the surgery and can return to regular activities in a week or two.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Lumbar Spine Injuries in Sports: Chiropractic Healing
References
Köckerling, F., Koch, A., & Lorenz, R. (2019). Groin Hernias in Women-A Review of the Literature. Frontiers in surgery, 6, 4. doi.org/10.3389/fsurg.2019.00004
Northeast Georgia Health System. (2022). Living with a hernia. Northeast Georgia Health System Improving the health of our community in all we do. www.nghs.com/2022/02/15/living-with-a-hernia
Cauda equina syndrome/CES is a rare condition in which the nerves in the lower back are compressed. It can include sciatica as one of its symptoms. Individuals presenting with symptoms that could be CES are advised to see a healthcare provider as soon as possible, as delaying treatment can lead to permanent damage.
Cauda Equina Syndrome
A cluster of nerve roots called the cauda equina, Latin for horse’s tail, sends and receives messages to the legs, bladder, and other body parts. Cauda equina syndrome is a rare condition in which nerve roots in the lower spinal cord are compressed. This compresses the nerves and disrupts motor and sensory function in the bladder and lower extremities. The most common cause is a ruptured or herniated disc in the lumbar area. This usually occurs when a severe disc herniation compresses the nerve bundle at the base of the spinal cord, causing significant neurological dysfunction like bladder/bowel issues and numbness in the saddle area. If found early, it is treated with surgery within 24 to 48 hours of symptom onset.
This is characterized by symptoms that include unusual urinary sensation, loss of desire to urinate, poor urinary stream, and having to strain to urinate. (Gardner A., Gardner E., & Morley T. 2011)
Pott’s paralysis is a neurological complication of tuberculosis (TB) of the spine.
TB is a bacterial infection that usually affects the lungs but can spread to the spine.
Iatrogenic Side Effects
Injuries or illnesses that result from medical or surgical treatment
Spinal Lesions or Malignant Tumors
A spinal lesion refers to any abnormal growth or damage within the spine.
It can include benign (noncancerous) and malignant (cancerous) tumors.
A malignant tumor is a cancerous growth within the spine; essentially, a malignant tumor is a type of spinal lesion with the potential to spread to other parts of the body.
Spinal Infection, Inflammation, Hemorrhage, or Fracture
A spinal infection refers to a bacterial, fungal, or viral infection that occurs within the bones of the spine (vertebrae) or the surrounding tissues, potentially causing pain, inflammation, and, in severe cases, neurological complications like weakness or paralysis;
Spinal inflammation is a general term for swelling or irritation within the spinal column.
Spinal hemorrhage” indicates bleeding within the spinal canal.
A spinal fracture refers to a break in one or more of the vertebrae in the spine.
Spinal Arteriovenous Malformations (AVMs)
A spinal arteriovenous malformation (AVM) is a rare condition in which the arteries and veins in the spinal cord tangle abnormally.
This can damage the spinal cord over time.
Complications from Lumbar Surgery
Lumbar surgery can have several complications, including infections, blood clots, nerve damage, and spinal fluid leaks.
Spinal Anesthesia
Spinal anesthesia is a regional anesthesia that blocks pain and sensation in the lower body.
It involves injecting a local anesthetic medication into the subarachnoid space surrounding the spinal cord.
The exact cause is not fully understood, but it can involve direct nerve root injury from the needle, inflammation caused by the anesthetic, or a spinal hematoma compressing the nerve roots.
Infection of the tissues (meninges) that cover the cauda equina and spinal cord.
An abscess pressing on the cauda equina.
Diagnosis
Diagnosis requires a medical history of symptoms, general health, activity level, and a physical exam to assess strength, reflexes, sensation, stability, alignment, and motion. (American Association of Neurological Surgeons, 2024) Testing includes:
X-ray or computerized tomography (CT) imaging is enhanced by the injection of contrast material into the cerebrospinal fluid spaces, which can show displacement of the spinal cord or spinal nerves.
Specialized Nerve Testing
This could be nerve conduction velocity tests and testing electrical activity in muscles or electromyography.
Treatment
The extent of urinary problems can determine treatment protocols. A CES diagnosis is usually followed by emergency surgery within 24 to 48 hours to relieve compression of the nerves. Moving quickly is essential to prevent permanent complications such as nerve damage, incontinence, or leg paralysis. (American Association of Neurological Surgeons, 2024)
Depending on the cause, corticosteroids also may be prescribed to reduce swelling.
Antibiotics may be needed if an infection is responsible for CES.
For situations in which a tumor is the cause, surgery to remove it may be necessary, followed by chemotherapy and/or radiation.
The outcome with CES-I during surgery is generally favorable.
Those whose CES has deteriorated to CES-R tend to have a less favorable prognosis.
Post Surgery Therapy
After surgery, CES can be challenging to deal with. If bladder function has been impaired, recovery of control can take time.
Frequent urinary infections are also a potential complication.
Loss of bladder or bowel control can be psychologically distressing, impacting social life, work, and relationships.
Sexual dysfunction can also occur, contributing to relationship difficulties or depression.
Therapy with a mental health professional may be recommended. When damage is permanent, it will be important to include family and friends in the adjustment to living with a chronic condition. Psychological counseling and/or a support group can be helpful. Other specialists who can help include: (American Academy of Orthopaedic Surgeons, 2024)
Occupational therapist
Physical therapist
Physiotherapist
Sex therapist
Social worker
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Gardner, A., Gardner, E., & Morley, T. (2011). Cauda equina syndrome: a review of the current clinical and medico-legal position. 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, 20(5), 690–697. doi.org/10.1007/s00586-010-1668-3
Fairbank, J., & Mallen, C. (2014). Cauda equina syndrome: implications for primary care. The British journal of general practice: the journal of the Royal College of General Practitioners, 64(619), 67–68. doi.org/10.3399/bjgp14X676988
For individuals with shoulder pain and problems, what are the stages of a frozen shoulder, how long do they last, and what can be done to relieve pain?
Frozen Shoulder Stages
A frozen shoulder, also called adhesive capsulitis, is a very common cause of shoulder pain. It causes severe pain and limited mobility. The condition progresses through stages and can take up to two years to resolve completely. The stages of frozen shoulder include pre-freezing, freezing, freezing, and thawing.
Stage 1
Pre-Freezing – 1 month to 3 months
Pre-freezing describes the earliest stage of a frozen shoulder. This is when individuals first start to notice pain in their shoulder. (Soussahn, S. et al., 2024) Many in this stage will first experience the pain at night while changing sleeping positions. As the condition progresses, individuals may notice pain when they move their shoulders, especially when raising their arms or reaching behind them. Individuals may also find reduced mobility in that shoulder and may ache even when not using it. Because motion may be only slightly restricted in this stage, an early frozen shoulder can be mistaken for a rotator cuff problem. (Chan H. B. Y., Pua P. Y., & How C. H. 2017)
Root Cause
A frozen shoulder happens when there is inflammation in the tissue that surrounds the shoulder joint. Although the specific causes aren’t known, immobilization after an injury and other shoulder conditions, like bursitis, may play a role. (Johns Hopkins Medicine, 2025)
Stage 2
Freezing – 10 weeks to 8 months
The freezing stage is the most painful. The shoulder capsule becomes inflamed and can thicken and stiffen. As this happens, shoulder movements become increasingly difficult and painful. (Soussahn, S. et al., 2024)
Stage 3
Frozen – 4 months to 12 months
The third stage of a frozen shoulder is known as the frozen phase, where the shoulder is stiff. The examination finding confirming the frozen shoulder diagnosis is that neither the individual nor another person can move the shoulder. (UpToDate, 2024) With a rotator cuff issue, a patient cannot move their arm normally, but the healthcare provider can. This distinguishes between a frozen shoulder and a rotator cuff injury. The frozen stage is typically much less painful than freezing, but pain can result from simple activities. (Soussahn, S. et al., 2024) Rotation of the shoulder joint is limited, making activities like washing hair or reaching painful or difficult.
Stage 4
Thawing – 5 months to 2 years
In this phase, the shoulder joint capsule becomes thickened and stiff but gradually loosens with time. (Soussahn, S. et al., 2024) Stretching the shoulder capsule, even allowing for some discomfort, is important to ensure the shoulder joint’s mobility continues to recover. Not having the extreme pain associated with freezing the joint and seeing gradual gains in mobility make this stage tolerable.
Treatment
Frozen shoulder treatment starts with physical therapy and joint stretching. Anti-inflammatory medications, ice and heat application, and alternative therapies can all help manage the discomfort. A healthcare provider may also recommend a corticosteroid injection to reduce inflammation, relieve pain, and expedite improved mobility. Redler L. H. & Dennis E. R. 2019)
Surgery is seldom needed but is an option for treating a frozen shoulder. It is usually only considered if prolonged efforts at therapy have failed to improve symptoms. One of the problems is that surgery could worsen shoulder problems. (Le H. V., Lee S. J., Nazarian A., & Rodriguez E. K. 2017)
Prognosis
The timeline for recovery can be long, measured in months and possibly years. (Le H. V., Lee S. J., Nazarian A., & Rodriguez E. K. 2017) Expecting a quick recovery can cause more frustration. However, individuals can take steps to speed their recovery and reduce discomfort. Physical therapy can be beneficial, and a healthcare provider can suggest treatments to help alleviate pain while recovering. Over time, almost all patients will find complete relief and a normal or near-normal range of motion in their shoulder joints.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Motion Key To Healing
References
Soussahn, S., Hu, D., Durieux, J., Kosmas, C., & Faraji, N. (2024). Adhesive capsulitis: Utility of magnetic resonance imaging as a primary diagnostic tool and clinical management support. Current problems in diagnostic radiology, 53(4), 464–469. doi.org/10.1067/j.cpradiol.2024.03.005
Chan, H. B. Y., Pua, P. Y., & How, C. H. (2017). Physical therapy in the management of frozen shoulder. Singapore Medical Journal, 58(12), 685–689. doi.org/10.11622/smedj.2017107
Redler, L. H., & Dennis, E. R. (2019). Treatment of Adhesive Capsulitis of the Shoulder. The Journal of the American Academy of Orthopaedic Surgeons, 27(12), e544–e554. doi.org/10.5435/JAAOS-D-17-00606
Le, H. V., Lee, S. J., Nazarian, A., & Rodriguez, E. K. (2017). Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder & elbow, 9(2), 75–84. doi.org/10.1177/1758573216676786
For individuals who injure their neck or back, the muscles may spasm or seize up, making it difficult to get through the day, exercises, physical activities, etc. Can skeletal muscle relaxers help relieve pain and reduce frequency?
Back Spasms Muscle Relaxers
Back muscle spasms are common back pain that feels like a sudden tightness or contraction in the back muscles. They can range from minor twinges to severe pain.
Causes
Poor posture: Sitting or standing with bad posture can strain the back muscles.
Overuse: Picking something up, bending, or lifting can cause a spasm.
Dehydration: Not drinking enough water can cause electrolyte imbalances, leading to spasms.
Underlying conditions: A herniated disc or degenerative disc disease can cause back spasms.
Muscle imbalances: Weak muscles or muscles that are too tight can cause spasms.
Treatments
Home treatments: You can apply heat or ice, take over-the-counter pain medication, try gentle stretching, or massage the area.
Exercise: Improve your back’s strength and flexibility with exercise or physical therapy.
Hydration and nutrition: Drink enough water and eat foods rich in magnesium and calcium.
Chiropractic Adjustments: These can realign the spine to the correct position and muscles to relax.
Non-surgical Decompression: Decompression of the spine will allow more blood and nutrients to heal painful areas.
Skeletal Muscle Relaxers
A healthcare provider may prescribe skeletal muscle relaxers. These medications are not available over the counter and must be prescribed by a healthcare provider.
Skeletal muscle relaxers will probably cause drowsiness.
Individuals should not drive, operate heavy machinery, or engage in other physical activities while taking back spasm muscle relaxers.
Skeletal muscle relaxers are not recommended for 65 or older because safer, effective alternatives exist.
Also, women who are pregnant or breastfeeding should not take these medications.
Discuss these issues with your healthcare provider.
Carisoprodol
Carisoprodol is available generically and as Soma and Vanadom brands. It works by suppressing nerve impulses located in the brain and spinal cord. Healthcare providers prescribe this medication in combination with physical therapy for the healing release of any muscle spasm and management of musculoskeletal injuries and/or pain. (Witenko C. et al., 2014) It’s not about having to continue taking the medication to feel better but more as a jump start to help with the physical therapy program.
Back muscle spasms are a perfect example of a condition that may benefit from carisoprodol in the short term.
Carisoprodol can be habit-forming.
Be sure to talk to a healthcare provider before suddenly going off this medication.
Carisoprodol can cause side effects that may impair thinking or reactions.
Inform your healthcare provider of any drug allergies, kidney disease, or liver disease, or if you get seizures.
Cyclobenzaprine
Cyclobenzaprine is available as Amrix and in generic form. Like other muscle relaxers, cyclobenzaprine may cause dizziness or drowsiness. The sedation effects are how it works on painful, tension-filled muscles. Cyclobenzaprine is used together with physical therapy to treat skeletal muscle-related conditions and/or injuries, especially when pain or spasm is involved. When used in conjunction with physical therapy, it can help expedite recovery.
Cyclobenzaprine is chemically related to tricyclic antidepressants.
Although it is considered a derivative of the tricyclic antidepressant class, it does not pose the same risk to liver health.
According to the National Institutes of Health, reasons not to take this medication include having a thyroid disorder, heart block, congestive heart failure, a heart rhythm disorder, or having recently had a heart attack. (Witenko C. et al., 2014)
Metaxalone
Skelaxin is the brand name for metaxalone. As with the other muscle relaxers, metaxalone is used in combination with physical therapy and rest when muscles get too tight. (Witenko C. et al., 2014) It works by suppressing nerve impulses in the brain and spinal cord. In addition to older individuals and pregnant women, metaxalone is usually not prescribed for those with kidney disease, liver disease, seizures, or blood disorders.
Injury Medical Chiropractic and Functional Medicine Clinic
Back spasms: Muscle relaxers could help individuals, along with a personalized physical therapy treatment program. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Thoracic Spine Pain
References
Witenko, C., Moorman-Li, R., Motycka, C., Duane, K., Hincapie-Castillo, J., Leonard, P., & Valaer, C. (2014). Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. P & T: a peer-reviewed journal for formulary management, 39(6), 427–435.
Zacny, J. P., Paice, J. A., & Coalson, D. W. (2012). Subjective and psychomotor effects of carisoprodol in combination with oxycodone in healthy volunteers. Drug and alcohol dependence, 120(1-3), 229–232. doi.org/10.1016/j.drugalcdep.2011.07.006
Is applying ice the best option for individuals who experience an acute back strain injury?
Temperature Treatment
Ice temperature treatment, also known as cryotherapy or cold therapy, is a treatment that uses freezing temperatures to reduce pain and swelling. It can be applied in a variety of ways, including:
Ice packs:
Ice massage
Coolant sprays
Whirlpools
Ice baths
Ice is usually recommended for acute injuries and is a common and simple way to treat pain and swelling. Individuals can buy freezable gel packs or make their own with ice cubes in a plastic bag or towel. Heat therapy tends to be used more with chronic issues involving muscle spasms to increase blood circulation.
How Ice Relieves Pain and Reduces Inflammation
Ice temperature treatment works by:
Narrowing blood vessels slows blood circulation to the injured area and soft tissues and reduces swelling.
Reduced blood flow also helps control excessive swelling.
Ice has a short-term analgesic-numbing effect. The coldness numbs nerve endings, relieving pain symptoms.
Relieving the pain allows the muscles to relax.
Controlling blood circulation helps control pain by reducing the flow of irritating chemicals that can inundate the injury site. These chemicals are a natural and the correct response to inflammation, but the ice keeps them in check to help control pain.
After a Back Injury
For a back strain injury, ice and anti-inflammatory medication like NSAIDs are the first line of treatment during the inflammatory phase, which usually lasts 24 to 72 hours. Because heat can increase inflammation by increasing blood circulation, it is not recommended as an initial treatment. After the first few days, most doctors and pain specialists recommend using ice or heat, depending on the individual’s preference. While researchers continue to investigate the best ways to treat acute injuries, most doctors still recommend ice as the first line of defense for back injuries.
A review of studies evaluated 20 different treatment categories to learn about their safety and effectiveness. (McIntosh G. & Hall H. 2011) Treatments included over-the-counter pain medications, acupuncture, McKenzie exercises, other back exercises, and temperature treatments. Regarding temperature treatment, the review found moderate evidence that using a heat wrap 5 days after the injury could help relieve pain. However, there was not enough evidence to support the effectiveness of any of the temperature treatments, necessitating more research. (McIntosh G. & Hall H. 2011)
Physical Therapy and Activity
The review found that prolonged rest should be avoided, and gentle exercise and a progressive return to physical activity should be encouraged to achieve the best outcomes for pain relief and restoring function. Staying active significantly reduces time off from work and chronic disability for up to 1 year compared to traditional medical treatment. (McIntosh G. & Hall H. 2011) Research also found that introducing physical therapy early on could expedite recovery. Mobility work, targeted exercises, and strengthening exercises have been shown to relieve pain, reduce injury recurrence, and improve overall function. More research supports physical activity and exercise as effective treatment options for acute lower back strains. However, further research regarding temperature treatments is required. (French S. D. et al., 2006) (See Q. Y. et al., 2021)
Injury Medical Chiropractic and Functional Medicine Clinic
It is important to talk with a healthcare provider to determine the cause and extent of the injury to provide individualized patient education regarding treatment. This can include physical therapy, rest, health coaching, medication, and surgery, which may be recommended in certain cases. Overcoming these limitations is possible. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Beyond the Surface: Understanding the Effects of Personal Injury
References
McIntosh, G., & Hall, H. (2011). Low back pain (acute). BMJ clinical evidence, 2011, 1102.
French, S. D., Cameron, M., Walker, B. F., Reggars, J. W., & Esterman, A. J. (2006). A Cochrane review of superficial heat or cold for low back pain. Spine, 31(9), 998–1006. doi.org/10.1097/01.brs.0000214881.10814.64
See, Q. Y., Tan, J. B., & Kumar, D. S. (2021). Acute low back pain: diagnosis and management. Singapore Medical Journal, 62(6), 271–275. doi.org/10.11622/smedj.2021086
Can understanding what knee tests are used help a healthcare provider diagnose the cause of individuals experiencing knee pain?
Knee Pain Tests
A knee examination is the first step in determining the cause of knee pain. Different knee tests may be performed during the exam to help the healthcare provider find the cause and develop an optimal treatment plan. These tests evaluate knee function and range of motion and look for conditions and injuries such as arthritis, meniscus tears, ACL tears, other ligament injuries, and kneecap issues.
Checking If There is Fluid in the Knee
Many individuals know if their knee is swollen, as they can see or feel the swelling. However, if there is excess fluid in the knee joint, the healthcare provider may compress the joint to feel for excess fluid. Fluid is often visible above the kneecap and can be compressed in this area. Fluid may also be detected in the back of the knee, referred to as a Baker’s cyst if the fluid has collected into a cluster. (Frush T. J., & Noyes F. R. 2015)
Arthritis Tests
Certain characteristic findings can detect knee arthritis:
Crepitus
Crepitus is the sensation when rough cartilage or exposed bone is rubbing when the knee is bent. (Lo G. H. et al., 2018)
The examiner will feel and listen for grinding as the knee is bent back and forth.
Deformity
As knee cartilage wears away, the knees can become progressively knock-kneed or bow-legged.
Limited Motion
If arthritis, bone spurs, and swelling prevent normal mobility, the knee’s range of motion often becomes limited.
Torn Meniscus Tests
Tests used to determine if there is a meniscus tear include:
Joint Line Tenderness
Joint line tenderness is a non-specific test in which the area of the meniscus is felt. It is considered a positive test when there is pain in this area.
McMurray’s test
This test is performed with the patient lying flat. The examiner bends the knee and rotates the shin bone.
This test is performed with the patient squatting.
The test is performed with the leg fully externally rotated or internally rotated, depending on whether the lateral or medial meniscus is being tested.
A click is heard or felt over the area of the tear.
ACL Tear Tests
These knee pain tests are for an anterior cruciate ligament (ACL) tear:
Lachman Test
The Lachman test is one of the most reliable to diagnose an ACL tear.
With the knee slightly bent, the examiner stabilizes the thigh while pulling the shin forward.
The shin shifts too far forward with a torn ACL.
Anterior Drawer Test
This test is performed with the patient lying flat.
The knee is bent 90 degrees, and then the shin is pulled forward to check the stability of the ACL.
Pivot Shift Test
The pivot shift test can be difficult, especially if the patient is experiencing discomfort and cannot relax the knee.
This test places stress on the knee joint and assesses the rotational stability of the ACL.
Other Ligament Injuries
For a suspected injury to other ligaments, including the posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL), the following tests may be used:
Posterior Drawer Test
The posterior drawer is performed similarly to the anterior drawer test, in which the patient lies flat.
The knee is bent 90 degrees; the shin is pushed backward to check stability and function and detect if the posterior cruciate ligament (PCL) has been injured.
Collateral Ligament Stability
Side-to-side stability of the knee detects problems with the MCL and LCL.
The shin is shifted to each side, with the patient lying flat and the knee slightly bent.
The LCL or MCL damage causes the knee to open up too much, a condition known as varus (LCL) or valgus (MCL) instability. (Ohori T. et al., 2017)
Kneecap Tests
Tests for kneecap issues include:
Patellar Grind
In this test, also called Clarke’s sign, the patient lies on their back with the leg extended.
The examiner pushes the kneecap down to reproduce the knee pain while the patient flexes the thigh muscles.
Damaged cartilage can cause a grinding sensation/crepitus.
Patellar Tenderness
The examiner can slightly lift the kneecap and place direct pressure on parts of the underside.
The examiner looks for regions of sensitivity or pain.
Patellar Apprehension
This test indicates an unstable kneecap.
The examiner places pressure on the kneecap in a certain direction, and the patient may feel like the kneecap is going to pop out.
Injury Medical Chiropractic and Functional Medicine Clinic
Knee pain tests typically check the range of motion, discomfort symptoms, and sounds that could indicate a specific type of knee injury. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Overcoming an ACL Injury
References
Frush, T. J., & Noyes, F. R. (2015). Baker’s Cyst: Diagnostic and Surgical Considerations. Sports health, 7(4), 359–365. doi.org/10.1177/1941738113520130
Lo, G. H., Strayhorn, M. T., Driban, J. B., Price, L. L., Eaton, C. B., & Mcalindon, T. E. (2018). Subjective Crepitus as a Risk Factor for Incident Symptomatic Knee Osteoarthritis: Data From the Osteoarthritis Initiative. Arthritis care & research, 70(1), 53–60. doi.org/10.1002/acr.23246
Gupta, Y., Mahara, D., & Lamichhane, A. (2016). McMurray’s Test and Joint Line Tenderness for Medial Meniscus Tear: Are They Accurate?. Ethiopian journal of health sciences, 26(6), 567–572. doi.org/10.4314/ejhs.v26i6.10
Ohori, T., Mae, T., Shino, K., Tachibana, Y., Fujie, H., Yoshikawa, H., & Nakata, K. (2017). Varus-valgus instability in the anterior cruciate ligament-deficient knee: effect of posterior tibial load. Journal of experimental orthopaedics, 4(1), 24. doi.org/10.1186/s40634-017-0087-3
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