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
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.
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.
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.
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
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?
References
Aly R. M. (2020). Current state of stem cell-based therapies: an overview. Stem cell investigation, 7, 8. doi.org/10.21037/sci-2020-001
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. doi.org/10.3390/ijms21041306
Klemmt P. (2012). Application of amniotic fluid stem cells in basic science and tissue regeneration. Organogenesis, 8(3), 76. doi.org/10.4161/org.23023
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. doi.org/10.1371/journal.pone.0093726
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. doi.org/10.1038/cddis.2015.327
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. doi.org/10.3390/cells8121605
When individuals experience a neuromusculoskeletal injury strain, can following basic pulled muscle treatment protocols help in healing and a full recovery?
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.
Symptoms
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.
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
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.
To avoid injuries make sure the muscles are not over-exerted.
Gradually increase activity levels when starting an exercise program to build endurance.
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
References
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. doi.org/10.1007/s12178-010-9064-5
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. doi.org/10.1080/00325481.2015.992719
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. doi.org/10.1177/036354659602400203
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. doi.org/10.3390/ijms19051538
For individuals with a broken collarbone, can conservative treatment help in the rehabilitation process?
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)
Types
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.
The bruising can extend down to the chest and armpit.
Numbness and tingling down the arm.
Deformity of the collarbone.
In addition to swelling, some individuals may have a bump in the place where the fracture occurred.
It can take several months for this bump to fully heal, but this is normal.
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)
Diagnosis
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
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.
Age
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)
Broken collarbones should heal within 6–12 weeks in adults
3–6 weeks in children
Younger patients are usually back to full activities before 12 weeks.
The pain usually subsides within a few weeks. (UpToDate. 2023)
Immobilization is rarely needed beyond a few weeks, and with a doctor’s clearance light activity and gentle motion rehabilitation usually begins.
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. doi.org/10.1302/2058-5241.3.170078
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 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.
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.
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)
It is also important to rest your neck area following the injury.
A cervical collar can be utilized temporarily to stabilize the neck, but for long-term recovery, it is recommended to keep the area mobile.
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.
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
References
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. doi.org/10.1007/s11916-003-0038-9
Page P. (2011). Cervicogenic headaches: an evidence-led approach to clinical management. International journal of sports physical therapy, 6(3), 254–266.
Athletes regularly take an ice-water bath after training or playing. It is known as cold water immersion/cryotherapy. It is used to relieve and reduce muscle soreness and pain after intense training or competition. From runners to professional tennis and football players, taking an ice bath is a common recovery practice. Many athletes utilize ice baths to help with faster recovery, prevent injury, and cool down the body. Here we provide some research on cold-water immersion therapy.
Ice Water Bath
Cold Immersion After Exercise or Physical Activity
Exercise causes microtrauma/tiny tears in the muscle fibers. The microscopic damage stimulates muscle cell activity to repair the damage and strengthen the muscles/hypertrophy. However, hypertrophy is linked with delayed onset muscle soreness and pain/DOMS, between 24 and 72 hours after physical activity. An ice water bath works by:
Constricting the blood vessels.
Flushes out waste products (lactic acid), out of the muscle tissues.
Reduces inflammation, swelling, and tissue breakdown.
Then, applying heat or warming up the water increases and speeds up blood circulation, improving the healing process.
There is no current ideal time and temperature for cold immersion, but most athletes and trainers who use the therapy recommend a water temperature between 54 to 59 degrees Fahrenheit and immersion of five to 10 minutes, and depending on the soreness, sometimes up to 20 minutes.
Pros and Cons
The effects of ice baths and cold water immersion on exercise recovery and muscle soreness.
Relieves Inflammation but Can Slow Down Muscle Growth
A study determined that cold water immersion can disrupt training adaptations.
Research suggests that icing muscles right after maximum exercise decreases inflammation, but can slow down muscle fiber growth, and delay muscle regeneration.
Athletes trying to increase muscle size and strength may need to adjust the therapy sessions.
Reduce Muscle Soreness
A review concluded there was some evidence that ice water immersion reduced delayed onset muscle soreness when compared to resting and rehabilitation or no medical treatment.
The most effects were seen in running athletes.
There was no substantial evidence to conclude whether it improved fatigue or recovery.
The studies did not have a standard for adverse effects or follow-up with the participants regularly.
There was no difference in muscle soreness between cold water immersion, active recovery, compression, or stretching.
Pain Relief
Cold water immersion after a physical activity offers temporary pain relief but can help with a faster recovery.
A study of jiu-jitsu athletes found that following a workout with cold water immersion could lead to decreased muscle aches and help reduce lactate levels.
Alternating cold water and warm water baths (contrast water therapy), may help athletes feel better and offer temporary pain relief.
Active Recovery Alternative
More research is needed before a firm conclusion can be reached on ice-water bath therapy. However, active recovery is a recommended alternative for athletes looking to recover faster.
A study suggested that ice baths were equally effective, but not more effective, as active recovery for reducing inflammation.
Cold water immersion is no greater than active recovery upon local and systemic inflammatory cellular stress.
Research determined that active recovery is still the most widely used, and currently the best way to recover after intense exercise or physical activity.
Low-impact workouts and stretches are still considered the most beneficial cool-down methods.
Cold Water Therapy
Ice Bath
Individuals can use their tub at home to perform cold water therapy.
Individuals may want to purchase a large bag of ice, but the cold water from the faucet will work.
Fill the tub with cold water, and if desired, pour in some ice.
Let the water and ice sit to get the cold temperature.
Measure the temperature if necessary before getting in.
Submerge the lower half of the body and adjust the temperature based on feel by adding more water, ice, or warm water if freezing.
It’s like icing with an ice pack, but the whole body swelling reduces and relaxes the muscles.
Don’t overdo it – one review found the best routine was 11 to 15 minutes of immersion at a temperature between 52 and 60 degrees Fahrenheit.
Cold Shower
A few minutes in a cold shower is another way to perform the therapy.
Individuals can get in a cold shower or start with warm water and slowly transition to cold.
This is the easiest and most time-efficient method of cold water therapy.
Safety
Consult with your doctor or a health care practitioner before practicing cold water therapy.
Exposure to cold water can affect blood pressure, circulation, and heart rate.
Cold water immersion can cause cardiac stress and can result in a heart attack.
Be mindful that exposure to cold temperatures can result in hypothermia.
Get out of the cold water if you experience numbness, tingling, discomfort, and/or pain.
Optimizing Wellness
References
Allan, R, and C Mawhinney. “Is the ice bath finally melting? Cold water immersion is no greater than active recovery upon local and systemic inflammatory cellular stress in humans.” The Journal of Physiology vol. 595,6 (2017): 1857-1858. doi:10.1113/JP273796
Altarriba-Bartes, Albert, et al. “The use of recovery strategies by Spanish first division soccer teams: a cross-sectional survey.” The Physician and sports medicine vol. 49,3 (2021): 297-307. doi:10.1080/00913847.2020.1819150
Bieuzen, François, et al. “Contrast water therapy and exercise-induced muscle damage: a systematic review and meta-analysis.” PloS one vol. 8,4 e62356. 23 Apr. 2013, doi:10.1371/journal.pone.0062356
Fonseca, Líllian Beatriz et al. “Use of Cold-Water Immersion to Reduce Muscle Damage and Delayed-Onset Muscle Soreness and Preserve Muscle Power in Jiu-Jitsu Athletes.” Journal of athletic training vol. 51,7 (2016): 540-9. doi:10.4085/1062-6050-51.9.01
Forcina, Laura, et al. “Mechanisms Regulating Muscle Regeneration: Insights into the Interrelated and Time-Dependent Phases of Tissue Healing.” Cells vol. 9,5 1297. 22 May. 2020, doi:10.3390/cells9051297
Shadgan, Babak, et al. “Contrast Baths, Intramuscular Hemodynamics, and Oxygenation as Monitored by Near-Infrared Spectroscopy.” Journal of athletic training vol. 53,8 (2018): 782-787. doi:10.4085/1062-6050-127-17
Sutkowy, Paweł, et al. “Postexercise impact of ice-cold water bath on the oxidant-antioxidant balance in healthy men.” BioMed research international vol. 2015 (2015): 706141. doi:10.1155/2015/706141
A nerve becomes pinched/compressed when added pressure is placed on it by surrounding structures that can include muscles, bones, ligaments, tendons, or a combination. This injures and damages the nerve causing function problems and symptoms and sensations in that area or other parts of the body that are supplied by that nerve. Medical practitioners refer to this as nerve compression or entrapment. Although compressed nerves are more commonly associated with the neck, arms, hands, elbows, and lower back, any nerve in the body can experience irritation, spasms, inflammation, and compression. The causes and treatment of a compressed nerve in the knee.
Compressed Nerve In The Knee
There’s only one nerve that goes through the knee that has an increased risk of getting compressed. It’s a branch of the sciatic nerve called the peroneal nerve. The nerve goes around the outside of the knee before traveling down the outside of the lower leg. At the bottom of the knee, it lies between the bone and skin, making it vulnerable to irritation or compression by anything that can put pressure on the outside of the knee.
Causes
Traumatic injuries over time can lead to pressure on the nerve from inside the knee. Common causes of a compressed nerve in the knee include:
Frequently Crossing Legs
Compression by the opposite knee, while the legs are crossed is the most common cause.
Knee Brace
A too-tight or strong brace can compress the leg and nerve.
Thigh-High Compression Stockings
Designed to maintain pressure on the legs, if too tight these stockings can compress the nerve.
Squatting Posture For Long Periods
This position places pressure on the side of the knee.
Fractures
A fracture of the large lower leg bone/tibia or sometimes the small bone/fibula near the knee can entrap the nerve.
Lower Leg Cast
The portion of the cast around the knee can be tight and compress the nerve.
Tell the doctor if a cast or brace feels tight or is causing numbness or pain in the leg.
Knee-High Boots
The top of a boot can land right below the knee and be too tight pinching the nerve.
Knee Ligament Injury
The nerve can become compressed due to bleeding or inflammation from an injured ligament.
Knee Surgery Complications
This is rare, but the nerve can inadvertently get pinched during knee replacement surgery or an arthroscopic procedure.
Prolonged Bed Rest
When lying down the legs tend to rotate outward and the knees flex.
In this position, the mattress can place pressure on the nerve.
Tumors or Cysts
Tumors or cysts can develop right on top or next to a nerve irritating and compressing the area.
Abdominal or Gynecologic Surgery
The equipment used to keep the legs rotated outward and the knees flexed for gynecologic and abdominal surgeries can compress the nerve.
Symptoms
The peroneal nerve supplies sensation and movement to the outside of the lower leg and the top of the foot. When compressed, it becomes inflamed, which causes the symptoms of a compressed nerve. Usually, only the lining/myelin sheath around the nerve is what gets injured. However, when the nerve gets damaged, the symptoms are similar but more severe. Common symptoms include:
Weakness that limits the ability to lift the foot toward the leg aka dorsiflexion.
This causes dragging the foot when walking.
The ability to turn the foot outward and extend the big toe is also affected.
Symptoms can be felt on the outside of the lower leg and on the top of the foot and include:
Tingling or pins and needles sensations.
Numbness.
Loss of sensation.
Pain.
Burning.
For individuals that have had a pinched nerve for two or more weeks, the muscles supplied by the nerve can begin to waste away or atrophy.
Symptoms can be intermittent or continuous depending on the cause.
The other common cause is a pinched nerve in the lumbar/lower spine.
When this is the cause, sensations, and pain will present in the lower back or the back and outside of the thigh.
Diagnosis
A doctor will look at medical history and perform an examination to make a diagnosis, determine the cause, and lay out a personalized treatment plan. The nerve in the knee can be felt as it travels around the top of the tibia, so a doctor may tap on it. If there is shooting pain down the leg, a pinched nerve may be present. Tests a doctor may order can include:
Knee X-ray
Shows any bone fractures or abnormal masses.
Knee MRI
Can confirm the diagnosis
Shows masses within the nerve.
Shows details of fractures or other problems in the bones.
Electromyogram – EMG
Tests electrical activity in the muscles.
Nerve Conduction Test
Tests the signal speed of the nerve.
Treatment
Treatment is aimed at reducing pain and improving mobility.
Over-the-Counter Pain Medication
OTC medication can reduce inflammation and improve symptoms short term.
Ice and Heat
Applying either heat or ice for 15 to 20 minutes at a time can provide relief from the symptoms.
An ice pack can make symptoms worse if it adds more pressure on the nerve.
Chiropractic and Physical Therapy
Chiropractic and physical therapy can release the compressed nerve, realign the structures, strengthen the muscles, and provide gait training.
Orthotic Boot
If walking gait is affected because the foot cannot bend, an orthotic boot can help.
This is a support that maintains the foot in a neutral position to walk normally.
Corticosteroid Injection
A corticosteroid injection can reduce inflammation and relieve pressure on the nerve.
Surgery
The nerve can suffer permanent damage if it has been pinched for a long time.
If that happens, surgery cannot repair the damage.
A doctor can perform surgery to correct a fracture, tumor, or other invasive problem causing a compressed nerve.
If conservative treatment doesn’t work, a peroneal nerve decompression procedure can be done to remove the pressure.
If surgery is needed, symptoms can disappear immediately, but it takes around four months to recover and rehabilitate.
Injury Rehabilitation
References
Krych, Aaron J et al. “Is peroneal nerve injury associated with worse function after knee dislocation?.” Clinical orthopedics and related research vol. 472,9 (2014): 2630-6. doi:10.1007/s11999-014-3542-9
Lezak B, Massel DH, Varacallo M. Peroneal Nerve Injury. [Updated 2022 Nov 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK549859/
Soltani Mohammadi, Sussan, et al. “Comparing the squatting position and traditional sitting position for ease of spinal needle placement: a randomized clinical trial.” Anesthesiology and pain medicine vol. 4,2 e13969. 5 Apr. 2014, doi:10.5812/aapm.13969
Stanitski, C L. “Rehabilitation following knee injury.” Clinics in sports medicine vol. 4,3 (1985): 495-511.
Xu, Lin, et al. Zhongguo gu Shang = China Journal of Orthopedics and Traumatology vol. 33,11 (2020): 1071-5. doi:10.12200/j.issn.1003-0034.2020.11.017
Yacub, Jennifer N et al. “Nerve injury in patients after hip and knee arthroplasties and knee arthroscopy.” American Journal of physical medicine & Rehabilitation vol. 88,8 (2009): 635-41; quiz 642-4, 691. doi:10.1097/PHM.0b013e3181ae0c9d
Automobile accidents and collisions can cause knee and ankle injuries in various ways. Automobile crashes are considered high-energy collisions versus slip and fall traumas which are generally low-energy. However, a 30mph or under-collision can have serious and detrimental effects on the knees and ankles. The sudden forces can cause the knees to collide with the dashboard or push the feet and legs into the body, generating intense pressure and compressing the bones, muscles, and ligaments damaging soft tissues and bone structures from the impact. The Injury Medical Chiropractic and Functional Medicine Clinic Team can rehabilitate, realign, strengthen, and restore function to individuals with minor to severe auto collision injuries.
Knee and Ankle Injuries
Musculoskeletal motor vehicle crash/collision injuries affect the body’s movement. The impact can pull, tear, crush, and smash bones, muscles, tendons, ligaments, discs, and nerves. These injuries restrict the range of motion and can cause pain and sensation symptoms. The National Accident Sampling System reports 33% of injuries sustained during vehicle collisions are to the lower extremities.
Despite the knees and ankles having soft tissues that absorb and distribute the energy’s impact, the forces from the collision often happen instantly and unexpectedly, causing the individual to tense up, which overwhelms the structures.
Even panic stepping on the brake pedal can cause injury to the ankle and foot.
A passenger’s reflex of trying to resist forces can experience foot, ankle, and knee injuries from bracing off the vehicle’s floorboard.
Automobile collisions can cause strains, sprains, fractures, and dislocations.
Torn, Strained, or Sprained Knee
If the foot becomes planted on the floorboard while the body continues to move forward or sideways, the force can travel into the knee, causing twisting or shearing.
Depending on the injury type, the impact strength can damage different ligaments.
The ligaments resist forces that push the knee inwards/medially and outwards/laterally and slightly resist rotational forces.
When any of these ligaments are damaged, swelling, pain, and limited ranges of motion can result.
Putting weight on the affected leg can be difficult.
In some cases, the ligaments tear completely, necessitating surgical repair.
Once the individual can engage in mild activity, they can begin a rehabilitation program to restore function.
Recovery times vary based on the location and severity of the injury.
Fractured Knee or Ankle
When a fracture occurs in a joint, like the knees or ankles, surgical procedures may be necessary to repair the broken bone/s.
Broken bones can result in simultaneous damage and/or inflammation of the connective tissues that can cause the muscles to contract/tighten or atrophy during the recovery and healing phases.
Joints and bones are kept healthy with moderate movement and weight-bearing.
Fractures require immobilization of the affected area.
A physical therapy rehabilitation program can begin when the brace or cast comes off.
Targeted exercises and resistance will strengthen and stretch the joint to improve flexibility and promote healing through improved circulation.
Torn Meniscus
The meniscus is a C-shaped area of cartilage that rests between the thigh and shin bones.
It acts as a shock absorber.
The meniscus can become torn, resulting in pain, stiffness, and loss of motion.
This injury can heal independently with the right rest and therapeutic exercises.
A chiropractic auto collision specialist can diagnose the severity of the tear and provide the recommendations needed to rehabilitate and strengthen the knee.
If the tear is severe enough, surgery may be required.
Strained or Sprained Ankle
Strained tendons and sprained ligaments can result from the ankle being subject to tremendous force.
Strains and sprains vary in severity.
Both indicate that the connective tissue has been damaged or stretched beyond normal limits.
They can present with pain, inflammation, and problems moving the affected area.
With proper medical attention and rehabilitation, recovery is possible.
Torn Achilles Tendon
The Achilles tendon connects the calf muscle to the heel and is necessary for walking, running, physical activity, and bearing weight.
If the tendon gets torn, surgery will be required to reattach the muscle and tendon.
After recovery, the individual can begin physical therapy to work the tendon and muscle, slowly building strength and range of motion.
It is critical to do this with the supervision of an expert in musculoskeletal rehabilitation to avoid re-injury or developing new injuries.
Chiropractic Treatment
Any musculoskeletal motor vehicle injuries can result in intense pain that worsens with activity, inflammation, swelling, redness, and/or heat in the affected area. This is why correctly diagnosing the injury is essential if the condition is to be properly and thoroughly treated. A physical examination will vary based on the individual’s state and can include:
Strength assessment
Range of motion
Reflexes
Other variables to determine the underlying issues.
Diagnostic imaging such as X-rays, MRIs, and CT scans can help identify and clarify injuries’ extent, nature, and location and rule out problems.
A qualified healthcare professional will combine the data with medical history to develop an accurate diagnosis. Our ability to effectively treat accident individuals is based on applying clinical expertise in musculoskeletal diagnosis and care. Our medical team takes a practical approach to help individuals quickly heal from musculoskeletal injuries using the latest treatments possible. When you meet with one of our professionals, you will feel relaxed and confident that you have come to the right place.
From Injury To Recovery
References
Dischinger, P C et al. “Consequences and costs of lower extremity injuries.” Annual proceedings. Association for the Advancement of Automotive Medicine vol. 48 (2004): 339-53.
Fildes, B et al. “Lower limb injuries to passenger car occupants.” Accident; analysis and prevention vol. 29,6 (1997): 785-91. doi:10.1016/s0001-4575(97)00047-x
Gane, Elise M et al. “The impact of musculoskeletal injuries sustained in road traffic crashes on work-related outcomes: a protocol for a systematic review.” Systematic reviews vol. 7,1 202. 20 Nov. 2018, doi:10.1186/s13643-018-0869-4
Hardin, E C et al. “Foot and ankle forces during an automobile collision: the influence of muscles.” Journal of biomechanics vol. 37,5 (2004): 637-44. doi:10.1016/j.jbiomech.2003.09.030
Li, Wen-Wei, and Cheng-Chang Lu. “Knee deformity following a motor vehicle accident.” Emergency medicine journal: EMJ vol. 38,6 (2021): 449-473. doi:10.1136/emermed-2020-210054
M, Asgari, and Keyvanian Sh S. “Crash Injury Analysis of Knee Joint Considering Pedestrian Safety.” Journal of biomedical physics & Engineering vol. 9,5 569-578. 1 Oct. 2019, doi:10.31661/jbpe.v0i0.424
Torry, Michael R et al. “Relationship of knee shear force and extensor moment on knee translations in females performing drop landings: a biplane fluoroscopy study.” Clinical biomechanics (Bristol, Avon) vol. 26,10 (2011): 1019-24. doi:10.1016/j.clinbiomech.2011.06.010
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