Back Clinic Injury Care Chiropractic and Physical Therapy Team. There are two approaches to injury care. They are active and passive treatment. While both can help get patients on the road toward recovery, only active treatment has a long-term impact and keeps patients moving.
We focus on treating injuries sustained in auto accidents, personal injuries, work injuries, and sports injuries and provide complete interventional pain management services and therapeutic programs. Everything from bumps and bruises to torn ligaments and back pain.
Passive Injury Care
A doctor or a physical therapist usually gives passive injury care. It includes:
Acupuncture
Applying heat/ice to sore muscles
Pain medication
It’s a good starting point to help reduce pain, but passive injury care isn’t the most effective treatment. While it helps an injured person feel better in the moment, the relief doesn’t last. A patient won’t fully recover from injury unless they actively work to return to their normal life.
Active Injury Care
Active treatment also provided by a physician or physical therapist relies on the injured person’s commitment to work. When patients take ownership of their health, the active injury care process becomes more meaningful and productive. A modified activity plan will help an injured person transition to full function and improve their overall physical and emotional wellness.
Spine, neck, and back
Headaches
Knees, shoulders, and wrists
Torn ligaments
Soft tissue injuries (muscle strains and sprains)
What does active injury care involve?
An active treatment plan keeps the body as strong and flexible as possible through a personalized work/transitional plan, which limits long-term impact and helps injured patients work toward a faster recovery. For example, in injury Medical & Chiropractic clinic’s injury care, a clinician will work with the patient to understand the cause of injury, then create a rehabilitation plan that keeps the patient active and brings them back to proper health in no time.
For answers to any questions, you may have, please call Dr. Jimenez at 915-850-0900
Is applying ice the best option for individuals who experience an acute back strain injury?
Temperature Treatment
Ice temperature treatment, also known as cryotherapy or cold therapy, is a treatment that uses freezing temperatures to reduce pain and swelling. It can be applied in a variety of ways, including:
Ice packs:
Ice massage
Coolant sprays
Whirlpools
Ice baths
Ice is usually recommended for acute injuries and is a common and simple way to treat pain and swelling. Individuals can buy freezable gel packs or make their own with ice cubes in a plastic bag or towel. Heat therapy tends to be used more with chronic issues involving muscle spasms to increase blood circulation.
How Ice Relieves Pain and Reduces Inflammation
Ice temperature treatment works by:
Narrowing blood vessels slows blood circulation to the injured area and soft tissues and reduces swelling.
Reduced blood flow also helps control excessive swelling.
Ice has a short-term analgesic-numbing effect. The coldness numbs nerve endings, relieving pain symptoms.
Relieving the pain allows the muscles to relax.
Controlling blood circulation helps control pain by reducing the flow of irritating chemicals that can inundate the injury site. These chemicals are a natural and the correct response to inflammation, but the ice keeps them in check to help control pain.
After a Back Injury
For a back strain injury, ice and anti-inflammatory medication like NSAIDs are the first line of treatment during the inflammatory phase, which usually lasts 24 to 72 hours. Because heat can increase inflammation by increasing blood circulation, it is not recommended as an initial treatment. After the first few days, most doctors and pain specialists recommend using ice or heat, depending on the individual’s preference. While researchers continue to investigate the best ways to treat acute injuries, most doctors still recommend ice as the first line of defense for back injuries.
A review of studies evaluated 20 different treatment categories to learn about their safety and effectiveness. (McIntosh G. & Hall H. 2011) Treatments included over-the-counter pain medications, acupuncture, McKenzie exercises, other back exercises, and temperature treatments. Regarding temperature treatment, the review found moderate evidence that using a heat wrap 5 days after the injury could help relieve pain. However, there was not enough evidence to support the effectiveness of any of the temperature treatments, necessitating more research. (McIntosh G. & Hall H. 2011)
Physical Therapy and Activity
The review found that prolonged rest should be avoided, and gentle exercise and a progressive return to physical activity should be encouraged to achieve the best outcomes for pain relief and restoring function. Staying active significantly reduces time off from work and chronic disability for up to 1 year compared to traditional medical treatment. (McIntosh G. & Hall H. 2011) Research also found that introducing physical therapy early on could expedite recovery. Mobility work, targeted exercises, and strengthening exercises have been shown to relieve pain, reduce injury recurrence, and improve overall function. More research supports physical activity and exercise as effective treatment options for acute lower back strains. However, further research regarding temperature treatments is required. (French S. D. et al., 2006) (See Q. Y. et al., 2021)
Injury Medical Chiropractic and Functional Medicine Clinic
It is important to talk with a healthcare provider to determine the cause and extent of the injury to provide individualized patient education regarding treatment. This can include physical therapy, rest, health coaching, medication, and surgery, which may be recommended in certain cases. Overcoming these limitations is possible. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Beyond the Surface: Understanding the Effects of Personal Injury
References
McIntosh, G., & Hall, H. (2011). Low back pain (acute). BMJ clinical evidence, 2011, 1102.
French, S. D., Cameron, M., Walker, B. F., Reggars, J. W., & Esterman, A. J. (2006). A Cochrane review of superficial heat or cold for low back pain. Spine, 31(9), 998–1006. doi.org/10.1097/01.brs.0000214881.10814.64
See, Q. Y., Tan, J. B., & Kumar, D. S. (2021). Acute low back pain: diagnosis and management. Singapore Medical Journal, 62(6), 271–275. doi.org/10.11622/smedj.2021086
For individuals going through post surgery, injury rehabilitation, illness and/or chronic condition management, can physical therapy isometric exercises help?
Isometric Exercise
Isometric exercises are used in physical therapy to help build muscle endurance, improve range of motion, relieve pain, and reduce blood pressure more effectively than other types of exercise. Because they don’t involve joint movement, they are a solid starting point for rehabilitation and are suitable for individuals with a limited range of motion. They can be performed by pushing against an immovable object, like a wall, or by having a therapist provide resistance. Examples of isometric exercises include:
A physical therapist/PT may have a patient perform isometric exercises after injury or illness. During an isometric contraction, the muscle does not change in length, and there is no motion around the joint surrounding the muscle/s. (Rhyu H. S. et al., 2015)
When To Use
Isometric muscular contractions can be used at any time during physical rehabilitation and strengthening or a home exercise program and are regularly used with the following (Rhyu H. S. et al., 2015)
Post-surgery
When muscles cannot contract forcefully enough to move the joint it surrounds.
To help increase neuromuscular input to a specific muscle/s.
When injury or condition frailty makes other forms of exercise dangerous and not beneficial.
A healthcare provider or physical therapist should be consulted first if isometrics are used in a rehabilitation program.
Benefits
The benefits of using isometric exercise after injury or surgery may include the following:
No special equipment is necessary to perform isometric exercises.
The ability to safely contract a muscle while protecting a surgical incision or scar tissue.
The muscles can be strengthened in a specific range of motion around a joint. (NikolaidouO. et al., 2017)
A physical therapist can help determine whether isometric exercise benefits the specific condition.
Effectiveness
Isometric exercise is very effective after injury or surgery. However, when a muscle is contracted isometrically, it gains strength in a very small area and with a short range of motion. For example, an isometric shoulder external rotation performed with the arm at the side will only strengthen the rotator cuff muscles in the specific position that the arm is in. (NikolaidouO. et al., 2017).
Strength gains are specific to the joint’s position during the exercise.
Individuals who want to strengthen their gluteal muscles in their hip using isometrics would have to contract their glute muscles in one specific position for several reps.
Once several reps of the exercise in one position have been performed, the individual moves their hip joint into a new position and repeats the gluteal contractions in the new position.
This makes the exercise time-consuming, but it is perfect for injury rehabilitation, preventing and avoiding worsening or further injuries.
How to Perform
To perform isometric exercises, all that is needed is something stable to push against. (Rhyu H. S. et al., 2015) For example, to strengthen the shoulder muscles:
Stand next to a wall and try to lift an arm out to the side.
Allow the hand to press against the wall so no motion occurs at the shoulder joint.
Once pressed against the wall, hold the contraction for 5 to 6 seconds and slowly release it.
Perform 6 to 10 repetitions of the exercise.
This could be one set of completed isometric exercises for the shoulder muscles.
Elastic resistance bands or tubing can also be used to perform isometric exercises. Hold the tubing in a specific position and then move the body away from the anchor point instead of moving the joint. The muscles will contract against the increased resistance of the elastic tubing, and no motion will occur at the joint. A physical therapist can show and train on how to perform isometric exercises with the bands.
Neuromuscular Stimulation
Isometric exercise can strengthen muscles and help improve the neuromuscular recruitment of the muscles being trained. This enhances muscle contraction and expedites gains in muscle recruitment while protecting the joint. Isometric exercise can also be used during physical therapy using neuromuscular electrical stimulation (NMES). (Fouré A. et al., 2014) For example, a PT may use NMES to improve muscular function for individuals who have difficulty contracting their quadriceps after knee surgery and may be instructed to perform isometric quad-setting exercises during the session.
Injury Medical Chiropractic and Functional Medicine Clinic
A physical therapist can use isometric exercises to help individuals injured or have had surgery and are experiencing difficulty with normal functional mobility by improving their strength during recovery. The exercises can safely enhance the function and stability of the muscles and return individuals to the previous level of activity and function. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Personal Injury Rehabilitation
References
Rhyu, H. S., Park, H. K., Park, J. S., & Park, H. S. (2015). The effects of isometric exercise types on pain and muscle activity in patients with low back pain. Journal of Exercise Rehabilitation, 11(4), 211–214. doi.org/10.12965/jer.150224
Nikolaidou, O., Migkou, S., & Karampalis, C. (2017). Rehabilitation after Rotator Cuff Repair. The Open Orthopaedics Journal, 11, 154–162. doi.org/10.2174/1874325001711010154
Fouré, A., Nosaka, K., Wegrzyk, J., Duhamel, G., Le Troter, A., Boudinet, H., Mattei, J. P., Vilmen, C., Jubeau, M., Bendahan, D., & Gondin, J. (2014). Time course of central and peripheral alterations after isometric neuromuscular electrical stimulation-induced muscle damage. PloS one, 9(9), e107298. doi.org/10.1371/journal.pone.0107298
Individuals who have been injured or ill or have a chronic disability may be having difficulty performing everyday activities. Can recreation therapy help rehabilitate injuries and manage chronic conditions?
Recreation Therapy
Living with a chronic disability or functional limitation due to an illness or injury can significantly impact an individual’s quality of life. Working with a team of rehabilitation professionals can help improve mobility and the ability to complete everyday tasks comfortably. A recreational therapist is one professional who helps regain emotional and functional well-being. A recreational therapist is a healthcare professional who helps individuals maximize physical and emotional health through recreational activities. Also known as therapeutic recreation, the therapist will use activities to help move and feel better. A physical or occupational therapist uses exercises to improve functional mobility, and a recreational therapist uses recreational activities to help regain mobility and improve well-being. Activities can include:
Playing games
Outdoor activities
Hiking
Puzzles
Horseback riding
Cooking
Therapy
A healthcare specialist uses activity-based interventions to help individuals move and feel better after injury or illness or if they have a chronic disability. The interventions and therapies are based on recreational activities the individual likes and are designed to help recover physical, functional, and emotional health. Recreational therapists are trained to evaluate an individual’s condition and intervene in ways that help maximize social, mental, and physical health. The main goal is to reduce depression and anxiety and to help individuals socialize comfortably. (American Therapeutic Recreation Association, 2024)
Activities
Therapeutic recreation involves engaging in specific activities to help individuals regain their confidence and independence. Examples of activities can include: (American Therapeutic Recreation Association, 2024)
Painting or drawing
Dancing
Sports programs
Cooking
Community outings
Group exercise classes
The key to a positive experience is that the activity should be specific to the individual’s emotional and physical needs and capabilities and something the individual would want to do as an activity.
Other Types of Therapy
Individuals may be familiar with other types of therapists, like physical and occupational therapists. These professionals help individuals regain pain-free functional mobility after injury or illness. For individuals who cannot move their upper extremities after falling, the physical therapist can measure their shoulder range of motion and strength and develop a personalized treatment program. Recreation therapists are similar; they meet with patients regularly to help them recover from injuries or positively socialize with their community. During the initial meeting, they will evaluate the individual’s condition and learn how their emotional and physical needs prevent them from achieving maximal potential. (American Therapeutic Recreation Association, 2024) The patient and therapist will engage in activities to help move and feel better during therapy. During the activity, the therapist may suggest adjustments or ideas that improve movement and ability to interact with the environment.
Who Can Benefit?
Individuals of all ages and abilities with physical and psychological conditions can benefit from working with a recreational therapist. Children, teenagers, adults, and older individuals who have a disability, either temporary or permanent, can engage in recreation therapy as part of a rehabilitation and recovery program. (American Therapeutic Recreation Association, 2024)
Benefits
Whenever engaging in any healthcare activity or treatment, ask if that treatment can help your specific condition. A review of the use of recreational dance in children and young people ages 5 to 21 found evidence of the benefits of the therapy, which included: (Burkhardt J, Brennan C. 2012)
Decreased anxiety
Improve self-image
Improved cardiovascular fitness
Decreased obesity
Improved bone health
Another study examined health improvements in individuals injured in military service after a week-long recreational therapy wellness retreat. The participating service members’ results showed significant improvement in outcome measures for post-traumatic stress disorder, stress, anxiety, and depression. The health improvements remained three and six months after completing the recreation therapy. This shows that therapeutic recreation may offer significant emotional and psychological benefits to injured military service members’ long-term health and an effective treatment to improve the well-being of injured or disabled individuals with limited negative side effects. (Townsend J, Hawkins BL, Bennett JL, et al., 2018)
Professional Background
Most therapists have a bachelor’s degree in recreational or leisure studies, focusing on art, psychology, and music classes. Upon graduation, students can take a national exam and become Certified Therapeutic Recreation Specialists/CTRS. (Hoss M.A.K, 2019) Once certified, therapists must regularly take continuing education classes and undergo a recertification process every five years.
Receiving Therapy Services
To start working with a recreational therapist, visit your healthcare provider and request a referral. They can ensure the treatment is appropriate for the specific injury and/or condition and should be able to help find a therapist. (American Therapeutic Recreation Association, 2024) Individuals in an inpatient hospital will likely spend time with a recreational therapist at some point. Just like working with a physical or occupational therapist to help individuals move better, working with a recreation therapist while in rehabilitation may be an everyday occurrence to help reintegrate into the community after discharge.
Insurance Coverage
One question regarding recreational therapy is, will my insurance cover the services of a recreational therapist?
For individuals with Medicare insurance, recreational therapy is a covered service for individuals with certain diagnoses and settings.
Therapeutic recreation is a covered rehabilitation service for individuals in an inpatient rehabilitation facility.
Individuals who receive outpatient recreational therapy should ensure they have a prescription and letter of medical necessity from a physician to qualify for Medicare reimbursement. (American Therapeutic Recreation Association, 2024)
Individuals with private insurance should call their insurance provider and inquire about coverage for recreation therapy.
Individuals who do not have insurance can expect to pay $100-$150 per session.
Injury Medical Chiropractic and Functional Medicine Clinic
Working in therapeutic recreation may help decrease anxiety and depression, improve the sense of well-being, and improve function in daily tasks. (Townsend J, Hawkins BL, Bennett JL, et al., 2018) Always consult your healthcare provider before beginning new treatment methods. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Integrative Healthcare
References
American Therapeutic Recreation Association. Association, A. T. R. (2024). What is Recreational Therapy? www.atra-online.com/about-rt
Burkhardt, J., & Brennan, C. (2012). The effects of recreational dance interventions on the health and well-being of children and young people: A systematic review. Arts & Health, 4(2), 148–161. doi.org/10.1080/17533015.2012.665810
Townsend, J., Hawkins, B. L., Bennett, J. L., Hoffman, J., Martin, T., Sotherden, E., … Duregger, C. (2018). Preliminary long-term health outcomes associated with recreation-based health and wellness programs for injured service members. Cogent Psychology, 5(1). doi.org/10.1080/23311908.2018.1444330
Hoss, PhD, CTRS, FACHE, FDRT, M. A. K. (2019). Recreational therapy workforce: An update. American Journal of Recreation Therapy, 18(3), 9–15. doi.org/10.5055/ajrt.2019.0191
De Vries, DHA, MPA, CTRS, D. (2014). Regulatory requirements for recreational therapy in nursing homes. American Journal of Recreation Therapy, 13(1), 25–30. doi.org/10.5055/ajrt.2014.0063
The vastus lateralis is a muscle on the outside part of the thigh. Injuries to the muscle include strains, tendinitis, femoral nerve compression, and others. Can rehabilitation like heat and ice, massage, and strength and mobility exercises help individuals return to normal activities and function?
Vastus Lateralis Muscle
The vastus lateralis is the largest of the four quadriceps muscles on the thigh’s outer portion. The vastus lateralis helps extend the knee joint and maintain the knee position when walking or running. The vastus lateralis functions to work with the other quad muscles to help extend the knee joint.
Anatomy
Most muscles are attached to bone points of attachment, called the origin and insertion points. The vastus lateralis origin and insertion points are as follows (Vieira, EPL. 2017)
Origin
The origin is on the upper inter-trochanteric line of the femur or thigh bone.
It also arises from the base of the greater trochanter and the linea aspera, the supracondylar ridge, and the lateral intermuscular septum.
Insertion
From its origin, the muscle courses down the lateral thigh and inserts as part of the lateral quadriceps tendon on the tibial tubercle, an elevated portion of the upper shin.
The muscle is a large, flat structure with different attachments and a flat aponeurosis or sheath of connective tissue on the outer thigh.
The femoral nerve from lower back levels two, three, and four controls or innervates the muscle.
Blood supply to the muscle goes through the lateral circumflex femoral artery of the upper thigh.
Function
The muscle works with the other quadriceps muscles to extend or straighten the knee. The quads are responsible for functional activities like walking, running, climbing stairs, and getting up from a seated position. The vastus lateralis and the iliotibial band, which courses down the lateral thigh next to this muscle, form the lateral wall of the thigh. The vastus lateralis is on the opposite side of the vastus medialis muscle on the inner portion of the thigh. These muscles work together to maintain the appropriate position of the patella/kneecap in the femoral groove of the thigh bone. Malfunctioning these muscles properly can lead to knee pain from patellofemoral stress syndrome. (American Academy of Orthopaedic Surgeons, 2024)
Conditions
Many different injuries and conditions can affect the vastus lateralis and quad muscles, especially in athletes or active individuals. These injuries can cause vastus lateralis pain and other problems. (Timothy J. Von Fange, 2024) Some of the injuries and conditions include:
Patellofemoral Stress Syndrome – PFSS
This occurs when the kneecap tracks improperly in the femoral groove of the knee joint.
This leads to pain and difficulty when walking and running.
Vastus Lateralis Strain
A sudden force on the thigh can cause the quad muscle to be strained.
If the vastus lateralis suffers a pull injury, individuals may have pain, muscle swelling, thigh bruising, and walking difficulties.
Patellar Tendinitis
Irritation of the quad tendon that courses over the kneecap can cause patellar tendinitis.
Femoral Nerve Compression Weakness
The femoral nerve may become pinched or irritated from a herniated disc, lumbar stenosis, or arthritis.
Pain, numbness, tingling, or weakness in the thigh may result.
Iliotibial Band Friction Syndrome
Tight or weak muscles can irritate the IT band, and the vastus lateralis muscle can be affected.
Injury Rehabilitation
Injury to the vastus lateralis or quad muscles can cause pain, swelling of the thigh, or limited walking ability. Various treatments are available to help expedite recovery. A primary healthcare provider may recommend working with a physical therapy team. Self-care techniques can include:
Heat and Ice
Ice may be applied to the lateral thigh the first few days after injury to control pain and decrease swelling and inflammation.
Ice should be applied for 10 to 15 minutes.
Individuals may switch to heat two to three days after to promote circulation and improve tissue mobility.
Heat should be applied for 10 to 15 minutes.
Massage
Massage can help decrease pain and promote circulation.
Massage techniques can improve tissue mobility before stretching to help improve quadriceps motion.
Exercises and Stretching
A physical therapy team will prescribe certain exercises and stretches to help regain strength and range of motion. After an injury, quad stretching can improve the mobility and function of the muscle group.
Prone Towel Quad Stretch
Lie on your stomach and place a towel or strap around the ankle.
Bend the knee up, and gently pull on the towel to bend the knee fully.
A pulling sensation should be felt in the front of the thigh.
Hold the stretch for 30 seconds and release.
Repeat three times.
Half-kneeling Quad and Hip Flexor Stretch
Kneel on one knee.
Slowly move forward until a stretch is felt in the front of the hip and thigh.
Hold this position for 30 seconds.
Relax back to the starting position.
Repeat three times.
Back Exercises
If femoral nerve irritation coming from the lower back is causing thigh pain or weakness, exercises to release the nerve may be helpful and can include:
Prone press-ups
Supine lumbar flexion
Lumbar side glides
The exercises are designed to relieve pressure on the lumbar nerve, and postural correction exercises may be performed to maintain decompression.
Strengthening
Weakness to the vastus laterals and quads may be causing injury, and strengthening exercises may be prescribed during rehabilitation and can include:
Hip-strengthening exercises
Straight leg raises
Leg extension exercises
Lunges
Squats
Strengthening exercises should be done two to four times weekly with appropriate rest between sessions.
Balance exercises and sport-specific plyometric training may be recommended to ensure the quad functions normally.
Most quadriceps and vastus lateralis muscle injuries heal within six to eight weeks.
Recovery may be shorter or longer depending on the nature of the injury.
Injury Medical Chiropractic and Functional Medicine Clinic
By understanding the anatomy and function of the vastus lateralis muscle, a healthcare provider can help individuals understand their specific injury and develop a treatment program to rehabilitate the muscle properly. At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for you and strive to develop fitness and better the body through research methods and total wellness programs. These natural programs use the body’s ability to achieve improvement goals, and athletes can condition themselves to excel in their sport through proper fitness and nutrition. Our providers use an integrated approach to create personalized programs, often including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.
Ramírez-delaCruz, M., Bravo-Sánchez, A., Esteban-García, P., Jiménez, F., & Abián-Vicén, J. (2022). Effects of Plyometric Training on Lower Body Muscle Architecture, Tendon Structure, Stiffness, and Physical Performance: A Systematic Review and Meta-analysis. Sports medicine – open, 8(1), 40. doi.org/10.1186/s40798-022-00431-0
Can physical therapies help individuals with a Colles’ or wrist fracture?
Colles’ Fracture
A broken wrist or Colles fracture can be a painful and stressful experience. Individuals may be unable to perform their jobs or engage in recreational activities. A Colles fracture is a break in the radius bone of the forearm that occurs near the wrist, usually about an inch from the end of the bone. It’s a common type of broken wrist often caused by falling on an outstretched hand. (American Academy of Orthopaedic Surgeons, 2022) As the individual lands on their hand, the end of the radius bone breaks off and gets pushed toward the inner wrist. If the wrist is flexed when falling on the hand, the radius may break and move toward the front of the wrist. This is called a Smith’s fracture. (Matsuura, Y. et al., 2017) A physical therapy team can help improve functional mobility to quickly and safely return to normal activity.
Symptoms
Individuals who have suffered trauma to their wrist or have fallen onto their hand or wrist may have a Colles fracture. Common signs and symptoms of a wrist or Colles fracture include: (American Academy of Orthopaedic Surgeons, 2022)
Bruising
Loss of mobility in the wrist.
Swelling in the arm, wrist, or hand.
Pain
Visible deformity or a lump on the backside of the forearm near the wrist.
Initial Treatment
Individuals who have fallen and injured their wrist and hand and suspect a Colles fracture seek immediate medical attention. Call a healthcare provider or report to a local emergency clinic. Left untreated, it can result in complications and permanent loss of arm and hand function. (American Academy of Orthopaedic Surgeons, 2022)
An X-ray will show a wrist fracture.
Because of the pain and swelling, it is recommended that individuals put an ice pack on their wrists and hands until they can get to a healthcare provider or emergency room. The R.I.C.E. principle can help control swelling and lessen pain until a medical professional can provide treatment. The initial treatment is to reduce the fracture. This is where a healthcare provider situates the broken bone or bones back into the correct position to ensure proper healing. This is done manually if the fractured bone is not too far out. If the fracture is severe, a surgical procedure known as an open reduction internal fixation or ORIF may be required to reduce the fracture. (American Academy of Orthopaedic Surgeons, 2022)
Once the fracture has been reduced, it must be immobilized. This is done with a cast or a brace. Individuals may also be required to wear a sling. They may need to visit a physical therapist to learn how to wear the sling properly. It is essential to keep the bones immobilized for proper healing. Consult a healthcare provider for questions about cast, sling, or brace.
Physical Therapy
After four to six weeks of immobilization, a healthcare provider may remove the cast and refer a physical therapist or team. (American Academy of Orthopaedic Surgeons, 2022) A physical therapist may measure and evaluate pain, swelling, range of motion, and strengthening. The physical therapist may assess the surgical scar tissue and analyze the hand, wrist, and arm function of individuals who underwent an ORIF procedure to reduce the fracture. After the initial evaluation, a physical therapist will work with the patient to develop an appropriate plan of care to help improve the impairments and functional limitations. The therapist may prescribe a specific exercise program as well.
Pain and Swelling
Individuals may experience pain and swelling around their wrists and hands.
A physical therapist can provide individuals with various treatments and modalities to help decrease swelling and pain.
Range of Motion
After a Colles’ fracture, individuals may lose hand, wrist, and elbow mobility.
The shoulder may also be tight, especially after wearing a sling.
Range of motion exercises for the hand, wrist, and elbow can be prescribed.
Strength
Loss of strength is common after a Colles’ fracture.
Exercises focusing on hand, wrist, and elbow strength may be prescribed.
At-home exercises and stretches will get the best results from physical therapy.
Scar Tissue
Individuals who have had an ORIF procedure will likely have scar tissue that has developed around the surgical site.
A physical therapist may perform scar tissue massage and mobilization to help improve mobility and can train patients how to self-massage.
Injury Medical Chiropractic and Functional Medicine Clinic
After a few weeks of physical therapy, individuals should notice their mobility and strength improve while pain and swelling decrease. Individuals will find it easier to use their arms and hands to perform functional activities. While the fracture should be fully healed six to eight weeks after injury, individuals may still be limited for potentially 12 to 16 weeks. At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for every patient to restore function. If other treatment is needed, individuals will be referred to a clinic or physician best suited to their injury, condition, or ailment.
Matsuura, Y., Rokkaku, T., Kuniyoshi, K., Takahashi, K., Suzuki, T., Kanazuka, A., Akasaka, T., Hirosawa, N., Iwase, M., Yamazaki, A., Orita, S., & Ohtori, S. (2017). Smith’s fracture generally occurs after falling on the palm of the hand. Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 35(11), 2435–2441. doi.org/10.1002/jor.23556
For individuals dealing with finger injuries, which can occur from various causes, including overuse, jobs, sports, and more, can knowing the cause of finger pain help healthcare providers determine what steps to take for treatment?
Finger Injuries
Finger injuries are common and can range from minor to serious. (van Veenendaal L. M. et al., 2014) Symptoms can result from an acute injury, including broken fingers and sprains, or chronic conditions like arthritis.
Fractures
Finger fractures can vary and can be serious and lead to permanent damage, deformity, and loss of function if not treated properly. What is important is that fractures are appropriately diagnosed so the proper treatment plan can be initiated. Most finger fractures can be addressed with simple treatments, while others may require surgery. (Oetgen M. E., and Dodds S. D. 2008)
Sprain and Dislocation
Sprains and dislocations are common finger injuries. (Prucz R. B. and Friedrich J. B. 2015) Both damage the ligaments that support the finger joints. In more severe injuries, a dislocation can occur, necessitating the finger to be put back into place or reduced. Individuals with a sprain or dislocation often notice finger swelling or stiffness for months after the injury.
Ligament Damage
Some call this injury skier’s or gamekeeper’s thumb, which results from a specific type of thumb dislocation. Here, the ulnar collateral ligament of the thumb is damaged. This ligament helps keep the thumb stable and supports grip and hand strength. However, this type of ligament injury often requires surgery. (Christensen T. et al., 2016)
Arthritis
Arthritis causes damage to normal joint surfaces where two bones come together. Fingers are one of the most common locations where arthritis occurs. (Spies C. K. et al., 2018) Two types of arthritis commonly affect the fingers: osteoarthritis and rheumatoid arthritis.
Arthritis of The Thumb
Arthritis of the thumb usually occurs at the joint where the thumb meets the wrist. This joint called the carpometacarpal/CMC joint, helps with gripping and pinching. Thumb arthritis is more common in women than men and increases in frequency over 40. (Deveza L. A. et al., 2017)
Trigger Finger
Trigger finger or stenosing tenosynovitis, is a common injury that causes pain and snapping of the fingers’ tendons, resulting in a sensation of locking or catching when bending and straightening the digits. (Makkouk A. H. et al., 2008) Other symptoms include pain and stiffness in the fingers and thumb. Treatments can vary from observation, rest, splinting, injections, and surgery.
Tendon Injuries
Mallet finger
A mallet finger is an injury to the tip of the finger. Usually, it occurs when the end of a straightened finger or thumb is hit, jamming the finger. After the injury, the individual may notice that they cannot fully straighten the tip of the finger. Treatment almost always uses a splint that has to stay on for about six weeks without removal. (Alla, S. R., Deal, N. D., and Dempsey, I. J. 2014) Very rarely is a surgical procedure necessary.
Jersey Finger
This is an injury to the finger flexor tendon. The flexor tendon pulls the finger into the palm when contracting the forearm flexor muscles. The injury occurs at the tip of the finger; typically, the tendon snaps back to the finger’s base or into the palm.
Ring Injuries
Injuries to the finger while wearing wedding bands or other finger jewelry can lead to serious complications. Even minor injuries can have devastating complications if the severity of the injury is not recognized and addressed. If an injury occurs while wearing the jewelry and there is soft tissue damage, including blood circulation being cut off, immediate medical attention is necessary.
Other Injuries
Bruises
The most common finger injury is caused by direct trauma to the skin and muscles. Symptoms include pain, swelling, tenderness, and discoloration of the skin.
Cuts and Scrapes
These can range from minor to more serious, such as injuries that cut through blood vessels, nerves, and tendons.
Injury Medical Chiropractic and Functional Medicine Clinic
After the initial inflammation and swelling have subsided, a doctor will recommend a treatment plan that usually involves physical therapy, self-performed physical rehabilitation, or supervision by a physical therapist or team. At Injury Medical Chiropractic and Functional Medicine Clinic, our areas of practice include Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Wellness & Nutrition, Functional Medicine Treatments, and in-scope care protocols. We focus on what works for you to relieve pain and restore function. If other treatment is needed, individuals will be referred to a clinic or physician best suited to their injury, condition, and/or ailment.
Sports Injury Rehabilitation
References
van Veenendaal, L. M., de Klerk, G., & van der Velde, D. (2014). A painful finger as first sign of a malignancy. Geriatric orthopaedic surgery & rehabilitation, 5(1), 18–20. doi.org/10.1177/2151458514522125
Oetgen, M. E., & Dodds, S. D. (2008). Non-operative treatment of common finger injuries. Current reviews in musculoskeletal medicine, 1(2), 97–102. doi.org/10.1007/s12178-007-9014-z
Prucz, R. B., & Friedrich, J. B. (2015). Finger joint injuries. Clinics in sports medicine, 34(1), 99–116. doi.org/10.1016/j.csm.2014.09.002
Christensen, T., Sarfani, S., Shin, A. Y., & Kakar, S. (2016). Long-Term Outcomes of Primary Repair of Chronic Thumb Ulnar Collateral Ligament Injuries. Hand (New York, N.Y.), 11(3), 303–309. doi.org/10.1177/1558944716628482
Spies, C. K., Langer, M., Hahn, P., Müller, L. P., & Unglaub, F. (2018). The Treatment of Primary Arthritis of the Finger and Thumb Joint. Deutsches Arzteblatt international, 115(16), 269–275. doi.org/10.3238/arztebl.2018.0269
Deveza, L. A., Hunter, D. J., Wajon, A., Bennell, K. L., Vicenzino, B., Hodges, P., Eyles, J. P., Jongs, R., Riordan, E. A., Duong, V., Min Oo, W., O’Connell, R., & Meneses, S. R. (2017). Efficacy of combined conservative therapies on clinical outcomes in patients with thumb base osteoarthritis: protocol for a randomised, controlled trial (COMBO). BMJ open, 7(1), e014498. doi.org/10.1136/bmjopen-2016-014498
Makkouk, A. H., Oetgen, M. E., Swigart, C. R., & Dodds, S. D. (2008). Trigger finger: etiology, evaluation, and treatment. Current reviews in musculoskeletal medicine, 1(2), 92–96. doi.org/10.1007/s12178-007-9012-1
Alla, S. R., Deal, N. D., & Dempsey, I. J. (2014). Current concepts: mallet finger. Hand (New York, N.Y.), 9(2), 138–144. doi.org/10.1007/s11552-014-9609-y
Can using a cane help individuals after an injury, living with chronic pain or balance issues, or post-surgery?
Walking With A Cane
A cane is an assistive device that can help individuals walk after injury or surgery and aids with balance and stability. It can be used for:
Balance or Stability Issues
Canes can help with minor balance or stability issues, such as weakness in the leg or trunk, or after an injury.
Pain
Canes can help reduce stress on painful joints or limbs.
Independence
Canes can help people continue living independently, especially the elderly.
There are different types of canes, including single-point and quad canes. Single-point canes are generally the least expensive. Quad canes have four points and can provide more stability. It is important to use it correctly to prevent falls and injuries.
Post-surgery or Injury
A cane can help reduce pressure on the leg or back after surgery or injury. Healthcare providers may recommend a cane as a step-down device after using a walker or crutches. Before walking with the cane, ensure it is at the right height. Hold the cane in the hand on the opposite side of the injury. Hold the cane’s handle at the level of the bend in the wrist when standing with the elbow slightly bent. (American Academy of Orthopaedic Surgeons, 2020) If there are issues in both legs or a cane is used after back surgery, keep the cane in the hand with the most support.
Step forward with the cane and injured leg at the same time.
Step the non-injured leg up with the cane firmly on the ground to meet the injured leg.
The feet should be side by side.
Walking Normally
Once comfortable taking practice steps, try walking normally with the cane. Step forward with the cane and injured leg simultaneously. The cane should be off the ground when the wounded leg is in the air. Firmly plant the cane when stepping onto the injured leg. Step forward with the cane and the injured leg first, then step past the injured leg with the good leg.
Step down with the injured leg while lowering the cane to the step below.
Make sure the cane is firmly on the stairs.
Bring the good leg down to the same step.
If a handrail is available, use it. Although doing so may require moving the cane to the other hand, even if it’s on the same side as the injured leg, it will improve stability and reduce the risk of falling. Once proficient on the stairs, individuals may alternate placing one foot on each step.
Walking With Chronic Pain
Walking with a cane with a chronic pain condition is similar to using it with an injury. The location of the pain will determine which hand the cane is held in. If the pain is on the right side of the body, keep the cane on the left side or vice versa. If chronic pain is not in the legs but, for example, back pain makes it difficult to walk, hold the cane on either side, whichever feels more supportive and comfortable. If there is weakness on one side of the body or decreased sensation/numbness in one of the legs or feet, hold the cane on the opposite side of the pain, weakness, or numbness. Walking with a cane can also benefit individuals with other medical conditions. For example, assistive devices may be recommended for those with balance issues. (National Library of Medicine, 2023)
Cane Types
There are two primary types of canes, characterized by their points, and choosing the right one depends on the reason it’s needed. (Arthritis Foundation, N.D.)
Single-point
Single-point canes have one tip at the end.
These are recommended for those who need to relieve some pressure off an injured leg or need support due to occasional difficulties with balance.
Quad
Quad canes have four tips or feet to provide more stability.
They provide more support and are recommended for those with significant weakness in one leg or difficulty maintaining their balance while walking.
The traditional cane has a rounded C handle. Other types have contoured handles for a more secure grip. Talk to a doctor, physical therapist, or other health care professional for suggestions on which cane is right for you.
Losing Balance
A potential risk of using a cane is losing balance. If unable to maintain balance with a cane, individuals may want to consider a different walking device, such as a walker or crutches. To reduce the risk of falls, consider the following tips (American Academy of Orthopaedic Surgeons, 2020)
Wear shoes with nonskid soles.
Add lighting so you can see where you are walking.
Remove throw rugs or objects that can cause tripping.
Arrange furniture to allow for wide walking paths throughout the home.
Carry objects in a backpack or fanny pack rather than holding them.
Injury Medical Chiropractic and Functional Medicine Clinic
Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other associated medical professionals to develop a personalized treatment plan to help relieve muscle pain, improve the body’s flexibility and mobility, resolve musculoskeletal issues, and prevent future pain symptoms from reoccurring.
Hirayama, K., Otaka, Y., Kurayama, T., Takahashi, T., Tomita, Y., Inoue, S., Honaga, K., Kondo, K., & Osu, R. (2022). Efficiency and Stability of Step-To Gait in Slow Walking. Frontiers in human neuroscience, 15, 779920. doi.org/10.3389/fnhum.2021.779920
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