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.
Muscle spasms also referred to as muscle cramps, are painful contractions and tightening of the muscles. They are common, involuntary, and unpredictable. Temperature drops and cold weather can cause the muscles and joints to contract and tighten, leading to spasms and pain. Chiropractic, physical therapy massage, exercises, stretching, and an anti-inflammatory diet can bring relief and help strengthen the muscles to prevent future episodes.
Muscle Spasms
Spasms are common and can affect any of the muscles. They can involve part of a muscle, all of a muscle, or several muscles in a group. Spasms occur when the muscle/s involuntary and forcibly contract uncontrollably and are unable to relax. The most common sites for muscle spasms include:
As the weather gets colder, this causes the muscles in the body to lose heat, causing them to contract. As a result, the muscles and joints become tighter, stiffer, and decrease mobility and range of motion. This forces the muscles to work harder than usual to compensate. This can increase the fatigue of the muscles, leading to more prolonged bouts of pain and discomfort after physical activity, movement, exercise, etc.
Symptoms and Causes
A cramp can last a few seconds or last up to 15 minutes. During a muscle spasm, the following may be experienced:
Twitching in the muscle.
Pain in the muscle.
Throbbing.
Hardness and/or stiffness.
The muscles appear physically distorted.
Because the muscles have to work harder, the cold weather can increase muscle spasms. One of the most common causes of muscle spasms is overuse and fatigue. However, exact causes vary from person to person. Some experts believe that one or more of the following contribute to the spasms/cramps, and they include:
Dehydration.
Stress.
Not stretching the body regularly.
Muscle fatigue.
Restricted blood circulation.
Involuntary nerve discharge/s.
Over-exercising.
Exercising in the heat.
Exhaustion of salts and minerals:
Potassium
Magnesium
Calcium
Possible causes for leg cramps at night or nocturnal leg cramps specifically include:
Sitting for too long without moving around to keep circulation healthy.
Sitting with unhealthy posture.
Overusing the muscles.
Standing or working on hard floors.
Dealing With The Cold
One way to deal with the cold is to warm up before any physical activity. Taking a few minutes to get the heart rate up can increase the blood flow and flexibility of the muscles. This will ensure the muscles are functioning correctly and avoid the need to work harder to stop spasms. When a cramp strikes, there are a few steps to try to alleviate the spasm:
Stretching the affected area.
Massaging the affected area manually with a massage roller, percussive massager.
Stand up.
Move around.
Apply heat or ice.
A warm bath, shower with massage setting if possible.
Herzberg J. Stevermer J. Treatments for Nocturnal Leg Cramps. (www.aafp.org/afp/2017/1001/od3.pdf) Am Fam Physician 2017;96(7):468-469. Accessed 3/1/2021.
A common symptom of sciatica is radiating/spreading pain running down the leg. However, the leg pain could be something to do with the blood vessels. If the pain travels from the low back to the hip, through the buttocks, down the leg, and into the foot, then more than likely it is sciatica. However, sciatica is just one condition that causes leg pain; other causes of leg pain include:
Bone spurs
Herniated disc
Arthritis
All can irritate the sciatic nerve causing sciatica.
The vascular system, also called the circulatory system, comprises the vessels that circulate blood and lymph throughout the body. Problems with the vascular system are a less common cause of leg pain but can be severe. Therefore, it is vital to learn to tell the difference.
Deep Vein Thrombosis
Deep vein thrombosis – DVT happens when a blood clot forms in a deep vein in the body and not the superficial veins just under the skin. The legs’ deep veins are susceptible to clotting. The formation of a clot can happen:
After surgery
From an accident
When recovering, bed resting and not moving.
When the body is in the same position for a long time with little to no movement, like a long plane ride.
On long plane rides, try to get up and walk around every hour. If unable to walk, do three sets of 20 reps of heel-to-toe exercises every hour.
Deep vein thrombosis can cause leg pain or swelling but can also present without causing any symptoms. Other risk factors include:
Blunt or penetrating injury to the blood vessel and/or its walls.
Pain running down the leg from a blood clot feels like:
Tightness
Cramping soreness
Throbbing
Possible warmth
Swelling.
Blood clots and sciatica are reported to feel relatively different. The pain from a blood clot does not spread out and does not extend from or to the back. Sciatica does not cause swelling, redness, and warmth. If a doctor suspects a blood clot is causing the pain, they will order an ultrasound to confirm the diagnosis. If it is deep vein thrombosis, blood thinners could be recommended for three to six months.
A doctor may recommend aspirin, which can help in the prevention of blood clots.
In some cases, the clot may have to be surgically removed.
Vascular Conditions and Pain Running Down The Leg
Other blood vessel conditions that can cause individuals to believe they have sciatica include:
Peripheral artery disease – PAD
This often presents in individuals with diabetes or who smoke. It causes pain in the calf area but does not radiate throughout the leg. The pain usually presents with physical effort movement. If the pain occurs when at rest, this could be a serious medical emergency. Peripheral artery disease is a chronic condition that can worsen if lifestyle changes are not made to reduce risk factors.
Acute limb ischemia
This condition can cause leg pain, but not the same as sciatica. What happens is the leg is not receiving blood, causing:
Intense pain in the extremity
Change in the color of the skin
Numbness
Weakness
Loss of a pulse
This vascular condition is a medical emergency and requires immediate treatment.
Acute compartment syndrome
This can happen after some kind of trauma to the leg.
The pain is acute, with the leg swelling up and a building up of tight pressure.
It usually affects the lower part of the leg.
This condition can also cause:
Numbness
Tingling
Visible swelling
Bruising
It is considered a medical emergency and needs to be treated quickly to avoid complications.
Varicose veins
Varicose veins can cause some pain running down the leg and/or aching, but the discomfort is not as intense. Treatment has come a long way, is less invasive, and includes:
Compression stockings, including prescription socks/stockings
Laser treatments
Minimally invasive procedures
Not staying on the feet too much
Elevating the legs
Maintaining an ideal weight can help
Vascular Disorder Prevention
Healthy lifestyle habits are recommended to keep the vascular system operating correctly. This includes:
If it is sciatica, fortunately, most cases go away on their own, but if treatment is needed, it is recommended to start with conservative treatments such as:
Chiropractic
Physical therapy
Anti-inflammatory medication
Muscle relaxants
Corticosteroid injections
In severe cases, surgery like a microdiscectomy or laminectomy will be performed to relieve pressure on the sciatic nerve.
Body Composition
Why might blood pressure be different when measuring on each arm?
The heart sits just to the left of the midline in the chest cavity. The aorta is the largest blood vessel in the body. It leaves through the left side of the heart and transports blood to a network of blood vessels that branch out, supplying the body with oxygen and nutrients. The arteries that branch off the aorta and go to the left and right sides of the body are different.
On the right, the brachiocephalic trunk comes off the aorta and splits into the right common carotid artery and right subclavian artery. The left common carotid and left subclavian arteries branch directly off the aorta. The differences mean that the risk for arterial thrombosis is not the same for the right and left subclavian arteries. Arterial thrombosis causes the blood vessels to become stiff, causing obstruction over time and is more likely to happen in the left subclavian than in the right. The difference in arterial branching affects blood pressure measurements on the left and right arms. The blood vessels are surrounded by:
Muscle
Fat
Connective tissue
When muscles place pressure on the blood vessels around the heart, it can cause short-term turbulence changes that can affect blood pressure.
Acute and chronic sports injuries. Individuals who participate in sports or physical activities have an increased risk of experiencing an injury. These types of damages range from minor to severe and could require medical attention. Acute sports injuries happen suddenly and are usually the result of trauma to the area. A specific, identifiable incident is what causes an acute injury. Chronic sports injuries, also known as repetitive/overuse injuries, happen with time and are not caused by a single incident.
Acute and Chronic Sports Injuries Identification
Acute injuries can be identified by their cause. This could be a falling down during a run, sharp pain that presents in the shoulder after a throw, or a sprained ankle. The ability to focus on one cause usually means it’s acute. Acute injuries are characterized by:
Sudden pain in an area where there was none.
Swelling
Redness
Tenderness
Limited range of motion.
The inability of the injured area to support its weight.
A broken bone.
Dizziness
Headache
Nausea
Vomiting
Chronic injuries are different but are usually easy to identify. The pain begins gradually, usually over weeks or months. Repetitive activities like running, throwing, and swinging can exacerbate the pain. However, it is difficult to point to a specific issue that first caused the discomfort or pain. Chronic sports injuries are characterized by:
Pain and tenderness in the area, especially during and immediately after activity.
Minor swelling and limited range of motion.
Dull pain when resting.
These two types of injuries have different causes – trauma for acute and wear-and-tear for chronic – but they can both result in similar issues. For example, shoulder rotator cuff injuries are common, especially those that repeatedly use their shoulder to swing, throw, swim, etc. The individual needs to undergo a rotator cuff injury test to diagnose the injury correctly, whether the damage is acute or chronic. Chronic injuries can cause acute injuries, and acute injuries can lead to chronic injuries if left untreated.
Examples of Acute and Chronic Sports Injuries
Chronic and acute injuries are common in every type of sport. There’s an opportunity for both types of injuries. The most common include:
Other injuries from trauma, overuse, or both include:
Nonspecific Back Pain
Herniated Disc/s
Spondylolysis
Treatment
Minor acute injuries can be treated with rest, ice, compression, and elevation, aka R.I.C.E. Overuse injuries, are different as the injury has been gradually increasing in its severity, possibly causing scar tissue and ganglion cysts to develop. To prevent the injury from worsening, it’s recommended to see a sports injury chiropractor or physical therapist. These professionals can help heal the body and educate the individual on self-care and prevention.
Chiropractic
The musculoskeletal system takes a beating. Chronic injuries usually affect the bones, joints, muscles, or a combination. Chiropractic helps keep the musculoskeletal system limber and in proper alignment. Adjustments include:
Neck adjustments
Arm and hand adjustments
Shoulder adjustments
Knee adjustments
Hip adjustments
Foot adjustments
Physical Therapy
Physical therapy for a chronic injury can help prevent future injuries. A physical therapist helps:
Improve range of motion
Reduces pain and swelling
Increases strength
Whether an athlete or is just staying active and having some fun with sports, acute and chronic injuries can sneak up and worsen if they are not treated properly. Healing with the help of a professional can quicken recovery time and prevent future injuries.
Body Composition
Maintain Muscle Mass While Losing Fat
Individuals who want to lose weight should focus on losing excess fat tissue, not muscle mass. Studies have shown that diet and exercise are crucial to preserving Skeletal Muscle Mass while losing weight. Losing weight healthily includes:
A healthy balance of cardio and resistance training to burn calories and build muscle.
Wörtler, K, and C Schäffeler. “Akute Sportverletzungen und chronische Überlastungsschäden an Vor- und Mittelfuß” [Acute sports injuries and chronic overuse stress damage to the forefoot and midfoot]. Der Radiologe vol. 55,5 (2015): 417-32. doi:10.1007/s00117-015-2855-3
Yang, Jingzhen et al. “Epidemiology of overuse and acute injuries among competitive collegiate athletes.” Journal of athletic training vol. 47,2 (2012): 198-204. doi:10.4085/1062-6050-47.2.198
Polymyositis is a disease that causes the body’s muscles to become irritated and inflamed. It can affect the muscles all over the body. The muscles gradually begin to break down and weaken, making everyday movements difficult. This disease falls into a category known as inflammatory myopathies.
Polymyositis Unknown Causation
The causes of polymyositis are currently unknown. However, experts believe it could be associated with or triggered by a virus or an autoimmune reaction. An autoimmune response is when the body attacks itself along with the body’s tissues. It’s seen in individuals ages 31 to 60 and is rarely seen in individuals younger than 18. In some instances, medication can lead to an allergic reaction/response that causes muscle irritation and damage. But in most cases, healthcare experts are not able to find the exact cause.
Symptoms
The condition can affect the muscles all over the body. Physical activities like walking, getting up from a chair, or lifting objects can become difficult to perform. It can also affect the muscles that allow for eating and breathing. The muscles at the center of the body tend to be affected the most. Common symptoms include:
Muscle pain.
Muscle stiffness.
Muscle weakness, specifically in the abdomen, shoulders, upper arms, and hips.
Joint pain and stiffness.
Breathing problems.
Problems swallowing.
Abnormal weight loss can become an issue if there are problems with swallowing.
Irregular heart rhythms if the heart muscle/myocardium becomes inflamed.
Individuals may notice they have trouble climbing stairs or lifting their arms.
The inflammation can worsen, causing pain and weakness that affects the wrists, lower arms, and ankles.
Diagnosis
Diagnosis begins with the individual’s medical history, family medical history if necessary, and a physical examination. The examination includes seeing and feeling the strength of the muscles. Tests will be required that include:
Blood Tests
Blood tests allow the doctor to see if there are signs of muscle inflammation.
They also show if there are abnormal proteins that form in autoimmune diseases.
Electromyogram EMG
This test can be used to find abnormal electrical activity in the affected muscles.
MRI
Magnets and computer graphic imagery are used to help the doctor inspect for inflammation in the body.
Muscle Biopsy
A small piece of muscle tissue is removed to be analyzed with a microscope.
Treatment
Treatment depends on how severe the condition is,individual symptoms, age, and overall health. Currently, there is no cure for polymyositis, but symptoms can be managed. Individuals are recommended to utilize more than one type of treatment because the treatment plan may also need to be changed as treatment progresses. Treatments include:
Anti-inflammatory Medication
Steroid medication can help manage the disease and reduce symptoms, and corticosteroids can help ease inflammation in the body. The symptoms improve within 4 to 6 weeks, and a healthcare provider can lower the dosage after the symptoms decrease to reduce and ease any side effects.
Immunosuppressive Medication
These medications block or slow down the body’s immune system responses.
Talk with a doctor about the risks, benefits, and side effects of all medications.
Chiropractic and Physical therapy
Chiropractic treatment and physical therapy can help:
Aligning the spine to provide optimal nerve energy and blood circulation.
Therapeutic massage to stimulate and keep the muscles loose.
Specific exercises to help stretch and strengthen the muscles.
These can help keep the muscles from shrinking.
Heat therapy and Rest
Heat therapy and allowing the body to rest thoroughly can help decrease pain symptoms.
Special Braces
Body, hip, and leg braces can help support the muscles and help with mobility.
Complications
Polymyositis left untreated can lead to severe complications. The muscles become weaker, increasing the risk of falling and limiting daily activities.
If the chest muscles are affected, there could be problems with breathing that can lead to respiratory failure.
If the digestive tract is affected, malnutrition and unintentional weight loss can result.
Polymyositis poorly managed well can cause severe disability.
Body Composition
Nutrition and Muscle Growth
Protein
Protein is the foundation for gaining muscle.
This essential component is for all of the body’s daily functions.
It is essential to balance protein increase with overall diet.
Carbs should be a daily element of nutritional intake because they are the primary component.
Acquiring energy
Preventing muscle weakness and degradation
Consuming Carbs
Understanding how accurate results only happen when both sides work together.
Healthy consumption of protein and carbohydrates can help muscle growth and sustain optimal health for all body types.
References
Corrado, Bruno et al. “Supervised Physical Therapy and Polymyositis/Dermatomyositis-A Systematic Review of the Literature.” Neurology international vol. 12,3 77-88. 24 Nov. 2020, doi:10.3390/neurolint12030015
Findlay, Andrew R et al. “An overview of polymyositis and dermatomyositis.” Muscle & nerve vol. 51,5 (2015): 638-56. doi:10.1002/mus.24566
Sasaki, Hirokazu, and Hitoshi Kohsaka. “Current diagnosis and treatment of polymyositis and dermatomyositis.” Modern rheumatology vol. 28,6 (2018): 913-921. doi:10.1080/14397595.2018.1467257
Van Thillo, Anna et al. “Physical therapy in adult inflammatory myopathy patients: a systematic review.” Clinical rheumatology vol. 38,8 (2019): 2039-2051. doi:10.1007/s10067-019-04571-9
Calf pain is common in individuals that are on their feet for long periods. This could be standing, walking, as part of a job or jogging, and running. In most cases, calf soreness and/or pain result from repetitive/overuse strain/injury/tear of the calf muscles. Pain along with stiffness presents with physical activity, exercise, movement. Chiropractic treatment and Active Release can help alleviate and eliminate calf pain.
Calf Muscles
The calf muscle is in the back of the lower leg, behind the shin bone, and consists of three muscles. The calf muscle supports the body when standing and enables movement of the foot and lower leg. The calf muscles support the body when:
Walking
Running
Jumping
Standing on the toes.
Flexing the foot – lifting the toes toward the knee.
It helps push the body forward and allows jumping, ankle rotation, and flexing of the foot.
Causes, Conditions, and Disorders
The overuse of the calf muscles usually causes calf soreness, discomfort, and pain. Over time, tiny tears develop in the muscles of the lower legs and calves. Repeated use can lead to more severe injury or condition without proper treatment. Conditions include:
Strain
The most common injury is a strain. Strains happen when the muscle fibers are overused and get stretched too far and/or tear. However, the fibers may not tear in that instance, and so the tear could occur at a later time while doing a basic movement like slightly bending or kneeling to tie a shoe. This is when individuals wonder how a tear happened with a simple action. But the tear was already present, just not fully torn.
Cramps
Muscle cramps and muscle spasms in the calves can be excruciating limiting mobility. Calf cramps can happen during the day or at night. They can result from several factors that include:
Healthcare providers call this strain tennis leg because it happens when the leg extends and the foot flexes. Tennis players are in this position when they serve and push themselves off into motion; however, it can happen in any sport, job, chore that involves the same movement. This type of muscle strain injury affects the gastrocnemius muscle.
Compartment syndrome
Compartment syndrome happens when pressure builds up inside a muscle. The pressure significantly reduces the flow of blood and oxygen. It can result from trauma like a fracture or strenuous exercise/activity.
Symptoms
Calf muscle issues can cause calf muscle:
Pain
Tightness
Stiffness
Pain may be sharp or dull
Pain can start as mild pain and progressively worsen.
Limited mobility
Limited range of motion
Muscle weakness
A bump, bulge, or lump in the back of the lower leg.
Tenderness
Bruising
General leg cramps are common and are more likely to happen as the body ages.
Healthcare professionals estimate around 75% of individuals over 50 have had leg cramps and pain.
Calf Health
To prevent and avoid problems with the calf muscles, individuals are recommended to:
Maintain a healthy diet and weight
Individuals that are overweight are more likely to pull or strain a muscle.
Excess pounds add pressure on the legs placing individuals at a higher risk of an injury.
If obese or overweight, talk to a healthcare professional about healthy weight.
Stay hydrated
Drink the proper amount of water and other fluids
This decreases the chance of causing a cramp.
Stretch and warm-up
Warmed-up calf muscles are less likely to stretch too far or tear.
Before engaging in physical activity at work or school, do a few warm-up stretches to increase flexibility.
When exercising, gradually increase the intensity.
Talk to a doctor about taking another medication that does not cause these side effects.
Body Composition
Nutrients of Protein
Protein is necessary for all of the body’s physiological functions. Protein and amino acids are the building blocks of the muscle tissue in the body. The body’s muscles are a house, protein is the bricks, and the amino acids that form protein are the building blocks of muscle. The body manufactures various amino acids, but nine are essential amino acids – EAA because they are not made in the body. Individuals have to consume EAAs from food sources like:
Meat
Beans
Nuts
Soy
A diet that consists of mixed amino acids can help maximize muscle protein synthesis. Protein is essential in building muscle because amino acids help repair and maintain muscle tissue. After a strenuous activity or a workout, protein helps the body repair muscles that are slightly torn. To build a healthy body, the body needs to have the right amount of protein. Protein is an essential component of:
The hands are a magnificent piece of work. Its intricate design and functional form follow the hand. However, any injury to the underlying structures of the hand can overlap with other injuries/conditions. Even the smallest hand injuries require a proper medical examination. The objective is a quick and accurate initial evaluation along with treatment. Early treatment is done quickly to minimize short and long-term effects.
Anatomy
The hand consists of 27 bones that include 8 bones in the wrist. If the associated structures:
Nerves
Arteries
Veins
Muscles
Tendons
Ligaments
Joint cartilage
Fingernails
Get injured or damaged in some way; there is increased potential for various injuries.
Causes
The most common cause of injury/s is blunt trauma, followed by injury from a sharp object. Hand injuries are divided into categories:
Symptoms vary depending on the type of injury, how the injury occurred/mechanism, the depth, severity, and location. Common symptoms:
Lacerations
Tenderness
Pain
Bleeding
Numbness
Decreased range of motion
Difficulty moving
Weakness
Pale appearance
Fractures and Dislocations
Swelling
Discoloration
Tenderness
Deformity
Reduced range of motion
Numbness
Weakness
Bleeding
Soft Tissue Injuries and Amputations
Swelling
Discoloration
Tenderness
Deformity with or without tissue loss/bone loss
Bleeding
Weakness
Numbness
Infection
Tenderness
Swelling
Warmth/Heat around the area
Redness
Deformity
Reduced range of motion
Fever is rare in hand infections
Burns
Redness
Tenderness
Blistering
Complete numbness
Discoloration
Loss of tissue
The texture of the skin change
Areas of tissue blackened
Deformity
High-pressure Injection Injury
Pain
Swelling
Bleeding
Skin discoloration
Muscle, tendon, ligament tears
Cracked/Broken bones
Medical Care
Anyone with a hand injury is recommended to call a doctor or seek medical attention. When medical attention is delayed, the possibility of worsening or creating further injuries increases. Even the smallest cut or what looks like a minor injury could require advanced treatment to prevent infection or loss of function. Any cut or laceration that requires stitches to repair should also have a medical evaluation to make sure the musculoskeletal system of the hands is functioning properly. Injuries causing the following symptoms require emergency medical attention at an emergency clinic.
Severe bleeding
Severe pain
Numbness
Loss of motion
Loss of strength
Deformity
Signs of infection – tenderness, warmth/heat, redness, swelling, pus, or fever
Exposure of structures – tendons, bones, joints, arteries, veins, or nerves
Diagnosis
A medical examination can include a medical history and physical examination.
Medical History
Past medical history
Does the patient have diabetes or arthritis?
Is the patient right or left-handed?
Occupation
Extracurricular activities and hobbies
How does the patient use their hands?
How did the injury occur, mechanism of injury?
Does the patient smoke?
Physical Exam
Visual inspection look at the injury
Sensory nerve exam feeling
Vascular exam circulation of blood supply
Muscular and tendon exam movement and strength
Bone exam broken bones or dislocated joints
Tests
A doctor will order X-rays after the history and physical exam if necessary. Certain injuries will require imaging to identify fractures/dislocations or to rule out foreign bodies. Many types of injuries can lead to compartment syndrome. Compartment syndrome is a condition in which there is swelling and an increase in pressure within a limited space or a compartment that presses on and compromises blood vessels, nerves, and/or tendons that run through that particular area. Once the immediate injury is addressed, a personalized treatment plan can be developed .to rehabilitate the hand/s to optimal function quickly
Body Composition
Artificial Sweeteners And Muscle Gain
Artificial sweeteners don’t individuals that are trying to build lean body mass. The body needs carbs after a workout for replenishing the depleted glycogen stores. Many commercially prepared protein supplements are made with artificial sweeteners that don’t provide an adequate source of carbohydrates. If an individual consumes only protein made with sugar substitutes after a workout, they are missing essential components of post-workout recovery. A study found that supplementing with carbohydrates before and during strength training can increase performance, compared to participants that were taking the artificial sweeteners saccharin and aspartame. To properly refuel after a workout, remove the artificially sweetened protein powders and replace them with a snack packed with protein and high-quality carbohydrates. These include:
Greek yogurt
Fruit with nuts or nut butter
Hummus with whole-grain crackers
Tuna
Hard-boiled eggs
References
Banting, Joshua, and Tony Meriano. “Hand Injuries.” Journal of special operations medicine: a peer-reviewed journal for SOF medical professionals vol. 17,4 (2017): 93-96.
Fuhrer, Reto et al. “Tipps und Tricks in der Behandlung offener Handverletzungen in der Notfallpraxis” [Treatment of acute injuries of the hand]. Therapeutische Umschau. Revue therapeutique vol. 77,5 (2020): 199-206. doi:10.1024/0040-5930/a001177
Harrison, BP, and M W Hilliard. “Emergency department evaluation and treatment of hand injuries.” Emergency medicine clinics of North America vol. 17,4 (1999): 793-822, v. doi:10.1016/s0733-8627(05)70098-5
MedscapeReference.com. High-Pressure Hand Injury.
MedscapeReference.com. Soft Tissue Hand Injury Differential Diagnoses.
Siotos, C et al. “Hand injuries in low- and middle-income countries: a systematic review of existing literature and call for greater attention.” Public health vol. 162 (2018): 135-146. doi:10.1016/j.puhe.2018.05.016
The quadriceps muscle consists of four muscles in front of the thigh that connects to the knee right below the knee cap. These muscles straighten the knee for walking, running, and jumping. They also help bend the knee for squatting. They move the leg forward when running and fire/transmit electrical impulses when the foot hits the ground to absorb shock. When jumping, the muscles provide stability coming down as well as when standing on one leg.
Quadriceps Strain
Thigh strains are common in sports. Most players are sidelined because of this injury when compared to strains in the hamstrings or groin. Factors that can increase the risk of injury include:
Exhaustion
Muscle weakness
The strength of the quadriceps to the hamstrings is uneven, causing one set to get overused.
Consistent sprinting and/or kicking
Previous strain and/or injury
The quadriceps is made up of four muscles. One is the rectus femoris, which gets injured the most. It’s the only muscle that crosses two joints – the hip joint and the knee joint.
Symptoms and Injury Grades
Individuals commonly report a pulling/stretching sensation in the front of the thigh. Common symptoms include:
Pain
Swelling
Bruising
Muscle tenderness
For minor quadriceps strains or tears, moderate to dull pain presents along with stiff movement.
Grades categorize the severity of the strain:
Grade 1 presents with mild discomfort in the thigh with no loss of strength.
Grade 2 presents with moderate pain, swelling, and some loss of strength.
Grade 3 is a complete rupture of the fibers. Individuals are in severe pain and unable to walk.
Grade 3 is where surgery is required.
Symptoms can vary depending on the type of injury that has been sustained and the severity. There is pain and localized swelling for both strains and contusions. If a muscle rupture has happened, there could be a bump/lump within the muscle or a gap in the muscle. If rupture of the Quadriceps Tendon has occurred, individuals often report hearing a pop when the injury happens. The swelling often makes straightening the leg difficult or impossible.
Injury causes
Thigh strains usually happen when slowing down/decelerating after a sprint. This can be because the individual takes too small or too large steps causing the muscles to overstretch, much like a rubber band that, if overstretched, tears, and if under stretched, it bunches up, which can cause spasms and tears.
Treatment
In the initial stages after a quadriceps strain, it is recommended to follow the RICE Procedure for 24 hours: This includes:
Rest
Ice
Compression
Elevate
The leg needs to be rested every 2-3 hours in 20-minute sessions.
A bandage can provide added support.
For slight tears and strains, it is recommended to stretch the quadriceps gently.
This helps prevent the muscles from experiencing shortening. This happens by the formation of scar tissue that pulls the muscle/s, making them shorter.
Gentle stretches allow the muscles to heal with minimal shortening. This helps prevent further and/or re-injury.
Chiropractic Physical Therapy Rehabilitation
After the acute stage of the injury, receiving regular chiropractic sports adjustments, physical therapy massage, coupled with strength training exercises will speed up recovery.
Physical therapy massage will remove scar tissue and keep the muscle/s loose and flexible.
Exercises for strengthening the muscles after injury will be recommended according to the individual’s condition/case.
Following correct post-injury-care, exercises, and physical therapy.
Healing time can be 4- 6 weeks.
Body Composition
Strength Training: The Inverted Row
This workout targets the back muscles, spine and scapular stabilizers, deep abdominals, and arms. Everyday activities that require various types of pulling motion, lifting, etc., become easier. To perform:
Lie flat on your back.
Grab a stable barbell or set of straps that are above you.
Pull your upper body up as high as possible while keeping the back straight.
Squeeze the shoulder blades together at the top.
Complete as many reps as possible.
Once enough strength and endurance have been built, try a pullup.
References
Kary, Joel M. “Diagnosis and management of quadriceps strains and contusions.” Current reviews in musculoskeletal medicine vol. 3,1-4 26-31. 30 Jul. 2010, doi:10.1007/s12178-010-9064-5
Hillermann, Bernd, et al. “A pilot study comparing the effects of spinal manipulative therapy with those of extra-spinal manipulative therapy on quadriceps muscle strength.” Journal of manipulative and physiological therapeutics vol. 29,2 (2006): 145-9. doi:10.1016/j.jmpt.2005.12.003
Wenban, Adrian B. “Influence of active release technique on quadriceps inhibition and strength: a pilot study.” Journal of manipulative and physiological therapeutics vol. 28,1 (2005): 73. doi:10.1016/j.jmpt.2004.12.015
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