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
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
Can knowing the characteristics of each stage of healing help expedite recovery for individuals who are healing after neck and back injuries?
Back or Neck Injury Healing Stages
At each stage, different things happen at the injury site. This means recommended exercises and activity levels will vary depending on how long it’s been since the injury. The stages to know about when healing from a neck or back injury. (Brumitt J., and Cuddeford T. 2015)
Inflammation or Acute Stage
Also known as the inflammatory stage, the acute stage occurs during the injury and can continue for 72 hours. The body releases repair chemicals in response to tissue damage, causing inflammation and pain. Symptoms of inflammation, including redness, swelling, pain at rest, and diminished function, are expected. Inflammation and pain during the inflammation stage are caused by the body’s repair chemicals released in response to tissue damage. (Wu, Y. S. and Chen S. N. 2014) The biological reaction decreases mobility so the injured area can rest and heal, but the substances that promote healing also cause pain and swelling. (Shah A. and Amini-Nik S. 2017) Scar tissue also begins to form during the inflammatory stage. (Wilgus T. A. 2020) Initial treatment focuses on reducing pain, swelling, and muscle spasms. Individuals are encouraged to use ice packs, compression, and over-the-counter anti-inflammatory medications like ibuprofen or naproxen. (Duchesne E., Dufresne S. S., and Dumont N. A. 2017)
Subacute Stage
Inflammation decreases, and new connective tissue and capillaries grow to help repair damaged structures. The subacute phase generates new connective tissue and capillary growth and reduced inflammation. (Brumitt J., and Cuddeford T. 2015) Scar tissue continues to grow during this time, as well. The tissues are still fragile at this stage, stressing the injured area should be limited to when the therapist or doctor is examining or working with the patient. Most physical therapists recommend beginning with gentle movement during the subacute phase and gradually building up the intensity of exercise. Mild isometric and low-intensity exercises are often used. Because activity is restricted, the muscles may seem weak. Depending on the severity of the injury and the type of tissue that was injured (i.e., tendons have less blood circulation and tend to heal more slowly, it can take a few days to several weeks. (Brumitt J., and Cuddeford T. 2015)
The Chronic Stage or Maturation
The inflammation disappears entirely during the chronic or maturation stage of neck or back injury healing. The new collagen fibers build strength, and the wound shrinks. (Brumitt J., and Cuddeford T. 2015) During this stage, pain associated with the injury tends to be limited to the end joint’s range of motion. The first ten weeks of the chronic stage are essential for engaging in exercises that enhance healing and help remodel the fibers so they will function as close as possible to the way they did before the injury. (Azevedo P. S. et al., 2016) Exercises during the ten weeks are important because otherwise, individuals can permanently lose some of their ability to move and function.
After around ten weeks, the scar tissue can permanently change, so re-acquiring strength and flexibility may necessitate surgery or manual release treatment from a physical therapist or chiropractor. During this time, the scar tissue can be remodeled with exercise, meaning that the activities and motions performed on the injured area will affect the formation of new tissue fibers. The chronic stage of healing begins after 21 days and doesn’t end after the 10-week prime time (Brumitt J., and Cuddeford T. 2015). It can continue for quite some time.
Treatment
Treatment focuses on engaging the injured muscles in light isometric contractions to help align new collagen fibers. Physical therapy helps rebuild mobility, strength, balance, and flexibility and can also help learn about injury and how to recover. A treatment that may also help during these phases is massage therapy. Extended bed rest or immobility can prolong symptoms and delay recovery. Tips to manage pain and recovery:
When sitting for long periods, get up and move around frequently.
Wear comfortable shoes.
When driving long distances, stop frequently to stand up and walk around.
Sleep on the side with a small pillow between the knees.
Limit how much weight is carried.
Add exercises gradually.
Most symptoms of back strain or sprain improve in about two weeks. Individuals may need additional treatment if symptoms continue for longer than two weeks. Maintaining exercises will continue to make the body stronger, more flexible, more functional, and pain-free.
Chiropractic Care for Healing After Trauma
References
Brumitt, J., & Cuddeford, T. (2015). CURRENT CONCEPTS OF MUSCLE AND TENDON ADAPTATION TO STRENGTH AND CONDITIONING. International journal of sports physical therapy, 10(6), 748–759.
Wu, Y. S., & Chen, S. N. (2014). Apoptotic cell: linkage of inflammation and wound healing. Frontiers in pharmacology, 5, 1. doi.org/10.3389/fphar.2014.00001
Shah, A., & Amini-Nik, S. (2017). The Role of Phytochemicals in the Inflammatory Phase of Wound Healing. International journal of molecular sciences, 18(5), 1068. doi.org/10.3390/ijms18051068
Wilgus T. A. (2020). Inflammation as an orchestrator of cutaneous scar formation: a review of the literature. Plastic and aesthetic research, 7, 54. doi.org/10.20517/2347-9264.2020.150
Duchesne, E., Dufresne, S. S., & Dumont, N. A. (2017). Impact of Inflammation and Anti-inflammatory Modalities on Skeletal Muscle Healing: From Fundamental Research to the Clinic. Physical therapy, 97(8), 807–817. doi.org/10.1093/ptj/pzx056
Azevedo, P. S., Polegato, B. F., Minicucci, M. F., Paiva, S. A., & Zornoff, L. A. (2016). Cardiac Remodeling: Concepts, Clinical Impact, Pathophysiological Mechanisms and Pharmacologic Treatment. Arquivos brasileiros de cardiologia, 106(1), 62–69. doi.org/10.5935/abc.20160005
Individuals who have sustained trauma to the knee area from work, physical activity, or a motor vehicle collision can experience significant pain and mobility impairment. Can physical therapy help heal and strengthen the PLC?
Posterolateral Corner Knee Injury
The posterolateral corner, or PLC, comprises muscles, tendons, and ligaments in the back of the knee that help support and stabilize the outside region. The primary role of the PLC is to prevent the knee from excessive amounts of rotation or bowing/turning outward. (Chahla J. et al., 2016) Posterolateral corner injuries can cause significant pain and can dramatically impact an individual’s ability to walk, work, or maintain independence. Treatment options will depend on the severity of the injury.
The Posterolateral Corner
The posterolateral corner comprises multiple structures that support and stabilize the outside of the knee. The structures are subdivided into primary and secondary stabilizers. The primary group includes:
The primary role is to prevent the knee from excessively turning outward, so the grouping provides secondary assistance in preventing the lower leg bone/tibia from shifting forward or backward on the thighbone/femur. Occasionally, one or several posterolateral corner structures can be sprained, strained, or torn.
How Injury Occurs
An injury occurs when a direct blow to the inner portion of the front of the knee causes the leg to bow outward. A posterolateral corner injury may also be sustained without contact, for example, if the knee hyperextends or buckles away from the other leg into a varus/bow leg position. Because the knee usually moves during a PLC, concurrent sprains or tears to the anterior cruciate ligament/ACL or posterior cruciate ligament/PCL are also common. (Chahla J. et al., 2016) Other situations that can also cause PLC injuries include automobile crashes and falls from elevated surfaces. (Shon O. J. et al., 2017) When this type of trauma causes a posterolateral corner injury, bone fractures are also common.
Symptoms
Depending on the severity of the injury, multiple symptoms may be present, including:
For individuals who suspect that they have sustained a PLC injury or have any of the symptoms listed, it is critical to be seen by an orthopedic specialist or emergency room physician. A healthcare provider will properly evaluate the leg and develop the appropriate treatment.
Diagnosis
Diagnosis begins with a comprehensive examination. In addition to looking for the symptoms noted, a healthcare provider will move the legs in different directions to assess for any instability. The dial test may be performed, which involves having the patient lie on their stomach while the healthcare professional assesses the side-to-side rotation in the leg to check for excessive motion. (Shon O. J. et al., 2017) Imaging is frequently ordered to determine which anatomical structures are affected more accurately. X-rays can help rule out concurrent fractures and check for excessive laxity in the knee area. MRIs are also useful for visualizing the various tendons and ligaments, helping the healthcare provider look closely at any sprains or tears that may have occurred. However, MRIs may be less accurate in diagnosing PLC injuries after 12 weeks, so they should be obtained as soon as possible. Based on this evaluation, the injury may be classified using the following system (Shon O. J. et al., 2017)
Grade 1
0 to 5 degrees of rotational or varus/bowing instability.
Incompletely torn posterolateral corner.
Grade 2
6 to 10 degrees of rotational or varus/bowing instability.
Incompletely torn posterolateral corner.
Grade 3
Eleven or more degrees of rotational or varus/bowing instability.
Completely torn posterolateral corner.
Treatment
The care received after a posterolateral corner injury can vary depending on the structures involved and the overall severity.
Nonsurgical
Nonsurgical treatment is typically reserved for isolated grade 1 or 2 PLC injuries. (Shon O. J. et al., 2017) Depending on which structures are affected, a stabilizing brace may be worn, and crutches are often needed to decrease the strain on the knee. Physical therapy is also commonly prescribed and focuses on the following goals:
Gradually reintroducing specific movements like running and jumping.
Surgery
Non-surgical treatment tends not to work with grade 3 injuries. If surgery is not performed, individuals may also suffer from chronic knee instability or develop long-term osteoarthritis. (Chahla J. et al., 2019) Surgical treatment is often recommended for grade 3 injuries. The damaged primary stabilizers are surgically reconstructed using a graft from another body region. Surgical repairs may also be performed on any secondary stabilizers to improve stability. (Chahla J. et al., 2019) Any other ligament injuries, such as ACL, PCL, or concurrent fractures, will also be addressed. Following the procedure, individuals immobilize their knee with a brace and do not place weight on the affected leg to protect the surgical area. Depending on the surgeon’s recommendations, this can last six weeks or more. Physical therapy is also initiated after a surgical procedure. Though rehabilitation progresses slowly, the goals are often the same as when treating milder PLC injuries. Returning to work, sports, and/or physical activity after surgery may take six months of therapy or more. (Shon O. J. et al., 2017)
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment program through an integrated approach to treat injuries and chronic pain syndromes, improve flexibility, mobility, and agility, relieve pain, and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Knee Injury Rehabilitation
References
Chahla, J., Moatshe, G., Dean, C. S., & LaPrade, R. F. (2016). Posterolateral Corner of the Knee: Current Concepts. The archives of bone and joint surgery, 4(2), 97–103.
Shon, O. J., Park, J. W., & Kim, B. J. (2017). Current Concepts of Posterolateral Corner Injuries of the Knee. Knee surgery & related research, 29(4), 256–268. doi.org/10.5792/ksrr.16.029
Chahla, J., Murray, I. R., Robinson, J., Lagae, K., Margheritini, F., Fritsch, B., Leyes, M., Barenius, B., Pujol, N., Engebretsen, L., Lind, M., Cohen, M., Maestu, R., Getgood, A., Ferrer, G., Villascusa, S., Uchida, S., Levy, B. A., Von Bormann, R., Brown, C., … Gelber, P. E. (2019). Posterolateral corner of the knee: an expert consensus statement on diagnosis, classification, treatment, and rehabilitation. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 27(8), 2520–2529. doi.org/10.1007/s00167-018-5260-4
Can neurological physical therapy help individuals diagnosed with a recently acquired or chronic neurological condition gain strength and functioning?
Neurological Physical Therapy
Neurological physical therapy can be extremely beneficial. It aims to restore functional mobility, strength, balance, and coordination in those with neurological conditions that affect their quality of life and ability to move around. It also helps recover from neurological injuries or prevent the progression and worsening of chronic neurological conditions. Depending on the severity of the condition, individuals may receive this therapy as an inpatient or outpatient. Exercise can help improve mobility, increase independence, and decrease the need for assistance, all of which can improve one’s quality of life.
Process
Neurological physical therapy is geared toward treating individuals with conditions affecting the brain and spinal cord, such as stroke, spinal cord injury, and Parkinson’s disease, to help restore mobility and function. The therapy is performed in hospitals, private practice physical therapy clinics, doctors’ offices, rehabilitation facilities, or at a patient’s home. Whether an individual needs inpatient or outpatient physical therapy will depend on the severity of the neurological condition.
Newly acquired neurological conditions such as strokes or traumas like spinal cord injuries and traumatic brain injuries or TBIs often require inpatient rehabilitation.
Once the patient gains enough strength, coordination, and independence with movements like standing and walking, they can progress to outpatient physical therapy.
The patient will undergo a physical exam after a physical therapist has gathered enough information about medical history during the initial evaluation.
The therapist will check muscle strength, coordination, range of motion, reflexes, and the muscle tone of the arms and legs. They may also perform neurological tests to examine coordination, such as following moving objects with the eyes, touching the finger to the nose, and rapidly alternating movements.
The individual general level of attention, cognition, and sensation will also be assessed to determine if these areas have been affected by the neurological condition. (Cleveland Clinic, 2022)
The therapist will then assess the patient’s ability to perform movements called transfers, which are transitions to and from positions such as lying down to sitting up or standing up to sitting.
They will note if the patient can perform these movements independently or if they need assistance.
The initial evaluation will also include an assessment of balance, quality of gait, and whether the therapist needs to assist.
Depending on the severity of the neurological condition, the therapist may provide the patient with or recommend purchasing an assistive device to help walk.
Treatment Sessions
During therapy sessions, patients may receive the following interventions:
Gait Training
To improve walking ability, proper instruction on using assistive devices such as canes, walkers, and crutches.
Balance Training
To improve static/stationary and dynamic/while moving balance, both sitting unsupported to improve core control and standing upright with or without handheld support.
Therapeutic Activities
To improve independence with bed mobility skills like rolling and sitting up from lying down and transfers on and off beds, chairs, and toilets.
Therapeutic exercises for stretching and strengthening muscles and improving coordination and motor control.
Endurance Training
This can be done with cardiovascular equipment like treadmills, stationary bicycles, and ellipticals.
Vestibular Therapy Interventions
Balance exercises with head movements and exercises to treat a common cause of dizziness are used to improve eye movement control.
Examples are the Dix-Hallpike and Epley maneuvers.
Conditions
Neurological physical therapy can treat various conditions. Some neurological conditions are progressive, worsening over time, and require regular physical therapy and at-home exercises to maintain optimal health and wellness. Neurological conditions that can be treated with physical therapy include: (Cleveland Clinic, 2022)
Strokes – loss of blood supply to the brain.
Spinal cord injuries – damage to part of the central nervous system resulting in loss of movement and control.
Polyneuropathies – damage to the peripheral nerves.
Traumatic brain injuries – for example, concussions.
Cerebral palsy – a group of disorders affecting movement, balance, and posture.
Multiple sclerosis – a disabling disease of the brain and spinal cord.
Parkinson’s disease – a progressive nervous system disorder.
Guillain-Barre syndrome – an autoimmune disease attacking the nerves.
Amyotrophic lateral sclerosis/ALS, also known as Lou Gehrig’s disease.
Vertigo, including benign paroxysmal positional vertigo or BPPV.
Neurological conditions, like an automobile collision, can occur suddenly or be progressive, such as Parkinson’s. Physical therapy helps those individuals by increasing their use of weakened muscles, improving their motor control, coordination, and balance, and facilitating their independence with daily tasks and movements. Always seek immediate medical attention for any sudden, unexplained muscle weakness. Individuals who experience skeletal muscle weakness should discuss the type and duration of symptoms with their doctor, specialist, physical therapist, or chiropractor, as this might be a sign of a medical condition such as a neuromuscular disorder. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment program through an integrated approach to treat injuries and chronic pain syndromes, improving flexibility, mobility, and agility, relieving pain, and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Can incorporating stretches and exercises help relieve pain and provide more support for individuals with knee pain?
Knee Strengthening
The knee is the largest joint connecting the shin and thigh bones. Its cartilage, muscles, ligaments, and nerves all play a role in maintaining the joint’s health and movement. Individuals of all ages can experience knee pain, but it is more common in those with labor-intensive jobs, arthritis, and athletes. A healthcare provider will prescribe targeted stretches and exercises for individuals with pain, inflammation, or a health disorder that affects the strength of their knees to relieve knee pain while strengthening the muscles around the joint. Knee stretches and exercises are great for those with sore knees and knee pain or stiffness, but they can also be used as preventative medicine.
Exercise Benefits
Doing knee-strengthening exercises can significantly improve joint health. The benefits associated with exercises include (Zeng C. Y. et al., 2021)
Avoid curving the spine to get closer to the thigh during the stretch. The key is not how far you can bend down but getting a deep stretch. Individuals not yet flexible enough to go all the way down should bend until comfortable but can still feel the stretch in their hamstrings. With practice and time, flexibility will improve. This stretch should be felt in the hamstrings.
Step Exercises
Step exercises, or step-ups, involve using a platform at least 6 inches high. To perform the exercise:
Put one foot onto the platform and use that leg to lift the other foot off the floor.
Hold the position with the foot hanging loosely for 3 to 5 seconds, then place the foot back on the floor.
Avoid locking the knees when stepping up on the platform. Locking the knees switches off the muscles that need strengthening (American Academy of Orthopaedic Surgeons, 2009). Step exercises work out various areas of the leg. Individuals should feel this exercise in the thigh, hip, and buttocks.
Post-Exercise Stretching
Post-exercise stretching is vital in physical rehabilitation and strengthening. Stretching after exercise, individuals can (Afonso J. Clemente. et al., 2021)
Relieve and reduce soreness.
Expedite recovery times.
Increase range of motion.
Strengthen the knees more quickly and effectively.
Post-exercise stretches for knee pain and weakness can include:
Quadricep Stretch
This stretch targets the quad muscles located in the thighs. To perform this stretch:
Stand with the feet planted flat on the floor, spaced the same width as the shoulders.
Bending the left knee, grab the foot with the left hand and pull the heel toward the buttocks.
Hold for 5 to 10 seconds.
Repeat on both sides.
What to Avoid
There is no need to pull the heel too far into the buttocks. The goal is to feel a deep stretch. Pushing it too far can lead to injury. (Lee J. H. et al., 2021)
Toe Touches
Toe touches will help stretch calve muscles and hamstrings. To perform this stretch:
Sit on the floor with the legs straight out in front.
Bend the body over the legs at the hips, reaching for the toes in front while maintaining a straight back.
Relax the shoulders and keep them away from the ears.
Once touching the toes, hold the stretch for 15 seconds.
What To Avoid
Individuals who cannot yet touch their toes should perform the same steps and reach only as far as is comfortably possible. Over time, flexibility will improve. (Lee J. H. et al., 2021)
Injury Medical Chiropractic Clinic
These are examples of exercises and stretches that a physical therapy and chiropractic team may prescribe. Each case is different and requires reviewing individual medical history and physical examination to determine the proper treatment program. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized treatment program through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility to relieve pain and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Knee Pain Rehabilitation
References
Zeng, C. Y., Zhang, Z. R., Tang, Z. M., & Hua, F. Z. (2021). Benefits and Mechanisms of Exercise Training for Knee Osteoarthritis. Frontiers in physiology, 12, 794062. doi.org/10.3389/fphys.2021.794062
Kothawale S. and Rao K. (2018). Effectiveness of positional release technique versus active release technique on hamstrings tightness. Int J Physiother Res., 6(1), 2619-2622. doi.org/https://dx.doi.org/10.16965/ijpr.2017.265
Wang, H., Ji, Z., Jiang, G., Liu, W., & Jiao, X. (2016). Correlation among proprioception, muscle strength, and balance. Journal of physical therapy science, 28(12), 3468–3472. doi.org/10.1589/jpts.28.3468
Afonso, J., Clemente, F. M., Nakamura, F. Y., Morouço, P., Sarmento, H., Inman, R. A., & Ramirez-Campillo, R. (2021). The Effectiveness of Post-exercise Stretching in Short-Term and Delayed Recovery of Strength, Range of Motion and Delayed Onset Muscle Soreness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in physiology, 12, 677581. doi.org/10.3389/fphys.2021.677581
Lee, J. H., Jang, K. M., Kim, E., Rhim, H. C., & Kim, H. D. (2021). Effects of Static and Dynamic Stretching With Strengthening Exercises in Patients With Patellofemoral Pain Who Have Inflexible Hamstrings: A Randomized Controlled Trial. Sports health, 13(1), 49–56. doi.org/10.1177/1941738120932911
Can understanding the location of the funny bone and how pain can be managed after injury help expedite recovery and prevention for individuals who have hit their funny bone?
Elbow Funny Bone Nerve Injury
Behind the elbow is an area known as the “funny bone,” where the ulnar nerve has less tissue and bone protection. This is where part of the ulnar nerve passes around the back of the elbow. Because less tissue and bone protect the nerve in this area, taking a hit like bumping into something can cause an electric shock-like pain and a tingling sensation down the arm and to the outside fingers typical of an irritated nerve. Most injuries to the funny bone resolve quickly, and the pain disappears after a few seconds or minutes, but sometimes, an ulnar nerve injury can lead to more persistent symptoms.
Anatomy
The funny bone is not a bone but the ulnar nerve. The nerve runs down the arm, passing around the back of the elbow. (Dimitrova, A. et al., 2019) Because the ulnar nerve is on top of the elbow and there is very little fatty cushion, lightly bumping this spot can cause pain and tingling sensations down the forearm. Three bones comprise the junction of the elbow that include:
Humerus – arm bone
Ulna and radius – forearm bones
The humerus has a groove that protects and holds the ulnar nerve as it passes behind the joint. This is where the nerve can be injured or irritated when the nerve is hit or pinched against the end of the bone, causing the funny bone pain.
Electrical Pain Sensation
When hitting the ulnar nerve or funny bone where the ulnar nerve provides sensation, pain, and electrical/tingling sensations are experienced from the forearm to the outside fingers. This part of the arm and hand is called the ulnar nerve distribution. (American Academy of Orthopaedic Surgeons. 2024) The ulnar nerve provides sensation into most of the pinky finger and about half of the ring finger. Other nerves, including the median and radial nerve, supply sensation to the rest of the hand.
Treatment
Usually, a sharp jolt to the elbow quickly resolves. Some recommendations to help symptoms improve faster include:
Shaking the forearm and hand out.
Straightening out and bending the elbow to stretch the nerve.
Decreasing mobility of the elbow.
Applying ice to the area.
Taking anti-inflammatory medications.
Treating Long-Lasting Pain
In rare circumstances, injuries to the ulnar nerve can cause more persistent symptoms, a condition known as cubital tunnel syndrome. Cubital tunnel syndrome can happen after an injury or from elbow overuse. Individuals with cubital tunnel syndrome may benefit from wearing a splint at night. Standard-sized splints can be ordered online, but most are fabricated by an occupational or hand therapist. If symptoms become more long-lasting, surgery may be recommended to relieve pressure and tension on the ulnar nerve (American Academy of Orthopaedic Surgeons, 2024). The procedure decompresses the nerve by relieving any tight constrictions around it and releasing them. In severe cases, the nerve is repositioned to an area that doesn’t place as much pressure on the nerve, known as an ulnar nerve transposition.
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution that helps individuals return to normal. Our providers create personalized care plans for each patient, including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles through an integrated approach to treat injuries and chronic pain syndromes to improve ability through flexibility, mobility, and agility programs to relieve pain. If other treatment is needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Chiropractic Treatment For Carpal Tunnel Syndrome
References
Dimitrova, A., Murchison, C., & Oken, B. (2019). Local effects of acupuncture on the median and ulnar nerves in patients with carpal tunnel syndrome: a pilot mechanistic study protocol. Trials, 20(1), 8. doi.org/10.1186/s13063-018-3094-5
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