Back Clinic Conditions Treated. Chronic Pain, Auto Accident Care, Back Pain, Low Back Pain, Back Injuries, Sciatica, Neck Pain, Work Injuries, Personal Injuries, Sports Injuries, Migraine Headaches, Scoliosis, Complex Herniated Discs, Fibromyalgia, Wellness & Nutrition, Stress Management, and Complex Injuries.
At El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we are focused on treating patients after debilitating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility, and agility programs tailored for all age groups and disabilities.
If Dr. Alex Jimenez feels you need other treatment, then you will be referred to a clinic or Physician that is best suited for you. Dr. Jimenez has teamed with the top surgeons, clinical specialists, medical researchers, and premiere rehabilitation providers to bring El Paso the top clinical treatments to our community. Providing the top non-invasive protocols is our priority. Clinical insight is what our patients demand in order to give them the appropriate care required. For answers to any questions you may have please call Dr. Jimenez at 915-850-0900
As the weather gets colder, individuals may feel like their muscles and joints are frequently stiff and experience more aches and pains. This is even more evident for individuals that work outside in the winter or with specific ailments/conditions. Colder weather can increase the risk of suffering musculoskeletal injuries and intensify the condition.
How Colder Weather Impacts The Muscles
Individuals with arthritic conditions might find that symptoms become exacerbated. This can keep individuals away from regular activities. Conditions like rheumatoid arthritis and osteoarthritis tend not to react well to weather sudden atmospheric changes, worsening symptoms. However, individuals are well aware of how their body feels and moves when colder weather is present with or without existing conditions. Movement slows down, and when trying to move, the muscles can contract involuntarily, causing tension and stiffness. This usually results in soreness and pain. Feeling warm, safe, and comfortable is essential for the body’s overall health. Overuse and overexertion can increase the risk of injury in colder temperatures.
Barometric Pressure
When the weather gets colder, barometric pressure drops. The Body’s tissues like the muscles, tendons, and ligaments expand. This places pressure on nerves near the joints, causing discomfort and pain.
In cold weather, the fluid density in the joints lessens, causing the bones to rub against each other harder because the fluid is not thick enough to allow for proper lubrication.
The cold makes the muscles shiver, contract, and tighten. This can compress the nerves in the joints and increase pain symptoms.
Prevent Stiffness and Musculoskeletal-Related Injuries
Maintain an active lifestyle
It is recommended to engage in physical activity to exercise the muscles and joints.
A chiropractor can also help manage musculoskeletal condition-related pain during the winter months and help prevent musculoskeletal conditions for individuals that work outdoors.
Heil, Kieran et al. “Freezing and non-freezing cold-weather injuries: a systematic review.” British medical bulletin vol. 117,1 (2016): 79-93. doi:10.1093/bmb/ldw001
Kowtoniuk, Robert A et al. “Cutaneous Cold Weather Injuries in the US Military.” Cutis vol. 108,4 (2021): 181-184. doi:10.12788/cutis.0363
Long, William B 3rd et al. “Cold injuries.” Journal of long-term effects of medical implants vol. 15,1 (2005): 67-78. doi:10.1615/jlongtermeffmedimplants.v15.i1.80
Leg spasms and cramps are common conditions where the muscles in the leg suddenly become tight and painful. They present with no warning and can cause excruciating and debilitating pain. They usually occur in the calf muscles but can affect any area of the leg, including the feet and thighs. After the cramping has passed, pain and tenderness can remain in the leg for several hours. Although many leg spasm episodes go away by themselves, they can disrupt normal activities, exercise regimens, and sleep if they continue and are left untreated.
Leg Spasms and Symptoms
A leg spasm is a sudden, sharp contraction or tightening of a muscle in the leg. This can last a few seconds to a few minutes. Muscle cramps anywhere in the body cause sudden contraction of the muscle. This is an involuntary function and can include the following symptoms:
Soreness and discomfort can be mild to extreme.
Muscle tightening.
Hardening of the muscle.
Twitching of the muscle.
Pain.
Leg spasms are typically brief and go away on their own, but individuals are recommended to seek treatment if they are frequently experienced or last for extended periods.
Causes
Dehydration
Dehydration is a common cause of leg spasms and pain.
Lack of fluids can cause the nerve endings to become sensitized, triggering muscle contractions.
When the body sweats, it loses water and electrolytes.
When the body is low on electrolytes
Imbalances in:
Sodium
Calcium
Magnesium
Potassium
It can affect nerve transduction and lead to muscle spasms.
Hypothyroidism
If the body does not produce sufficient thyroid hormone, this is known as hypothyroidism.
Over time, this deficiency can damage the nerves that send signals from the brain and spine to the legs.
Tingling, numbness, and frequent cramping can result.
Spinal Misalignment
Spinal misalignment can compress nerve roots that run down the leg.
This can cause radiating leg pain and spasms, specifically in the back of the thigh.
Muscle and Connective Tissue Injuries
Injuries like tears, strains, and sprains can lead to leg spasms and frequent cramping.
Pregnancy
In the second and third trimesters of pregnancy, calcium and magnesium deficiency are common and can lead to leg spasms and cramps.
Treatment
The proper course of treatment for leg spasms depends on the severity and underlying cause/s. A chiropractor can identify the cause and develop a personalized treatment plan to relieve and eliminate leg cramps.
Chiropractic
Misalignments can compress the nerve roots radiating from the spine to the legs.
This can lead to radiating leg pain and/or leg spasms.
Realignment through chiropractic can relieve the pressure on compressed nerve roots, alleviating leg discomfort and pain.
A chiropractor will also recommend exercises and stretches to strengthen the legs and core muscles.
Physical Therapeutic Massage
A physical therapist will use various massage techniques to relax the leg muscles to prevent and reduce the severity of spasms.
Massage therapy will relieve any inflammation that accompanies leg spasms, decreasing pain and swelling in the area.
As a part of the treatment plan, a health coach will evaluate the individual’s diet and suggest changes that will help address any nutritional deficiencies contributing to leg spasms and cramps.
Body Composition
Track Inflammation and Fluid Imbalances From Injury or Surgery
Inflammation can occur with little to no visible symptoms following surgery or injury. Precision measurement of body water can detect water retention and inflammation to aid rehabilitation treatment. InBody effectively distinguishes water in the following compartments that comprise total body water.
Intracellular-ICW-within the tissues.
Extracellular-ECW-within the blood and interstitial fluids.
The Edema Index can be used to detect fluid imbalances resulting from inflammation from injury or recovery after surgery.
Assessing fluid balance in the body and specific segments can help identify inflammation and guide treatment to reduce the risk of re-injury or post-surgery complications. These measurements are provided for the whole body and can determine where fluid imbalances may be occurring for more precise analysis.
References
Araújo, Carla Adriane Leal de et al. “Oral magnesium supplementation for leg cramps in pregnancy. An observational controlled trial.” PloS one vol. 15,1 e0227497. 10 Jan. 2020, doi:10.1371/journal.pone.0227497
Garrison, Scott R et al. “Magnesium for skeletal muscle cramps.” The Cochrane database of systematic reviews vol. 2012,9 CD009402. 12 Sep. 2012, doi:10.1002/14651858.CD009402.pub2
Kang, Seok Hui et al. “Clinical Significance of the Edema Index in Incident Peritoneal Dialysis Patients.” PloS one vol. 11,1 e0147070. 19 Jan. 2016, doi:10.1371/journal.pone.0147070
Luo, Li et al. “Interventions for leg cramps in pregnancy.” The Cochrane database of systematic reviews vol. 12,12 CD010655. 4 Dec. 2020, doi:10.1002/14651858.CD010655.pub3
Mekhail, Nagy et al. “Long-term safety and efficacy of closed-loop spinal cord stimulation to treat chronic back and leg pain (Evoke): a double-blind, randomized, controlled trial.” The Lancet. Neurology vol. 19,2 (2020): 123-134. doi:10.1016/S1474-4422(19)30414-4
A Trendelenburg gait is an abnormal walking gait resulting from a defective or weakened hip abductor.The gluteal musculature is the primary musculature that includes the gluteus medius and gluteus minimus muscles. Weakness in these muscles causes sagging/dropping of the pelvis on the opposite side while walking. There will be a noticeable side-to-side motion if the glutes are too weak to support the body’s weight when walking. It can look as though the individual is limping or missing a step. Individuals can minimize the effects with foot orthotics, core strengthening, chiropractic, and physical therapy.
Trendelenburg Gait Causes
This gait often results from straining the hip abductor muscles during physical activity. Exercises specifically for the glutes done improperly are a common cause. When improper exercise form is the cause, the abnormal gait usually goes away as muscle inflammation fades. The gait can also present after total hip replacement surgery, as the procedure requires incisions in the gluteus medius muscle. This can weaken the muscle causing an abnormal gait. Weakness in these muscles can also be caused by:
Nerve damage or dysfunction in the nerves that run through the gluteal minimus and medius muscles.
Osteoarthritis is a type of arthritis that occurs when joint cartilage starts to wear down.
Muscular dystrophy is a condition that causes the muscles and bones to become weak over time.
Poliomyelitisis a condition associated with polio that weakens the muscles.
Cleidocranial dysostosis is a condition present from birth that can cause your bones to develop improperly.
Symptoms
The walking gait is made up of two phases:
Swing – When one leg moves forward.
Stance – The other leg stays still and maintains balance.
The main symptom of Trendelenburg gait can be seen when one leg swings forward and the hip drops down and move outward. This is because the hip abductor of the other leg is too weak to support the weight. Individuals may lean back or to the side slightly when walking to maintain balance, or they may lift the foot higher off the ground with each step to avoid losing balance or tripping as the pelvis shifts unevenly.
Diagnosis
Abnormal hip movement during a swing of one or both legs can give a doctor enough evidence to diagnose a Trendelenburg gait. A doctor will observe the individual’s walk in front and behind to get a detailed view. A doctor will also use the Trendelenburg test to diagnose the condition. The doctor will instruct the individual to lift one leg for 30 seconds. If the individual cannot keep the hips parallel with the ground while lifting, it could indicate Trendelenburg gait. X-rays of the hip will be used to identify any causes of weakness in the gluteus minimus or medius.
Treatment Options
Treatment options will depend on the severity and cause of the gait.
Medication
If the gait is causing pain, over-the-counter nonsteroidal anti-inflammatory NSAIDs, like ibuprofen or acetaminophen, will help ease symptoms.
In severe cases, a doctor may prescribe cortisone injections to help reduce pain.
Foot Orthotics
A doctor could also recommend using a foot orthotic in one or both shoes to compensate the hip abductor muscle weakness.
Chiropractic, Physical Therapy, and Exercise
Chiropractic and physical therapy can help adjust, realign, and strengthen the muscles to regain control of the Trendelenburg gait. The chiropractor or physical therapist will move the legs in various directions to help the joints become more accustomed to moving in certain directions and increase muscle strength and resistance. Exercises that can strengthen the hip abductor muscles include:
Lie on the side and extend the leg straight out.
Lie on the floor and move one leg up, over the other, and back in the opposite direction.
Step sideways and onto an elevated surface, then back down again.
Talk with a doctor or chiropractor before beginning any new exercise routine so they can recommend specific exercises and educate on proper form.
Complications
If left untreated, moderate-to-severe cases of Trendelenburg gait can become debilitating, leading to severe complications. These include:
Pinched nerves.
Sciatica.
Pain, stiffness, or grinding in the hips.
Loss of range of motion in the hips and gait.
Losing the ability to walk, which could require the use of a walker or wheelchair.
Trendelenburg gait is treatable with special shoes, orthotics, and exercises designed to strengthen the hip abductor muscles. Chiropractic and physical therapy can help limit the condition’s impact on the body’s health, the ability to walk, and reduce the risk of complications.
Body Composition
Heart-Healthy Foods
Citrus
The bright and tangy fruits are packed with vitamins and unique plant compounds known as polyphenols that can help lower blood pressure naturally.
However, it’s important to note that grapefruit and grapefruit juice could interact with certain prescription medications.
Beans and Lentils
Foods high in magnesium, potassium, and fiber can help maintain healthy blood pressure.
This is where beans and legumes come in, as they are high in fiber, potassium, and magnesium.
Individuals that swapped beans and lentils noticed a lower blood pressure, whether or not they had been diagnosed with hypertension.
Pumpkin Seeds
These seeds are packed with potassium, magnesium, and arginine.
Arginine is an amino acid used to make nitric oxide, which helps the blood vessels relax and dilate, allowing lower blood pressure.
A study found that postmenopausal women who took 3 grams of pumpkin seed oil daily for six weeks saw a significant decrease in their systolic blood pressure.
Garlic
Garlic contains nitric oxide, which has been shown to relax blood vessels.
Kyolic garlic, in particular, has been shown to help with arterial stiffness and can improve cholesterol levels.
References
Feyh, Andrew et al. “Role of Dietary Components in Modulating Hypertension.” Journal of Clinical & experimental cardiology vol. 7,4 (2016): 433. doi:10.4172/2155-9880.1000433
Gandbhir, Viraj N., et al. “Trendelenburg Gait.” StatPearls, StatPearls Publishing, 19 August 2021.
Giangarra CE, et al. (2018). Clinical orthopedic rehabilitation: A team approach.sciencedirect.com/science/book/9780323393706
Gilliss AC, et al. (2010). Use of osteopathic manipulative treatment to manage compensated Trendelenburg gait caused by sacroiliac somatic dysfunction.
jaoa.org/article.aspx?articleid=2093879
Maricelli JW, et al. (2016). Trendelenburg-like gait, instability and altered step patterns in a mouse model for limb-girdle muscular dystrophy 2i. DOI:
10.1371/journal.pone.0161984
Mayo Clinic Staff. (2017). Osteoarthritis.mayoclinic.org/diseases-conditions/osteoarthritis/home/ovc-20198248
Michalopolous N, et al. (2016). A personalized monitoring and recommendation framework for kinetic dysfunctions: The Trendelenburg gait. DOI: 10.1145/3003733.3003786
The shoulder is a ball-and-socket joint. The shoulder has several muscles that help it move and allow a wide range of motion. A strain or pulled shoulder muscle can affect the slightest movements, making simple activities difficult and painful. Pulling a muscle in the shoulder can be caused by an injury, overuse, and general wear and tear. Minor shoulder injuries usually heal on their own with rest and self-care. Severe shoulder muscle injuries should be addressed by a medical professional.
Pulled Shoulder Muscle Causes
Pulling a muscle in the shoulder can happen quickly. This could be from falling on the shoulder, an auto accident, or a work accident. It can develop after weeks, months, and years of repetitive motion and overuse. It is common among individuals that play certain sports or jobs that require repetitive activities with the shoulders. They can also happen with no apparent cause. Treatment and recovery depend on the type and severity of the injury.
How to Tell If It’s a Pulled Muscle
It can be hard to tell the cause unless the individual has experienced the specific type of pain before. Otherwise, it is recommended to consult a medical professional like a physical therapist or chiropractor. This is because shoulder pain can be caused by inflammation of the tendons and joints and/or the joint itself.
Pulled Muscle Shoulder Symptoms
A pulled muscle is characterized by:
Tenderness
Dull, sore, or aching pain.
Sometimes it can cause shooting pain between the shoulder blades in the front or back.
Pain when the shoulder is at rest.
Pain when the specific muscle is used.
Swelling of the area.
Shoulder instability.
The shoulder feels fragile.
Movement causes pain.
A bump may develop at the top of the shoulder near the end of the collarbone.
Inability to use the muscle at all.
If the pain is persistent, it could signify that there is something other than a pulled muscle like a pinched nerve or a joint issue.
Treatment and Recovery Options
Treatment and recovery vary and depend on the severity of the pull and the individual’s overall health. Many find that their pain is reduced with self-care in 2 or 3 weeks. Chiropractic treatment for a pulled shoulder muscle can provide relief within 1 or 2 weeks.
Self Care
Depending on the severity of the pull and how much pain is being experienced, individuals could be recommended to take an NSAID like Ibuprofen to reduce pain and swelling. Self-care can include:
Ice To Reduce Swelling
Applying ice or a cold pack to the area can help reduce swelling.
Place a cloth or towel between the skin and the cold pack.
Apply it for 20 minutes an hour.
The swelling should reduce in a day or two.
Rest
It is recommended to rest the shoulder for no more than 2 or 3 days.
This begins the healing process and prevents worsening the injury.
Wrap or Sling
During rest days, it can be hard to keep the shoulder from moving.
To avoid this, use a shoulder wrap or a sling to support the arm.
However, they should not be used for more than 2 or 3 days.
Gentle Stretching
It is essential to get the muscle working again after 2 or 3 days of rest.
Stretches will help the muscle group heal and gain strength.
Not stretching the muscle could prolong recovery and worsen the injury, and possibly cause new injuries.
Stretches For a Pulled Shoulder
Stretching a pulled shoulder muscle after a few days of rest is recommended because not working out the injured muscle can cause more problems. Not using the muscle can cause it to atrophy, which will take longer to heal, and the surrounding muscles become weak.
Pendulum Stretch
Slightly bent support the body by placing the unaffected arm on a table or chair.
Let the injured arm hang straight down.
Swing the arm in small circles clockwise as far as the pain or discomfort allows.
Perform for 1 minute.
Go counterclockwise for one minute.
Repeat 4 to 8 times throughout the day.
Chiropractic
If self-care is not providing sufficient relief, then chiropractic treatment is recommended. A doctor of chiropractic can advise on the best treatment options and get to the root of the issue. Chiropractors have a treatment arsenal of modalities and approaches to help treat pulled muscles. These include:
A somatotype is the overall shape and composition of the human body. Body types based on physique have three generalized divisions:
Endomorph
Mesomorph
Ectomorph
However, it is rare for someone to fall entirely into one somatotype. Individuals can have a combination of qualities from two somatotypes, like an ectomorph-endomorph hybrid or an endomorph-ectomorph, for example.
Ectomorphs
Naturally lean with long limbs, ectomorphs typically possess a slender look no matter what type of diet.
A lot of endurance runners and swimmers are ectomorphs.
Ectomorphs may have a decent amount of muscle but may appear to have less muscle development because of their long limb length.
Body fat also seems to get hidden by the long, slender figure, which means they can get away with a few extra pounds of fat.
However, if ectomorphs do not watch their health, they can become skinny fat.
Mesomorphs
Mesomorphs have a natural athletic look.
They can achieve a muscular physique without really trying.
The physiology tends to include:
Narrow hips
Wide back
A large frame contributes to a muscular appearance.
Many professional fighters, football, and basketball players are mesomorphs.
Endomorphs
Endomorphs have a larger structure with wide hips and shoulders.
Shorter arms and legs.
This type of body shape is excellent for activities that require a lot of strength.
Rugby players, strength athletes, and powerlifters are endomorphs.
This body type is considered to be a contributing performance factor in Ironman athletes.
References
Blache, Y et al. “Superficial shoulder muscle co-activations during lifting tasks: Influence of lifting height, weight, and phase.” Journal of electromyography and kinesiology: official journal of the International Society of Electrophysiological Kinesiology vol. 25,2 (2015): 355-62. doi:10.1016/j.jelekin.2014.11.004
Brantingham, James W et al. “Manipulative therapy for shoulder pain and disorders: expansion of a systematic review.” Journal of manipulative and physiological therapeutics vol. 34,5 (2011): 314-46. doi:10.1016/j.jmpt.2011.04.002
Kandel, Michel et al. “Somatotype, training and performance in Ironman athletes.” European journal of sports science vol. 14,4 (2014): 301-8. doi:10.1080/17461391.2013.813971
McFarland, Daniel C et al. “Spatial dependency of shoulder muscle demand during dynamic unimanual and bimanual pushing and pulling.” Applied ergonomics vol. 73 (2018): 199-205. doi:10.1016/j.apergo.2018.07.011
Compartment syndrome is a condition that causes pressure within a group of muscles to build up to dangerous levels. This pressure build-up begins to decrease blood flow, not allowing proper circulation, nutrients, and oxygen from getting to the nerves and muscle cells. The syndrome can be acute or chronic, and surgery can be required. Acute compartment syndrome is considered a medical emergency, usually caused by a severe injury and requires immediate treatment; otherwise, it can lead to permanent muscle damage. Chronic compartment syndrome or exertional compartment syndrome is usually not a medical emergency and is often caused by physical exertion.
The fascia does not stretch or expand because its job is to keep the tissues in place. If compartmental pressure builds up, swelling and bleeding may occur. When the tissues don’t have enough blood to provide the proper amount of oxygen and nutrients, the tissues begin to die, leading to permanent damage. Because the fascia does not stretch if there is swelling or bleeding within a compartment, this increases pressure on the:
Capillaries
Nerves
Muscles in that compartment.
Blood circulation does not reach the compartment to supply oxygen and nutrients.
Nerve and muscle cells get damaged.
Compartment syndrome most often takes place in the lower leg’s anterior/front calf compartment.
However, it can also develop in other areas like the:
Legs
Arms
Hands
Feet
Buttocks
Acute
The typical symptom is pain, specifically when the muscle in the compartment is stretched.
The pain is more intense than the injury itself.
Flexing, contracting, or stretching the muscles increases the pain.
Tingling or burning sensations may present.
Muscle tightness or fullness sensation like bloating.
Numbness or paralysis are late symptoms that usually indicate severe to permanent tissue injury.
The acute syndrome develops after a severe injury, like an automobile accident or from a broken bone. Injuries and conditions that can cause acute compartment syndrome include:
Fractures
Muscle contusion/bruise that goes beyond just a bump. Two examples include a motorcycle falling on the rider’s leg or a football player getting hit in the leg intensely.
Constricting bandages – Casts and bandages that are too tight can cause the blockage of blood. If symptoms develop, remove or loosen any constricting bandages. If it is from a cast, contact the doctor immediately.
Anabolic steroids – Taking steroids is a possible factor in compartment syndrome.
Blood circulation restoration after a blockage.
When sleeping, a blood vessel can get blocked. Lying for a long time in a position that causes a limb to go to sleep, then shifting, moving, or getting up can contribute to the condition. This type of development can happen in individuals with neurological damage or who do not realize what is occurring. This can happen after intense intoxication with alcohol and/or drugs.
Surgical repair of a damaged blood vessel that was blocked can result in compartment swelling.
Permanent disability and tissue death can result unless the pressure is relieved.
Chronic Physical Exertion
The pain and swelling from the chronic condition are caused by vigorous physical activity/exercise. It most often occurs in the leg. Individuals that participate in activities with repetitive motions have an increased risk. Physical activities/sports include:
Running
Biking
Swimming
This is usually not dangerous and is often relieved by discontinuing the specific exercise/s or physical activity for a while. Symptoms include:
Pain during exercise.
Cramping during exercise.
Numbness
Moving the foot is difficult.
Muscle bulge can be seen.
Chiropractic Treatment
Leg pain should not be ignored for long as the problems could escalate into severe/dangerous territory. Chiropractic treatment is highly effective in the detection and treatment of leg pain. Chiropractors are experts in the neuromusculoskeletal system. Their expertise in promoting physical function applies to the whole body’s systems, including the:
Muscles
Bones
Ligaments
Nerves
Tendons
They are trained to diagnose and treat developing and chronic musculoskeletal problems and know when to seek specialized medical care when necessary.
Body Composition
Can’t Individuals Just Exercise More and Eat Whatever They Want?
No individuals cannot just exercise/move more and eat whatever they want if they are serious about losing excess weight. A healthy diet and exercise are essential parts of the formula for effective weight loss. One study shows that being aware of diet in quality and quantity overtakes just exercising when achieving and maintaining healthy body composition changes as a vital part of maintaining a healthy lifestyle. Evaluating the effects of diet, exercise, or a combination of both revealed that long-term success was most significant in the mix of diet and exercise. Individuals can exercise vigorously, but losing weight can be very difficult if they have unhealthy eating habits or cannot stick to a healthy diet. The individual can develop other health problems from an unhealthy diet.
References
Braver, Richard T. “Chronic Exertional Compartment Syndrome.” Clinics in podiatric medicine and surgery vol. 33,2 (2016): 219-33. doi:10.1016/j.cpm.2015.12.002
Joubert, Sonia V, and Manuel A Duarte. “Chronic Exertional Compartment Syndrome in a Healthy Young Man.” Journal of chiropractic medicine vol. 15,2 (2016): 139-44. doi:10.1016/j.jcm.2016.04.007
Schmidt, Andrew H. “Acute compartment syndrome.” Injury vol. 48 Suppl 1 (2017): S22-S25. doi:10.1016/j.injury.2017.04.024
Vajapey, Sravya, and Timothy L Miller. “Evaluation, diagnosis, and treatment of chronic exertional compartment syndrome: a review of current literature.” The Physician and sportsmedicine vol. 45,4 (2017): 391-398. doi:10.1080/00913847.2017.1384289
The Gluteus Maximus Muscle is the largest and the outermost of the gluteal muscles. It stretches from the sacrum and coccyx, parts of the spinal column, down to the femur. The other gluteal muscles include the gluteus minimus and medius. They each have a role in the normal function of the hips and legs. They are prone to tightness resulting in soreness, aches, and pain around the hips and in and around the buttocks.
The Gluteal/Rear End Muscles
There are three rear-end muscles:
The Gluteus Maximus extends the hip and rotates the thigh outwards, straightens the legs when moving, and provides strength.
Gluteus Minimus
Gluteus Medius
The minimus and medius are underneath the Maximus and stabilize the hip when:
Walking
Jumping
Other physical activities
There is another group of diagonal muscles under the gluteus minimus that attaches to the femur. The uppermost is the piriformis that is attached to the sacrum. The sciatic nerve and major arteries run below it.
Tightness and Irritation
The primary function of the muscles is to open the hips and push the legs out. Sitting for long periods shortens the gluteal muscles causing them to become tight, limiting normal hip function. The gluteal muscles are susceptible to tightness brought on from overuse and lack of development/strength. This can develop into tender/tight muscle bands that interfere with the normal function of the muscles. To get an example of what is happening imagine flexing and contracting one of the bicep muscles 6-10 hours a day. It would be extremely sore, tight, and tender.
Sports and Physically Active
Athletes and individuals that are physically active can also have tight gluteal muscles. This can cause post-game/exercise muscle soreness. Intense activities force the gluteal muscles to work overtime to support the back and knees. Sports that require a lot of leg muscle activation include:
Running
Soccer
Football
Crossfit
Dancing
Weight training
Awkward Walking Gait
Individuals that move with an unusual gait are vulnerable to straining the muscles. What happens is the muscles become stiff from the awkward positions/postures. This places additional strain on the back and hip muscles and worsens their overall posture. The hip muscles are also attached to the pelvis, and when the muscles begin to tighten they can pull on the gluteal muscles. Irritation of the sacroiliac joint can also place pressure on the piriformis, causing spasms that affect the gluteal muscles. Piriformis muscle spasms can also place pressure on the sciatic nerve, causing sciatica.
Diagnosis and Treatment
An examination will be necessary to diagnose whether the soreness or pain is due to muscle inflammation or other cause. Sciatica symptoms and problems at the hip level that involves the gluteus minimus and medius can be felt in the leg. The examination includes seeing and feeling muscle reactions, responses, contractions through a series of motion exercises and movements that involve different muscles. Common treatment includes:
Range of motion exercises
Strengthening exercises like bridging and resistance bands
Deep tissue massages
Heat and cold packs
Physical therapy
Electric muscle stimulation
Tightness in the glutes can be managed with chiropractic treatment. This includes:
Soft tissue work
Spinal joint manipulation
Lifestyle adjustments
Stretching
Diet
Health coaching
Simple exercises can help engage and strengthen the muscles. These include:
Individuals that sit for long periods of time, don’t get enough physical activity, and have an unhealthy diet can experience insulin resistance. This happens when insulin is not able to transport excess blood sugar out of the blood and into the muscles. A study found that women who sat for eight hours a day had an increased chance of developing diabetes. Diabetics can be inclined to have more fat within the body, specifically visceral fat. This further encourages insulin resistance. Diabetics also experience rapid loss of muscle mass as they age, intensifying symptoms and further affecting body composition.
References
Cochrane, Darryl J et al. “Does short-term gluteal activation enhance muscle performance?.” Research in sports medicine (Print) vol. 25,2 (2017): 156-165. doi:10.1080/15438627.2017.1282358
Coratella, Giuseppe et al. “The Activation of Gluteal, Thigh, and Lower Back Muscles in Different Squat Variations Performed by Competitive Bodybuilders: Implications for Resistance Training.” International journal of environmental research and public health vol. 18,2 772. 18 Jan. 2021, doi:10.3390/ijerph18020772
Distefano, Lindsay J et al. “Gluteal muscle activation during common therapeutic exercises.” The Journal of orthopedic and sports physical therapy vol. 39,7 (2009): 532-40. doi:10.2519/jospt.2009.2796
Kalyani, Rita Rastogi et al. “Age-related and disease-related muscle loss: the effect of diabetes, obesity, and other diseases.” The lancet. Diabetes & endocrinology vol. 2,10 (2014): 819-29. doi:10.1016/S2213-8587(14)70034-8
Selkowitz, David M et al. “Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes.” The Journal of orthopedic and sports physical therapy vol. 43,2 (2013): 54-64. doi:10.2519/jospt.2013.4116
Vitamin B12 and Shoulder Injuries. Most shoulder injuries involve the muscles, ligaments, and tendons. Individuals that perform repetitive arm motions/movements, constantly lift objects as part of their job, and athletes that use their arms repetitively have an increase in developing/experiencing shoulder injuries and problems. Shoulder injuries are commonly caused by physical activities that involve:
Excessive motions
Repetitive motions
Overhead motions
Sports like swimming, tennis, pitching, and weightlifting involve these repetitive arm/shoulder motions that contribute to shoulder injuries.
Injuries can also be brought on from everyday activities like washing/painting walls, hanging curtains/plants, and gardening.
Shoulder Injury Symptoms
If there is discomfort and/or pain in and around the shoulder here are a few ways to analyze the situation.
Does the shoulder feel like it could pop out or slide out of its socket?
Is there a lack of strength in the shoulder for normal daily activities?
If yes was an answer to any of these questions, individuals should consult an orthopedic surgeon and/or chiropractor for assistance in determining the problem and its severity.
Injury Categories
Individuals often underestimate the extent of an injury and usually just push/play through the discomfort and pain. This is how powerful the brain is as it ignores steady pain, weakness, or limitation of joint motion. Shoulder injuries and problems are grouped in the following categories.
Instability
This is when a shoulder joint moves/shifts or is forced out of its normal position. This is called instability and can result in dislocation of the joints in the shoulder. Individuals will experience pain when raising their arms. It can feel as if the shoulder is slipping out.
Impingement
Impingement is caused by excessive rubbing/friction of the muscles against the top part of the shoulder blade, known as the acromion. Impingement can happen during physical activities that require excessive overhead arm motion. Medical examination and care are recommended for inflammation, as it could eventually lead to a more serious injury.
Injuries
Bursitis
The bursa is the fluid-filled sacs that cushions the joints. These can become swollen and irritated from repetitive motions, falls, or other injuries. Individuals will notice the pain most when moving/rotating the shoulder.
Cartilage tear
The cartilage – the rubbery padding that goes around the rim of the shoulder joint can get damaged from repetitive motions, overextending, falls, or from intense force to the shoulder. With this type of injury individuals feel pain when reaching overhead, weakness, and/or catching, locking, and grinding feelings.
Rotator cuff tear
The rotator cuff consists of a group of muscles and tendons that hold the arm in place and allow for lifting the arm up and overhead. It can get damaged through overuse, falls, and regular wear and tear with age. Pain often presents at night, when lifting objects, and there could be a cracking sound when trying to move or rotate.
Frozen shoulder
This condition limits the joint’s movement. What happens is abnormal bands of tissue called adhesions build up in the joint and restrict movement. The shoulder can freeze up from not using it. This could be because pain or surgery causes an individual to use it less. This is when adhesions begin to build up.
Separation
This injury affects the joint where the collarbone and shoulder blade join. It is known as the acromioclavicular or AC joint. A fall or hard impact can tear the ligaments that hold it together. If the collarbone gets pushed out of place a bump forms/develops on top of the shoulder.
Fracture
A bone can break or crack from a vehicle accident, fall, or takes a hard hit. The most common fractures are to the clavicle – collarbone and the humerus – arm bone closest to the shoulder. This type of injury causes a great deal of pain and bruising. If the collarbone is broken, the shoulder can sag with the inability to lift the arm.
Vitamin B12
Rotator cuff injuries involve dysfunctional and/or damaged connective tissue. This could be from impaired collagen synthesisVitamin B12 helps combat inflammation and plays a significant role in collagen formation. Low vitamin B12 status can be directly linked to pro-inflammatory cytokines. This means that a lack of vitamin B12 increases inflammation.
Researchers followed a group of individuals to determine if their individual vitamin B12 levels correlated with an increased risk of a rotator cuff tear. To begin the study, levels of vitamin B12 were measured along with other nutrients that included:
Vitamin D
Zinc
Calcium
Magnesium
Folate
Homocysteine and blood sugar biomarkers, which are both associated with B12 metabolism were also measured. Homocysteine is a metabolite that builds up in the blood when specific nutrients, like B12, folate, or B6 become deficient. Elevated levels of homocysteine can be harmful and cause damage to blood vessels and brain tissue when not detoxified properly. In the study, the homocysteine levels did not differ between the groups, but vitamin B12 levels were significantly different.
The patients that were included were a healthy group that did not have any rotator cuff injury during the study.
The second group all experienced a rotator cuff tear that required surgery during the study.
With the various nutrients measured, only vitamin B12 and vitamin D showed differences. With the B12 and D being lower in the group that had the shoulder injury.
Specifically, the B12 levels in the healthy group were 627 pg/mL compared to 528 pg/mL in the injured group. This was a 16% decrease.
These subclinical deficiencies are usually missed with traditional serum testing which is why functional nutritional testing is clinically recommended.
Body Compositional Testing
Disclaimer
The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.
Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico
References
American Society for Surgery of the Hand: Shoulder Pain.
American Academy of Family Physicians: Shoulder Pain.
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