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.
Regarding the musculoskeletal system, the various muscles, tissues, and ligaments help protect the spine and vital organs that make the body functional. These muscles are sectioned into different groups that help provide movement and motion to the host without feeling pain. However, when normal factors or traumatic forces begin to affect the musculoskeletal system, it can cause unnecessary stress on the muscle fibers. These environmental factors can lead to muscle pain and correlating symptoms affecting the upper and lower body portions. When muscle pain affects the body, it can mask other pre-existing conditions that can make the individual feel miserable. Fortunately, many individuals will go to therapy treatment to reduce the effects of muscle pain and have a personalized plan that they can follow to prevent muscle pain from returning in the future. Today’s article focuses on one of the non-surgical treatments known as MET (muscle energy technique) therapy that can help reduce the effects of muscle pain and what is the protocol treatment plan to relieve muscle pain in the body. 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 musculoskeletal pain. 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 Muscle Pain Affect The Body?
Do you experience muscle aches, stiffness, or pain in one or more parts of your body? These pain-like symptoms are often caused by muscle pain. Research studies revealed that free nerve endings in muscle fibers can send pain signals to the brain, leading to decreased productivity and economic burden. Overstretching muscles during daily routines can cause trigger points, small nodules in muscle fibers that cause stiffness and contraction. This can lead to misalignment and additional problems over time.
Muscle pain can be a symptom of different conditions, with severity ranging from acute to chronic. Research studies stated that when musculoskeletal pain affects more than 30% of the world, it can significantly impact an individual’s life. This type of pain can be related to sensory innervation of the bones, joints, and muscles and can negatively affect a person’s daily routine. However, there are various ways to reduce muscle pain, which individuals can incorporate to relieve muscle pain and reduce its chances of returning.
Movement As Medicine- Video
When it comes to musculoskeletal pain, it can have a significant impact on a person’s body. It can affect their daily routine, causing them to have limited mobility and feel miserable. Musculoskeletal pain causes the involved muscle fibers to stiffen up and contract. This causes the surrounding muscles to compensate for the pain the affected muscle feels and causes body misalignment. However, all is not lost, as available treatments can help reduce the effects of muscle pain and can bring back a person’s mobility. One of these treatments is MET (muscle energy technique) therapy. Research studies reveal that MET is an osteopathic technique that many pain specialists like chiropractors and massage therapists use to improve musculoskeletal function by mobilizing joints, stretching tight muscles and facia to reduce pain, and improving circulation and lymphatic flow. Since many individuals don’t stretch their bodies as often as needed, their muscles can become tight and stiff, which causes the development of muscle pain. So by utilizing MET therapy, a person dealing with muscle pain can regain mobility. MET therapy can also be combined with other treatments like chiropractic care to help realign the body out of subluxation and strengthen/lengthen tight muscles. The video above explains how movement is used as medicine to reduce the effects of muscle pain.
MET Treatment Protocol
According to “Clinical Application of Neuromuscular Techniques,” written by Leon Chaitow, N.D., D.O., and Judith Walker DeLany, L.M.T., when the body is experiencing restricted joints, incorporating MET therapy can indicate where the problem is located in the soft musculoskeletal tissues. When it comes to many individuals going to MET therapy for muscle pain, many doctors have their protocol approach when assessing patients for muscle pain treatment.
Looking At Body Language
When assessing patients with muscle pain, looking at their body language and how they carry themselves is important. Many doctors and pain specialists should note how the individual is breathing, their posture, and if there is any perspiration on the skin. By taking note of how the individual looks physically, many doctors will begin to formulate a treatment plan while communicating with the patient to gather more information and create a trusting relationship. Afterward, the doctor can start the physical examination to locate where the pain is in the body.
Physical Examination
The MET treatment protocol’s physical examination portion allows the doctor to go through a sequential assessment involving observation, joint and muscle testing, palpations, evaluation of accessory movement, etc., to create a basic formula to create a personalized treatment plan. The physical examination of MET allows the muscles to influence muscle contractions on the surrounding fascia and alter the muscle’s physiology by reflex mechanisms. These stretches help the restricted joints be re-mobilized, and help stretch the tightened muscles to feel relief from metabolic waste.
Therapeutic Plan
The therapeutic plan for MET treatment is personalized and customizable for the individual to follow through to reduce muscle pain from re-occurring in the body. Many doctors specializing in MET therapy work with other associated medical providers to ensure that the person in pain has the help they need. Physical therapy, dietary nutrition, non-surgical treatments, and health coaches all work together to create a personalized health and wellness plan to make sure that muscle pain and its associated factors are being treated. This allows individuals to be more mindful of their bodies and regain their health and wellness.
Conclusion
Muscle pain can affect a person’s ability to move around and can affect multiple areas in the upper and lower body portions. Muscle pain correlates to tight muscle fibers that become stiff and can develop trigger points in the fascia and cause restricted movement. When this happens, it can cause the individual to miss out on daily activities and prevent them from working. Luckily available treatments can help reduce muscle pain by re-mobilizing the joints and stretching out the tight muscle. MET, or muscle energy technique therapy, helps stretch muscle fascia and mobilize joints to regain the body’s range of motion and help reduce muscle pain. Many people who incorporate MET into their daily routine can restore mobility and continue their health and wellness journey.
References
Chaitow, L., & Delany, J. (2002). Clinical application of neuromuscular techniques. Vol. 2, The lower body. Churchill Livingstone.
It can be challenging to find the proper treatment for general aches and pains in the body due to various environmental factors. These factors, such as home life, physical activity, and work conditions, can lead to overlapping symptoms that negatively impact a person’s mental and emotional well-being. If left untreated and depending on the severity, these symptoms can develop into chronic conditions. However, individuals can find personalized solutions to reduce pain and discomfort by taking charge of their health and wellness. This article will explore gender-affirming care, a treatment that can benefit the LGBT+ community, and non-surgical options like spinal decompression and chiropractic care. We work with certified medical providers who use our patients’ valuable information to provide treatments like gender-affirming care for individuals with general body pain. 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
What Is Gender-Affirming Care?
When seeking treatment, people often research and find the care that best suits their needs. One treatment that has been shown to impact many individuals positively is gender-affirming care. Research studies revealed that this process could address gender affirmation through various means, including clothing, hair, voice and pronouns, name changes, medical and surgical care, and social transition. People may use gender-affirming care uniquely to receive the treatment they deserve. Research also suggests that gender-affirming care should be multidisciplinary, involving diagnostic assessments, psychotherapy/counseling, and therapies. Many individuals in the LGBT+ community seek gender-affirming care to improve their mental and physical well-being, which can be life-saving.
How Does Gender-Affirming Care Help The LGBT+?
Gender-affirming care is an important aspect of supporting the LGBT+ community. It involves acknowledging and accepting a person’s gender identity and making necessary changes to help them express it. Creating a safe and positive environment for gender-affirming care can significantly improve the experience, health outcomes, and life quality of many individuals in the LGBT+ community, particularly those who identify as transgender. It’s important to understand the meaning of “gender” and “affirming” to provide effective care. Gender refers to how society perceives a person’s sex as either male/man or female/woman, while affirming involves accepting and validating a person’s identity. Research studies have revealed that gender-affirming care positively impacts the LGBT+ community, making it a crucial component of healthcare for this population.
In the LGBT+ community, the “T” stands for transgender individuals with a gender identity that does not match their assigned sex at birth. This can include:
Transgender woman: Male-to-female, assigned male at birth, lives female/affirmed woman, transfeminine spectrum
Transgender man: Female-to-male, assigned female at birth, live male/affirmed man, transmasculine spectrum
Transexual: individuals in the transgender community who has transitioned to the opposite sex, often including sexual reassignment surgery
Many transgender people seek gender-affirming care to improve their overall health and well-being by making changes to align their bodies and mind. Unfortunately, there are barriers associated with accessing gender-affirming care.
Barriers Associated With Gender-Affirming Care
Accessing gender-affirming care can be a barrier for many in the LGBT+ community, leading to poor mental health, decreased social support, and discrimination. Research studies revealed that these burdens can contribute to developing body dysmorphia and associated symptoms. Research has shown that individuals with body dysmorphia may develop comorbid disorders during general examinations, including gender dysmorphia, which can lead to distress for the patient. However, creating a safe and respectful environment for the LGBT+ community is possible by providing personalized gender-affirming care. The Injury Medical Chiropractic and Functional Medicine Team is committed to building a positive space for individuals who identify as transgender and alleviating pain-like symptoms through personalized treatment plans.
The Benefits of a Healthy Diet & Chiropractic Care- Video
Beneficial Treatments Utilize In Gender-Affirming Care
There is hope for individuals seeking gender-affirming care, as many beneficial treatments are available. Non-surgical options such as spinal decompression and chiropractic care can ease musculoskeletal issues and educate patients on environmental factors that affect their well-being. Hormone, physical, and mental therapy are important for personalized care plans, making them affordable and ensuring safety. Individuals in the LGBT+ community face unique health challenges, and having a safe and positive space can make their health and wellness journey more manageable.
References
Bhatt, N., Cannella, J., & Gentile, J. P. (2022). Gender-affirming Care for Transgender Patients. Innovations in Clinical Neuroscience, 19(4-6), 23–32. www.ncbi.nlm.nih.gov/pmc/articles/PMC9341318/
Carroll, R., & Bisshop, F. (2022). What you need to know about gender‐affirming healthcare. Emergency Medicine Australasia, 34(3). doi.org/10.1111/1742-6723.13990
Grant, J. E., Lust, K., & Chamberlain, S. R. (2019). Body dysmorphic disorder and its relationship to sexuality, impulsivity, and addiction. Psychiatry Research, 273, 260–265. doi.org/10.1016/j.psychres.2019.01.036
Hashemi, L., Weinreb, J., Weimer, A. K., & Weiss, R. L. (2018). Transgender Care in the Primary Care Setting: A Review of Guidelines and Literature. Federal Practitioner, 35(7), 30–37. www.ncbi.nlm.nih.gov/pmc/articles/PMC6368014/
Kaplan, E., & Bard, P. (2023). The Ultimate Spinal Decompression. JETLAUNCH.
Tordoff, D. M., Wanta, J. W., Collin, A., Stepney, C., Inwards-Breland, D. J., & Ahrens, K. (2022). Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care. JAMA Network Open, 5(2). doi.org/10.1001/jamanetworkopen.2022.0978
The piriformis is a large and powerful muscle beneath the gluteal/buttocks muscles. It runs from the bottom of the sacrum, where the base of the spine and pelvis converge to the top of the femur. This muscle plays a critical role in running motion; it helps externally rotate the hips and upper leg outward, provides hip flexibility and stability, and stabilizes the pelvis. The sciatic nerve passes next to, over, under, or through the piriformis muscle. When the piriformis contracts or spasms, it can irritate, become entangled and compress the nerve, resulting in painful symptoms. This can lead to various problems and is how piriformis syndrome occurs.
Running Piriformis Syndrome
The proper function of the piriformis muscle is essential for athletes who participate in running sports. Repetitive activities, like running, can fatigue the muscle and irritate and inflame the nerve.
Symptoms
Piriformis syndrome can be challenging to diagnose because it can be confused for a herniated disc, sciatica, a proximal hamstring strain/high hamstring tendinitis, or lower back problems. A few symptoms that can help determine whether the piriformis is the cause include:
Sitting, Stairs, Squatting Discomfort or Pain
Individuals don’t always experience discomfort while running.
Instead, it’s sitting, climbing stairs, and squatting where pain symptoms present.
Pain while running, specifically an overstretched sensation when going up a hill or increasing speed, is more associated with a proximal hamstring strain.
Tenderness
The area around the piriformis is tender.
Applying pressure can cause discomfort or pain around the area and radiate down the leg.
Centered Pain
Piriformis syndrome is usually felt in the middle of the glutes.
A proximal hamstring strain typically causes non-radiating pain at the bottom of the glutes, where the hamstrings connect to the pelvis.
Causes
Pelvic misalignment.
Pelvic misalignments created by other conditions, like a tilted pelvis, functional leg-length discrepancy, or practicing unhealthy posture, make the piriformis work harder to compensate, which leads to tightness and/or spasms.
Sudden increases in distance or workout intensity can worsen any weakness in the piriformis and other gluteal muscles.
Continuing to run, which is possible, can worsen and prolong the condition.
When running, the muscle’s signal transmissions are interrupted by inflammation and/or compression and cannot synchronize with each other.
The result is the inability to withstand the repetitive strain of running.
Resting may not be enough to alleviate piriformis syndrome. This is especially true if the problem involves spine and pelvic misalignment. Chiropractic can provide significant relief from running piriformis syndrome. A combination of spinal, pelvic, and extremity adjustments, therapeutic massage, MET, decompression, stretches, and anti-inflammatory nutrition will take the pressure off overly tight areas, realign the body, and maintain nervous system function.
Running form could be evaluated and checked for leg-length discrepancies and muscle-strength imbalances.
Running can continue if the individual can do so without pain or symptoms.
But it is recommended to avoid slanted surfaces, which increase the risk of pelvic misalignment.
Avoid long runs, which increase the chance of overload and fatigue.
The goal is to relax and release the piriformis.
If it’s impinging on the sciatic nerve, loosening and releasing the muscle will significantly lessen radiating pain.
Orthotics may be recommended for excessive overpronation or inward movement of the foot when landing.
Other treatments to stop piriformis spasms.
Ice and take over-the-counter anti-inflammatory medications can be used during acute phases when the area is tender.
Work out tight spots using a foam roller or percussive massager.
Stretching and loosening the muscle before and after runs can help it relax and increase blood flow.
Ahmad Siraj, Sidra, and Ragini Dadgal. “Physiotherapy for Piriformis Syndrome Using Sciatic Nerve Mobilization and Piriformis Release.” Cureus vol. 14,12 e32952. 26 Dec. 2022, doi:10.7759/cureus.32952
Chang A, Ly N, Varacallo M. Piriformis Injection. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
Heiderscheit, Bryan, and Shane McClinton. “Evaluation and Management of Hip and Pelvis Injuries.” Physical Medicine and rehabilitation clinics of North America vol. 27,1 (2016): 1-29. doi:10.1016/j.pmr.2015.08.003
Julsrud, M E. “Piriformis syndrome.” Journal of the American Podiatric Medical Association vol. 79,3 (1989): 128-31. doi:10.7547/87507315-79-3-128
Kraus, Emily, et al. “Piriformis Syndrome With Variant Sciatic Nerve Anatomy: A Case Report.” PM & R: the Journal of Injury, Function, and Rehabilitation vol. 8,2 (2016): 176-9. doi:10.1016/j.pmrj.2015.09.005
Lenhart, Rachel, et al. “Hip muscle loads during running at various step rates.” The Journal of Orthopedic and sports physical therapy vol. 44,10 (2014): 766-74, A1-4. doi:10.2519/jospt.2014.5575
Sulowska-Daszyk, Iwona, and Agnieszka Skiba. “The Influence of Self-Myofascial Release on Muscle Flexibility in Long-Distance Runners.” International Journal of environmental research and public health vol. 19,1 457. Jan 1, 2022, doi:10.3390/ijerph19010457
Back pain is a common issue experienced by people all over the world. The human body’s main structure is the back, divided into three sections: cervical, thoracic, and lumbar. These sections help in body movement, including twisting and turning, moving the extremities, and have a relationship with the gut and central nervous system. The surrounding muscles in the back also provide support and protect the spine. However, normal activities like bending down to pick up a heavy object, sitting down for an extended period, or falling can cause changes that lead to back pain, misalignment, and risk profiles in the upper and lower extremities. Today’s article focuses on the causes of back pain and the treatments available to relieve its effects. We utilize and incorporate valuable information about our patients to certified medical providers using non-surgical treatments to reduce the impact of back pain. We encourage and refer patients to associated medical providers based on their findings while supporting that education is a remarkable and fantastic way to ask our providers the essential questions at the patient’s acknowledgment. Dr. Alex Jimenez, D.C., comprises this information as an educational service. Disclaimer
An Overview Of Back Pain
Do you have pain in your upper, middle, or lower back? Do you experience aches and pains in the morning? Did lifting something heavy cause you pain? These symptoms could be signs of back pain, a common and costly reason for emergency room visits. Research studies reveal that back pain can have various causes and affect the entire body, either mechanically or non-specifically. The three sections of the back – cervical, thoracic, and lumbar – can all be impacted, causing referred pain in different parts of the body. For instance, cervical (upper) back pain can cause stiffness in the neck, while thoracic (middle) back pain can lead to shoulder and posture issues. Lumbar (low) back pain, the most common type, can cause hip and sciatic problems. Additional research studies reveal that back pain is a complex issue that can severely affect body function, and environmental factors can also influence it.
Causes Of Back Pain
Various factors can be the cause of back pain, thus resulting in spine misalignment. In their book, “The Ultimate Spinal Decompression,” Dr. Eric Kaplan, D.C., FIAMA, and Dr. Perry Bard, D.C., explain that the back muscles play a significant role in protecting the spine. Environmental factors can also impact the spine, leading to potential back pain. The book further notes that wear and tear and disc protrusion on the spine can result in disc herniation and degeneration, also associated with back pain. Some common causes of back pain include:
Visceral-somatic/Somato-visceral pain (Affected organ or muscle causes referred pain to different body parts)
Pregnancy
Further research indicates that various environmental factors, such as physical activity, lifestyle, stress, and work conditions, are associated with back pain and can overlap as risk factors. If left untreated, these environmental factors can lead to chronic conditions and significantly impact a person’s quality of life.
Chiropractic Secrets Exposed- Video
Have you been feeling numbness or tingling in your arms or legs? Do you experience back muscle pain when you stretch? Or do you feel pain in your low back or other parts of your body? These issues are often associated with back pain and, if left untreated, can lead to disability and loss of function. Fortunately, there are many ways to reduce back pain and its associated symptoms and promote natural healing. The video above explains how non-surgical treatments like chiropractic care can help alleviate back pain through manual manipulation. This treatment can realign the spine, stretch out tight muscles, and restore the body’s range of motion.
Treatments For Back Pain
If you are experiencing back pain, various treatments can help ease your symptoms and improve your mobility. You have two options for treating back pain: surgical and non-surgical. Surgical treatment may be necessary if you are experiencing nerve compression or have sustained an injury that requires spinal fusion. Non-surgical treatments can help relieve pressure on your spine, reduce back pain, and even alleviate pain in other areas of your body. Some non-surgical treatments for back pain include:
Physical therapy
Exercise
Chiropractic care
Acupuncture
Spinal Decompression
According to research, non-surgical treatments can alleviate pressure on spinal discs, loosen tight muscles, improve joint mobility, and promote natural healing. Many people supplement these treatments with healthy lifestyle choices, making small adjustments to their routine and paying closer attention to their physical well-being.
Conclusion
Since back pain is a widespread problem affecting people globally, it can be caused by various environmental factors that impact the cervical, thoracic, and lumbar back sections, leading to overlapping risk profiles and affecting different body parts. Tight and strained muscles and a compressed spine are common symptoms of this issue. However, treatments available can effectively reduce pain, stretch tight muscles, and relieve pressure off the spinal disc. By incorporating these treatments, individuals can alleviate back pain and allow their bodies to heal naturally.
References
Allegri, Massimo, et al. “Mechanisms of Low Back Pain: A Guide for Diagnosis and Therapy.” F1000Research, 28 June 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4926733/.
Casiano, Vincent E, et al. “Back Pain.” In: StatPearls [Internet]. Treasure Island (FL), 20 Feb. 2023, www.ncbi.nlm.nih.gov/books/NBK538173/.
Choi, Jioun, et al. “Influences of Spinal Decompression Therapy and General Traction Therapy on the Pain, Disability, and Straight Leg Raising of Patients with Intervertebral Disc Herniation.” Journal of Physical Therapy Science, Feb. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4339166/.
Kaplan, Eric, and Perry Bard. The Ultimate Spinal Decompression. JETLAUNCH, 2023.
See, Qin Yong, et al. “Acute Low Back Pain: Diagnosis and Management.” Singapore Medical Journal, June 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC8801838/.
Intercostal muscles are the muscles within the rib cage, commonly called the intercostals, which connect the ribs and make up the chest wall. An intercostal muscle strain refers to an injury between two or more ribs. If these muscles become overstretched, restricted, or suffer damage, it can cause inflammation and significant pain in the middle and upper back. Intercostal muscle strain is a common injury in athletes and physically demanding jobs. Chiropractic care and massage therapy can realign the vertebrae with the ribs and loosen and relax the muscles to increase circulation and restore mobility and function.
Intercostal Muscle Strain
The intercostal muscles have different layers attached to the ribs to help build the chest wall and assist in breathing. There are 11 intercostal muscles on each side of the rib cage. Each set is located between connected ribs in the upper and mid-back and consists of the following:
External
These are the outermost intercostals, responsible for expanding the chest during breathing to help inhale air and allow full deep breaths.
The external intercostals originate at the lower edge of a rib and run diagonally to attach to the upper edge of the rib below.
They are found in the rib cage’s back, sides, and front.
Internal
These sit directly underneath the externals and help collapse the chest during breathing to exhale.
The muscle fibers run perpendicular to the external intercostals, moving diagonally from front to back along the ribs, and are in the entire rib cage.
Innermost
These sit directly underneath, run parallel to the internal intercostals, and run from the back of the rib cage to each side.
The veins, arteries, and nerves lie between the internal and innermost intercostals.
When an intercostal muscle gets twisted, overused, or stretched too far, it can tear, causing muscle strain. Often radiating pain along the rib cage is experienced that extends to the back.
Causes
An intercostal muscle strain often occurs as the result of an injury or overexertion of the muscles. Common causes include:
Trauma to the rib cage, such as from a fall or automobile collision.
Impact trauma from sports or physical activities.
Over twisting the torso beyond its normal range of motion from lifting weights, sports, yoga postures, or dance positions.
Repeatedly reaching overhead for work or tasks like cleaning or painting.
Lifting heavy objects above shoulder height.
Repetitive torso movements.
A sudden increase in physical activity that the body is not used to can also lead to intercostal muscle strain.
This can happen when a lack of conditioning or unhealthy postures weaken muscles.
Symptoms
The signs and symptoms can vary, depending on the severity and cause. Symptoms can include:
Intercostal muscle spasms.
Mobility difficulties.
Inflammation, swelling, and sensitivity in the affected area.
Stiffness and tension, causing upper back pain.
Upper back and rib pain.
Tenderness in the area between the ribs.
Muscle rigidity when bending or twisting the upper body.
Gradual worsening pain after repetitive movements.
Worsening pain when coughing, sneezing, or breathing in deeply.
Severe and sudden pain, particularly if caused by direct trauma to the chest or back.
Chiropractic
Diagnosis involves the individual’s medical history and a physical exam to check for movement limitations and assess affected and sensitive areas. Once the inflammation is reduced, chiropractic and physical therapy will focus on the following:
Pain relief treatment.
Breathing exercises.
Posture training.
Stretching under supervision.
Strengthing exercises.
Most cases fully heal within 6 to 8 weeks.
Rib Muscle Injury
References
De Troyer, A et al. “Mechanics of intercostal space and actions of external and internal intercostal muscles.” The Journal of clinical investigation vol. 75,3 (1985): 850-7. doi:10.1172/JCI111782
Lord, Michael J, and William G Carson Jr. “Multiple Rib Stress Fractures.” The Physician and sports medicine vol. 21,5 (1993): 80-91. doi:10.1080/00913847.1993.11947575
Morrison W. What is an intercostal muscle strain? Medical News Today. Jan 2020
Page P. Current Concepts in Muscle Stretching for Exercise and Rehabilitation. International Journal of Sports Physical Therapy. 2012;7(1):109-119.
Park, Kyung-hee, et al. “Difference in selective muscle activity of thoracic erector spinae during prone trunk extension exercise in subjects with slouched thoracic posture.” PM & R: the Journal of Injury, Function, and Rehabilitation vol. 7,5 (2015): 479-84. doi:10.1016/j.pmrj.2014.10.004
Tran H. Causes of Intercostal Muscle Strain. Spine-health. October 2017
Yoo, Won-Gyu. “Effect of a combined thoracic and backward lifting exercise on the thoracic kyphosis angle and intercostal muscle pain.” Journal of physical therapy science vol. 29,8 (2017): 1481-1482. doi:10.1589/jpts.29.1481
Yoo, Won-Gyu. “Effect of thoracic stretching, thoracic extension exercise and exercises for cervical and scapular posture on thoracic kyphosis angle and upper thoracic pain.” Journal of physical therapy science vol. 25,11 (2013): 1509-10. doi:10.1589/jpts.25.1509
The hamstring muscles attach, through a tendon called the proximal hamstring tendon, to the ischial tuberosity, the bones used to sit deep in the buttock muscles. When the tendon is subjected to overuse/repetitive stresses and strains, the internal structure can become compromised, leading to weakness and pain symptoms. This is known as proximal hamstring tendinopathy. Tendinopathy is an overuse injury where the tendon is repeatedly strained until microscopic tears form. It is common in athletes that do a lot of running but also in individuals that sit for prolonged periods. If left untreated, high hamstring tendinopathy can lead to progressive degeneration of the tissues, leading to chronic weakness, pain, and dysfunction.
High Hamstring Tendinopathy
The hamstrings are a powerful muscle group that extends the hip and flexes the knee. They experience stress and pressure during activity and inactivity/sitting and are susceptible to strain injuries. Tendons attach muscle to bone and are designed to take compressive and tensile weight/loads that stretch or flex. A tendon is made up of fibrous tissue containing organized type 1 collagen. Tendons receive blood; however, the supply is less where the tendon attaches to the bone and is commonly where tendinopathy occurs.
Injury
A hamstring injury involves the bruising, irritation, or tearing of the hamstring tendon or muscle tissue. Severity can range from:
Microtears that cause stiffness and pain symptoms but heal fast on their own.
Severe ruptures that cause debilitating pain, dysfunction and require medical intervention.
The tendon attaches to the ischial tuberosity or sitting buttock bone. Tendons can have a spasm-like reaction to sudden or quick shift changes. A sudden change can cause adverse changes to the tendon. Too much load on the tendon beyond its ability to recover can cause the structure to change and the collagen to break down/tear like a rope tearing and unraveling. High hamstring tendinopathy happens around the hip area and presents as buttock or upper thigh pain. Individuals report deep, dull, radiating buttock pain during walking, running, and prolonged sitting or driving. Sometimes the sciatic nerve can become irritated or entrapped by an affected tendon’s scar tissue, causing sciatica-like symptoms.
Stages of Tendon Pathology
Reactive Phase
Caused by an acute overload of physical activity or inactivity.
The tendon will thicken temporarily to decrease the stress; however, there may be no inflammation.
The tendon can return to normal if the load is reduced or sufficient time for recovery and repair is allowed.
Disrepair
Chronically overloaded.
Unsuccessful healing.
More negative tendon changes occur.
Reversibility is possible with load management and targeted exercises to stimulate the tendon and surrounding tissues.
Degenerative
Continual progression of adverse tendon changes.
More common in older individuals.
Continue load management and strength training to maximize the tendon’s tolerance.
Chiropractic Treatment
A chiropractic therapy team will develop a personalized treatment program to improve tendon structure and strengthen the hamstrings, gluteal, and side abdominal muscles. They will begin with tendon symptom-relieving massage to loosen the muscles and get the blood circulating, MET-targeted stretches to lengthen the muscles, and spinal and pelvic adjustments to realign the body.
Sciatica Explained
References
Buckley, Mark R et al. “Distributions of types I, II and III collagen by region in the human supraspinatus tendon.” Connective tissue research vol. 54,6 (2013): 374-9. doi:10.3109/03008207.2013.847096
Lempainen, Lasse, et al. “Expert opinion: diagnosis and treatment of proximal hamstring tendinopathy.” Muscles, ligaments, and tendons journal vol. 5,1 23-8. 27 Mar. 2015
Mattiussi, Gabriele, and Carlos Moreno. “Treatment of proximal hamstring tendinopathy-related sciatic nerve entrapment: presentation of an ultrasound-guided “Intratissue Percutaneous Electrolysis” application.” Muscles, ligaments, and tendons journal vol. 6,2 248-252. 17 Sep. 2016, doi:10.11138/mltj/2016.6.2.248
Ono, T et al. “Estimation of tensile force in the hamstring muscles during overground sprinting.” International Journal of sports medicine vol. 36,2 (2015): 163-8. doi:10.1055/s-0034-1385865
White, Kristin E. “High hamstring tendinopathy in 3 female long-distance runners.” Journal of chiropractic medicine vol. 10,2 (2011): 93-9. doi:10.1016/j.jcm.2010.10.005
Wilson, Thomas J et al. “Sciatic Nerve Injury After Proximal Hamstring Avulsion and Repair.” Orthopedic Journal of sports medicine vol. 5,7 2325967117713685. 3 Jul. 2017, doi:10.1177/2325967117713685
Automobile collisions, work, sports, and personal accidents can cause neck injuries that can affect other areas, leading to long-term health problems. Neck injuries involving soft tissue damage frequently persist after the incident. One of the injuries includes vocal cord damage caused by impact to the larynx. The larynx, or voicebox, is an organ that is behind the Adam’s apple. A neck injury impacting the larynx can affect the ability to speak and breathe and cause vocal cord paralysis. Treatment can involve surgery, voice therapy, physical therapy, and chiropractic.
Vocal Cord Injury
The vocal cords are two flexible bands of muscle tissue at the entrance of the trachea. The vocal cords are normally in a relaxed open position to allow breathing. When talking, the bands combine and vibrate to make a sound. Surgery, viral infections, certain cancers, and neck trauma can cause vocal cord paralysis. In this condition, nerve damage blocks or inhibits impulses from transmitting to the voice box. The muscles, usually one of them, become paralyzed, preventing swallowing and ingesting saliva through the windpipe/trachea. In rare cases, both muscles are unable to move.
Trauma to the neck or chest can injure the voice box nerves.
Infections
Infections like Lyme disease, Epstein-Barr virus, and herpes can cause inflammation and nerve damage.
Tumors
Tumors, cancerous and noncancerous, can grow inside or around the muscles, cartilage, and nerves.
Neurological
Neurological conditions like multiple sclerosis or Parkinson’s disease can lead to vocal cord paralysis.
Surgical Injury
Surgical procedure mistakes or complications on or near the neck or upper chest can result in damage to the voice box nerves.
Surgeries to the thyroid or parathyroid glands, esophagus, neck, and chest have an increased risk.
Stroke
A stroke chokes blood flow to the brain and can damage the region of the brain that transmits messages to the voice box.
Treatment
Treatment is determined by a doctor based on the individual medical condition and diagnostic tests. Treatment can involve:
Speech Therapy
Speech therapy is recommended as the laryngeal muscles are strengthened through various exercises, improving breathing function. A speech therapist will begin working with the individual on exercises targeting the weakened vocal folds by enhancing airflow and blood circulation.
Physical Therapy and Chiropractic
Treatment involves performing gentle exercises that work on the vocal cords gradually and progressively but does not stress them. Chiropractors work with the physical therapist performing high-velocity, low-amplitude manipulation targeted at the lower neck and upper thoracic area, the C3/T1 vertebrae. A treatment plan will also use massage, non-surgical decompression, instrument/tool-assisted soft-tissue mobilization, low laser or ultrasound, and at-home stretches and exercises.
Surgery
Surgery could be necessary for individuals experiencing no improvement despite doing the prescribed speech and physical therapy exercises. Different types of procedures are based on the degree and extent of the paralysis:
Injections – Collagen and fillers are injected into the vocal cords to reposition the affected muscles closer to the larynx.
Phonosurgery – The vocal cords are repositioned through restructuring.
Tracheotomy – If the vocal folds are closing, a surgeon may make an incision in the neck at the opening of the windpipe and insert a breathing tube. This bypasses the air blockage caused by the vocal folds and promotes proper air circulation.
Cervical Spine Instability
References
Chen, Ching-Chang, et al. “Long-term result of vocal cord paralysis after anterior cervical discectomy.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 23,3 (2014): 622-6. doi:10.1007/s00586-013-3084-y
Dankbaar JW, et al. Vocal cord paralysis: Anatomy, imaging, and pathology. Insights in Imaging. 2014; doi:10.1007/s13244-014-0364-y.
Fitzpatrick, P C, and R H Miller. “Vocal cord paralysis.” The Journal of the Louisiana State Medical Society: official organ of the Louisiana State Medical Society vol. 150,8 (1998): 340-3.
Kriskovich, M D et al. “Vocal fold paralysis after anterior cervical spine surgery: incidence, mechanism, and prevention of injury.” The Laryngoscope vol. 110,9 (2000): 1467-73. doi:10.1097/00005537-200009000-00011
Waddell, Roger K. “Chiropractic care for a patient with spasmodic dysphonia associated with cervical spine trauma.” Journal of chiropractic medicine vol. 4,1 (2005): 19-24. doi:10.1016/S0899-3467(07)60108-6
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