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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
Individuals that engage in heavy exercise can develop heat cramps from overexertion. Can knowing the causes and symptoms help prevent future episodes from happening?
Heat Cramps
Heat cramps can develop during exercise from overexertion or prolonged exposure to high temperatures. The muscle cramps, spasms, and pain can range from mild to severe.
Electrolytes like sodium, calcium, and magnesium are important for properly functioning muscles, including the heart. The primary role of sweating is to regulate the body’s temperature. (MedlinePlus. 2015) Sweat is mostly water, electrolytes, and sodium. Excessive sweating from physical activity and exertion or a hot environment can cause electrolyte imbalances that lead to cramps, spasms, and other symptoms.
Causes and Activities
Heat cramps most commonly affect individuals who sweat excessively during strenuous activity or are exposed to hot temperatures for prolonged periods. The body and organs need to cool down, which causes sweat production. However, too much sweating can lead to dehydration and electrolyte depletion. (Centers for Disease Control and Prevention. 2022)
Age – Children and adults 65 years and older have the highest risk.
Excessive sweating.
Low sodium diet.
Preexisting Medical Conditions – heart disease, diabetes mellitus, and obesity are conditions that can increase the risk of muscle cramping.
Medications – blood pressure, diuretics, and antidepressants can affect electrolyte balance and hydration.
Alcohol consumption.
Self-Care
If heat cramps begin, immediately stop the activity and look for a cool environment. Rehydrate the body to replenish the fluid loss. Staying hydrated and drinking fluids regularly during intense activity or in a hot environment can help prevent the body from cramping. examples of beverages that increase electrolytes include:
Gently applying pressure and massaging affected muscles can help reduce pain and spasms. As symptoms resolve, it is recommended to not return to strenuous activity too soon because additional exertion can progressively lead to heatstroke or heat exhaustion. (Centers for Disease Control and Prevention. 2021) Heatstroke and heat exhaustion are two heat-related illnesses. (Centers for Disease Control and Prevention. 2022)
Heatstroke is when the body loses the ability to regulate temperature and can cause dangerously high temperatures.
Heat exhaustion is the body’s response to excessive fluid and electrolyte loss.
The majority of heat cramps develop during activities because of the exertion and sweating, causing more electrolytes to be lost and the body to become more dehydrated.
Symptoms can also develop minutes to hours after activity has ceased.
Duration
Most heat-related muscle cramps will resolve with rest and hydration within 30–60 minutes.
If muscle cramping or spasms do not subside within one hour, seek professional medical attention.
For individuals with heart conditions or on a low-sodium diet who develop heat cramps, regardless of duration, medical help is necessary to ensure there are no complications.
The discs between the spine’s vertebrae provide cushioning and shock absorption in the spine and the rest of the body. Degenerative changes to the discs are believed to be the start of spinal stenosis. When the discs lack sufficient hydration/water and disc height decreases over time, the cushioning and shock absorption becomes less and less effective. The vertebrae can then become compressed, causing friction. Degenerative spinal stenosis can also develop from excess scar tissue and bone spurs (growth that develops on the edge of a bone) that can form after injury or spinal surgery.
Assessment
A physician will make a diagnosis of spinal stenosis. The doctor will take an imaging scan of the spine to determine the exact location of the degeneration and to measure how narrow the openings have become. Pain, stiffness, limited mobility, and loss of range of motion are often present. If spinal stenosis has caused nerve compression, there may also be pain, numbness, tingling, or weakness in the buttocks (sciatica), thighs, and lower legs. A physical therapist will determine the degree by assessing the following:
Vertebrae mobility – how the spine bends and twists in different directions.
Ability to change positions.
The strength of the core, back, and hip muscles.
Balance
Posture
Gait pattern
Nerve compression to determine if there are any symptoms in the legs.
Milder cases usually do not involve nerve compression, as back stiffness is more common.
In more severe cases, there may be significant pain, limited mobility, and nerve compression, causing leg weakness.
The most common symptom of spinal stenosis is increased pain with backward bending or extension of the lumbar spine. This includes positions that extend the spine, such as standing, walking, and lying on the stomach. Symptoms usually improve when bending forward and when the spine is positioned more into a flexed or bent position, like when sitting and reclining. These body positions open up the spaces in the central spinal canal.
Surgery
Spinal stenosis is the most common reason for undergoing surgery in adults 65 and older. However, surgery is almost always performed as a last resort if pain, symptoms, and disability persist after trying conservative therapies, including chiropractic, non-surgical decompression, and physical therapy, for months or years. The severity of symptoms and current state of health will determine whether a doctor will recommend surgery. (Zhuomao Mo, et al., 2018). Conservative measures can be safer and just as effective. A systematic review or study based on all available primary research found that physical therapy and exercise resulted in similar outcomes to surgery for improving pain and disability. (Zhuomao Mo, et al., 2018). Except for severe cases, surgery is often not necessary.
Physical Therapy for Spinal Stenosis
The objective of physical therapy includes:
Decreasing pain and joint stiffness.
Relieving nerve compression.
Reducing tightness in the surrounding muscles.
Improving the range of motion.
Improving postural alignment.
Strengthening the core muscles.
Improving leg strength to help with balance and overall function.
Stretching of the back muscles, including those running vertically along the spine and those running diagonally from the pelvis to the lumbar spine, helps relieve muscle tightness and pain and can improve overall mobility and range of motion of the lumbar spine.
Stretching the hip muscles, including the hip flexors in the front, the piriformis in the back, and the hamstrings that run from the back of the hip down the leg to the knee, is also important as these muscles are attached to the pelvis, which directly connects to the spine.
Exercises for strengthening the abdominal core muscles, including the muscles in the trunk, pelvis, lower back, hips, and abdomen, help stabilize the spine and protect it from excessive movement and compressive forces.
With spinal stenosis, the core muscles often become weak and inactive and unable to do their job to support the spine. Core exercises often begin by activating the deep abdominal muscles while lying flat on the back with the knees bent.
Exercises will progress as the individual gains more strength and control as the spine stabilizes.
Spinal stenosis physical therapy will also involve balance training and glute exercises for strengthening the leg muscles.
Prevention
Working with a physical therapist can help prevent future problems by maintaining spinal mobility, keeping the individual active, and exercising to maintain strength and stability to provide a solid foundation to support the lower back and prevent symptoms from worsening.
Severe Spinal Stenosis Physical Therapy
Physical therapy usually involves performing stretches for the lower back, hips, and legs, mobility exercises, and core strengthening exercises to improve spinal support and decrease pain. Treatments like heat or electrical stimulation may also be used on a case-by-case basis if there is significant pain or tightness in the back muscles. However, there is not enough clinical evidence to support that there are additional benefits. (Luciana Gazzi Macedo, et al., 2013) The effectiveness of physical therapy is high because surgery alone cannot strengthen the muscles that stabilize the spine, increase the mobility or flexibility of the surrounding muscles, and improve postural alignment.
The Root Causes of Spinal Stenosis
References
Lurie, J., & Tomkins-Lane, C. (2016). Management of lumbar spinal stenosis. BMJ (Clinical research ed.), 352, h6234. doi.org/10.1136/bmj.h6234
Mo, Z., Zhang, R., Chang, M., & Tang, S. (2018). Exercise therapy versus surgery for lumbar spinal stenosis: A systematic review and meta-analysis. Pakistan journal of medical sciences, 34(4), 879–885. doi.org/10.12669/pjms.344.14349
Macedo, L. G., Hum, A., Kuleba, L., Mo, J., Truong, L., Yeung, M., & Battié, M. C. (2013). Physical therapy interventions for degenerative lumbar spinal stenosis: a systematic review. Physical therapy, 93(12), 1646–1660. doi.org/10.2522/ptj.20120379
For individuals affected by headaches that occur 15 or more days a month for more than three months, can knowing the signs and symptoms help healthcare providers help treat and prevent chronic tension headaches?
Chronic Tension Headaches
Most individuals have experienced a tension-type headache. The pain is usually described as a dull tightening or pressure on both sides of the head, like having a tightening band around the head. Some individuals experience these headaches frequently, a condition known as chronic tension headaches. Chronic tension headaches are uncommon but can be debilitating, as they can interfere with a healthy quality of life and daily living.
Tension headaches are typically caused by stress, anxiety, dehydration, fasting, or lack of sleep and usually resolve with over-the-counter medications. (Cleveland Clinic. 2023)
This is a primary headache disorder that affects around 3% of the population.
Chronic tension headaches can occur daily and negatively impact the quality of life and daily functioning. (Cleveland Clinic. 2023)
Symptoms
Tension headaches can be referred to as stress headaches or muscle contraction headaches.
They can present with dull, aching pain and include tightness or pressure across the forehead, sides, or back of the head. (Cleveland Clinic. 2023)
Additionally, some individuals experience tenderness on the scalp, neck, and shoulders.
Chronic tension headaches materialize 15 or more days a month on average for more than three months.
The headache can last for several hours or be continuous for several days.
Causes
Tension headaches are typically caused by tight muscles in the shoulders, neck, jaw, and scalp.
Teeth grinding/bruxism and jaw clenching can also contribute to the condition.
Headaches can be brought on by stress, depression, or anxiety and are more common in individuals who:
Individuals experiencing headaches that interfere with daily life or need to take medication more than twice a week are recommended to consult a healthcare provider. Before the appointment, it can be helpful to keep a headache diary:
Record the days
Times
Description of the pain, intensity, and other symptoms.
Some questions the healthcare provider may ask include:
Is the pain pulsating, sharp, or stabbing, or is it constant and dull?
Where is the pain most intense?
Is it all over the head, on one side, on the forehead, or behind the eyes?
Do the headaches interfere with sleep?
Is working or doing tasks difficult or impossible?
A healthcare provider will likely be able to diagnose the condition based on symptoms alone. However, if the headache pattern is unique or different, the provider may order imaging tests, like MRI or CT scans, to rule out other diagnoses. Chronic tension headaches can be confused with other chronic daily headache disorders like chronic migraine, hemicrania continua, temporomandibular joint dysfunction/TMJ, or cluster headaches. (Fayyaz Ahmed. 2012)
Treatment
Pharmacological therapy for chronic tension headaches usually involves preventive medication.
Amitriptyline is one medication that has been found to be beneficial in chronic tension headache prevention.
According to a meta-analysis of 22 published studies in the Journal of General Internal Medicine, these medications are superior to placebo in reducing headache frequency, with an average of 4.8 fewer headache days per month.
Additional preventive medications may include other antidepressants like:
Remeron – mirtazapine.
Anti-seizure medications – like Neurontin – gabapentin, or Topamax – topiramate.
A healthcare provider may also prescribe medication to treat headache episodes, which include:
Prescription non-steroidal anti-inflammatory drugs or NSAIDs, including acetaminophen, naproxen, indomethacin, or ketorolac.
Opiates
Muscle relaxants
Benzodiazepines – Valium
Non-Medication Treatment
Behavioral therapies are sometimes used on their own or in combination with medication to prevent and manage chronic tension headaches. Examples include:
Acupuncture
An alternative therapy that involves using needles to stimulate specific points on the body believed to connect with certain pathways/meridians that carry vital energy/chi throughout the body.
Biofeedback
In Electromyography – EMG biofeedback, electrodes are placed on the scalp, neck, and upper body to detect muscle contraction.
The process can be costly and time-consuming, and there is little evidence to support its effectiveness.
Physical Therapy
A physical therapist can work out stiff and tight muscles.
Train individuals on stretches and targeted exercises for loosening tight head and neck muscles.
Cognitive Behavioral Therapy/CBT
Involves learning how to identify headache triggers and cope in a less stressful and more adaptive way.
Headache specialists often recommend CBT in addition to medication when developing a treatment plan. (Katrin Probyn et al., 2017)
Teeth-grinding and jaw-clenching training/treatment can help when they are contributors.
Regular exercise, as well as practicing healthy sleep hygiene, can be beneficial in prevention.
Supplements
Some individuals with chronic tension headaches may find relief using supplements. The American Academy of Neurology and the American Headache Society report the following supplements can be effective: (National Center for Complementary and Integrative Health. 2021)
Butterbur
Feverfew
Magnesium
Riboflavin
If the headaches come on suddenly, cause waking up from sleep, or last for days, it’s important to consult a healthcare provider to rule out any underlying causes and develop a personalized treatment plan.
Ahmed F. (2012). Headache disorders: differentiating and managing the common subtypes. British journal of pain, 6(3), 124–132. doi.org/10.1177/2049463712459691
Jackson, J. L., Mancuso, J. M., Nickoloff, S., Bernstein, R., & Kay, C. (2017). Tricyclic and Tetracyclic Antidepressants for the Prevention of Frequent Episodic or Chronic Tension-Type Headache in Adults: A Systematic Review and Meta-Analysis. Journal of general internal medicine, 32(12), 1351–1358. doi.org/10.1007/s11606-017-4121-z
Probyn, K., Bowers, H., Mistry, D., Caldwell, F., Underwood, M., Patel, S., Sandhu, H. K., Matharu, M., Pincus, T., & CHESS team. (2017). Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components. BMJ open, 7(8), e016670. doi.org/10.1136/bmjopen-2017-016670
Individuals that experience nerve pain in the foot could be caused by a number of different conditions, can recognizing the most common causes help in developing an effective treatment plan?
Nerve Pain In The Foot
These sensations can feel like a burning, shooting, electrical, or stabbing pain and can happen while in motion or at rest. It can occur on the top of the foot or through the arch. The area closest to the nerve may be sensitive to the touch. A number of different conditions can cause nerve pain in the foot, including:
Morton’s neuroma
Pinched nerve
Tarsal tunnel syndrome
Diabetic peripheral neuropathy
Herniated disc
Morton’s Neuroma
Morton’s neuroma involves the nerve that runs between the third and fourth toes, but can sometimes occur between the second and third toes becoming thicker. Typical symptoms include a burning or shooting pain in the area, usually while walking. (Nikolaos Gougoulias, et al., 2019) Another common symptom is the sensation of pressure beneath the toes like the sock is bunched up underneath. Treatments can include:
Arch supports
Cortisone injections to decrease swelling
Footwear modifications – can include lifts, orthotics combined with metatarsal pads, and rocker soles, to provide cushion where needed.
Things that increase the risk of developing the condition include:
Regularly wearing high-heels – the condition occurs more frequently in women.
Shoes that are too tight.
Participating in high-impact sports like running.
Having flat feet, high arches, bunions, or hammertoes.
Pinched Nerve
A pinched nerve can feel like shooting or burning pain. Nerve entrapment can occur in various regions of the foot or the area on top of the foot may feel sensitive. Causes can be caused by: (Basavaraj Chari, Eugene McNally. 2018)
Trauma that causes swelling.
Blunt impact.
Tight shoes.
Treatment can include:
Massage
Physical therapy
Rest
Footwear modifications
Anti-inflammatories.
Things that increase the risk of developing a pinched nerve in the foot include:
Poor-fitting footwear.
Repetitive stress injury.
Trauma to the foot.
Obesity.
Rheumatoid arthritis.
Tarsal Tunnel Syndrome
Another type of nerve entrapment is tarsal tunnel syndrome. Tarsal tunnel syndrome is “anything that produces compression on the posterior tibial nerve.” (American College of Foot and Ankle Surgeons. 2019) The tibial nerve is located near the heel. Symptoms include numbness and foot cramps, burning, tingling, or shooting sensations that often radiate from the instep/arch. Both can worsen while the foot is at rest, like when sitting or sleeping. Treatment can consist of:
Placing padding in the shoe where the foot is being compressed to relieve the pain.
Custom foot orthotics.
Cortisone shots or other anti-inflammatory treatments.
Surgery may be necessary to release the nerve.
Conditions that compress the tibial nerve and can lead to tarsal tunnel syndrome include:
Flat feet
Fallen arches
Ankle sprain
Diabetes
Arthritis
Varicose veins
Bone spurs
Diabetic Peripheral Neuropathy
Long-term high blood sugar/glucose associated with diabetes can lead to a form of nerve damage known as peripheral neuropathy. (Centers for Disease Control and Prevention. 2022) Neuropathy pain feels like burning or shooting pain, or the sensation of walking on bubble wrap that usually shows up overnight. The pain can come and go as well as a gradual loss of feeling in the feet that begins in the toes and moves up the foot. It’s estimated that around half of individuals with diabetes will eventually develop neuropathy. (Eva L. Feldman, et al., 2019) Treatments can include:
Physical therapy massage to increase circulation.
Topical treatments with capsaicin.
Vitamin B.
Blood sugar management.
Alpha lipoic acid.
Medication.
Individuals with diabetes have an increased risk of developing peripheral neuropathy if:
Blood sugar is not well-controlled.
Diabetes has been present for many years.
Kidney disease.
Smoke.
Overweight or obese.
Herniated Disc
Nerve pain in the foot can be caused by spinal issues. A herniated disc in the lower back can irritate and compress the nerves, causing pain that radiates down the leg and foot. Additional symptoms usually include muscle weakness in the legs and/or numbness and tingling. Most herniated discs don’t require surgery and get better with conservative treatment. (Wai Weng Yoon, Jonathan Koch. 2021) If symptoms don’t improve or worsen, a healthcare provider may recommend surgery. Herniated discs are most common in young and middle-aged adults. Increased chances of developing a herniated disc can come from:
Degenerative changes in the spine from normal age wear and tear.
Physically demanding job.
Lifting incorrectly.
Overweight or obese.
Genetic predisposition – family history of herniated discs.
Spinal Stenosis
Spinal stenosis occurs when the spaces in the spine begin to narrow, creating pressure on the spinal cord and nerve roots. It is usually caused by wear and tear on the spine as the body ages. Stenosis in the lower back can cause burning pain in the buttocks and leg. As it progresses pain can radiate into the feet along with numbness and tingling. Conservative treatment consists of physical therapy exercises and non-steroidal anti-inflammatory medications/NSAIDs. (Jon Lurie, Christy Tomkins-Lane. 2016) Cortisone injections can be beneficial and if the condition worsens, surgery may be an option. Risk factors include:
Physical trauma – after surgery or an automobile or sports accident.
Certain cancer, antiviral medications, or antibiotics.
Complex regional pain syndrome.
Tumors that irritate and/or compress a nerve.
Liver or kidney disease.
Infectious diseases – Lyme disease complications or viral infections.
Nerve pain in the foot is definitely a reason to see a healthcare provider. Early diagnosis can help prevent symptom progression and future problems. Once the cause of the pain has been identified, the healthcare team can work together to develop a personalized treatment plan to release compressed nerves and restore mobility and function. See a healthcare provider right away if the pain and symptoms worsen, or if there are difficulties standing or walking.
Chiropractic After Accidents and Injuries
References
Gougoulias, N., Lampridis, V., & Sakellariou, A. (2019). Morton’s interdigital neuroma: instructional review. EFORT open reviews, 4(1), 14–24. doi.org/10.1302/2058-5241.4.180025
Chari, B., & McNally, E. (2018). Nerve Entrapment in Ankle and Foot: Ultrasound Imaging. Seminars in musculoskeletal radiology, 22(3), 354–363. doi.org/10.1055/s-0038-1648252
Feldman, E. L., Callaghan, B. C., Pop-Busui, R., Zochodne, D. W., Wright, D. E., Bennett, D. L., Bril, V., Russell, J. W., & Viswanathan, V. (2019). Diabetic neuropathy. Nature reviews. Disease primers, 5(1), 42. doi.org/10.1038/s41572-019-0097-9
Yoon, W. W., & Koch, J. (2021). Herniated discs: when is surgery necessary?. EFORT open reviews, 6(6), 526–530. doi.org/10.1302/2058-5241.6.210020
Lurie, J., & Tomkins-Lane, C. (2016). Management of lumbar spinal stenosis. BMJ (Clinical research ed.), 352, h6234. doi.org/10.1136/bmj.h6234
Staff, N. P., & Windebank, A. J. (2014). Peripheral neuropathy due to vitamin deficiency, toxins, and medications. Continuum (Minneapolis, Minn.), 20(5 Peripheral Nervous System Disorders), 1293–1306. doi.org/10.1212/01.CON.0000455880.06675.5a
Temporomandibular joint disorder causes pain and jaw locking that can be worsened with certain activities. How individuals can manage and prevent flare-ups by learning what not to do to worsen the condition?
What Not To Do Temporomandibular Joint Disorder
Tenderness, aching, pain, and jaw locking are symptoms of temporomandibular joint disorder or TMJ. The temporomandibular joint connects the jaw to the skull. It is used daily for eating, drinking, and talking. It is a small disc in the joint that allows the jaw bones to slip and slide correctly. With TMJ, the disc shifts out of place, leading to clicking, snapping, and limited jaw movement. It can also cause pain in the jaw and face, neck pain, and headaches, and the muscles around the jaw and neck can become sore and/or go into spasm. Any type of activity that stresses or overworks the joint can trigger a flare-up and worsen TMJ symptoms. (Schiffman E, et al. 2014) This article looks at avoiding activities that make TMJ worse and what not to do to help keep TMJ symptoms in check.
Chewing Gum
Gum chewing is not recommended for individuals with TMJ.
The jaw is one of the most used joints in the body.
Limiting excessive use alleviates pressure allowing the joints and muscles to rest.
Resting sore muscles and joints is the first step in injury recovery.
Eating Chewy and Hard Foods
Chewy and hard foods make the jaw have to work overtime.
Avoid eating hard foods like chewy candies, hard and chewy breads, vegetables like corn on the cob, and fruits like apples.
These foods can place excessive stress on the jaw, and prevent the joint from properly resting and healing.
Chewing Only On One Side
Many individuals chew their food on only one side of the mouth.
This can stress out one side of the temporomandibular joint and surrounding muscles, leading to pain and dysfunction. (Urbano Santana-Mora, et al., 2013)
Stay aware of chewing habits and make sure to utilize both sides of the mouth.
Individuals with dental issues or tooth pain are recommended to see a dentist.
Non-Functional Jaw Activities
Going through each day, individuals tend to do things unconsciously or out of habit.
For example, individuals:
Reading or writing might chew on a pen or pencil.
Bite their nails or chew on the inside of their mouth while watching TV or internet browsing.
These activities can place stress on the joint, worsen the condition, and extend the healing process.
Resting on The Chin
Individuals will rest their jaw in their hands while studying, on social media, or watching TV.
This position can be comfortable, but it can affect the jaw.
This position can build pressure against the side of the jaw and push against the joint, causing the disc to shift out of place affecting how the jaw opens and closes.
Breaking the chin resting habit can allow the joint to relax and heal correctly.
Teeth Clenching
Bruxism is the medical term for clenching the teeth.
This can occur during the day or during sleep.
Teeth clenching is often brought on by stress and can place incredible pressure on the jaw’s muscles and worsen TMJ.
A dentist can prescribe a mouth guard to be worn while sleeping to protect the teeth from excessive clenching. (Miriam Garrigós-Pedrón, et al., 2019)
Slouching
The function of the jaw is closely related to body posture.
The jaw operates optimally when the head is above the cervical spine and the posture is upright.
Slouching can change how the jaw muscles work and the way the jaw opens and closes.
Part of physical therapy for TMJ is working on posture adjustments and training.
This can involve strengthening the back and shoulder muscles and setting up posture reminders.
Sitting and standing correctly can keep the jaw operating properly.
Postponing Treatment
Many with musculoskeletal issues and symptoms wait for the pain to go away.
Individuals having problems with their jaw should not wait to get treatment.
TMJ has a positive rate of recovery with conservative treatment, which is all the more reason to seek treatment. (G Dimitroulis. 2018)
A dentist or healthcare provider can provide an accurate diagnosis if TMJ is suspected.
Individuals can benefit from visiting a physical therapist to learn exercises and strategies to self-treat the condition. (Yasser Khaled, et al., 2017)
Treatment
Treatment can involve:
Initial treatment focuses on pain relief and jaw function opens and closes improvement.
A guard can help with night teeth grinding/bruxism.
Anti-inflammatory treatments.
In severe cases, surgery may be recommended to correct the problem, as a last resort. (Meghan K Murphy, et al., 2013)
Follow recommendations on what not to do and avoid certain activities.
Quick Patient Initiation
References
Schiffman, E., Ohrbach, R., Truelove, E., Look, J., Anderson, G., Goulet, J. P., List, T., Svensson, P., Gonzalez, Y., Lobbezoo, F., Michelotti, A., Brooks, S. L., Ceusters, W., Drangsholt, M., Ettlin, D., Gaul, C., Goldberg, L. J., Haythornthwaite, J. A., Hollender, L., Jensen, R., … Orofacial Pain Special Interest Group, International Association for the Study of Pain (2014). Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. Journal of oral & facial pain and headache, 28(1), 6–27. doi.org/10.11607/jop.1151
Santana-Mora, U., López-Cedrún, J., Mora, M. J., Otero, X. L., & Santana-Penín, U. (2013). Temporomandibular disorders: the habitual chewing side syndrome. PloS one, 8(4), e59980. doi.org/10.1371/journal.pone.0059980
Garrigós-Pedrón, M., Elizagaray-García, I., Domínguez-Gordillo, A. A., Del-Castillo-Pardo-de-Vera, J. L., & Gil-Martínez, A. (2019). Temporomandibular disorders: improving outcomes using a multidisciplinary approach. Journal of multidisciplinary healthcare, 12, 733–747. doi.org/10.2147/JMDH.S178507
Dimitroulis G. (2018). Management of temporomandibular joint disorders: A surgeon’s perspective. Australian Dental Journal, 63 Suppl 1, S79–S90. doi.org/10.1111/adj.12593
Khaled Y, Quach JK, Brennan MT, NapeÑas JJ. Outcomes after physical therapy for the treatment of temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol, 2017;124(3: e190. doi:10.1016/j.oooo.2017.05.477
Abouelhuda, A. M., Khalifa, A. K., Kim, Y. K., & Hegazy, S. A. (2018). Non-invasive different modalities of treatment for temporomandibular disorders: a review of the literature. Journal of the Korean Association of Oral and Maxillofacial Surgeons, 44(2), 43–51. doi.org/10.5125/jkaoms.2018.44.2.43
Murphy, M. K., MacBarb, R. F., Wong, M. E., & Athanasiou, K. A. (2013). Temporomandibular disorders: a review of etiology, clinical management, and tissue engineering strategies. The International journal of oral & maxillofacial implants, 28(6), e393–e414. doi.org/10.11607/jomi.te20
Can chiropractic treatment protocols diagnose what’s causing head pressure in individuals, and provide effective treatment?
Head Pressure
Head pressure can have various causes and symptoms that affect different areas depending on whether the cause is a headache, allergies, injury, illness, or disease. The location of the pressure or pain can help a doctor of chiropractic determine the cause.
The underlying factor is usually not life-threatening, but the pressure that has built can be the result of serious conditions like a head injury or brain tumor.
Chiropractic care, which includes a combination of spinal manipulation, active and passive exercises, and massage, is often used for headache management and prevention. (Moore Craig, et al., 2018)
Chiropractic therapy is often sought out for tension and cervicogenic headaches, migraines, and each responds differently to the treatment.
The Head
The head is made up of a complex system of lobes, sinuses/channels, blood vessels, nerves, and ventricles. (Thau L, et al., 2022)
The pressure of these systems is regulated and any disruption to this balance can be noticeable.
Diagnosis can be difficult to figure out what is causing discomfort or head pressure.
Pain, pressure, irritability, and nausea are all symptoms that can occur with headaches. (Rizzoli P, Mullally W. 2017)
Head pressure can also occur only at times when standing up, bending down to pick up an object, or otherwise changing posture in some way that blood pressure is affected.
Chiropractic Treatment
The Injury Medical team will develop a personalized treatment plan to help relieve pressure symptoms through a multidisciplinary approach that can include. (Moore Craig, et al., 2018)
Moore, C., Leaver, A., Sibbritt, D., & Adams, J. (2018). The management of common recurrent headaches by chiropractors: a descriptive analysis of a nationally representative survey. BMC neurology, 18(1), 171. doi.org/10.1186/s12883-018-1173-6
Schizodimos, T., Soulountsi, V., Iasonidou, C., & Kapravelos, N. (2020). An overview of the management of intracranial hypertension in the intensive care unit. Journal of Anesthesia, 34(5), 741–757. doi.org/10.1007/s00540-020-02795-7
Stiffness and pain developing in the shoulder could be adhesive capsulitis, (frozen shoulder), a condition in the shoulder’s ball-and-socket joint/glenohumeral joint. It usually develops over time and limits the functional use of the arm. The pain and tightness restrict arm movement, and the duration of symptoms can persist for 12-18 months. The cause is often unknown, but it is more common in individuals over 40, individuals with diabetes, thyroid disease, and cardiac conditions have an increased risk of developing the condition, and women tend to develop the condition more than men. Chiropractic treatment can be effective at relieving pain and expediting recovery.
Stiffness and Pain
The shoulder joint allows more movement than any other joint in the body. A frozen shoulder causes the capsule surrounding the shoulder joint to contract and form scar tissue. The capsule contraction and the formation of adhesions cause the shoulder to become stiff, restrict movement, and cause pain and discomfort symptoms.
Stages
The progression is marked by three stages:
Freezing
Stiffness and pain begin to restrict motion.
Frozen
Movement and motion are severely restricted.
Thawing
The shoulder starts to loosen up.
It can take years to fully resolve symptoms.
In mild cases, a frozen shoulder can go away on its own but that does not mean that it is truly healed and correctly aligned.
Even in mild cases seeking treatment is recommended, rather than just waiting for it to go away.
Symptoms
Limited range of motion.
Stiffness and tightness.
Dull or aching pain throughout the shoulder.
Pain can radiate into the upper arm.
Pain can be triggered by the smallest movements.
The symptoms are not always due to weakness or injury, but actual joint stiffness.
Causes
Most frozen shoulders occur with no injury or discernible cause but the condition is often linked to a systemic condition or one that affects the entire body.
Age and Gender
Frozen shoulder most commonly affects individuals between the ages of 40 to 60, and is more common in women than in men.
Endocrine Disorders
Individuals with diabetes have an increased risk of developing a frozen shoulder.
Other endocrine abnormalities like thyroid problems can also lead to the development of this condition.
Shoulder Trauma and/or Surgery
Individuals who sustain a shoulder injury, or undergo surgery on the shoulder can develop a stiff and painful joint.
When injury or surgery is followed by prolonged immobilization/resting the arm, the risk of developing a frozen shoulder increases.
Other Systemic Conditions
Several systemic conditions such as heart disease have also been associated with an increased risk of developing the condition and can include:
High cholesterol
Adrenal disease
Heart and lung disease
Parkinson’s disease
Stiffness and pain can also be associated with damage to the joint from injuries or other shoulder problems that include:
A frozen shoulder associated with any of these causes is considered secondary.
Treatment
A diagnosis is made by observing the range of motion in the shoulder, considering the two types:
Active Range
This is how far an individual can move a body part on their own.
Passive Range
This is how far another person like a therapist or doctor can move the body part.
Therapies
Chiropractic, massage, and physical therapy involve stretches, realignment, and exercises to relieve pain symptoms and restore mobility and function.
Usually, strength is not affected by a frozen shoulder but a chiropractor may want to strengthen the surrounding muscles to better support the shoulder and prevent worsening the injury or causing a new injury.
Anti-inflammatory medications and corticosteroid injections may help manage pain symptoms.
Getting a diagnosis and treatment during the freezing stage can keep the condition from progressing and expedite recovery time.
Enhancing Health: Evaluation and Treatment
References
Brun, Shane. “Idiopathic frozen shoulder.” Australian Journal of general practice vol. 48,11 (2019): 757-761. doi:10.31128/AJGP-07-19-4992
Chan, Hui Bin Yvonne, et al. “Physical therapy in the management of frozen shoulder.” Singapore medical journal vol. 58,12 (2017): 685-689. doi:10.11622/smedj.2017107
Cho, Chul-Hyun, et al. “Treatment Strategy for Frozen Shoulder.” Clinics in orthopedic surgery vol. 11,3 (2019): 249-257. doi:10.4055/cios.2019.11.3.249
Duzgun, Irem, et al. “Which method for frozen shoulder mobilization: manual posterior capsule stretching or scapular mobilization?.” Journal of Musculoskeletal & neuronal interactions vol. 19,3 (2019): 311-316.
Jain, Tarang K, and Neena K Sharma. “The effectiveness of physiotherapeutic interventions in the treatment of frozen shoulder/adhesive capsulitis: a systematic review.” Journal of back and musculoskeletal rehabilitation vol. 27,3 (2014): 247-73. doi:10.3233/BMR-130443
Kim, Min-Su, et al. “Diagnosis and treatment of calcific tendinitis of the shoulder.” Clinics in shoulder and elbow vol. 23,4 210-216. 27 Nov. 2020, doi:10.5397/cise.2020.00318
Millar, Neal L et al. “Frozen shoulder.” Nature reviews. Disease primers vol. 8,1 59. 8 Sep. 2022, doi:10.1038/s41572-022-00386-2
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