Select Page

Injury Care

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

Break Up Scar Tissue With Friction Massage

Break Up Scar Tissue With Friction Massage

For individuals having difficulty moving or functioning normally due to injury, surgery, or illness, can a chiropractic and physical therapy team help expedite recovery?

Break Up Scar Tissue With Friction Massage

Friction Massage

Individuals may develop scar tissue or tissue adhesions that limit normal motion after injury or surgery. A pain management team may use various treatments and modalities and may incorporate friction massage as part of a rehabilitation treatment plan. Friction massage, also known as transverse friction or cross friction massage, is a technique used to help improve scar tissue and adhesion mobility to move better and decrease the negative effects. The therapist uses their fingers to massage the scar in a direction that is at right angles to the scar line. It is a specialized technique that breaks up tissue adhesions that are limiting normal movement in the skin and underlying tissues. (Haris Begovic, et al., 2016)

Scar Tissue and Adhesions

For individuals who require surgery due to an injury or an orthopedic condition, their doctor will cut into the skin, tendons, and muscle tissue during the operation. Once sutured and healing has begun, scar tissue forms. Healthy tissue is made up of collagen that is comprised of cells that are arranged in a regular pattern. Healthy collagen is strong and can resist forces when tissues are pulled and stretched. (Paula Chaves, et al., 2017)

During the healing process after an injury, the collagen cells are laid down in a haphazard pattern and form scar tissue. The random accumulation of cells becomes tight and does not react well to tension and stretching forces. (Qing Chun, et al., 2016) The body can form scar tissue after a soft tissue injury, like a muscle or tendon strain. (Qing Chun, et al., 2016)

If a muscle or tendon gets strained the body will generate new collagen during the healing. The new collagen is laid down in a random fashion, and scar tissue or tissue adhesions can form that can limit the normal range of motion. Healthy tissue stretches and glides as the body moves. Scar tissue is rigid. At the site of the scar tissue, there can be some movement, but it is tight, less pliable, and can be painful. If scar tissue or adhesions are limiting motion, cross-friction massage can improve tissue gliding and sliding. This process is referred to as remodeling.

Massage Objectives

The objectives and goals of friction massage to adhesions or scar tissue may include:

  • Stimulation of nerve fibers to decrease and relieve pain.
  • Increase blood circulation to the tissues.
  • Working the affected tissue to break up scarring.
  • Collagen fibers tissue realignment.
  • Improve mechanoreceptor activity.

Massage Technique

Friction massage treatment follows a specific technique: (Paula Chaves, et al., 2017)

  • The entire area of scar tissue or adhesion should be treated.
  • If the scar tissue is in a muscle, it should be relaxed.
  • If the scar tissue is in a tendon sheath, that tendon should be slightly stretched during the procedure.
  • The therapist places two or three fingers over the scar or adhesion and moves their fingers perpendicular to the scar to smooth the collagen fibers down.
  • The fingers and underlying tissues move together.
  • The massage should feel deep and uncomfortable but not painful.
  • There may be some pain, but should remain within the individual’s tolerance.
  • If the massage is too painful, less pressure may be used.
  • After several minutes the therapist will assess the tissue mobility.
  • Specific stretches may be done to elongate the scar tissue or adhesions.
  • At-home exercises and stretches may be prescribed to maintain flexibility.


There are situations where friction massage should not be used and can include: (Paula Chaves, et al., 2017)

  • Around an active open wound.
  • If there is a bacterial infection.
  • Areas with decreased sensation.
  • If calcification is present in the muscle or tendon tissue.

The therapist will explain the procedure and inform of the goals and risks associated with it.

Diagnoses Treated

Diagnoses that can be treated with friction massage can include: (Paula Chaves, et al., 2017)

  • Muscle tears or strains.
  • For tendonitis or tendinopathy.
  • After a tendon tear.
  • Adhesive capsulitis in the shoulder/frozen shoulder.
  • Joint contracture.
  • Ligament tears.
  • Scar tissue buildup after surgery or trauma.

Friction massage is a popular technique used in physical therapy, but some research suggests it is not any more effective than other rehabilitation techniques. One study found that static stretches and exercises were more effective than massage in improving tissue length and strength in uninjured soccer players. Other studies have supported this, but individuals may find that the massage helps improve injured tissues’ movement as well. (Mohammed Ali Fakhro, et al. 2020)

The main goal of any treatment in physical therapy is to help the individual regain movement and flexibility. Friction massage, combined with targeted stretches and exercises, can help individuals expedite recovery and get back to normal.

Chiropractic Care After Accidents and Injuries


Begovic, H., Zhou, G. Q., Schuster, S., & Zheng, Y. P. (2016). The neuromotor effects of transverse friction massage. Manual therapy, 26, 70–76.

Chaves, P., Simões, D., Paço, M., Pinho, F., Duarte, J. A., & Ribeiro, F. (2017). Cyriax’s deep friction massage application parameters: Evidence from a cross-sectional study with physiotherapists. Musculoskeletal science & practice, 32, 92–97.

Chun, Q., ZhiYong, W., Fei, S., & XiQiao, W. (2016). Dynamic biological changes in fibroblasts during hypertrophic scar formation and regression. International wound journal, 13(2), 257–262.

Fakhro, M. A., Chahine, H., Srour, H., & Hijazi, K. (2020). Effect of deep transverse friction massage vs stretching on football players’ performance. World journal of orthopedics, 11(1), 47–56.

How to Recognize and Treat a Groin Strain Injury

How to Recognize and Treat a Groin Strain Injury

When a groin strain injury happens, can knowing the symptoms help in the diagnosis, treatment, and recovery times?

How to Recognize and Treat a Groin Strain Injury

Groin Strain Injury

A groin strain is an injury to an inner thigh muscle. A groin pull is a type of muscle strain affecting the adductor muscle group (the muscles help pull the legs apart). (Parisa Sedaghati, et al., 2013) The injury is caused when the muscle is stretched beyond its normal range of motion, creating superficial tears. Severe strains can tear the muscle in two. (Parisa Sedaghati, et al., 2013)

  • A groin muscle pull causes pain and tenderness that worsens when squeezing the legs together.
  • There may also be swelling or bruising in the groin or inner thigh.
  • An uncomplicated groin pull takes four to six weeks to heal with proper treatment. (Andreas Serner, et al., 2020)


A groin pull can be painful, interfering with walking, navigating stairs, and/or driving a car. In addition to pain, other symptoms around the injured area include: (Parisa Sedaghati et al., 2013)

  • A popping sound or snapping sensation when the injury occurs.
  • Increased pain when pulling the legs together.
  • Redness
  • Swelling
  • Bruising of the groin or inner thigh.

Groin pulls are graded by severity and how much they impact mobility:

Grade 1

  • Mild discomfort but not enough to limit activities.

Grade 2

  • Moderate discomfort with swelling or bruising that limits running and/or jumping.

Grade 3

  • Severe injury with significant swelling and bruising can cause pain while walking and muscle spasms.

Signs of a severe groin strain

  • Difficulty walking
  • Groin pain while sitting or resting
  • Groin pain at night
  • A healthcare provider should see severe groin pulls because the muscle may have ruptured or be on the verge of rupturing.
  • In severe cases, surgery is necessary to reattach the torn ends.

Groin pulls are sometimes accompanied by a stress fracture of the pubis/forward-facing pelvic bones, which can significantly extend healing and recovery time. (Parisa Sedaghati et al., 2013)


Groin pulls are often experienced by athletes and individuals who play sports where they must stop and change directions quickly, placing excessive strain on the adductor muscles. (Parisa Sedaghati et al., 2013) The risk is increased in individuals who: (T. Sean Lynch et al., 2017)

  • Have weak hip abductor muscles.
  • Are not in adequate physical condition.
  • Have a previous groin or hip injury.
  • Pulls can also occur from falls or extreme activities without the proper conditioning.


A healthcare provider will perform a thorough investigation to confirm the diagnosis and characterize the severity. This involves: (Juan C. Suarez et al., 2013)

Medical History Review

  • This includes any previous injuries and specifics about where and when the symptoms started.

Physical Examination

  • This involves palpating – lightly touching and pressing the groin region and manipulating the leg to understand better where and how extensive the injury is.

Imaging Studies

  • Ultrasound or X-rays.
  • If a muscle rupture or fracture is suspected, an MRI scan may be ordered to visualize soft tissue injuries and stress fractures better.

Differential Diagnosis

Certain conditions can mimic a groin pull and require different treatments. These include: (Juan C. Suarez, et al., 2013)

Sports Hernia

  • This type of inguinal hernia occurs with sports and work injuries.
  • It causes a portion of the intestine to pop through a weakened muscle in the groin.

Hip Labral Tear

  • This is a tear in the cartilage ring of the labrum outside the rim of the hip joint socket.

Hip Osteoarthritis

  • This is the wear-and-tear form of arthritis that can present with groin pain symptoms.

Osteitis Pubis

  • This is inflammation of the pubic joint and surrounding structures, usually caused by the overuse of the hip and leg muscles.

Referred Groin Pain

  • This nerve pain originates in the lower back, often due to a pinched nerve, but is felt in the groin.


Beginning treatment is conservative and includes rest, ice application, physical therapy, and prescribed gentle stretching and exercises.

  • Individuals may need crutches or a walking device to reduce pain and prevent further injury if the pain is significant. (Andreas Serner, et al., 2020)
  • Physical therapy will be a part of the treatment plan.
  • Over-the-counter pain medications like Tylenol/acetaminophen or Advil/ibuprofen can help with pain relief short term.
  • If there is severe pain from a grade 3 injury, prescription medications may be used for a short period to help minimize pain. (Andreas Serner, et al., 2020)
  • Surgery is not usually necessary. (Andreas Serner, et al., 2020)


Recovery times can vary based on the injury’s severity and physical condition before the injury.

  • Most injuries will heal within four to six weeks with rest and proper treatment.
  • Severe groin strains can take up to 12 weeks or longer if surgery is involved. (Andreas Serner, et al., 2020)

Injury Rehabilitation


Sedaghati, P., Alizadeh, M. H., Shirzad, E., & Ardjmand, A. (2013). Review of sport-induced groin injuries. Trauma monthly, 18(3), 107–112.

Serner, A., Weir, A., Tol, J. L., Thorborg, K., Lanzinger, S., Otten, R., & Hölmich, P. (2020). Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthopaedic journal of sports medicine, 8(1), 2325967119897247.

Lynch, T. S., Bedi, A., & Larson, C. M. (2017). Athletic Hip Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 25(4), 269–279.

Suarez, J. C., Ely, E. E., Mutnal, A. B., Figueroa, N. M., Klika, A. K., Patel, P. D., & Barsoum, W. K. (2013). Comprehensive approach to the evaluation of groin pain. The Journal of the American Academy of Orthopaedic Surgeons, 21(9), 558–570.

How to Identify and Treat Finger Sprains and Dislocations

How to Identify and Treat Finger Sprains and Dislocations

Finger sprains and dislocations are common hand injuries that can happen during work, physical/sports activities, or in automobile collisions and accidents. Can recognizing the symptoms help in developing an effective treatment strategy?

How to Identify and Treat Finger Sprains and Dislocations

Finger Sprains and Dislocations

Finger sprains and dislocations are common injuries of the hand that cause pain and swelling.

  • A sprain happens when the finger tissue that supports a joint gets stretched beyond its limits in a way that stresses the ligaments and tendons.
  • The ligament tissue can be partially or completely torn. If the damage is bad enough, the joint comes apart.
  • This is a dislocation – A dislocation happens when the joint in the finger gets shifted out of its normal position.
  • Both injuries can cause pain and stiffness in the finger and hand.


Finger sprains can happen any time the finger bends in an awkward or unusual way. This can happen from falling on the hand or getting hurt when engaged in physical activities like sports or household chores. Sprains can occur in any of the knuckle joints in the finger. However, most commonly, the joint in the middle of the finger gets sprained. It’s known as the proximal interphalangeal or PIP joint. (John Elfar, Tobias Mann. 2013) Symptoms of a finger sprain can include:

  • Pain when you move your finger
  • Swelling around the knuckle
  • Tenderness in the finger and around the joint
  • For a sprain, individuals may need to have imaging done to see if any of the bones in the hand are broken or fractured. (OrthoInfo. American Academy of Orthopaedic Surgeons. 2022)


Individuals are encouraged not to move the injured finger while in recovery and healing. It can be hard to do, but wearing a splint can help.

  • Splints are supports that are usually made from foam and pliable metal.
  • A sprained finger can also be taped to one of the fingers next to it while in recovery, known as buddy-taping.
  • Splinting a sprained finger while engaged in activities can protect the hand from worsening or further injury.
  • However, splinting the finger when it is not needed can cause the joint to become stiff. (OrthoInfo. American Academy of Orthopaedic Surgeons. 2022)
  1. An injury known as “gamekeeper’s thumb” is a more serious type of sprain.
  2. Injury to the ligaments at the thumb joint can cause difficulty in pinching and gripping.
  3. This injury must often be taped up or splinted for a significant amount of time for full recovery and could require surgery. (Chen-Yu Hung, Matthew Varacallo, Ke-Vin Chang. 2023)

Other treatments to help a sprained finger include:

  • Elevate the hand if swelling and inflamed.
  • Gentle finger exercises/movements to prevent stiffness.
  • Icing the injured finger.
  • Take an anti-inflammatory medication.

Individuals who have not broken bones or dislocated the joint will probably be able to move their finger in about a week. A doctor will set a timeline for when to start using the finger normally.

  1. Individuals who sprain their finger that feels swollen and stiff for longer than a few weeks are recommended to consult a doctor or specialist.
  2. They will need to check the hand to make ensure there aren’t any breaks or fractures. (OrthoInfo. American Academy of Orthopaedic Surgeons. 2022)
  3. Thumb sprains and finger sprains in children may need to be splinted or taped for longer periods, as the ligament is not fully developed or as strong, which could lead to a tear.


A finger dislocation is a more severe injury involving the ligament, joint capsule, cartilage, and other tissues that causes misalignment of the finger. The ligaments and the joint capsule get torn when a joint is dislocated. The joint needs to be reset, which can be a simple process, or in severe cases, patients may need to be placed under anesthesia or undergo surgery to reset the joint properly.

  • In these cases, tendons or other tissues might be preventing the joint from getting into position.
  • Putting the finger back into the right position is known as”reduction.” Once reduced, the finger needs to be splinted.
  • Individuals also need an X-ray to ensure the joint is lined up correctly and that any bones were not broken or fractured when they sustained the injury. (James R. Borchers, Thomas M. Best. 2012)
  • Once reset, caring for a dislocated finger is basically the same as a sprained finger. Using ice on the finger, keeping the hand elevated to reduce swelling.
  • Individuals need to check with their doctor to find out when to start moving the finger. (James R. Borchers, Thomas M. Best. 2012)

The Chiropractic Approach To Improving Health


Elfar, J., & Mann, T. (2013). Fracture-dislocations of the proximal interphalangeal joint. The Journal of the American Academy of Orthopaedic Surgeons, 21(2), 88–98.

OrthoInfo from the American Academy of Orthopaedic Surgeons. (2022) Hand fractures.

Hung, C. Y., Varacallo, M., & Chang, K. V. (2023). Gamekeeper’s Thumb. In StatPearls. StatPearls Publishing.

OrthoInfo from the American Academy of Orthopaedic Surgeons. (2022) Finger fractures.

Borchers, J. R., & Best, T. M. (2012). Common finger fractures and dislocations. American family physician, 85(8), 805–810.

Using Natural Biologics for Faster Injury Recovery

Using Natural Biologics for Faster Injury Recovery

As the body grows older the ability to live life to the fullest can be difficult. Can using natural biologics help enhance the body’s natural ability to heal?

Natural Biologics

Though sometimes a necessary treatment option, surgical procedures can be the first line of treatment introduced to patients. Natural biologics is a less invasive alternative that can eliminate hospitalizations and expedite recovery. (Riham Mohamed Aly, 2020)

What Are They?

The body is born with components to initiate healing and recovery. These components include:

  • Cells
  • Cytokines
  • Proteins
  • Collagens
  • Elastin
  • Hyaluronic acid

At the time of birth, these components are in abundance but decrease as the body ages. This is why children recover from injuries quicker than adults.  Recovery for adults can be slower from a decrease in these natural healing components. The objective of natural biologics treatments is to increase the healing components by reintroducing the body’s own components – autologous – or by bringing in new components – allogeneic – from a donor. (National Institutes of Health 2016) Choosing between the two options depends on an individual’s age and health, as those who are older or in poor physical health may experience complications from inferior component amounts.

  • Healing components derived from donor sources can show more promise, as treatments are usually acquired from discarded birth tissues at delivery.
  • Birth tissues are rich in healing components, containing the most abundant collection of natural healing elements.
  • It’s important to note that there is no harm to the mother or the baby from the obtained tissue products.

Using Natural Biologics for Faster Injury Recovery

Autologous Treatment

Derived from the individual receiving the cell therapy. (Yun Qian, et al., 2017)

Platelet-Rich Plasma – PRP

  • Platelet-rich plasma is cultivated by drawing an individual’s blood and spinning it in a centrifuge to separate the plasma.
  • The resulting liquid is reinjected into the injured area to generate a healing environment.
  • This form of natural biologics is effective for individuals with minor injuries that can be repaired easily.
  • This process is not as effective for older individuals who already have a reduction in natural healing components.
  • Lifestyle factors such as smoking, unhealthy diet, and alcohol/substance abuse can decrease the effectiveness of PRP treatments.

Bone Marrow Aspirate

  • This is an invasive, painful process that begins by putting a patient under anesthesia and drilling into the bone to extract the marrow. (American Cancer Society, 2023)
  • Like PRP, success depends on the individual’s age, health, and lifestyle.
  • Invasive procedures like this have a higher probability of infection and require a long-term recovery period.

Adipose-Derived Stem Cells

  • Adipose tissue/fat treatments are collected through a procedure that resembles the process of liposuction.
  • The procedure is done under general anesthesia and is an invasive process.
  • Once the tissue is collected, the cells are separated and reinjected. (Loubna Mazini, et al. 2020)
  • The treatment’s success depends on the individual’s health, age, and lifestyle.
  • There is more risk of infection when choosing this procedure and a long-term recovery period.

Allogeneic Treatment

Donor-based regenerative cells.

Amniotic Fluid Therapy

Amniotic fluid contains various growth factors, cytokines, and anti-inflammatory proteins that may promote tissue repair, reduce inflammation, and stimulate cellular regeneration. (Petra Klemmt. 2012)

  • Collected at the time of birth, this therapy is an ideal treatment for individuals who have sustained injuries that affect day-to-day functionality.
  • Physicians and clinicians are utilizing amniotic fluid therapy to treat many conditions, from orthopedic to wound care.
  • Amniotic fluid is collected at the time of birth and is abundant with increased healing components compared to autologous sources.
  • Amniotic fluid is immune-privileged (limits or suppresses immune response) and the risk of rejection is rare.
  • These therapies are usually done in a physician’s office with minimal downtime after treatment.

Wharton’s Jelly

  • Wharton’s jelly is derived from the umbilical cord at the time of birth and is primarily composed of a gel substance made up of hyaluronic acid and a network of collagen fibers.
  • Its unique properties make it ideal for protecting and supporting the umbilical cord. (Vikram Sabapathy, et al., 2014)
  • Believed to contain a population of mesenchymal stem cells that have the capacity to differentiate into various cell types, and other secreted growth factors and cytokines. (F. Gao, et al., 2016)
  • It is considered the most valuable source to enhance the healing of various tissues, including bone, cartilage, skin, and nerve tissue.
  • It is immune-privileged with little risk of rejection and minimal if any, recovery time after an in-office treatment.


  • Exosomes are small, membrane-bound vesicles that play a role in intercellular communication within the body. (Carl Randall Harrell, et al., 2019)
  • They contain a variety of bioactive molecules, including proteins, lipids, nucleic acids (like RNA), and signaling molecules.
  • They serve as vehicles for transferring the signaling molecules from one cell to another, allowing cells to influence the behavior and function of neighboring or distant cells.
  • They can be collected or isolated from various biological fluids and cell cultures through specialized techniques but are most robust when collected at birth.
  • The exosomes within the umbilical cord are utilized for tissue repair and regeneration, signaling the cells to promote:
  • Proliferation – increase in the number of cells through cell division.
  • Differentiation – the transformation of unspecialized cells into specialized cells.
  • Tissue healing in damaged or injured areas.
  • Exosomes from the umbilical cord are immune-privileged with minimal risk of rejection.
  • Treatments are ideal for increasing cell communication and initiating repair when paired with another source of allogeneic therapy like amniotic fluid or Wharton’s Jelly.

Choosing which natural biologics therapy is the best is different for everyone. When selecting a treatment, it is essential for individuals to consult their primary healthcare provider to determine which application will have optimal results.

Is Motion Key To Healing?


Aly R. M. (2020). Current state of stem cell-based therapies: an overview. Stem cell investigation, 7, 8.

National Institutes of Health. (2016). Stem Cell Basics.

Qian, Y., Han, Q., Chen, W., Song, J., Zhao, X., Ouyang, Y., Yuan, W., & Fan, C. (2017). Platelet-Rich Plasma Derived Growth Factors Contribute to Stem Cell Differentiation in Musculoskeletal Regeneration. Frontiers in chemistry, 5, 89.

American Cancer Society. (2023). Types of Stem Cell and Bone Marrow Transplants.

Mazini, L., Rochette, L., Admou, B., Amal, S., & Malka, G. (2020). Hopes and Limits of Adipose-Derived Stem Cells (ADSCs) and Mesenchymal Stem Cells (MSCs) in Wound Healing. International journal of molecular sciences, 21(4), 1306.

Klemmt P. (2012). Application of amniotic fluid stem cells in basic science and tissue regeneration. Organogenesis, 8(3), 76.

Sabapathy, V., Sundaram, B., V M, S., Mankuzhy, P., & Kumar, S. (2014). Human Wharton’s Jelly Mesenchymal Stem Cells plasticity augments scar-free skin wound healing with hair growth. PloS one, 9(4), e93726.

Gao, F., Chiu, S. M., Motan, D. A., Zhang, Z., Chen, L., Ji, H. L., Tse, H. F., Fu, Q. L., & Lian, Q. (2016). Mesenchymal stem cells and immunomodulation: current status and future prospects. Cell death & disease, 7(1), e2062.

Harrell, C. R., Jovicic, N., Djonov, V., Arsenijevic, N., & Volarevic, V. (2019). Mesenchymal Stem Cell-Derived Exosomes and Other Extracellular Vesicles as New Remedies in the Therapy of Inflammatory Diseases. Cells, 8(12), 1605.

Pulled Muscle Treatment: Tips to Get You Back in Motion

Pulled Muscle Treatment: Tips to Get You Back in Motion

When individuals experience a neuromusculoskeletal injury strain, can following basic pulled muscle treatment protocols help in healing and a full recovery?

Pulled Muscle Treatment

Pulled Muscle Treatment

A pulled muscle or muscle strain occurs when a muscle is stretched beyond its ability resulting in discomfort symptoms and mobility issues. Microscopic tears can occur within the muscle fibers potentially worsening the injury. This type of injury usually causes mild to severe pain, bruising, and immobility, and nerve injuries can develop as well. Common muscle strains include:

  • Pulled hamstrings
  • Groin strains
  • Pulled abdominal muscles
  • Calf strains

Pulled muscle treatment requires patience to promote proper healing and restoration of optimal function.

  • Individuals need to focus on the different stages of healing.
  • Gradually increase activity levels as the body allows to prevent stiffness and atrophy which can cause complications.


The usual symptoms of this type of injury include:

  • Pain
  • Limited mobility
  • Muscle spasms
  • Swelling
  • Bruising
  • Often individuals will feel a sudden grabbing or tearing sensation and are then unable to continue the activity.


Muscle strain injuries are graded by severity: (Hospital for Special Surgery. 2019)

Grade I

  • Mild discomfort.
  • Often there is no disability.
  • Usually does not limit activity.

Grade II

  • Moderate discomfort
  • Can limit the ability to perform certain activities.
  • May have moderate swelling and bruising.

Grade III

  • Severe injury that can cause significant pain.
  • Muscle spasms.
  • Swelling.
  • Significant bruising.

Basic Treatment Protocols

Most pulled muscle strain injuries heal with simple treatment. Following the right steps can ensure an expedited recovery. In the early stages after the injury, there is a balance between doing too much or not enough. The amount of activity an individual will be able to do, and the time required for recovery depends on the severity of the injury. Here are some guidelines in the right direction.


  • Rest is recommended for the early recovery stage.
  • Depending on the severity of the injury this could last from one to five days.
  • Immobilization is usually not necessary, and not moving at all can lead to muscle and joint stiffness.
  • This can be harmful and interfere with mobility. (Joel M. Kary. 2010)
  • If immobilization is necessary, like using a splint or cast, careful supervision should be monitored by a healthcare provider.

Cold Therapy

  • Cold therapy should begin as soon as possible after sustaining a pulled muscle.
  • The therapy/ice helps reduce swelling, bleeding, and pain. (Gerard A Malanga, Ning Yan, Jill Stark. 2015)
  • Cold therapy applications can be done frequently, but should not exceed 15 minutes at a time.


  • Stretching is important to relax the muscles and for pre-mobilization.
  • Muscles that maintain flexibility help prevent further injury.


  • The injury and the rest period can decrease the strength of the muscle.
  • It is important to rebuild strength before returning to physical activities.
  • Strengthened muscles help prevent re-injury.

Increased Activity to Prevent Muscle Fatigue

Properly Warming Up

  • Warming up before taking on physical activities will help loosen the muscles and prevent injuries.
  • Beginning work or exercise with stiff muscles can lead to an increased chance of strain.
  • Studies have shown that temperature can influence the stiffness of a muscle. (K. W. Ranatunga. 2018)
  • Maintaining body and muscle warmth helps prevent injury and re-injury.

Injuries and Chiropractic: The Road To Recovery


Hospital for Special Surgery, Muscle Strain: What You Need to Know About Pulled Muscles.

Kary J. M. (2010). Diagnosis and management of quadriceps strains and contusions. Current reviews in musculoskeletal medicine, 3(1-4), 26–31.

Malanga, G. A., Yan, N., & Stark, J. (2015). Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate medicine, 127(1), 57–65.

Mair, S. D., Seaber, A. V., Glisson, R. R., & Garrett, W. E., Jr (1996). The role of fatigue in susceptibility to acute muscle strain injury. The American journal of sports medicine, 24(2), 137–143.

Ranatunga K. W. (2018). Temperature Effects on Force and Actin⁻Myosin Interaction in Muscle: A Look Back on Some Experimental Findings. International journal of molecular sciences, 19(5), 1538.

Symptoms and Treatment for Broken Collarbones

Symptoms and Treatment for Broken Collarbones

For individuals with a broken collarbone, can conservative treatment help in the rehabilitation process?

Symptoms and Treatment for Broken Collarbones

Broken Collarbone

Broken collarbones are very common orthopedic injuries that can occur in any age group. Also known as the clavicle, it is the bone over the top of the chest, between the breastbone/sternum and the shoulder blade/scapula. The clavicle can be easily seen because only skin covers a large part of the bone. Clavicle fractures are extremely common, and account for 2% – 5% of all fractures. (Radiopaedia. 2023) Broken collarbones occur in:

  • Babies – usually during birth.
  • Children and adolescents – because the clavicle does not fully develop until the late teens.
  • Athletes – because of the risks of being hit or falling.
  • Through various types of accidents and falls.
  • The majority of broken collarbones can be treated with nonsurgical treatments, usually, with a sling to let the bone heal and physical therapy and rehabilitation.
  • Sometimes, when clavicle fractures are significantly shifted out of alignment, surgical treatment may be recommended.
  • There are treatment options that should be discussed with an orthopedic surgeon, physical therapist, and/or a chiropractor.
  • A broken collarbone is not more serious than other broken bones.
  • Once the broken bone heals, most individuals have a full range of motion and can return to the activities before the fracture. (Johns Hopkins Medicine. 2023)


Broken clavicle injuries are separated into three types depending on the location of the fracture. (Radiopaedia. 2023)

Mid-Shaft Clavicle Fractures

  • These occur in the central area which can be a simple crack, separation, and/or fractured into many pieces.
  • Multiple breaks – segmental fractures.
  • Significant displacement – separation.
  • Shortened length of the bone.

Distal Clavicle Fractures

  • These happen close to the end of the collarbone at the shoulder joint.
  • This part of the shoulder is called the acromioclavicular/AC joint.
  • Distal clavicle fractures can have similar treatment options as an AC joint injury.

Medial Clavicle Fractures

  • These are less common and often related to injury to the sternoclavicular joint.
  • The sternoclavicular joint supports the shoulder and is the only joint that connects the arm to the body.
  • Growth plate fractures of the clavicle can be seen into the late teens and early 20s.


Common symptoms of a broken collarbone include: (National Library of Medicine: MedlinePlus. 2022)

  • Pain over the collarbone.
  • Shoulder pain.
  • Difficulty moving the arm.
  • Difficulty raising the arm from the side.
  • Swelling and bruising around the shoulder.
  • The bruising can extend down to the chest and armpit.
  • Numbness and tingling down the arm.
  • Deformity of the collarbone.
  1. In addition to swelling, some individuals may have a bump in the place where the fracture occurred.
  2. It can take several months for this bump to fully heal, but this is normal.
  3. If the bump appears inflamed or irritated, inform a healthcare provider.

Clavicular Swelling

  • When the sternoclavicular joint swells up or gets bigger, it is referred to as clavicular swelling.
  • It is commonly caused by trauma, disease, or an infection that affects the fluid found in the joints. (John Edwin, et al., 2018)


  • At the healthcare clinic or emergency room, an X-ray will be obtained to assess for the specific type of fracture.
  • They will perform an examination to ensure the nerves and blood vessels surrounding the broken collarbone are unsevered.
  • The nerves and vessels are rarely injured, but in severe cases, these injuries can occur.


Treatment is accomplished either by allowing the bone to heal or by surgical procedures to restore the proper alignment. Some common treatments for broken bones are not used for clavicle fractures.

  • For example, casting a broken collarbone is not done.
  • In addition, resetting the bone or a closed reduction is not done because there is no way to hold the broken bone in proper alignment without surgery.

If surgery is an option the healthcare provider looks at the following factors: (UpToDate. 2023)

Location of Fracture and Degree of Displacement

  • Nondisplaced or minimally displaced fractures are usually managed without surgery.


  • Younger individuals have an increased ability to recover from fractures without surgery.

Shortening of the Fracture Fragment

  • Displaced fractures can heal, but when there is a pronounced shortening of the collarbone, surgery is probably necessary.

Other Injuries

  • Individuals with head injuries or multiple fractures can be treated without surgery.

Patient Expectations

  • When the injury involves an athlete, heavy job occupation, or the arm is the dominant extremity, there can be more reason for surgery.

Dominant Arm

  • When fractures occur in the dominant arm, the effects are more likely to be noticeable.

The majority of these fractures can be managed without surgery, but there are situations where surgery can produce better results.

Supports for Non-surgical Treatment

  • A sling or figure-8 clavicle brace.
  • The figure-8 brace has not been shown to affect fracture alignment, and many individuals generally find a sling more comfortable. (UpToDate. 2023)
  1. Broken collarbones should heal within 6–12 weeks in adults
  2. 3–6 weeks in children
  3. Younger patients are usually back to full activities before 12 weeks.
  4. The pain usually subsides within a few weeks. (UpToDate. 2023)
  5. Immobilization is rarely needed beyond a few weeks, and with a doctor’s clearance light activity and gentle motion rehabilitation usually begins.

Long-Lasting Injuries


Radiopaedia. Clavicular fracture.

Johns Hopkins Medicine. Clavicle fractures.

National Library of Medicine: MedlinePlus. Broken collarbone – aftercare.

UpToDate. Clavicle fractures.

Edwin, J., Ahmed, S., Verma, S., Tytherleigh-Strong, G., Karuppaiah, K., & Sinha, J. (2018). Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies. EFORT open reviews, 3(8), 471–484.

Cervical Acceleration – Deceleration – CAD

Cervical Acceleration – Deceleration – CAD

Individuals who have suffered cervical acceleration-deceleration/CAD more commonly known as whiplash, can experience headaches, and other symptoms like neck stiffness, pain, fatigue, and shoulder/neck/back discomfort. Can non-surgical and conservative treatments help alleviate the symptoms?

Cervical Acceleration - Deceleration - CAD

Cervical Acceleration – Deceleration or CAD

Cervical acceleration-deceleration is the mechanism of a neck injury caused by a forceful back-and-forth neck motion. It happens most commonly in rear-end vehicle collisions when the head and neck whip forward and backward with intense acceleration and/or deceleration causing the neck to flex and/or extend rapidly, more than normally, straining and possibly tearing muscle tissues and nerves, ligaments, dislocation of spinal discs and herniations, and cervical bone fractures.

  • For symptoms that do not improve or worsen after 2 to 3 weeks, see a healthcare provider or chiropractor for further evaluation and treatment.
  • Whiplash injuries strain or sprain the neck muscles and/or ligaments, but can also affect the vertebrae/bones, disc cushions between the vertebrae, and/or the nerves.
  • For individuals who experience a headache that starts at the base of the skull following a motor vehicle accident is more than likely a whiplash headache. (National Institute of Neurological Disorders and Stroke. 2023)


Whiplash symptoms can present right away, or after several hours to a few days after the incident, and tend to worsen in the days after the injury. Symptoms can last a few weeks to a few months, and can severely limit activity and range of motion. Symptoms can include: (National Institute of Neurological Disorders and Stroke. 2023)

  • Pain that extends into the shoulders and back.
  • Neck stiffness
  • Limited neck motion
  • Muscle spasms
  • Numbness and tingling sensations – paresthesias or pins and needles in the fingers, hands, or arms.
  • Sleep problems
  • Fatigue
  • Irritability
  • Cognitive impairment – memory and/or concentrating difficulties.
  • Ringing in the ears – tinnitus
  • Dizziness
  • Blurred vision
  • Depression
  • Headaches – A whiplash headache usually starts at the base of the skull and can vary in intensity. Most individuals experience pain on one side of the head and toward the back, though some can experience symptoms all over their head, and a small number experience headaches on the forehead or behind the eyes. (Monica Drottning. 2003)
  • The headaches can become aggravated by moving the neck around, especially when looking up.
  • Headaches are often associated with shoulder pain along with sensitive neck and shoulder muscles that when touched can increase pain levels.
  • Whiplash headaches can lead to chronic neck-related headaches known as cervicogenic headaches. (Phil Page. 2011)


The most common cause of whiplash is rear-end automobile accidents and collisions. (National Institute of Neurological Disorders and Stroke. 2023)
However, cervical acceleration-deceleration injuries can also occur from:

  • Playing sports – hockey, martial arts, boxing, tackle football, gymnastics, basketball, volleyball, soccer, and baseball.
  • A slip and fall that causes the head to suddenly jolt forward and back.
  • Physical assault – getting punched or shaken.
  • Being struck on the head by a heavy or solid object.


  1. Symptoms usually resolve within 2 to 3 weeks.
  2. Icing the neck for 10 minutes several times a day can help reduce pain and inflammation. (National Institute of Neurological Disorders and Stroke. 2023)
  3. It is also important to rest your neck area following the injury.
  4. A cervical collar can be utilized temporarily to stabilize the neck, but for long-term recovery, it is recommended to keep the area mobile.
  5. Physical activity reduction until the individual can look over both shoulders, and tilt their head all the way forward, all the way back, and from side to side without pain or stiffness.

Additional Treatments

  • Traction and decompression therapies.
  • Chiropractic adjustments
  • Therapeutic various massage techniques.
  • Electronic nerve stimulation
  • Posture retraining
  • Stretching
  • Sleep position adjustments.
  • Non-steroidal anti-inflammatories – NSAIDs – Ibuprofen or Naproxen.
  • Muscle relaxers

If symptoms do not improve, a healthcare provider may recommend physical therapy and/or stronger pain medications. For whiplash headaches that last for several months, acupuncture, or spinal injections may be recommended.

Neck Injuries


National Institute of Neurological Disorders and Stroke. Whiplash Information Page.

Drottning M. (2003). Cervicogenic headache after a whiplash injury. Current pain and headache reports, 7(5), 384–386.

Page P. (2011). Cervicogenic headaches: an evidence-led approach to clinical management. International journal of sports physical therapy, 6(3), 254–266.