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Personal Injury

Back Clinic Personal Injury Chiropractic Team. Injuries from an accident can not only cause physical harm to you or a loved one, being involved in a personal injury case can often be a complicated and stressful situation to handle. These types of circumstances are unfortunately fairly common and when the individual is faced with pain and discomfort as a result of trauma from an accident or an underlying condition that has been aggravated by the injury, finding the right treatment for their specific issue can be another challenge on its own.

Dr. Alex Jimenez’s compilation of personal injury articles highlights a variety of personal injury cases, including automobile accidents resulting in whiplash, while also summarizing various effective treatments, such as chiropractic care. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 540-8444.

The Ultimate Guide To Strengthening Multifidus Muscles

The Ultimate Guide To Strengthening Multifidus Muscles

For individuals experiencing lower back pain can understanding the anatomy and function of the multifidus muscle help in injury prevention and in the development of a highly effective treatment plan?

The Ultimate Guide To Strengthening Multifidus Muscles

Multifidus Muscle

The multifidus muscles are long and narrow on either side of the spinal column, which helps stabilize the lower region of the spine or lumbar spine. (Maryse Fortin, Luciana Gazzi Macedo 2013) Sitting too much, practicing unhealthy postures, and lack of movement can progress to the multifidus muscle weakening or atrophy, which can lead to spinal instability, vertebral compression, and back pain. (Paul W. Hodges, Lieven Danneels 2019)


Known as the deep layer, it is the innermost layer of the three muscle layers of the back and controls the movement of the spine. The other two layers, known as the intrinsic and superficial, are responsible for the thoracic cage/rib cage and shoulder movement. (Anouk Agten et al., 2020) The multifidus has attachment points at:

  • The thoracic spine of the middle back.
  • The lumbar spine of the lower back.
  • The iliac spine – the base of the wing-shaped iliac bone of the pelvis.
  • Sacrum – series of bones at the base of the spine connected to the tailbone.
  • When standing or moving, the multifidus muscle works with the transversus abdominus and pelvic floor muscles to stabilize the lumbar spine. (Christine Lynders 2019)

Muscle Function

The main function is to stabilize the lower back, but it also helps extend the lower spine whenever reaching or stretching. (Jennifer Padwal et al., 2020) Because the muscle has numerous attachment points and is serviced by a specific branch of nerves known as the posterior rami, it allows each vertebra to work individually and more efficiently.

  • This protects against spinal deterioration and the development of arthritis. (Jeffrey J Hebert et al., 2015)
  • The multifidus muscle works with two other deep muscle groups to stabilize and move the spine. (Jeffrey J Hebert et al., 2015)
  • The rotatores muscle enables unilateral rotation, turning from side to side, and bilateral extension or bending backward and forward.
  • The semispinalis muscle above the multifidus allows extension and rotation of the head, neck, and upper back.
  • The multifidus muscle ensures spinal strength because it has more attachment points to the spine than the other layers, which reduces spinal flexibility and rotation but increases strength and stability. (Anouk Agten et al., 2020)

Lower Back Pain

A weak multifidus muscle destabilizes the spine and provides less support to the vertebra. This adds pressure on muscles and connective tissues between and adjacent to the spinal column, increasing the risk of lower back pain symptoms. (Paul W. Hodges, Lieven Danneels 2019) The loss of muscle strength and stability can cause atrophy or wasting away. This can cause compression and other back problems. (Paul W. Hodges et al., 2015) Back problems associated with multifidus muscle deterioration include (Paul W. Hodges, Lieven Danneels 2019)

  • Herniated discs – also bulging or slipped discs.
  • Nerve entrapment or compression pinched nerve.
  • Sciatica
  • Referred pain – nerve pain originating from the spine felt in other areas.
  • Osteoarthritis – wear-and-tear arthritis
  • Spinal osteophytes – bone spurs
  • Weak abdominal or pelvic floor muscles can compromise the core, increasing the risk of chronic lower back pain and injury.

Individuals are recommended to consult a physical therapist and chiropractor who can help develop the appropriate treatment, rehabilitation, and strengthening plan based on age, injury, underlying conditions, and physical abilities.

Can Core Exercises Help with Back Pain?


Fortin, M., & Macedo, L. G. (2013). Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: a systematic review with a focus on blinding. Physical therapy, 93(7), 873–888.

Hodges, P. W., & Danneels, L. (2019). Changes in Structure and Function of the Back Muscles in Low Back Pain: Different Time Points, Observations, and Mechanisms. The Journal of orthopaedic and sports physical therapy, 49(6), 464–476.

Agten, A., Stevens, S., Verbrugghe, J., Eijnde, B. O., Timmermans, A., & Vandenabeele, F. (2020). The lumbar multifidus is characterised by larger type I muscle fibres compared to the erector spinae. Anatomy & cell biology, 53(2), 143–150.

Lynders C. (2019). The Critical Role of Development of the Transversus Abdominis in the Prevention and Treatment of Low Back Pain. HSS journal : the musculoskeletal journal of Hospital for Special Surgery, 15(3), 214–220.

Padwal, J., Berry, D. B., Hubbard, J. C., Zlomislic, V., Allen, R. T., Garfin, S. R., Ward, S. R., & Shahidi, B. (2020). Regional differences between superficial and deep lumbar multifidus in patients with chronic lumbar spine pathology. BMC musculoskeletal disorders, 21(1), 764.

Hebert, J. J., Koppenhaver, S. L., Teyhen, D. S., Walker, B. F., & Fritz, J. M. (2015). The evaluation of lumbar multifidus muscle function via palpation: reliability and validity of a new clinical test. The spine journal : official journal of the North American Spine Society, 15(6), 1196–1202.

Hodges, P. W., James, G., Blomster, L., Hall, L., Schmid, A., Shu, C., Little, C., & Melrose, J. (2015). Multifidus Muscle Changes After Back Injury Are Characterized by Structural Remodeling of Muscle, Adipose and Connective Tissue, but Not Muscle Atrophy: Molecular and Morphological Evidence. Spine, 40(14), 1057–1071.

FOOSH Injury Treatment: What to Know

FOOSH Injury Treatment: What to Know

During a fall individuals tend to automatically outstretch their hands to help break a fall, which can slam onto the ground causing a falling onto an outstretched hand or FOOSH injury. Should individuals get checked by a healthcare provider if they believe there is no injury?

FOOSH Injury Treatment: What to Know

FOOSH Injuries

Falling down usually results in minor injuries. A FOOSH injury occurs when falling down and trying to break the fall by reaching out with the hand/s. This can result in an upper extremity injury like a sprain or a fracture. But sometimes, falling on one’s hands can lead to serious injuries and/or create future musculoskeletal issues. Individuals who have fallen or suffered a FOOSH injury should consult their healthcare provider and then a physical therapist or chiropractor to safely develop a treatment plan to rehabilitate, strengthen, and expedite recovery.

After The Injury

For individuals who have fallen down and landed on their hand, wrist, or arm, here are a few things to ensure the proper care for the injury, including:

  • Follow the R.I.C.E. protocol for acute injuries
  • Visit a healthcare provider or local emergency clinic
  • Contact a physical therapist

A FOOSH injury could be or become serious, so to avoid letting small issues become big problems, get examined by a musculoskeletal specialist. The healthcare provider will obtain an imaging scan of the injured and surrounding areas. They will perform a physical examination to determine the type of injury, like a sprain or muscle strain. Not getting appropriate medical treatment after a fall can result in chronic pain and loss of function. (J. Chiu, S. N. Robinovitch. 1998)

Common Injuries

A FOOSH injury can injure different areas. These usually involve the wrist and hand, but the elbow or shoulder can also be injured. Common injuries include:

Colles’ fracture

  • A wrist fracture where the end of the arm bone is displaced backward.

Smith’s fracture

  • A wrist fracture, similar to a Colles’ fracture, is where the end of the arm bone is displaced towards the front of the wrist.

Boxer’s fracture

  • A fracture of the small bones in the hand.
  • Typically, it occurs after punching something, but it can happen from falling on an outstretched fist.

Elbow dislocation or fracture

  • The elbow can pop out of the joint or can break a bone in the elbow.

Collarbone fracture

  • The force from falling with the hands and arms outstretched can travel up to the collarbone, causing a fracture.

Proximal humeral fracture

  • Falling onto an outstretched hand injury can cause the arm bone to get jammed into the shoulder, causing a proximal humeral fracture.

Shoulder dislocation

  • The shoulder can pop out of the joint.
  • This can cause a rotator cuff tear or labrum injury.

Regardless of the injury, individuals should visit a healthcare provider to evaluate the damage. If the injury is serious, the practitioner can make an accurate or differential diagnosis and develop a treatment plan. (William R. VanWye et al., 2016)

Physical Therapy

Individuals can benefit from physical therapy to help recover and return to their previous level of function. Physical therapy varies depending on the specific injury, but generally, a physical therapist can help individuals return to function after a fall on an outstretched hand. (William R. VanWye et al., 2016) Common treatments can include:

  • Treatments and modalities to decrease pain, inflammation, and swelling.
  • Instruction on how to wear an arm sling properly.
  • Exercises and stretches to improve the range of motion, strength, and functional mobility.
  • Balance exercises.
  • Scar tissue management if surgery was necessary.

The therapy team will ensure the proper treatment is utilized to quickly and safely return to normal activities.

Chiropractic Care For Healing After Trauma


Chiu, J., & Robinovitch, S. N. (1998). Prediction of upper extremity impact forces during falls on the outstretched hand. Journal of biomechanics, 31(12), 1169–1176.

VanWye, W. R., Hoover, D. L., & Willgruber, S. (2016). Physical therapist screening and differential diagnosis for traumatic-onset elbow pain: A case report. Physiotherapy theory and practice, 32(7), 556–565.

Cracked Rib: A Complete Guide on Causes and How to Treat It

Cracked Rib: A Complete Guide on Causes and How to Treat It

Individuals may not realize they have a cracked rib until symptoms like pain when taking in a deep breath begin to present. Can knowing the symptoms and causes of cracked or broken ribs help in diagnosis and treatment?

Cracked Rib: A Complete Guide on Causes and How to Treat It

Cracked Rib

A broken/fractured rib describes any break in the bone. A cracked rib is a type of rib fracture and is more a description than a medical diagnosis of a rib that has been partially fractured. Any blunt impact to the chest or back can cause a cracked rib, including:

  • Falling
  • Vehicle collision
  • Sports injury
  • Violent coughing
  1. The main symptom is pain when inhaling.
  2. The injury typically heals within six weeks.


Cracked ribs are usually caused by a fall, trauma to the chest, or intense violent coughing. Symptoms include:

  • Swelling or tenderness around the injured area.
  • Chest pain when breathing/inhaling, sneezing, laughing, or coughing.
  • Chest pain with movement or when lying down in certain positions.
  • Possible bruising.
  • Although rare, a cracked rib can cause complications like pneumonia.
  • See a healthcare provider immediately if experiencing difficulty breathing, severe chest pain, or a persistent cough with mucus, high fever, and/or chills.


In most cases, a rib usually gets broken in one area, causing an incomplete fracture, which means a crack or break that does not go through the bone. Other types of rib fractures include:

Displaced and Nondisplaced Fractures

  • Completely broken ribs may or may not shift out of place.
  • If the rib does move, this is known as a displaced rib fracture and is more likely to puncture lungs or damage other tissues and organs. (Yale Medicine. 2024)
  • A rib that stays in place usually means the rib is not completely broken in half and is known as a nondisplaced rib fracture.

Flail Chest

  • A section of the ribcage can break away from the surrounding bone and muscle, although this is rare.
  • If this happens, the ribcage will lose stability, and the bone will move freely as the individual inhales or exhales.
  • This broken ribcage section is called a flail segment.
  • This is dangerous as it can puncture the lungs and cause other serious complications, like pneumonia.


Common causes of cracked ribs include:

  • Vehicle collisions
  • Pedestrian accidents
  • Falls
  • Impact injuries from sports
  • Overuse/Repetitive stress brought on by work or sports
  • Severe coughing
  • Older individuals can experience a fracture from a minor injury due to the progressive loss of bone minerals. (Christian Liebsch et al., 2019)

The Commonality of Rib Fractures

  • Rib fractures are the most common type of bone fracture.
  • They account for 10% to 20% of all blunt trauma injuries seen in emergency rooms.
  • In cases where an individual seeks care for a blunt injury to the chest, 60% to 80% involve a broken rib. (Christian Liebsch et al., 2019)


A cracked rib is diagnosed with a physical exam and imaging tests. During the examination, a healthcare provider will listen to the lungs, press gently on the ribs, and watch as the rib cage moves. The imaging test options include: (Sarah Majercik, Fredric M. Pieracci 2017)

  • X-rays – These are for detecting recently cracked or broken ribs.
  • CT Scan – This imaging test comprises multiple X-rays and can detect smaller cracks.
  • MRI – This imaging test is for soft tissues and can often detect smaller breaks or cartilage damage.
  • Bone Scan – This imaging test uses a radioactive tracer to visualize the structure of bones and can show smaller stress fractures.


In the past, treatment used to involve wrapping the chest with a band known as a rib belt. These are rarely used today as they can restrict breathing, increasing the risk of pneumonia or even a partial lung collapse. (L. May, C. Hillermann, S. Patil 2016). A cracked rib is a simple fracture that requires the following:

  • Rest
  • Over-the-counter or prescription medications can help manage pain symptoms.
  • Nonsteroidal anti-inflammatory drugs – NSAIDs like ibuprofen or naproxen are recommended.
  • If the break is extensive, individuals may be prescribed stronger pain medication depending on the severity and underlying conditions.
  • Physical therapy can expedite the healing process and help maintain the range of motion of the chest wall.
  • For patients who are frail and elderly individuals, physical therapy can help the patient walk and normalize certain functions.
  • A physical therapist can train the individual to transfer between bed and chairs safely while maintaining awareness of any movements or positioning that make the pain worse.
  • A physical therapist will prescribe exercises to keep the body as strong and limber as possible.
  • For example, lateral twists can help improve the range of motion in the thoracic spine.
  1. During the early stages of recovery, it is recommended to sleep in an upright position.
  2. Lying down can add pressure, causing pain and possibly worsen the injury.
  3. Use pillows and bolsters to help support sitting up in bed.
  4. An alternative is to sleep in a reclining chair.
  5. Healing takes at least six weeks. (L. May, C. Hillermann, S. Patil 2016)

Other Conditions

What may feel like a cracked rib may be a similar condition, which is why it’s important to get checked out. Other possible symptom causes can include:


The most common complication is being unable to take a deep breath because of the pain. When the lungs cannot breathe deeply enough, mucous and moisture can build up and lead to an infection like pneumonia. (L. May, C. Hillermann, S. Patil 2016). Displaced rib fractures can also damage other tissues or organs, increasing the risk of a collapsed lung/pneumothorax or internal bleeding. It is recommended to seek immediate medical attention if symptoms develop like:

  • Shortness of breath
  • Difficulty breathing
  • A bluish color of the skin caused by lack of oxygen
  • A persistent cough with mucus
  • Chest pain when breathing in and out
  • Fever, sweating, and chills
  • Rapid heart rate

The Power of Chiropractic Care In Injury Rehabilitation


Yale Medicine. (2024). Rib fracture (broken rib).

Liebsch, C., Seiffert, T., Vlcek, M., Beer, M., Huber-Lang, M., & Wilke, H. J. (2019). Patterns of serial rib fractures after blunt chest trauma: An analysis of 380 cases. PloS one, 14(12), e0224105.

May L, Hillermann C, Patil S. (2016). Rib fracture management. BJA Education. Volume 16, Issue 1. Pages 26-32, ISSN 2058-5349. doi:10.1093/bjaceaccp/mkv011

Majercik, S., & Pieracci, F. M. (2017). Chest Wall Trauma. Thoracic surgery clinics, 27(2), 113–121.

Cold Therapy with Ice Tape for Musculoskeletal Injuries

Cold Therapy with Ice Tape for Musculoskeletal Injuries

For individuals into sports, fitness enthusiasts, and those that engage in physical activities, musculoskeletal injuries are common. Can using ice tape help during the initial or acute phase of injury decrease inflammation and swelling to expedite recovery and return to activities sooner?

Cold Therapy with Ice Tape for Musculoskeletal InjuriesIce Tape

After a musculoskeletal injury, individuals are recommended to follow the R.I.C.E. method to help reduce swelling and inflammation.  R.I.C.E. is the acronym for Rest, Ice, Compression, and Elevation. (Michigan Medicine. University of Michigan. 2023) The cold helps to decrease pain, lower tissue temperature, and decrease swelling around the site of the injury. By controlling the inflammation with ice and compression early after injury, individuals can maintain the appropriate range of motion and mobility around the injured body part. (Jon E. Block. 2010) There are different ways to apply ice to an injury.

  • Store-bought ice bags and cold packs.
  • Soaking the injured body part in a cold whirlpool or tub.
  • Making reusable ice packs.
  • A compression bandage can be used together with the ice.

Ice Tape is a compression bandage that provides cold therapy all at once. After an injury, applying it can help decrease the pain and swelling during the acute inflammatory phase of healing. (Matthew J. Kraeutler et al., 2015)

How The Tape Works

The tape is a flexible bandage that is infused with therapeutic cooling gel. When applied to an injured body part and exposed to air, the gel activates, generating a cold sensation around the area. The therapeutic medicinal effect can last five to six hours. Combined with a flexible bandage, it provides ice therapy and compression. The ice tape can be used straight out of the package but can also be stored in the refrigerator to increase the cold effect. Depending on the maker’s instructions, the tape should not be stored in the freezer as this can make it too hard to wrap around the injured area.


The benefits include the following:

Easy to Use

  • The product is easy to use.
  • Take out the tape, and start wrapping it around the injured body part.

Fasteners Not Required

  • The wrap sticks to itself, so the tape stays in place without using clips or fasteners.

Easy to Cut

  • The standard roll is 48 inches long by 2 inches wide.
  • Most injuries require enough to wrap around the injured area.
  • Scissors cut the exact amount needed, and store the rest in the resealable bag.


  • After 15 to 20 minutes of application, the product can be easily removed, rolled up, stored in the bag, and used again.
  • The tape can be used multiple times.
  • The tape begins to lose its cooling quality after several uses.


  • The tape does not need to be placed in a cooler when traveling.
  • It is easily portable and perfect for a quick ice and compression application immediately after an injury.
  • It can decrease pain and inflammation and kept at the workplace.


A few disadvantages include the following:

Chemical Odor

  • The gel on the flexible wrap can have a medicine odor.
  • It is not quite as powerful smelling as pain creams, but the chemical odor could bother some individuals.

Might Not Be Cold Enough

  • The tape works for immediate pain relief and inflammation, but it may not get cold enough for the user when applied right from the package at room temperature.
  • However, it can be placed in a refrigerator to increase the coldness and may provide a more therapeutic cooling effect, especially for those dealing with tendinitis or bursitis.

Stickiness Could Be Distracting

  • The tape could be a bit sticky for some.
  • This sticky factor can be a minor annoyance.
  • However, it just feels sticky when being applied.
  • A couple of flecks of the gel may get left behind when removed.
  • The ice tape can also stick to clothing.

For individuals looking for a quick, on-the-go cooling therapy for injured or aching body parts, ice tape may be an option. It could be good to have on hand to provide cooling compression if a minor injury occurs while participating in athletics or physical activities and relief for overuse or repetitive strain injuries.

Treating Ankle Sprains


Michigan Medicine. University of Michigan. Rest, Ice, Compression, and Elevation (RICE).

Block J. E. (2010). Cold and compression in the management of musculoskeletal injuries and orthopedic operative procedures: a narrative review. Open access journal of sports medicine, 1, 105–113.

Kraeutler, M. J., Reynolds, K. A., Long, C., & McCarty, E. C. (2015). Compressive cryotherapy versus ice-a prospective, randomized study on postoperative pain in patients undergoing arthroscopic rotator cuff repair or subacromial decompression. Journal of shoulder and elbow surgery, 24(6), 854–859.

Dislocated Elbow: Causes and Treatment Options

Dislocated Elbow: Causes and Treatment Options

A dislocated elbow is a common injury in adults and children and often happens in tandem with bone fractures and nerve and tissue damage. Can physical therapy help to support recovery and ensure range of motion?

Dislocated Elbow: Causes and Treatment Options

Dislocated Elbow Injury

Elbow dislocations are generally caused by trauma when the elbow bones no longer connect. Individuals falling onto an outstretched hand is the most common cause of the injury. (James Layson, Ben J. Best 2023) Healthcare providers will try to relocate the elbow using a closed reduction. Individuals may require surgery if they cannot relocate the elbow using closed reduction.

Resetting The Elbow

The elbow is made up of a hinge and ball-and-socket joint, enabling unique motions: (American Society for Surgery of the Hand. 2021)

Hinge joint

  • The hinge function allows the bending and straightening of the arm.

Ball-and-socket joint

  • The ball-and-socket function allows you to rotate the palm of your hand to face up or face down.

A dislocated elbow injury can damage bones, muscles, ligaments, and tissues. (American Academy of Orthopaedic Surgeons. 2021) The longer the elbow remains out of the joint, the more damage can occur. Elbow dislocations rarely reset into their joints on their own and are recommended to be evaluated by a qualified healthcare provider to prevent permanent damage to nerves or function.

  • It is not recommended to try to reset the elbow on your own.
  • A healthcare provider will work to restore the joint and ensure proper alignment.
  • Before the reset, they will perform a physical examination to assess blood circulation and any nerve damage.
  • Providers will order an imaging scan to examine the dislocation and identify broken bones. (American Academy of Orthopaedic Surgeons. 2021)

Type of Dislocation

The two types of elbow dislocations are: (James Layson, Ben J. Best 2023)

Posterior Dislocation

  • Occurs when there is a significant force on the palm that spreads toward the elbow.
  • Falling with the hands stretched out to catch yourself, and the elbow joint pushes backward/posterior.

Anterior Dislocation

  • This is less common and results from applied force on a flexed elbow.
  • Falling to the ground when the hand is up near the shoulder.
  • In this case, the elbow joint pushes forward/anterior.
  • X-rays are used to determine the type of dislocation and to identify any broken bones. (American Society for Surgery of the Hand. 2021)
  • Depending on the injury, the provider may order a CT scan or MRI to ensure no damage has occurred to nerves or ligaments. (Radiopaedia. 2023)

Signs and Symptoms

A dislocated elbow injury is often caused by trauma. (American Academy of Orthopaedic Surgeons. 2021) General signs and symptoms include: (American Society for Surgery of the Hand. 2021)

  • Inability to move the elbow.
  • Bruising and swelling around the area.
  • Intense pain in the elbow and surrounding area.
  • Deformity around the elbow joint.
  • Numbness, tingling, or weakness in the arm or hand can indicate nerve damage.

Treatment Without Surgery

  • Healthcare providers initially try to treat a dislocated elbow using a closed reduction technique. (American Society for Surgery of the Hand. 2021)
  • A closed reduction means that the elbow can be relocated without surgery.
  • Before the closed reduction, a healthcare provider will administer medications to help relax the individual and address the pain. (Medline Plus. 2022)
  • Once relocated into the correct position, a healthcare provider applies a splint (usually at a 90-degree angle of flexion) to keep the elbow in place. (James Layson, Ben J. Best 2023)
  • The objective is to prevent elbow extension, which can cause re-dislocation.
  • The splint remains in place for one to three weeks. (American Academy of Orthopaedic Surgeons. 2021)
  • A physical therapist will assess motion and prescribe exercises to prevent elbow range of motion loss.

Treatment With Surgery

  1. The elbow remains unstable with a slight extension.
  2. The bones are not correctly aligning.
  3. The ligaments need further repair after a closed reduction.
  • Complex elbow dislocations can make it difficult to maintain joint alignment.
  • An assistive device, like an external hinge, may be recommended to help prevent re-dislocating the elbow.
  • The surgeon will recommend physical therapy after surgery to assist with range-of-motion exercises to optimize and expedite recovery.


  • Recovery times can vary as every injury is different. (American Society for Surgery of the Hand. 2021)
  • The recovery time depends on the elbow’s stability after closed reduction or surgery.
  • Healthcare providers will initiate active motion exercises. (American Society for Surgery of the Hand. 2021)
  • Limiting how long the joint is immobilized will prevent stiffness, scarring, and inhibited movement.
  • Healthcare providers don’t recommend immobilization for more than a few weeks.

Resuming Normal Activities

Resuming regular activity often depends on the type of treatment for the elbow dislocation: (Ortho Bullets. 2023)

Closed Reduction

  • The elbow is splinted for five to ten days.
  • Individuals may engage in physical therapy early motion activity to help prevent loss of range of motion.
  • Individuals are recommended to do light exercises within two weeks after the injury.

Surgical Reduction

  • The elbow may be placed in a brace that allows for a gradual increase in motion.
  • It is essential to maintain controlled movement to prevent motion loss.
  • The elbow can extend fully within six to eight weeks, although it could take up to five months for complete restoration.
  • The healthcare provider will determine when it’s safe to resume normal activity.

The Path to Healing Personal Injury


Layson J, Best BJ. Elbow Dislocation. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:

American Society for Surgery of the Hand. (2021). Elbow dislocation.

American Academy of Orthopaedic Surgeons. (2023). Elbow dislocation.

Jones J, Carroll D, El-Feky M, et al. (2023). Elbow dislocation. Reference article,

Medline Plus. (2022). Closed reduction of a fractured bone.

Ortho Bullets. (2023). Elbow dislocation.

Physical Therapy After Total Ankle Replacement Surgery

Physical Therapy After Total Ankle Replacement Surgery

Progress can be challenging for individuals in post total ankle replacement surgery. How can physical therapy help in recovery and restoring leg function?

Physical Therapy After Total Ankle Replacement Surgery

Total Ankle Replacement Post Surgery Physical Therapy

Total ankle replacement surgery is a major procedure that takes time to recover. A total ankle replacement surgery or arthroplasty can benefit individuals with chronic ankle pain or disability. This procedure can significantly improve an individual’s overall pain and function with time. Physical therapy is essential to regaining movement in the ankle and restoring full mobility. A physical therapist will work with the individual to control pain and swelling, restore the ankle’s range of motion, train on walking gait and balance, and rebuild strength in the leg. This will help maximize the chances of a successful outcome after surgery.

Total Ankle Replacement

The ankle joint is the section of the lower leg where the shinbone/tibia meets the talus bone on the top of the foot. What can happen is the slippery surface/articular cartilage that coats the ends of these bones begins to thin or deteriorate. As the deterioration progresses, it can lead to significant pain, disability, and difficulty walking. (Cleveland Clinic. 2021) This is where a specialist may recommend total ankle replacement for the best results. Various conditions can be helped by this procedure, including:

  • Joint damage caused by gout
  • Post-traumatic arthritis
  • Rheumatoid arthritis
  • Advanced osteoarthritis
  • Osteonecrosis
  • Septic arthritis (Cort D. Lawton et al., 2017)

During an ankle replacement procedure, an orthopedic surgeon removes the damaged ends of the tibia and talus bones and replaces them with an artificial covering. A polyethylene component is also secured between the two structures to support the smooth movement of the new joint endings. (Massachusetts General Hospital. N.D.) Following the procedure, individuals are typically placed in a protective boot or splint. The healthcare provider will recommend staying off the leg for 4 to 8 weeks to allow healing.

Physical Therapy

Outpatient physical therapy is usually initiated several weeks after the ankle operation. (UW Health Orthopedics and Rehabilitation. 2018) Physical therapy can last for five months or more, depending on the severity of the condition and injury. The physical therapist will focus on different areas to get the best results. (Cort D. Lawton et al., 2017)

Pain and Swelling Control

Post-operative pain and swelling are normal after a total ankle replacement. It is not unusual for an ankle to be swollen for even six to 12 months after the operation. (UW Health Orthopedics and Rehabilitation. 2018) The surgeon will normally prescribe medication to help manage discomfort early on, and physical therapy also plays an important role in addressing the symptoms. Treatments used can include:

  • Electrical stimulation – mild electrical pulses applied to the muscles.
  • Ice
  • Vasopneumatic compression, where an inflatable sleeve is used to create pressure around the area, is commonly utilized at the beginning of physical therapy to reduce pain or swelling.
  • Other modalities, such as stretching and targeted exercises, are combined with other treatments.

Range of Motion

  • Early after the procedure, the ankle will be very stiff and tight. This is due to several factors, including the inflammation and swelling after surgery and the time spent immobilized in a boot.
  • The physical therapist will employ various techniques to improve the ankle joint’s range of motion to rotate and flex.
  • The physical therapist may employ passive stretching induced by an outside force such as the therapist or a resistance band) to help improve mobility.
  • Manual techniques like soft tissue massage and joint mobilizations are also utilized. (Massachusetts General Hospital. N.D.)
  • The therapist will develop a home rehabilitation program comprising self-stretching techniques and gentle movements.

Gait and Balance Training

  • After weeks of staying off the affected ankle, the surgeon will clear the patient to begin walking training.
  • The physical therapist will work to improve the overall gait pattern and reduce limping.
  • They will also help transition from using crutches or a walker to walking independently. (UW Health Orthopedics and Rehabilitation. 2018)
  • After multiple weeks of reduced movement and lack of bearing any weight on the ankle, the muscles that surround the ankle have often atrophied/weakened, which can impact balance.
  • When the individual can begin placing weight on the leg, the therapist will apply proprioceptive/sense of body position training to improve overall stability. (UW Health Orthopedics and Rehabilitation. 2018)
  • Balance exercises will be added to the home program and will progress from week to week.


The muscles in the leg, ankle, and foot become weak from the surgery and the time spent in a splint or boot. These structures have a significant role in balance, the ability to stand, walk, and go up or down the stairs.

  • Regaining the strength and power of these muscles is a critical goal of rehabilitation.
  • In the first weeks, the physical therapist will focus on gentle strengthening exercises.
  • Isometrics lightly activate the muscles but avoid irritating the surgical site.
  • As time passes and weight-bearing is allowed, these gentle moves are replaced with more challenging ones, like resistance bands and standing exercises, to accelerate strength gains.

Treating Ankle Sprains with Chiropractic Care


Cleveland Clinic. (2021). Total ankle replacement.

Lawton, C. D., Butler, B. A., Dekker, R. G., 2nd, Prescott, A., & Kadakia, A. R. (2017). Total ankle arthroplasty versus ankle arthrodesis-a comparison of outcomes over the last decade. Journal of orthopaedic surgery and research, 12(1), 76.

Massachusetts General Hospital. (N.D.). Physical therapy guidelines for total ankle arthroplasty.

UW Health Orthopedics and Rehabilitation. (2018). Rehabilitation guidelines following total ankle arthroplasty.

Understand Turf Toe Injury: Symptoms, Treatment, and Recovery

Understand Turf Toe Injury: Symptoms, Treatment, and Recovery

For individuals experiencing a turf toe injury, can knowing the symptoms help athletes and non-athletes with treatment, recovery time, and returning to activities?

Understand Turf Toe Injury: Symptoms, Treatment, and Recovery

Turf Toe Injury

A turf toe injury affects the soft tissue ligaments and tendons at the base of the big toe under the foot. This condition usually occurs when the toe is hyperextended/forced upward, such as when the ball of the foot is on the ground and the heel is lifted. (American Academy of Orthopaedic Surgeons. 2021) The injury is common among athletes who play sports on artificial turf, which is how the injury got its name. However, it can also affect non-athletes, like individuals working on their feet all day.

  • Recovery time after turf toe injury depends on the severity and the type of activities the individual plans to return to.
  • Returning to high-level sports activities after a severe injury can take six months.
  • These injuries vary in severity but usually improve with conservative treatment. In severe cases, surgery could be required.
  • Pain is the primary issue that stops physical activities after a grade 1 injury, while grades 2 and 3 can take weeks to months to heal completely.


A turf toe injury refers to a metatarsophalangeal joint strain. This joint comprises ligaments that connect the bone on the sole of the foot, below the big toe/proximal phalanx, to the bones that connect the toes to the larger bones in the feet/metatarsals. The injury is usually caused by hyperextension that often results from a pushing-off motion, like running or jumping.


Turf toe injuries can range from mild to severe and are graded as follows: (American Academy of Orthopaedic Surgeons. 2021)

  • Grade 1 – The soft tissue is stretched, causing pain and swelling.
  • Grade 2 – The soft tissue is partially torn. Pain is more pronounced, with significant swelling and bruising, and it is difficult to move the toe.
  • Grade 3 – Soft tissue is completely torn, and symptoms are severe.

Is This What’s Causing My Foot Pain?

Turf toe can be an:

  • Overuse injury – caused by repeating the same motion repeatedly for an extended period, that causes symptoms to worsen.
  • Acute injury – that occurs suddenly, causing immediate pain.

Symptoms can include the following: (Mass General Brigham. 2023)

  • Limited range-of-motion.
  • Tenderness in the big toe and surrounding area.
  • Swelling.
  • Pain in the big toe and surrounding area.
  • Bruising.
  • Loose joints can indicate there is a dislocation.


If experiencing turf toe symptoms, see a healthcare provider for a proper diagnosis so they can develop a personalized treatment plan. They will perform a physical exam to assess pain, swelling, and range of motion. (American Academy of Orthopaedic Surgeons. 2021) If the healthcare provider suspects tissue damage, they may recommend imaging with X-rays and (MRI) to grade the injury and determine the proper course of action.


A healthcare provider will determine the best treatment based on the severity of the injury. All turf toe injuries can benefit from the RICE protocol: (American College of Foot and Ankle Surgeons. Foot Health Facts. 2023)

  1. Rest – Avoid activities that worsen symptoms. This can include using an assistive device like a walking boot or crutches to reduce pressure.
  2. Ice – Apply ice for 20 minutes, then wait 40 minutes before reapplying.
  3. Compression – Wrap the toe and foot with an elastic bandage to support and reduce swelling.
  4. Elevation – Prop the foot above the level of the heart to help decrease swelling.

Grade 1

Grade 1 turf toe is classified by stretched soft tissue, pain, and swelling. Treatments can include: (Ali-Asgar Najefi et al., 2018)

  • Taping to support the toe.
  • Wearing shoes with a rigid sole.
  • Orthotic support, like a turf toe plate.

Grades 2 and 3

Grades 2 and 3 come with partial or complete tissue tearing, severe pain, and swelling. Treatments for more severe turf toe can include: (Ali-Asgar Najefi et al., 2018)

  • Limited weight bearing
  • Using assistive devices like crutches, a walking boot, or a cast.

Other Treatment

  • Less than 2% of these injuries require surgery. It is usually recommended if there is instability in the joint or when conservative treatments are unsuccessful. (Ali-Asgar Najefi et al., 2018) (Zachariah W. Pinter et al., 2020)
  • Physical therapy is beneficial for decreasing pain and improving the range of motion and strength after injury. (American Academy of Orthopaedic Surgeons. 2021)
  • Physical therapy also includes proprioception and agility training exercises, orthotics, and wearing recommended shoes for specific physical activities. (Lisa Chinn, Jay Hertel. 2010)
  • A physical therapist can also help ensure that the individual does not return to physical activities before the injury is fully healed and prevent the risk of re-injury.

Recovery Time

Recovery depends on injury severity. (Ali-Asgar Najefi et al., 2018)

  • Grade 1 – Subjective as it varies depending on the individual’s pain tolerance.
  • Grade 2 – Four to six weeks of immobilization.
  • Grade 3 – Eight weeks minimum of immobilization.
  • It can take up to six months to return to normal function.

Returning To Normal Activities

After a grade 1 turf toe injury, individuals can return to normal activities once the pain is under control. Grades 2 and 3 take longer to heal. Returning to sports activities after a grade 2 injury can take around two or three months, while grade 3 injuries and cases that require surgery can take up to six months. (Ali-Asgar Najefi et al., 2018)

Sports Chiropractic Treatment


American Academy of Orthopaedic Surgeons. (2021). Turf toe.

Mass General Brigham. (2023). Turf toe.

American College of Foot and Ankle Surgeons. Foot Health Facts. (2023). RICE protocol.

Najefi, A. A., Jeyaseelan, L., & Welck, M. (2018). Turf toe: A clinical update. EFORT open reviews, 3(9), 501–506.

Pinter, Z. W., Farnell, C. G., Huntley, S., Patel, H. A., Peng, J., McMurtrie, J., Ray, J. L., Naranje, S., & Shah, A. B. (2020). Outcomes of Chronic Turf Toe Repair in Non-athlete Population: A Retrospective Study. Indian journal of orthopaedics, 54(1), 43–48.

Chinn, L., & Hertel, J. (2010). Rehabilitation of ankle and foot injuries in athletes. Clinics in sports medicine, 29(1), 157–167.