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
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
The function of the arm is to allow for movement of the wrist and hand. Various muscles initiate the arm’s actions, large muscles flex and extend, pronate and supinate, and the more sensitive muscles allow fine motor control. Lifting capacity and grip strength come from the arm muscles, making them essential for all types of activities. Because of the many functions and jobs the hands and arms do, added stress is placed on them. Arm discomfort symptoms, radiating pain, weakness, numbness, and tingling are common conditions. Chiropractic care can relieve injury symptoms and restore mobility and function.
Arm Discomfort Symptoms
The muscles of the upper arm, the biceps, and the triceps, control the movement and positioning of the elbow joint, and the muscles of the forearm control the wrist and hand. There are 30 bones from the top of the arm to the tip of the finger that include:
The humerus in the upper arm.
Ulna and radius in the forearm.
Carpal bones in the wrist.
Metacarpals and phalanges make up the hand and fingers.
The joints allow movement between the bones and are stabilized by ligaments and joint capsules.
Symptoms
Discomfort or Radiation
Symptoms vary based on the severity of the injury but commonly include.
Numbness and tingling in the elbow, forearm, or hand can develop.
Pain sensations often radiate to other areas.
Causes
Individuals that work with their hands related to work, home tasks, sports, or hobby activities, such as construction workers, hair stylists, store cashiers, graphic artists, automotive technicians, carpenters, painters, butchers, and more, have an increased risk of injury and developing chronic conditions. Work that involves manually cutting, writing, typing, gripping, operating motorized tools, hair clippers, working with animals, etc., makes the arms susceptible to injury from the constant stress on the ligaments. Common overuse injuries affecting the upper extremity include:
Carpal Tunnel Syndrome and Cubital Tunnel Syndrome
These conditions involve the nerves of the forearm.
Prolonged or repetitive bending or flexing of the wrist or elbow can generate swelling pressure that compresses the nerve/s.
Symptoms include numbness, coldness, tingling, and/or weakness in the hand and fingers.
Tennis, Golfer, and Pitcher Elbow
These conditions involve the inflammation of the tendon structures surrounding the elbow joint.
Repeating the same motion over and over causes damage.
This leads to tenderness and pain inside and surrounding the elbow.
De Quervain’s syndrome affects tendon structure in the wrist.
Swelling near the base of the thumb.
Individuals have difficulty grasping objects.
This is common for landscapers, gardeners, and sports where constant gripping is involved.
Tendonitis
Tendons attach muscles and bones
The condition causes tendon inflammation, presenting pain in the area around single or multiple joints.
Common types include wrist tendonitis, pitcher’s shoulder, and swimmer’s shoulder.
Tendon Tears
Overuse and frequent stress from continuous motion can wear tendons to the point of partial or complete tearing.
Rotator cuff tears in the shoulder are often caused by overuse wearing down.
Chiropractic Treatment
Chiropractic and massage therapy can rehabilitate arm injuries, restore function and reduce arm discomfort symptoms. Treatment includes:
Ice or heat treatment.
Manual therapy – soft tissue massage and trigger point alleviation.
Joint mobilization.
Taping or bracing support.
Rehabilitation targeted exercises.
Work and sports modification training.
Training on upper extremity overuse, practicing caution, and knowing when to seek professional medical help.
Shoulder Pain Rehabilitation
References
Bass, Evelyn. “Tendinopathy: why the difference between tendinitis and tendinosis matters.” International Journal of therapeutic massage & Bodywork vol. 5,1 (2012): 14-7. doi:10.3822/ijtmb.v5i1.153
Cutts, S et al. “Tennis elbow: A clinical review article.” Journal of Orthopaedics vol. 17 203-207. 10 Aug. 2019, doi:10.1016/j.jor.2019.08.005
Hoe, Victor C W, et al. “Ergonomic design and training for preventing work-related musculoskeletal disorders of the upper limb and neck in adults.” The Cochrane Database of systematic reviews vol. 2012,8 CD008570. 15 Aug. 2012, doi:10.1002/14651858.CD008570.pub2
Konijnenberg, H S et al. “Conservative treatment for repetitive strain injury.” Scandinavian Journal of Work, Environment & Health vol. 27,5 (2001): 299-310. doi:10.5271/sjweh.618
Luger, Tessy, et al. “Work-break schedules for preventing musculoskeletal symptoms and disorders in healthy workers.” The Cochrane Database of systematic reviews vol. 7,7 CD012886. 23 Jul. 2019, doi:10.1002/14651858.CD012886.pub2
Pitzer, Michael E et al. “Elbow tendinopathy.” The Medical Clinics of North America vol. 98,4 (2014): 833-49, xiii. doi:10.1016/j.mcna.2014.04.002
Verhagen, Arianne P et al. “Conservative interventions for treating work-related complaints of the arm, neck or shoulder in adults.” The Cochrane Database of systematic reviews vol. 2013,12 CD008742. 12 Dec. 2013, doi:10.1002/14651858.CD008742.pub2
Zaremski, Jason L et al. “Sport Specialization and Overuse Injuries in Adolescent Throwing Athletes: A Narrative Review.” Journal of athletic training vol. 54,10 (2019): 1030-1039. doi:10.4085/1062-6050-333-18
Pretty much everyone experiences a muscle cramp at some point. A muscle cramp is an involuntarily contracted muscle that does not relax, similar to a spasm, but a cramp lasts longer and is usually a forcible contraction. During a cramp, the muscles tighten without voluntary input from the brain and over-tighten. They can last anywhere from a few seconds to an hour or longer. They can be prevented through adequate nutrition and hydration, attention to safety when engaged in physical activity or exercise, and attention to posture and ergonomics. Injury Medical Chiropractic and Functional Medicine Clinic can develop personalized treatment plans for individuals experiencing musculoskeletal issues.
Muscle Cramp
Muscle cramps can occur in any muscle. The cramp may involve a portion of a muscle, the entire muscle, or several muscles that function together. A muscle or a few tissue fibers that involuntarily contracts is in a spasm. If the spasm is forcefully sustained, it turns into a cramp. They can cause a noticeable and/or hardening of the involved muscle/s. They can be experienced as mild twitches or can be excruciatingly painful. Some can involve the simultaneous contraction of muscles that normally move body parts in opposite directions. It is not uncommon for a cramp to flare up multiple times until it finally stops.
Causes
They can occur during physical activity, exercise, rest, or night, depending on the cause. There are various causes that, include:
Most times, they are not a cause for alarm; however, depending on the individual, their age, type of physical activity, and medical history, cramps could indicate a more serious underlying problem such as a thyroid disorder, liver cirrhosis, atherosclerosis, ALS, or a problem or condition of the spine or spinal nerves.
Muscles Involved
The muscles involved can indicate the mechanism and cause.
If the cramp is triggered by fatigue, a drop in muscle glycogen, dehydration, or an electrolyte imbalance, it’s most frequently to the calf muscles, feet, or back of the thigh/hamstring muscles.
This is typically due to a combination of fatigue and dehydration.
If it is triggered by nerve irritation, like a spinal disc injury, cramps tend to present in the forearm, hand, calf, and foot, depending on whether the disc injury is in the neck or lower back.
If there is a joint sprain in the neck, mid-back, or lower back, the cramp will present where the injury is and around the surrounding muscles.
A calf cramp happens when lying down because the foot points down, shortening the calf muscles.
A shortened muscle is more likely to go into spasm, especially if it is exhausted from activities and if the body is dehydrated, which is pretty common.
For two muscles that work together performing the same movement, called agonists, and the one muscle is weaker, the secondary muscle has to work harder, often going into a spasm or cramp from the added stress.
For example, if the buttock/gluteal muscles are weak, the hamstrings eventually spasm when exhausted.
Chiropractic
First, the cause needs to be identified through medical history and examination. There can be an underlying nerve irritation and interference, restricting the muscle or muscle group, which needs to be dealt with for the therapy to be effective. Chiropractic care, combined with therapeutic stretching and massage therapy, can:
Relieve muscle cramping
Improve blood circulation
Increase muscle movement
Improve musculoskeletal function
All help to diminish and prevent muscle cramping.
Adjustments will restore proper alignment and restore nerve communication. These treatments help to release toxins, loosen and relax the muscle tissues, and provide relief.
Say Goodbye to Pain With Chiropractic
References
Blyton, Fiona, et al. “Non-drug therapies for lower limb muscle cramps.” The Cochrane Database of systematic reviews vol. 1,1 CD008496. 18 Jan. 2012, doi:10.1002/14651858.CD008496.pub2
FIELDS, A. “Leg cramps.” California Medicine vol. 92,3 (1960): 204-6.
Garrison, Scott R et al. “Magnesium for skeletal muscle cramps.” The Cochrane Database of systematic reviews vol. 9,9 CD009402. 21 Sep. 2020, doi:10.1002/14651858.CD009402.pub3
Katzberg, Hans D. “Case Studies in Management of Muscle Cramps.” Neurologic clinics vol. 38,3 (2020): 679-696. doi:10.1016/j.ncl.2020.03.011
Miller, Kevin C et al. “An Evidence-Based Review of the Pathophysiology, Treatment, and Prevention of Exercise-Associated Muscle Cramps.” Journal of athletic training vol. 57,1 (2022): 5-15. doi:10.4085/1062-6050-0696.20
Miller, Timothy M, and Robert B Layzer. “Muscle cramps.” Muscle & nerve vol. 32,4 (2005): 431-42. doi:10.1002/mus.20341
Intercostal muscles are the muscles within the rib cage, commonly called the intercostals, which connect the ribs and make up the chest wall. An intercostal muscle strain refers to an injury between two or more ribs. If these muscles become overstretched, restricted, or suffer damage, it can cause inflammation and significant pain in the middle and upper back. Intercostal muscle strain is a common injury in athletes and physically demanding jobs. Chiropractic care and massage therapy can realign the vertebrae with the ribs and loosen and relax the muscles to increase circulation and restore mobility and function.
Intercostal Muscle Strain
The intercostal muscles have different layers attached to the ribs to help build the chest wall and assist in breathing. There are 11 intercostal muscles on each side of the rib cage. Each set is located between connected ribs in the upper and mid-back and consists of the following:
External
These are the outermost intercostals, responsible for expanding the chest during breathing to help inhale air and allow full deep breaths.
The external intercostals originate at the lower edge of a rib and run diagonally to attach to the upper edge of the rib below.
They are found in the rib cage’s back, sides, and front.
Internal
These sit directly underneath the externals and help collapse the chest during breathing to exhale.
The muscle fibers run perpendicular to the external intercostals, moving diagonally from front to back along the ribs, and are in the entire rib cage.
Innermost
These sit directly underneath, run parallel to the internal intercostals, and run from the back of the rib cage to each side.
The veins, arteries, and nerves lie between the internal and innermost intercostals.
When an intercostal muscle gets twisted, overused, or stretched too far, it can tear, causing muscle strain. Often radiating pain along the rib cage is experienced that extends to the back.
Causes
An intercostal muscle strain often occurs as the result of an injury or overexertion of the muscles. Common causes include:
Trauma to the rib cage, such as from a fall or automobile collision.
Impact trauma from sports or physical activities.
Over twisting the torso beyond its normal range of motion from lifting weights, sports, yoga postures, or dance positions.
Repeatedly reaching overhead for work or tasks like cleaning or painting.
Lifting heavy objects above shoulder height.
Repetitive torso movements.
A sudden increase in physical activity that the body is not used to can also lead to intercostal muscle strain.
This can happen when a lack of conditioning or unhealthy postures weaken muscles.
Symptoms
The signs and symptoms can vary, depending on the severity and cause. Symptoms can include:
Intercostal muscle spasms.
Mobility difficulties.
Inflammation, swelling, and sensitivity in the affected area.
Stiffness and tension, causing upper back pain.
Upper back and rib pain.
Tenderness in the area between the ribs.
Muscle rigidity when bending or twisting the upper body.
Gradual worsening pain after repetitive movements.
Worsening pain when coughing, sneezing, or breathing in deeply.
Severe and sudden pain, particularly if caused by direct trauma to the chest or back.
Chiropractic
Diagnosis involves the individual’s medical history and a physical exam to check for movement limitations and assess affected and sensitive areas. Once the inflammation is reduced, chiropractic and physical therapy will focus on the following:
Pain relief treatment.
Breathing exercises.
Posture training.
Stretching under supervision.
Strengthing exercises.
Most cases fully heal within 6 to 8 weeks.
Rib Muscle Injury
References
De Troyer, A et al. “Mechanics of intercostal space and actions of external and internal intercostal muscles.” The Journal of clinical investigation vol. 75,3 (1985): 850-7. doi:10.1172/JCI111782
Lord, Michael J, and William G Carson Jr. “Multiple Rib Stress Fractures.” The Physician and sports medicine vol. 21,5 (1993): 80-91. doi:10.1080/00913847.1993.11947575
Morrison W. What is an intercostal muscle strain? Medical News Today. Jan 2020
Page P. Current Concepts in Muscle Stretching for Exercise and Rehabilitation. International Journal of Sports Physical Therapy. 2012;7(1):109-119.
Park, Kyung-hee, et al. “Difference in selective muscle activity of thoracic erector spinae during prone trunk extension exercise in subjects with slouched thoracic posture.” PM & R: the Journal of Injury, Function, and Rehabilitation vol. 7,5 (2015): 479-84. doi:10.1016/j.pmrj.2014.10.004
Tran H. Causes of Intercostal Muscle Strain. Spine-health. October 2017
Yoo, Won-Gyu. “Effect of a combined thoracic and backward lifting exercise on the thoracic kyphosis angle and intercostal muscle pain.” Journal of physical therapy science vol. 29,8 (2017): 1481-1482. doi:10.1589/jpts.29.1481
Yoo, Won-Gyu. “Effect of thoracic stretching, thoracic extension exercise and exercises for cervical and scapular posture on thoracic kyphosis angle and upper thoracic pain.” Journal of physical therapy science vol. 25,11 (2013): 1509-10. doi:10.1589/jpts.25.1509
Massage is part of integrative medicine and can be used for various medical conditions. In massage therapy, a therapist rubs and kneads the body’s soft tissues, including muscle, connective tissue, tendons, ligaments, and skin. The therapist varies the amount of pressure and movement. Individuals often start feeling the effects right away. One of the benefits is increased temperature. Increased temperature amplifies blood flow and circulation, enabling muscular and connective tissues to release restriction, and muscle tightness, relieve tension, and improve movement. A massage therapist will use different techniques to increase the temperature to treat various conditions.
Increased Temperature
Some patients want to know why their muscles heat up or burn during a massage. Muscles burn because of the accumulation of waste in the cells. The waste products are released as a result of massage. The muscles release lactate, a byproduct of glucose. The effects of deep tissue massage are almost the same as the effects of exercise. During the massage:
The demand for oxygen in the tissues increases.
Because of this, blood flow circulation to these tissues increases.
This is necessary to supply oxygen and glucose.
It excretes waste substances and toxins.
Muscle heat or burn during massage differs for everybody. Some individuals don’t feel it at all. The session can be so intense that the muscles can’t clear the lactate/toxins fast enough, causing the burning sensation.
Fascia Circulation
The temperature of the fascia can also be increased. Fascia is the thick, fibrous layer of connective tissues beneath the skin that can often become restrictive. Increased temperature in the superficial and deep tissues releases, relaxes, and loosens tight, tense, shortened, and/or injured areas, allowing muscular tissues to increase in elasticity, flexibility, and relaxation. Heart rate is raised, improving circulation and increasing the delivery of oxygen and nutrients to the affected areas and the rest of the body.
Myofascial release involves slowly applying pressure to the area using flattened hands and fingers.
The slow, soft pressure increases the temperature of the fascia.
As the hands and fingers get deeper within, they slowly move around, spreading the fascia.
This releases the tightness and relieves the pain.
An individual’s posture can improve when the temperature is increased. Muscular tension and tightness can cause increased pain symptoms, not allowing healthy posture.
Muscle Burn Relief
Rehydrate
Drink plenty of water after the session is over.
Water maintains proper circulation for excreting waste products and nourishes the muscle cells with fresh nutrients and oxygen.
Avoid coffee and alcohol as they increase urination and blood osmolality and dehydrate the body.
Stretching
Stretching before and after a session can relieve muscle soreness.
Stretching exercises increase blood flow.
Stimulates the release of synovial fluid around the joints.
Sleep
Get plenty of rest after a session.
The body knows how to restore itself; during sleep, it reduces cortisol secretion.
It increases the stimulation of antioxidative hormones to go after free radicals.
Herbal Remedies
Herbal remedies like ginger, garlic, cloves, and cinnamon increase blood circulation, reducing pain and swelling.
They have anti-inflammatory properties that help with muscle burn and soreness.
After a session, a little peppermint or CBD oil can relieve the sore parts.
Chiropractic Success Story
References
Dion LJ, et al. Development of a hospital-based massage therapy course at an academic medical center. International Journal of Therapeutic Massage and Bodywork. 2015; doi:10.3822/ijtmb.v8i1.249.
Rodgers NJ, et al. A decade of building massage therapy services at an academic medical center as part of a healing enhancement program. Complementary Therapies in Clinical Practice. 2015; doi:10.1016/j.ctcp.2015.07.004.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
