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.
Back pain is one of the most common reasons for seeking health care. Individuals dealing with back pain but don’t know the cause may have some inflammatory joint disease or autoimmune condition. Can seeing a rheumatologist help?
Rheumatologist
Depending on what’s causing the back pain, individuals may need to see their primary doctor for a referral. Individuals are recommended to see a rheumatologist if they have back pain that doesn’t come from an injury that doesn’t go away after a few weeks, pain that comes back after treatment, or symptoms that suggest a rheumatic condition. Rheumatologists treat severe or persistent back pain and are experts in autoimmune diseases, including lupus, Sjogren’s syndrome, rheumatoid arthritis, ankylosing spondylitis, axial spondylitis, Psoriatic arthritis, and other forms of inflammatory or autoimmune arthritis.
What Do They Do?
A rheumatologist is an internist or pediatrician who has completed special training in treating conditions that are:
Inflammatory
Autoimmune
Related to painful joint disease
The doctors diagnose, treat, and manage these conditions long-term. Depending on diagnosis and care needs, they may also lead or be part of a team that includes other healthcare providers.
Symptoms
When muscles ache, pain presents, or joints hurt, and especially if there are signs of inflammation that don’t go away, seeing a healthcare provider is recommended. Symptoms of inflammation include:
Redness
Swelling
Pain
Stiffness
Loss of joint function
Usually, to see a rheumatologist, individuals need a referral from their primary care provider and may be referred when:
There is no evidence of a back injury.
At-home therapies like heat application, prescription medications, or physical therapy are unsuccessful.
There is uncertainty about what’s causing the back pain, but I suspect it’s rheumatological.
Blood tests for inflammatory markers or certain antibodies yield abnormal results.
There is a diagnosis of a rheumatic condition and recommend a specialist to manage it.
There is a family history of a rheumatic or autoimmune condition that may cause back pain.
Some types of arthritis can cause permanent, progressive joint damage.
Conditions
Conditions that can affect the spine and cause back pain and are treated by a rheumatologist include: (Johns Hopkins Medicine, 2024)
Rheumatoid arthritis (RA)
This often starts in smaller joints of the hands and feet and later moves to the neck and/or back.
It can also affect different body organs and have systemic symptoms.
Ankylosing Spondylitis (AS)
Primarily a disease of the spine, it may also impact the shoulders, hips, knees, and ankles.
Systemic symptoms, including fever and fatigue, can manifest.
Axial Spondylitis
This primarily affects the spine, chest, and pelvis.
It may also cause problems with the connective tissue, eyes, bowel, and skin.
Psoriatic Arthritis (PsA)
Pain in the lower back is common, especially in severe cases.
It can affect other joints and cause psoriasis.
Reactive Arthritis
This is a reaction to infection.
It is more common in the limbs, hands, and feet joints but can involve the spine.
Enteropathic Arthritis
This mainly affects the spine but can include other joints.
It is associated with inflammatory bowel disease.
Autoimmune diseases that don’t specifically target the spine but can also cause back pain include:
Lupus
Sjögren’s syndrome
Hashimoto’s thyroiditis
Finding a Doctor
Individuals may be fine with their primary healthcare provider’s choice regarding which rheumatologist to see. However, they may want to research other options to ensure the right rheumatologist is chosen. Things to look at include:
Search online medical directories.
Visit the websites of the doctors being considered to learn more about their training, approach, and specialties.
Check online reviews.
Check on health insurance coverage.
Ask members of the healthcare team, friends, and family for recommendations.
Contact rheumatologists’ offices to see if they are accepting new patients.
Once decided, pass along the information to the primary care doctor so they can make the referral.
Preparing For The Initial Visit
Before seeing a new rheumatologist, take a few minutes to prepare so you can make the most of the appointment. Individuals will want to have:
A list of back-related symptoms, including frequency and severity.
A list of what makes symptoms better or worse.
A copy of recent test results and records from other doctors.
Individuals can ask their provider/s to send their medical information to the rheumatologist’s office in advance.
A list of treatments that have been tried and how well they worked.
A list of all medications, over-the-counter and prescription, supplements, and herbal products taken.
A list of medication allergies.
Complete medical history and family history of potentially related diseases.
A list of any questions regarding conditions, treatment, etc.
If possible, fill out any paperwork for the new office beforehand to save time on the appointment day.
Injury Medical Chiropractic and Functional Medicine Clinic
Talking with a healthcare provider is important. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. Using an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers.
Quick Patient Initiation Process
References
Hospital for Special Surgery. (2023). What Is a Rheumatologist and What Conditions Do They Treat? https://www.hss.edu/conditions_what-is-a-rheumatologist.asp#when
Yale University School of Medicine. Dee, J. E. (2021). 5 reasons why a patient should see a rheumatologist. https://medicine.yale.edu/news-article/5-reasons-to-see-a-rheumatologist/
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2023). Autoimmune diseases. Retrieved from https://www.niams.nih.gov/health-topics/autoimmune-diseases
Johns Hopkins Medicine. (2024). Spinal arthritis (arthritis in the back or neck). https://www.hopkinsmedicine.org/health/conditions-and-diseases/spinal-arthritis
Individuals dealing with symptoms like sudden pain, weakness, and tenderness in the back of the knee could have a hamstring injury. Can knowing the symptoms and performing self-care help bring relief?
Hamstring Pain Behind The Knee
The hamstrings consist of three long muscles that run down the back of the thigh, cross over the back of the knee, and connect to bones in that area. A hamstring injury, such as a strain or tear, tendonitis, or biceps femoris tendinopathy, can cause pain in the back of the knee, difficulty bending the knee, swelling, and bruising. A hamstring strain occurs when the muscle is stretched too far or torn completely. This can happen from sudden, forceful movements or overstretching. Hamstring tendonitis develops over time, usually after a sudden increase in activity, when the hamstring tissue cannot recover from too much loading. Pain is often felt after physical activity and exercise and, in severe cases, during the activity or throughout the day. Biceps femoris tendinopathy can also cause pain in the back of the knee. Strains, tendonitis, bursitis, and muscle tears are all possible explanations for a hamstring injury that leads to pain behind the knee. Discussing pain symptoms with a healthcare provider is recommended, especially if it occurs suddenly during physical activity or exercise. They can help identify the exact cause and offer guidance for rehabilitation, including physical therapy referrals.
Causes and Triggers
Individuals may experience hamstring pain behind the knee when the muscles in that area are overworked, inflamed, or injured, such as from activities like running, walking, dancing, soccer, or basketball. Possible types of injuries and their causes.
A primary cause of muscle strain occurs when the muscle is stretched too far or has to handle a sudden force like sprinting or kicking. (American Academy of Orthopaedic Surgeons, 2021)
Severe Cases
Most causes of pain behind the knee are easily treatable at home with self-care and rest. However, it can be more severe, signaling a blood clot, infection, torn muscle or tendon/ligament. Hamstring knee pain may be serious if any of the following is experienced (American Academy of Orthopaedic Surgeons, 2021)
Sudden pain during physical activity, often during a full stride.
Feeling a pop or sharp pain that causes falling or limping.
Pain that worsens over time and prevents or hinders walking or exercising as normal.
If pain is severe and does not improve with rest and anti-inflammatory medications, evaluation by a healthcare professional is necessary.
Assesses Hamstring Pain
A healthcare provider will ask about symptoms and injury, including what happened when the pain began. They will perform a physical examination, which may include pressing on the back of the thigh to look for swelling, bruising, tenderness, or bunched-up muscles. (American Academy of Orthopaedic Surgeons, 2021) The healthcare provider will ask the patient to perform specific resisted movements, such as the manual muscle test, and measure the range of motion. Diagnostic testing includes an X-ray or MRI to determine the degree of the injury and which soft tissues or bones may be involved.
Self-Care
The first line of treating hamstring knee pain is the RICE protocol, which includes: (Mount Siani, 2024)
Rest
Stop any activity that causes symptoms and pain.
A healthcare provider may recommend crutches or a knee scooter in severe cases.
Ice
Apply cold packs to the swollen or painful area for 20 minutes throughout the day.
Compression
A knee brace, wrap, or bandage that applies gentle pressure to the injured area can help reduce and prevent swelling.
Elevation
Lifting the leg higher than the heart will help reduce swelling and blood accumulation.
Individuals may need to lie on a bed or sofa and elevate their legs with pillows.
Individuals can use at-home pain relievers like acetaminophen or NSAIDs like ibuprofen or naproxen. Over time, and depending on the severity of the injury, a healthcare provider will advise on gentle hamstring stretches and how to ease back into physical activity.
A healthcare provider will advise immobilizing the knee to help with muscle healing, which could involve wearing a knee brace or using crutches.
Physical therapy
A healthcare provider may refer the patient to a physical therapist, who will perform a personalized evaluation and prescribe targeted exercises to heal the injury and regain strength, flexibility, and movement.
Surgery
Tendon avulsion injuries are when the hamstring tendon completely tears away from the bone, and surgery is required to reattach the tendon.
Platelet-rich plasma – PRP
Platelet-rich plasma has become an additional treatment for hamstring muscle strain or tendonitis. (Seow D. et al., 2021)
The treatment involves injecting a solution from the patient’s blood into the muscle to heal the injury.
Recovery
Predicting how long a hamstring injury takes to heal and how long the pain will linger depends on the type, location, and severity. The most severe type is the hamstring coming unattached around the knee. This surgical repair and rehabilitation take at least three months before returning to sports and exercise (American Academy of Orthopaedic Surgeons, 2021). Lesser injuries like tendonitis or a mild strain can take less time to heal. However, it’s essential to avoid reinjuring the area so the condition does not become chronic. This includes: (American Academy of Orthopaedic Surgeons, 2021)
Stretching to encourage and maintain flexibility.
Fixing muscle imbalances between the quadriceps and hamstring.
Endurance and conditioning.
Avoiding overuse.
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. We focus on what works for you and use an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility, relieving pain and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers. Our providers use Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.
Chiropractic Care for Leg Instability
References
National Library of Medicine. (2017). Tendinitis Also called: Tendonitis. Retrieved from https://medlineplus.gov/tendinitis.html
American Academy of Orthopaedic Surgeons. OrthoInfo. (2020). Sprains, strains, and other soft tissue injuries. https://orthoinfo.aaos.org/en/diseases–conditions/sprains-strains-and-other-soft-tissue-injuries/
American Academy of Orthopaedic Surgeons. OrthoInfo. (2021). Hamstring muscle injuries. https://orthoinfo.aaos.org/en/diseases–conditions/hamstring-muscle-injuries/
American Academy of Orthopaedic Surgeons. OrthoInfo. (2021). Pes aserine (knee tendon) bursitis. https://orthoinfo.aaos.org/en/diseases–conditions/pes-anserine-knee-tendon-bursitis/
Mount Siani. (2024). Hamstring strain – aftercare. https://www.mountsinai.org/health-library/selfcare-instructions/hamstring-strain-aftercare
Seow, D., Shimozono, Y., Tengku Yusof, T. N. B., Yasui, Y., Massey, A., & Kennedy, J. G. (2021). Platelet-Rich Plasma Injection for the Treatment of Hamstring Injuries: A Systematic Review and Meta-analysis With Best-Worst Case Analysis. The American journal of sports medicine, 49(2), 529–537. https://doi.org/10.1177/0363546520916729
Individuals who have sustained trauma to the knee area from work, physical activity, or a motor vehicle collision can experience significant pain and mobility impairment. Can physical therapy help heal and strengthen the PLC?
Posterolateral Corner Knee Injury
The posterolateral corner, or PLC, comprises muscles, tendons, and ligaments in the back of the knee that help support and stabilize the outside region. The primary role of the PLC is to prevent the knee from excessive amounts of rotation or bowing/turning outward. (Chahla J. et al., 2016) Posterolateral corner injuries can cause significant pain and can dramatically impact an individual’s ability to walk, work, or maintain independence. Treatment options will depend on the severity of the injury.
The Posterolateral Corner
The posterolateral corner comprises multiple structures that support and stabilize the outside of the knee. The structures are subdivided into primary and secondary stabilizers. The primary group includes:
The primary role is to prevent the knee from excessively turning outward, so the grouping provides secondary assistance in preventing the lower leg bone/tibia from shifting forward or backward on the thighbone/femur. Occasionally, one or several posterolateral corner structures can be sprained, strained, or torn.
How Injury Occurs
An injury occurs when a direct blow to the inner portion of the front of the knee causes the leg to bow outward. A posterolateral corner injury may also be sustained without contact, for example, if the knee hyperextends or buckles away from the other leg into a varus/bow leg position. Because the knee usually moves during a PLC, concurrent sprains or tears to the anterior cruciate ligament/ACL or posterior cruciate ligament/PCL are also common. (Chahla J. et al., 2016) Other situations that can also cause PLC injuries include automobile crashes and falls from elevated surfaces. (Shon O. J. et al., 2017) When this type of trauma causes a posterolateral corner injury, bone fractures are also common.
Symptoms
Depending on the severity of the injury, multiple symptoms may be present, including:
For individuals who suspect that they have sustained a PLC injury or have any of the symptoms listed, it is critical to be seen by an orthopedic specialist or emergency room physician. A healthcare provider will properly evaluate the leg and develop the appropriate treatment.
Diagnosis
Diagnosis begins with a comprehensive examination. In addition to looking for the symptoms noted, a healthcare provider will move the legs in different directions to assess for any instability. The dial test may be performed, which involves having the patient lie on their stomach while the healthcare professional assesses the side-to-side rotation in the leg to check for excessive motion. (Shon O. J. et al., 2017) Imaging is frequently ordered to determine which anatomical structures are affected more accurately. X-rays can help rule out concurrent fractures and check for excessive laxity in the knee area. MRIs are also useful for visualizing the various tendons and ligaments, helping the healthcare provider look closely at any sprains or tears that may have occurred. However, MRIs may be less accurate in diagnosing PLC injuries after 12 weeks, so they should be obtained as soon as possible. Based on this evaluation, the injury may be classified using the following system (Shon O. J. et al., 2017)
Grade 1
0 to 5 degrees of rotational or varus/bowing instability.
Incompletely torn posterolateral corner.
Grade 2
6 to 10 degrees of rotational or varus/bowing instability.
Incompletely torn posterolateral corner.
Grade 3
Eleven or more degrees of rotational or varus/bowing instability.
Completely torn posterolateral corner.
Treatment
The care received after a posterolateral corner injury can vary depending on the structures involved and the overall severity.
Nonsurgical
Nonsurgical treatment is typically reserved for isolated grade 1 or 2 PLC injuries. (Shon O. J. et al., 2017) Depending on which structures are affected, a stabilizing brace may be worn, and crutches are often needed to decrease the strain on the knee. Physical therapy is also commonly prescribed and focuses on the following goals:
Gradually reintroducing specific movements like running and jumping.
Surgery
Non-surgical treatment tends not to work with grade 3 injuries. If surgery is not performed, individuals may also suffer from chronic knee instability or develop long-term osteoarthritis. (Chahla J. et al., 2019) Surgical treatment is often recommended for grade 3 injuries. The damaged primary stabilizers are surgically reconstructed using a graft from another body region. Surgical repairs may also be performed on any secondary stabilizers to improve stability. (Chahla J. et al., 2019) Any other ligament injuries, such as ACL, PCL, or concurrent fractures, will also be addressed. Following the procedure, individuals immobilize their knee with a brace and do not place weight on the affected leg to protect the surgical area. Depending on the surgeon’s recommendations, this can last six weeks or more. Physical therapy is also initiated after a surgical procedure. Though rehabilitation progresses slowly, the goals are often the same as when treating milder PLC injuries. Returning to work, sports, and/or physical activity after surgery may take six months of therapy or more. (Shon O. J. et al., 2017)
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment program through an integrated approach to treat injuries and chronic pain syndromes, improve flexibility, mobility, and agility, relieve pain, and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Knee Injury Rehabilitation
References
Chahla, J., Moatshe, G., Dean, C. S., & LaPrade, R. F. (2016). Posterolateral Corner of the Knee: Current Concepts. The archives of bone and joint surgery, 4(2), 97–103.
Shon, O. J., Park, J. W., & Kim, B. J. (2017). Current Concepts of Posterolateral Corner Injuries of the Knee. Knee surgery & related research, 29(4), 256–268. https://doi.org/10.5792/ksrr.16.029
Chahla, J., Murray, I. R., Robinson, J., Lagae, K., Margheritini, F., Fritsch, B., Leyes, M., Barenius, B., Pujol, N., Engebretsen, L., Lind, M., Cohen, M., Maestu, R., Getgood, A., Ferrer, G., Villascusa, S., Uchida, S., Levy, B. A., Von Bormann, R., Brown, C., … Gelber, P. E. (2019). Posterolateral corner of the knee: an expert consensus statement on diagnosis, classification, treatment, and rehabilitation. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 27(8), 2520–2529. https://doi.org/10.1007/s00167-018-5260-4
Competitive swimmers, recreational, and swimming enthusiasts who experience pinching and sharp shoulder pain while swimming may suffer from shoulder impingement. Can understanding symptoms can help healthcare providers develop an effective treatment program?
Swimmer’s Shoulder
Swimmer’s shoulder, medically known as rotator cuff impingement syndrome, is a common injury among swimmers. It can limit swimming ability and normal arm use for functional tasks. It is caused by persistent and abnormal rubbing and pinching of the structures in the shoulder, causing pain and irritation of the shoulder’s rotator cuff tendons and the bursa. The injury affects 40% to 90% of swimmers at some point. (Wanivenhaus F. et al., 2012) Self-care treatment involves rest, anti-inflammatory medication, and exercise to restore normal shoulder mobility. Most cases resolve within a few months, but physical therapy may be needed along with continued exercises and stretches to maintain pain relief.
Anatomy
The shoulder is a complex joint with extreme mobility. It is comprised of three bones:
The scapula or shoulder blade.
The clavicle or collar bone.
The humerus or upper arm bone.
These three bones combine at various places to make up the joint. Several muscles attach to and move the joint. (Kadi R. et al., 2017) The rotator cuff is one group of four muscles deep in the shoulder surrounding the joint. When lifting the arm, these muscles contract to hold the ball in the joint’s socket, allowing the arm to be raised in a fluid and smooth motion. Several ligaments hold the shoulder joint together and connect the various bones of the shoulder, giving the joint stability when moving. (Kadi R. et al., 2017)
Shoulder pain when bearing weight through the arm.
Symptoms tend to be worse during or immediately after swimming.
This is due to the position of the arms and upper extremities while swimming. (Wanivenhaus F. et al., 2012) Reaching overhead and turning the hand inward can cause the rotator cuff tendons or shoulder bursa to become pinched underneath the acromion process of the shoulder blade, similar to the motion that occurs during the crawl or freestyle stroke. When pinching/impingement occurs, the tendons or bursa can become inflamed, leading to pain and difficulty with normal arm use. (Struyf F. et al., 2017) The condition may also occur due to the laxity of the shoulder ligaments. (Wanivenhaus F. et al., 2012) It is theorized that the ligaments in swimmers become stretched and lax, leading to shoulder joint instability. This can cause the shoulder joint to become loose and compress the shoulder structures.
Diagnosis
A clinical examination can diagnose cases of swimmer’s shoulder. (Wanivenhaus F. et al., 2012) The exam can include:
Palpation
Strength test
Specialized tests
One shoulder test that is often used is called Neer’s test. A physician elevates the arm overhead to the maximum degree during this examination. If this results in pain, the rotator cuff tendons may be compressed, and the test is positive. Individuals may begin treatment after the examination, but a doctor may also refer them for diagnostic testing. An X-ray may be taken to examine the bone structures, and an MRI may be used to examine the soft tissue structures, such as the rotator cuff tendons and the bursa.
Treatment
Appropriate treatment of swimmer’s shoulder involves managing pain and inflammation in your shoulder and improving the way your shoulder moves so you avoid pinching structures inside the joint. (Wanivenhaus F. et al., 2012) There are various treatments available and can include:
Rest
Physical therapy
Acupuncture
Non-surgical decompression
Targeted exercises and stretches
Medications
Injections
Surgery for serious cases
Physical Therapy
A physical therapist can treat shoulder impingement. They can assess the condition and prescribe treatments and exercises to improve mobility and strength. (Cleveland Clinic, 2023) They may use various treatment modalities to decrease pain and improve circulation to facilitate and expedite healing. Physical therapy treatments can include:
Ice
Heat
Trigger point release
Joint mobilizations
Stabilization
Stretching
Exercise
Electrical stimulation
Ultrasound
Taping
Medication
Medication may include over-the-counter anti-inflammatory medicine to help decrease pain and inflammation. A physician may prescribe stronger medication to manage inflammation if the condition is severe. While taking medication, the shoulder will need rest, so avoiding swimming or other shoulder movements for a week or two may be necessary.
Injections
Cortisone is a powerful anti-inflammatory medicine. Individuals may benefit from cortisone injections into their shoulders. (Wanivenhaus F. et al., 2012) When injected, cortisone decreases pain, reduces swelling in the rotator cuff and bursa, and improves shoulder mobility.
Surgery
If symptoms are persistent and fail to be alleviated with conservative treatments, surgery may be recommended. An arthroscopic procedure called subacromial decompression may be performed. (Cleveland Clinic, 2023) This type of surgery is done with small incisions, inserting a camera, and tiny tools. During this procedure, inflamed tissue and bone spurs are removed from the underside of the acromion process of the shoulder blade, allowing more space to the shoulder joint. Post-surgery, individuals can gradually return to swimming and all other activities in about eight weeks.
Recovery
Most episodes last about eight to ten weeks, and severe cases last up to three months. (Struyf F. et al., 2017) Often, the symptoms slowly resolve with rest and gentle stretching. As symptoms improve, individuals can slowly return to normal activity and swimming. However, performing prescribed exercises two to three times a week may be necessary to maintain shoulder strength and mobility and help prevent future episodes of shoulder impingement. Individuals experiencing any of these symptoms should visit their physician for an accurate diagnosis of their condition to begin proper treatment. Discuss goals with a healthcare professional and physical therapist.
Sports Injuries Rehabilitation
References
Wanivenhaus, F., Fox, A. J., Chaudhury, S., & Rodeo, S. A. (2012). Epidemiology of injuries and prevention strategies in competitive swimmers. Sports health, 4(3), 246–251. https://doi.org/10.1177/1941738112442132
Kadi, R., Milants, A., & Shahabpour, M. (2017). Shoulder Anatomy and Normal Variants. Journal of the Belgian Society of Radiology, 101(Suppl 2), 3. https://doi.org/10.5334/jbr-btr.1467
Struyf, F., Tate, A., Kuppens, K., Feijen, S., & Michener, L. A. (2017). Musculoskeletal dysfunctions associated with swimmers’ shoulder. British journal of sports medicine, 51(10), 775–780. https://doi.org/10.1136/bjsports-2016-096847
Can individuals with stiff person syndrome incorporate non-surgical treatments to reduce muscle stiffness and restore muscle mobility?
Introduction
The musculoskeletal system allows the body’s extremities to be mobile, provides stability to the host, and has an outstanding relationship with the other body systems. The musculoskeletal system’s muscles, tissues, and ligaments help protect the body’s vital organs from environmental factors. However, many individuals often deal with repetitive motions in the upper and lower body extremities that can cause pain and discomfort. Additionally, environmental factors, illnesses, and injuries can affect the musculoskeletal system and play a part in co-morbidities in overlapping risk profiles. These issues can cause the musculoskeletal system to develop a condition known as stiff person syndrome. Today’s articles focus on what stiff person syndrome is, the symptoms it is associated with, and how non-surgical treatments can help alleviate the symptoms of stiff person syndrome. We discuss with certified associated medical providers who consolidate our patients’ information to assess stiff person syndrome and its associated symptoms affecting the musculoskeletal system. We also inform and guide patients while asking their associated medical provider intricate questions to integrate non-surgical treatments to reduce the overlapping symptoms correlating with stiff person syndrome. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
What Is Stiff Person Syndrome
Have you been dealing with muscle stiffness in your lower extremities affecting your mobility? Have you noticed that your posture is rigid due to ongoing muscle spasms in your lower back? Or have you felt tightness in your back muscles? Many pain-like symptoms are associated with back pain, a common musculoskeletal condition; however, they can also correlate with a rare condition known as stiff person syndrome. Stiff person syndrome is a rare autoimmune disorder that is progressive and is characterized by rigidity and stimulus-triggered painful muscle spasms that affect the lower body and extremities. (Muranova & Shanina, 2024) There are three classifications that a person is experiencing with stiff person syndrome, and they are:
Classic Stiff Person Syndrome
Partial Stiff Person Syndrome
Stiff Person Syndrome Plus
Since stiff person syndrome is a rare condition, many individuals may not exhibit any objective findings early on, which then causes a delayed diagnosis that can impact a person’s quality of life (Newsome & Johnson, 2022). At the same time, since stiff person syndrome is a rare autoimmune disease, it can affect the musculoskeletal system with associated pain-like symptoms.
The Symptoms
Some symptoms associated with stiff person syndrome that can develop over time are muscle stiffness and painful muscle spasms. This is because the neuron receptors from the central nervous system can become haywire and cause non-specific somatic symptoms that make the individuals deal with comorbid chronic pain and myofascial tenderness in the muscles. (Chia et al., 2023) This is because stiff person syndrome can spread into different areas of the musculoskeletal system and can gradually develop over time. For muscle stiffness associated with stiff person syndrome, the muscles can become stiff over time, causing pain and discomfort, thus leading to many individuals developing abnormal posture, making it difficult to be mobile. Muscle spasms can affect the entire body itself or in a specific location and cause intense pain that lasts for hours. However, many individuals can incorporate non-surgical treatments to reduce the pain-like symptoms in the musculoskeletal system.
Movement Medicine: Chiropractic Care- Video
Non-Surgical Treatments For Stiff Person Syndrome
When it comes to reducing the musculoskeletal pain symptoms of stiff person syndrome, many individuals can begin to go to their primary doctor for early diagnosis and develop a customized treatment plan to manage the pain-like symptoms and provide a positive impact in creating awareness of this rare condition. (Elsalti et al., 2023) By assessing the pain-like symptoms of stiff person syndrome, many people can incorporate non-surgical treatments to manage the musculoskeletal pain symptoms and improve a person’s quality of life. Non-surgical treatments are cost-effective and can be combined with other therapies to restore mobility. One of the primary goals for managing stiff person syndrome is through pain management, symptom relief, and improved quality of life. (Cirnigliaro et al., 2021)
Chiropractic Care For Stiff Person Syndrome
One of the non-surgical treatments that can help reduce symptoms of muscle spasms and muscle stiffness is chiropractic care. Chiropractic care incorporates mechanical and manual manipulation to stretch and mobilize the joint-muscle function while reducing pain and discomfort. (Coulter et al., 2018) For individuals suffering from stiff person syndrome, chiropractic care can help reduce muscle stiffness and muscle spasms in the upper and lower extremities and relieve the pain. Additionally, incorporating non-surgical treatments like chiropractic care and combined therapies can help manage the musculoskeletal pain associated with stiff person syndrome and improve a person’s quality of life.
References
Chia, N. H., McKeon, A., Dalakas, M. C., Flanagan, E. P., Bower, J. H., Klassen, B. T., Dubey, D., Zalewski, N. L., Duffy, D., Pittock, S. J., & Zekeridou, A. (2023). Stiff person spectrum disorder diagnosis, misdiagnosis, and suggested diagnostic criteria. Ann Clin Transl Neurol, 10(7), 1083-1094. https://doi.org/10.1002/acn3.51791
Cirnigliaro, F. A., Gauthier, N., & Rush, M. (2021). Management of refractory pain in Stiff-Person syndrome. BMJ Case Rep, 14(1). https://doi.org/10.1136/bcr-2020-237814
Coulter, I. D., Crawford, C., Hurwitz, E. L., Vernon, H., Khorsan, R., Suttorp Booth, M., & Herman, P. M. (2018). Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. Spine J, 18(5), 866-879. https://doi.org/10.1016/j.spinee.2018.01.013
Elsalti, A., Darkhabani, M., Alrifaai, M. A., & Mahroum, N. (2023). Celebrities and Medical Awareness-The Case of Celine Dion and Stiff-Person Syndrome. Int J Environ Res Public Health, 20(3). https://doi.org/10.3390/ijerph20031936
Individuals experiencing pain, numbness, tingling, or a burning sensation in the front and outer thigh could have meralgia paresthetica, a nerve entrapment. Can understanding the condition help healthcare providers develop an effective treatment plan?
Meralgia Paresthetica
Meralgia paresthetica, or MP, is also known as Bernhardt-Roth syndrome, lateral femoral cutaneous nerve syndrome, or lateral femoral cutaneous neuralgia. It occurs when the lateral femoral cutaneous nerve, a sensory nerve that passes over the brim of the pelvis and down the front of the thigh, becomes compressed. The nerve supplies information about sensations over the front and outside of the thigh. This can happen for several reasons, including:
Recent hip injuries, such as from a motor vehicle collision/accident.
Repetitive hip activities, like cycling.
Pregnancy
Weight gain
Wearing tight clothing.
The nerve entrapment condition causes tingling, numbness, and burning pain in the front and/or outer thigh.
Causes
There can be several different causes of this condition, but it is frequently seen in pregnancy, sudden weight gain, wearing tight clothing or belts, and other conditions. (Ivins G. K. 2000) Sometimes, meralgia paresthetica can be caused by medical procedures. For example, the condition can present after an individual has surgery and is in an unusual position for a long period of time, where there is direct external pressure on the nerve. Also, the nerve can become damaged during a surgical procedure. (Cheatham S. W. et al., 2013) This can occur when a bone graft is obtained from the pelvis or anterior hip replacement surgery.
Sensitivity to lightly touching the outside of the thigh.
Worsening of symptoms with certain positions.
Increased symptoms when wearing belts, work belts, or tight-waist clothes.
The symptoms may come and go or be persistent. Some individuals are hardly noticeable and do not impact their lives or activities, while others can be very bothersome and cause significant pain. (Scholz C. et al., 2023)
Treatment
Treatment depends on how long the injury has been present and the frequency and severity of the condition.
Clothing Modifications
If the cause is due to tight clothing, belts, or work belts, then garment modification should alleviate symptoms.
If recent weight gain is thought to contribute to the condition, then a weight loss program may be recommended.
Cortisone Injections
If simple steps do not relieve symptoms, a cortisone injection around the nerve area may be recommended. The goal is to reduce inflammation that contributes to nerve pressure (Houle S. 2012) . Cortisone injections may be a definitive treatment or a temporary treatment.
Chiropractic
Chiropractic care can be an effective, natural, and safe treatment. Adjustments can help relieve pressure on the lateral femoral cutaneous nerve (LFCN) by realigning the spine and restoring nerve function. Chiropractors may also use soft tissue therapies, such as massage, to relieve muscle tension and support the body’s healing process. Other chiropractic techniques that may be used include:
A chiropractic treatment program may include 10–15 treatments over 6–8 weeks, but the number of treatments needed will vary from person to person. If there’s no noticeable progress after 3–4 weeks, it may be time to consult a specialist or surgeon.
Surgery
Surgery is rarely necessary. However, a surgical procedure may be considered when all conservative treatments fail to provide relief. (Schwaiger K. et al., 2018) A surgeon dissects and identifies the nerve, looks for compression locations, and tries to free the nerve from any areas where it may be pinched. Alternatively, some surgeons transect/cut the nerve so it no longer causes problems. If the transection procedure is performed, there will be a permanent area of numbness over the front of the thigh.
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a customized treatment plan to relieve pain, treat injuries, improve flexibility, mobility, and agility, and help individuals return to optimal function. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Chiropractic Care for Leg Instability
References
Ivins G. K. (2000). Meralgia paresthetica, the elusive diagnosis: clinical experience with 14 adult patients. Annals of surgery, 232(2), 281–286. https://doi.org/10.1097/00000658-200008000-00019
Cheatham, S. W., Kolber, M. J., & Salamh, P. A. (2013). Meralgia paresthetica: a review of the literature. International journal of sports physical therapy, 8(6), 883–893.
Chung, K. H., Lee, J. Y., Ko, T. K., Park, C. H., Chun, D. H., Yang, H. J., Gill, H. J., & Kim, M. K. (2010). Meralgia paresthetica affecting parturient women who underwent cesarean section -A case report-. Korean journal of anesthesiology, 59 Suppl(Suppl), S86–S89. https://doi.org/10.4097/kjae.2010.59.S.S86
Scholz, C., Hohenhaus, M., Pedro, M. T., Uerschels, A. K., & Dengler, N. F. (2023). Meralgia Paresthetica: Relevance, Diagnosis, and Treatment. Deutsches Arzteblatt international, 120(39), 655–661. https://doi.org/10.3238/arztebl.m2023.0170
Hosley, C. M., & McCullough, L. D. (2011). Acute neurological issues in pregnancy and the peripartum. The Neurohospitalist, 1(2), 104–116. https://doi.org/10.1177/1941875211399126
Houle S. (2012). Chiropractic management of chronic idiopathic meralgia paresthetica: a case study. Journal of chiropractic medicine, 11(1), 36–41. https://doi.org/10.1016/j.jcm.2011.06.008
Schwaiger, K., Panzenbeck, P., Purschke, M., Russe, E., Kaplan, R., Heinrich, K., Mandal, P., & Wechselberger, G. (2018). Surgical decompression of the lateral femoral cutaneous nerve (LFCN) for Meralgia paresthetica treatment: Experimental or state of the art? A single-center outcome analysis. Medicine, 97(33), e11914. https://doi.org/10.1097/MD.0000000000011914
Can individuals with osteoarthritis can incorporate cycling to reduce joint pain and regain their joint mobility?
Introduction
The joints in the musculoskeletal system allow the individual to be mobile while allowing the extremities to do their jobs. Just like the muscles and ligaments of the body, the joints can also wear and tear through repetitive motions, leading to joint pain in the extremities. Over time, the wear and tear from the joints can lead to the potential development of osteoarthritis, which then can affect joint mobility and lead to a life of pain and misery for individuals. However, numerous ways exist to reduce osteoarthritis’s pain-like symptoms and help restore joint mobility through cycling. Today’s article looks at how osteoarthritis affects the joints, how cycling is incorporated for osteoarthritis, and how it can reduce joint pain. We discuss with certified associated medical providers who consolidate our patients’ information to assess osteoarthritis and its associated pain symptoms affecting the joints in the extremities. We also inform and guide patients while asking their associated medical provider intricate questions to integrate cycling into their personalized treatment plan to manage the pain correlated with osteoarthritis affecting their joints. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
Osteoarthritis Affecting Joint Mobility
Do you feel pain and stiffness every morning in your joints only for it to feel better throughout the day? Do you experience pain in your knees, hips, and hands? Or have you noticed that your range of motion has decreased drastically? Many individuals, both young and old, can be affected by these pain-like issues and could be at risk of developing osteoarthritis in their joints. Osteoarthritis is the largest and most common musculoskeletal condition that causes a disturbance of the inflammatory cytokine balance, damaging the cartilage and other intra-articular structures surrounding the joints. (Molnar et al., 2021) This is because osteoarthritis develops over time, causing the cartilage to wear away and causing the connecting bones to rub against each other. This, in turn, can affect the extremity’s joint mobility, causing symptoms of stiffness, pain, swelling, and reduced range of motion to the joints.
Additionally, osteoarthritis is multifactorial as it can cause an imbalance in the joints due to genetics, environmental, metabolic, and traumatic factors that can contribute to its development. (Noriega-Gonzalez et al., 2023) This is because repetitive motions and environmental factors can impact the body and cause overlapping risk profiles to correlate with osteoarthritis. Some overlapping risk profiles associated with osteoarthritis are pathological changes in the joint structure that cause abnormal loading on the joints, which causes joint malalignment and muscle weakness. (Nedunchezhiyan et al., 2022) This causes many people to be in constant pain and trying to find relief from joint pain associated with osteoarthritis.
Chiropractic Solutions For Osteoarthritis-Video
Cycling For Osteoarthritis
Engaging in physical activities may seem daunting when managing osteoarthritis symptoms, but it can help restore joint mobility while reducing the pain associated with osteoarthritis. One of the physical activities that has little impact and does not impact the joints is cycling. Cycling for osteoarthritis has many beneficial properties as it can:
Strengthen surrounding muscles
Retain joint mobility
Improve range of motion
Weight management
Enhancing cardiovascular health
Cycling can help the individual focus on strengthening the lower extremity muscles surrounding the joints, which can help improve pain and functionality. (Katz et al., 2021) This, in turn, helps provide better support and stability to the joints, thus reducing overload on the body while minimizing the risk of injuries. Additionally, cycling can help improve many individuals looking for a healthier change and increase bone mineral density in the joints, thus decreasing the risk of fractures. (Chavarrias et al., 2019)
Cycling Reducing Joint Pain
Cycling is a safe and effective exercise for anyone, whether they’re just starting or haven’t been active for a while. The key to optimal recovery and joint functionality is to consult a doctor. This ensures that cycling is a safe option for you, helps you choose the right bike, and provides guidance on how to start slowly, warm up and stretch, maintain proper form, and stay consistent with the cycling sessions. This professional guidance is crucial, as it allows many individuals with joint pain to achieve complete functional recovery to their joints. (Papalia et al., 2020) Cycling is an excellent way to manage osteoarthritis and its associated symptoms. For many individuals with osteoarthritis, this low-impact exercise can be a game-changer, promoting muscle strengthening, improving joint range of motion, and helping alleviate osteoarthritis symptoms.
References
Chavarrias, M., Carlos-Vivas, J., Collado-Mateo, D., & Perez-Gomez, J. (2019). Health Benefits of Indoor Cycling: A Systematic Review. Medicina (Kaunas, Lithuania), 55(8). https://doi.org/10.3390/medicina55080452
Katz, J. N., Arant, K. R., & Loeser, R. F. (2021). Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review. JAMA, 325(6), 568-578. https://doi.org/10.1001/jama.2020.22171
Molnar, V., Matisic, V., Kodvanj, I., Bjelica, R., Jelec, Z., Hudetz, D., Rod, E., Cukelj, F., Vrdoljak, T., Vidovic, D., Staresinic, M., Sabalic, S., Dobricic, B., Petrovic, T., Anticevic, D., Boric, I., Kosir, R., Zmrzljak, U. P., & Primorac, D. (2021). Cytokines and Chemokines Involved in Osteoarthritis Pathogenesis. Int J Mol Sci, 22(17). https://doi.org/10.3390/ijms22179208
Nedunchezhiyan, U., Varughese, I., Sun, A. R., Wu, X., Crawford, R., & Prasadam, I. (2022). Obesity, Inflammation, and Immune System in Osteoarthritis. Front Immunol, 13, 907750. https://doi.org/10.3389/fimmu.2022.907750
Noriega-Gonzalez, D., Caballero-Garcia, A., Roche, E., Alvarez-Mon, M., & Cordova, A. (2023). Inflammatory Process on Knee Osteoarthritis in Cyclists. J Clin Med, 12(11). https://doi.org/10.3390/jcm12113703
Papalia, R., Campi, S., Vorini, F., Zampogna, B., Vasta, S., Papalia, G., Fossati, C., Torre, G., & Denaro, V. (2020). The Role of Physical Activity and Rehabilitation Following Hip and Knee Arthroplasty in the Elderly. J Clin Med, 9(5). https://doi.org/10.3390/jcm9051401
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