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Sports Injuries

Back Clinic Sports Injuries Chiropractic and Physical Therapy Team. Athletes from all sports can benefit from chiropractic treatment. Adjustments can help treat injuries from high-impact sports i.e. wrestling, football, and hockey. Athletes that get routine adjustments may notice improved athletic performance, improved range of motion along with flexibility, and increased blood flow. Because spinal adjustments will reduce the irritation of the nerve roots between the vertebrae, the healing time from minor injuries can be shortened, which improves performance. Both high-impact and low-impact athletes can benefit from routine spinal adjustments.

For high-impact athletes, it increases performance and flexibility and lowers the risk for injury for low-impact athletes i.e. tennis players, bowlers, and golfers. Chiropractic is a natural way to treat and prevent different injuries and conditions that impact athletes. According to Dr. Jimenez, excessive training or improper gear, among other factors, are common causes of injury. Dr. Jimenez summarizes the various causes and effects of sports injuries on the athlete as well as explaining the types of treatments and rehabilitation methods that can help improve an athlete’s condition. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 540-8444.

Sports Exercise Headaches Back Clinic Chiropractor

Sports Exercise Headaches Back Clinic Chiropractor

Sports exercise headaches are exertion headaches that involve pain during or immediately after sports, exercise, or some physical activity. They come on quickly but can last a few minutes, hours, or days. Activities associated with exercise headaches include running, weightlifting, tennis, swimming, and rowing. Chiropractic, massage, decompression, and traction therapies can realign the body and relax the muscles allowing for optimal circulation and certain strategies to help prevent future episodes. Usually, there is no underlying disease or disorder, but it is recommended to talk to a healthcare provider to make sure.

Sports, Exercise, Physical Activity Headaches Chiropractor

Sports Exercise Headaches

When individuals exert their bodies intensely, they need added blood and oxygen, particularly with activities that involve tightening/tensing the abdominal muscles or increasing chest pressure. Doctors and scientists believe an exertional headache occurs when intense physical activity causes the veins and arteries to expand to circulate more blood. The expansion and increased blood circulation generate pressure in the skull that can cause pain.

Alternate Triggers

Exercising is not the only cause; other physical activities that can trigger an exertion headache include:

  • Sneezing
  • Coughing
  • Straining to use the bathroom
  • Sexual intercourse
  • Lifting  or moving a heavy object


Symptoms of a sports exercise headache include:

  • Neck stiffness or pain
  • Pain on one or both sides of the head
  • Pulsating pain discomfort
  • Throbbing pain discomfort
  • Shoulder tightness, discomfort, and/or pain

Sometimes individuals report the headache can feel like a migraine that could include:

  • Vision problems like blind spots
  • Nausea
  • Vomiting
  • Light sensitivity

Most exercise headaches last five to 48 hours and can continue for three to six months.


An underlying disease or disorder does not cause most exertional headaches. However, individuals experiencing severe or frequent headaches should consult their doctor or a healthcare provider. Tests will be ordered to rule out possible causes that include:

If there is no underlying cause found, the medical provider can diagnose exertion headaches if there have been at least two headaches that:

  • Were caused by exercise or physical activity.
  • Started during or after the physical activity.
  • Lasted less than 48 hours.

Chiropractic Treatment

According to the American Chiropractic Association, spinal adjustments are an effective headache treatment option. This includes migraines, tension headaches, or sports exercise headaches. Using the targeted approaches, chiropractic restores the body’s natural alignment to improve function and alleviate stress on the nervous system. This allows the body to operate at optimal levels reducing muscle stress and muscle tension.

DOC Decompression Table


American Migraine Foundation. Secondary Headaches. ( Accessed 11/17/2021.

Evans, Randolph W. “Sports and Headaches.” Headache vol. 58,3 (2018): 426-437. doi:10.1111/head.13263

International Headache Society. HIS Classification ICHD-3. ( Accessed 11/17/2021.

McCrory, P. “Headaches and exercise.” Sports medicine (Auckland, N.Z.) vol. 30,3 (2000): 221-9. doi:10.2165/00007256-200030030-00006

National Headache Foundation. Exertional Headaches. ( Accessed 11/17/2021.

Ramadan, Nabih M. “Sports-related headache.” Current pain and headache reports vol. 8,4 (2004): 301-5. doi:10.1007/s11916-004-0012-1

Trotta K, Hyde J. Exercise-induced headaches: prevention, management, and treatment. ( U.S. Pharm. 2017;42(1):33-36. Accessed 11/17/2021.

Baseball Injuries Chiropractor Back Clinic

Baseball Injuries Chiropractor Back Clinic

The game of baseball takes a toll on the body, especially when players advance from little league to high school, college, minor league, and the pros. The most common baseball injuries can range from mild to severe, from normal wear and tear on the joints and muscles to repetitive stress injuries, collisions with other players, getting hit with the ball, or bodily trauma. A chiropractor can provide ideal treatment for players of all ages and levels with decreased downtime and expedited healing and recovery.

Baseball Injuries Chiropractor

Baseball Injuries

Although there have been a lot of advances in player safety and health, from helmets with face guards to shin and arm padding, the equipment lessens the impact and risks of injury. The game still involves running, sliding, twisting, and jumping, causing the body to maneuver awkwardly. Players often report sliding into first, feeling a pop or twisting to catch a fly ball, and feeling something snap. The most common injuries include:

Torn Labrum

  • Cartilage surrounding the shoulder joint socket, known as the labrum, often gets torn.
  • The soft tissue keeps the bones in place and provides stability.
  • Pitching and throwing motions stress the labrum.
  • With time, the cartilage begins to overstretch and tear, leading to swelling, shoulder pain, weakness, and overall instability.

Rotator Cuff Tears

  • The rotator cuff structure involves a complex set of tendons and muscles that stabilize the shoulder.
  • Pitchers are the most vulnerable, but all players are susceptible.
  • Cases are caused by not warming up and stretching correctly and repetitive/overuse movements.
  • Swelling and pain are the most common symptoms.
  • With a severe tear, a player will lose the ability to rotate the shoulder correctly.

Shoulder Instability or Dead Arm

  • This is when the shoulder muscles become overly fatigued, and the joint becomes unstable, losing the ability to throw precisely.
  • The condition is called dead arm by players and trainers.
  • This type of injury is caused by overuse and repeated stress.
  • Healing involves letting the shoulder rest for an extended period, but treatment, like chiropractic or physical therapy, could be recommended depending on the severity.

Pitchers Elbow

  • A pitcher’s elbow injury is caused by overuse and sustained/repeated damage to the tendons that rotate the wrist.
  • Pain and swelling occur along the inside of the elbow and forearm.

Wrist Tendonitis and Trauma

  • Wrist Tendonitis or tenosynovitis happens when the ligaments and tendons become tender, swollen, ruptured, or torn.
  • This causes inflammation, pain, and weakness.
  • Trauma injuries can result from collisions with another player, the ground, or a ball.

Knee Tears and Trauma

  • Knee injuries can be caused by normal wear and tear, overuse, or traumatic impact.
  • The fibrous bands are what stabilize and cushion the knee.
  • Overuse and any awkward movement can cause the tearing of the various ligaments.
  • The bands can develop micro-tears or complete ruptures, causing inflammation, pain, and instability.

Chiropractic Care and Rehabilitation

Chiropractic treatment and physical therapy have been found to help athletes maintain flexibility and range of motion, rehabilitate the body after an injury, and prevent new injuries or worsening of current injuries.

  • Chiropractic helps stretch and flex the muscles to stay limber and less prone to injury.
  • Chiropractic is a natural pain reliever for sore muscles and joint pain.
  • Physical therapy can strengthen an injured area during recovery and educate on proper form and techniques.
  • Taping and strapping can help support the elbows, wrists, ankles, and knees, reducing stress.
  • A combination of treatment approaches can help decrease recovery time so players can get back on the field.

Shoulder Adjustment Baseball Injuries


Bullock, Garrett S et al. “Shoulder Range of Motion and Baseball Arm Injuries: A Systematic Review and Meta-Analysis.” Journal of athletic training vol. 53,12 (2018): 1190-1199. doi:10.4085/1062-6050-439-17

Lyman, Stephen, and Glenn S Fleisig. “Baseball injuries.” Medicine and sport science vol. 49 (2005): 9-30. doi:10.1159/000085340

Matsel, Kyle A et al. “Current Concepts in Arm Care Exercise Programs and Injury Risk Reduction in Adolescent Baseball Players: A Clinical Review.” Sports health vol. 13,3 (2021): 245-250. doi:10.1177/1941738120976384

Shitara, Hitoshi, et al. “Shoulder Stretching Intervention Reduces the Incidence of Shoulder and Elbow Injuries in High School Baseball Players: a Time-to-Event Analysis.” Scientific reports vol. 7 45304. 27 Mar. 2017, doi:10.1038/srep45304

Wilk, Kevin E, and Christopher A Arrigo. “Rehabilitation of Elbow Injuries: Nonoperative and Operative.” Clinics in sports medicine vol. 39,3 (2020): 687-715. doi:10.1016/j.csm.2020.02.010

Sports Back Injuries: Spinal Decompression

Sports Back Injuries: Spinal Decompression

Whenever stepping out onto a playing field or gym, there is a risk of suffering sports back injuries. Back pulls, strain and sprain injuries are the most common. Low back pain is one of the most prevalent complaints at all levels of competition. 90% of these acute back injuries will heal on their own, usually in about three months. However, sometimes these injuries can be more severe and require professional medical care. Treatment options for different groups of athletes include nonsurgical motorized spinal decompression.

Sports Back Injuries: Spinal Decompression

Sports Back Injuries

Injury mechanisms vary from sport to sport, but there are recommendations regarding spinal decompression treatment for these injuries and return to play. Chiropractic healthcare specialists understand the sport-specific injury patterns and treatment guidelines for athletes following a back injury. Spinal decompression treatments are beneficial and result in higher rates of return to play depending on the specific sport of the injured athlete. A chiropractor will create a personalized spinal decompression treatment plan for the sport-specific context to meet the athlete’s short and long-term needs.

  • An estimated 10–15% of athletes will experience low back pain.
  • All types of sports place increased stress on the lumbar spine through physically demanding and repetitive movements/motions.
  • The repetitive shifting, bending, twisting, jumping, flexion, extension, and spinal axial loading motions contribute to low back pain even though the athletes are in top shape with increased strength and flexibility.
  • Injury patterns demonstrate the increased stresses that athletes place on the lumbar spine.

Common Spine Sports Injuries

Cervical Neck Injuries

  • Stingers are a type of neck injury.
  • A stinger is also known as a burner is an injury that happens when the head or neck gets hit to one side, causing the shoulder to be pulled in the opposite direction.
  • These injuries manifest as numbness or tingling in the shoulder from stretching or compressing the cervical nerve roots.

Lumbar Lower Back Sprains and Strains

  • When trying to lift too much weight or using an improper lifting technique when working out with weights.
  • Fast running, quick stopping, and shifting can cause the low back and hip muscles to get overly pulled/stretched.
  • Staying low to the ground and springing/jumping up can cause abnormal stretching or tearing of the muscle fibers.

Fractures and Injuries to the Supporting Spinal Structures

  • In sports that involve repetitive extension movements, spinal stress fractures are relatively common.
  • Also known as pars fractures or spondylolysis, these happen when there is a crack in the rear portion of the spinal column.
  • Excessive and repeated strain to the spinal column area leads to low back pain and injury.

Nonsurgical Spinal Decompression

Nonsurgical spinal decompression is motorized traction that is used to relieve compression pressure, restore spinal disc height, and relieve back pain.

  • Spinal decompression works to gently stretch the spine changing the force and position of the spine.
  • The gel-like cushions between the vertebrae are pulled to open up the spacing taking pressure off nerves and other structures.
  • This allows bulging or herniated discs to return to their normal position and promotes optimal circulation of blood, water, oxygen, and nutrient-rich fluids into the discs to heal, as well as, injured or diseased spinal nerve roots.

DRX 9000 Decompression


Ball, Jacob R et al. “Lumbar Spine Injuries in Sports: Review of the Literature and Current Treatment Recommendations.” Sports medicine – open vol. 5,1 26. 24 Jun. 2019, doi:10.1186/s40798-019-0199-7

Jonasson, Pall et al. “Prevalence of joint-related pain in the extremities and spine in five groups of top athletes.” Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA vol. 19,9 (2011): 1540-6. doi:10.1007/s00167-011-1539-4

Lawrence, James P et al. “Back pain in athletes.” The Journal of the American Academy of Orthopaedic Surgeons vol. 14,13 (2006): 726-35. doi:10.5435/00124635-200612000-00004

Petering, Ryan C, and Charles Webb. “Treatment options for low back pain in athletes.” Sports health vol. 3,6 (2011): 550-5. doi:10.1177/1941738111416446

Sanchez, Anthony R 2nd et al. “Field-side and prehospital management of the spine-injured athlete.” Current sports medicine reports vol. 4,1 (2005): 50-5. doi:10.1097/01.csmr.0000306072.44520.22

Squat Exercises Causing Low Back Pain

Squat Exercises Causing Low Back Pain

Squat exercises are highly effective, as they strengthen the back and core muscles, helping the prevention of injury. They can be done anywhere with or without equipment like weights and resistance bands and can be part of an aerobic workout. Squatting requires following proper form and posture. Using the improper form, adding too much weight too soon, overdoing it without enough recovery time can cause soreness, back pain, and injury. Having muscle soreness after performing squats is expected; however, if symptoms like chronic soreness, tingling, numbness, or sharp aches that come and go, begin to appear, it is recommended to consult a medical trainer, chiropractor, doctor, or spine specialist to evaluate the symptoms, and if necessary develop a treatment plan, as well as a prevention plan to continue exercising safely.

Squat Exercises Causing Low Back Pain

Squat Exercises

Squatting is a highly beneficial form of exercise. Athletes, trainers, coaches, and individuals just staying healthy use the technique as a part of their training and workouts. This is because squatting increases core muscle strength, increasing body power. Squat exercises benefits include:

Increased Flexibility

  • Improved strength and a range of motion allow the body to move flawlessly in various directions with minimal effort.

Increased Core Strength

  • All major muscles work together during a squat.
  • This increases muscle stabilization, maintains body balance, increasing core strength.

Injury Prevention

  • Squats work all leg muscles simultaneously, synchronizing the body.
  • This increases body stability decreasing the risk of injury.

Back Pain and Potential Injury

The spine is exposed and unprotected during a squat. This is where back pain and injury can happen. Potential causes include:

  • Not warming up/priming muscles properly.
  • Tight muscles and a limited range of motion.
  • Improper form and squatting technique.
  • Adding weight or loading too soon.
  • Weak core muscles.
  • Incorrect or improper footwear with inadequate arch support.
  • Weak ankle muscles are not used to the weight and shift, causing misalignment and awkward positioning.
  • Previous injuries to the lower back can cause a flare-up to the area and potentially worsen.


Ways to troubleshoot and prevent back pain during squat exercises.


  • Using a proper and effective warmup will ensure that the body is ready for the workout stress.
  • Priming each muscle is recommended. This could be:
  • Starting with glute work.
  • Then planks to activate the core.
  • Finish off with stretching and range of motion exercises.
  • A personal trainer can assist in creating a customized workout routine.

Starting Position

  • The feet should always face forward to protect the hips and knees when beginning a squat.
  • If the feet face at an angle, the form can be impacted, leading to back pain or collapsing arches.

Spinal Alignment

  • Maintaining a straight-ahead or upward gaze, which increases center awareness during squat exercises, can prevent the body from leaning forward and placing stress on the spine.
  • Only squat as far as possible, making sure to feel in control and maintain the form.
  • Squatting too deep can cause muscle strain leading to pain.
  • Focus on form, as it is more important than depth.

Joint mobility

  • Ankle mobility and stability are essential to balance and control.
  • If the ankle is compromised, the feet could lift off the floor, forcing the body to compensate, leading to strain and potential injuries.
  • Only squat as far as ankle stability allows.
  • Ankle flexibility exercises will help improve squat form.


A chiropractor or physical therapist will be able to evaluate spinal health, exercise form, and advise if there is an issue.

Body Composition

Achieve Health and Fitness Goals By Doing What You Enjoy

Don’t engage in workouts or fitness programs that make you miserable. Do workouts/activities that you enjoy and have fun doing. Exercise for the love of the body, keeping it healthy and in shape, not because there is a feeling of obligation.

  • Try and experiment with different workouts/physical activities to see and feel what works for you.
  • Individuals who don’t like lifting weights try using resistance bands or bodyweight exercises.
  • The same goes for nutrition. Don’t base diet and supplement choices on misperceptions about health.

Calatayud, Joaquín et al. “Tolerability and Muscle Activity of Core Muscle Exercises in Chronic Low-back Pain.” International journal of environmental research and public health vol. 16,19 3509. 20 Sep. 2019, doi:10.3390/ijerph16193509

Clark, Dave R et al. “Muscle activation in the loaded free barbell squat: a brief review.” Journal of strength and conditioning research vol. 26,4 (2012): 1169-78. doi:10.1519/JSC.0b013e31822d533d

Cortell-Tormo, Juan M et al. “Effects of functional resistance training on fitness and quality of life in females with chronic nonspecific low-back pain.” Journal of back and musculoskeletal rehabilitation vol. 31,1 (2018): 95-105. doi:10.3233/BMR-169684

Donnelly, David V et al. “The effect of the direction of gaze on the kinematics of the squat exercise.” Journal of strength and conditioning research vol. 20,1 (2006): 145-50. doi:10.1519/R-16434.1

Zawadka, Magdalena et al. “Altered squat movement pattern in patients with chronic low back pain.” Annals of agricultural and environmental medicine: AAEM vol. 28,1 (2021): 158-162. doi:10.26444/aaem/117708

Medial Tibial Stress Syndrome: Shin Splints

Medial Tibial Stress Syndrome: Shin Splints

When stress is placed on the shins with physical activity from walking, running, or exercise, the connective tissues attaching the leg muscles to the tibia can become inflamed, causing medial tibial stress syndrome, more commonly known as shin splints. This inflammation is caused by tiny tears in the muscles and tendons of the shin. Chronic shin pain could be related to foot arch problems, underlying issues with the muscles, or shoes that don’t support the feet properly. Although it usually goes away within a few days, it’s important to monitor to ensure that it does not progress into a stress fracture. A chiropractor can offer treatments to relieve the pain and help prevent shin splints from recurring.

Medial Tibial Stress Syndrome: Shin Splints

Medial Tibial Stress Syndrome

Medial tibial stress syndrome can impact anyone. It can come from walking far distances or in awkward positions like going downstairs with small steps, jumping rope, and playing with the kids on the playground can all cause burning, tightness, and pain in the shins. Shin splints affect individuals differently. For some, the pain recedes when the triggering activity is stopped. For others, the pain can become a chronic condition that results in continuous pain, even when at rest.

The Shin

  • The shin is a part of the tibia bone in the lower leg.
  • This bone absorbs the shocks when moving through daily activities.
  • The muscles that run along the shin support the foot’s arch and raise the toes during movement.
  • Medial tibial stress syndrome is caused by excessive force on the shinbone and the tissue around it, which causes the muscles to swell and increases pressure around the bone.
  • If left untreated, small tears in the muscle and the bone can form, leading to chronic pain and stress fractures.

Medial tibial stress syndrome is more likely to happen from:

  • Not stretching before physical activity or exercise.
  • Constantly walking or running on hard surfaces.
  • Wearing the wrong shoes that don’t provide enough cushioning or arch support.
  • Over-exertion on the body with activity and movement.
  • The body is not given the proper amount of time to recover.
  • Athletes often experience shin splints when they’ve intensified their training routine or changed it up.


  • Pain during exercise or activity.
  • Pain in the front of the lower leg.
  • Soreness in the lower leg.
  • Swelling in the lower leg.
  • Shin is hot to the touch.


Whenever pain is being experienced, some muscles will either get tight or weak in response. By identifying the weak and/or tight muscles, a chiropractor can prescribe stretches and exercises that will help alleviate the pain and prevent it. One of the main principles of chiropractic is to treat the body as an interconnected system. A chiropractor may work on an unrelated part of the body to treat the symptomatic area. For example, they may work to align the spine and pelvis to lessen the impact on the lower legs.

Part of a treatment plan may include:

Soft Tissue Mobilization

  • A handheld instrument loosens tight tissues during soft tissue mobilization therapy and breaks scar tissue around the tibia.
  • Massaging tight muscles in the leg keeps them loose and alleviates the pain.
  • Percussion massage can be added to reduce muscle knots, improve blood flow, and loosen up scar tissue.
  • The treatment relieves pain and can help avoid shin splints when returning to normal activities.

Ultrasound and Low Laser Therapy

  • Ultrasound and low laser therapy use heat to warm the deep tissues in the lower leg gently.
  • The treatment eases pain, reduces inflammation, swelling, and increases blood flow.

Kinesio Taping

  • Applying flexible Kinesio tape to the foot and lower leg can reduce stress on the shins.
  • The chiropractor or physical therapist will show how to apply the tape correctly.

Foot Orthotics

  • Individuals may be more likely to develop shin splints if they have high or low arches or their feet tend to roll inward or outward when walking.
  • Prescription foot orthotics can be made to keep the feet properly balanced and supported.

Stretching Exercises

  • Shin splints could be related to tight muscles in the back of the calf and weak muscles in the front of the lower leg.
  • A chiropractor or physical therapist will show stretching and strengthening exercises to maintain muscle balance.

Body Composition

Retaining Water Due To Salt Intake

Salt/sodium is everywhere and hard to avoid.

It might not be a surprise that a single patty cheeseburger contains over 500 mg of sodium – almost a quarter of the daily recommended level, but it is a surprise to know that the ranch dressing on a salad contains as much as 270 mg or a tablespoon of soy sauce on a healthy, vegetable-only stir-fry has 879 mg of sodium. The Mayo Clinic estimates that the average individual consumes about 3,400 mg of sodium a day: close to double what is recommended. Sodium is linked with water retention, and it is the kidneys’ job to expel unneeded sodium out of the body. Until the kidneys activate, an individual will temporarily be retaining extra water. If daily water and sodium intake habits change daily, this can contribute to water retention, causing fluctuations in daily weight. So, if an individual was on a diet but flooded the body with more salt than usual, expect to see a temporary increase in weight.


Bates, P. “Shin splints–a literature review.” British journal of sports medicine vol. 19,3 (1985): 132-7. doi:10.1136/bjsm.19.3.132

Chiropractic Economics: The Science Behind Percussion Massage.

Gross, ML et al. “Effectiveness of orthotic shoe inserts in the long-distance runner.” The American journal of sports medicine vol. 19,4 (1991): 409-12. doi:10.1177/036354659101900416

Heer, Martina et al. “Increasing sodium intake from a previous low or high intake affects water, electrolyte and acid-base balance differently.” The British journal of nutrition vol. 101,9 (2009): 1286-94. doi:10.1017/S0007114508088041

McClure, Charles J. and Robert Oh. “Medial Tibial Stress Syndrome.” StatPearls, StatPearls Publishing, 11 August 2021.

Sports Hernia: Core Muscle Injury

Sports Hernia: Core Muscle Injury

A sports hernia is a soft tissue injury that happens in and around the groin area. It is a strain or tear of any soft-tissue muscles, tendons, or ligaments in the lower abdomen or groin area. It usually happens during physical sports activities that require fast, quick, sudden changes of direction and/or intense twisting movements. Despite its name, a sports hernia is not a hernia in the classic sense. The condition’s proper term is athletic pubalgia. However, a sports hernia can lead to an abdominal hernia. The condition can happen to both men and women.

Sports Hernia: Core Muscle Injury


The soft tissues most affected by sports hernias are the oblique muscles in the lower abdomen, along with the tendons that attach the oblique muscles to the pubic bone, are the most at risk. In many cases, the tendons that attach the thigh muscles to the pubic bone or adductors are also stretched or torn.

Core Muscle Injury

A core muscle injury is when the deep layers of the abdominal wall weaken or tear. This can cause nerve irritation and contribute to uncomfortable symptoms of numbness or tingling. The most common causes include:

  • Planting the feet and turning or twisting with maximum force.
  • Constant repetitive hip and pelvic twisting motions.
  • Imbalances between the hip and abdominal muscles can also, over time, cause overuse injuries.
  • Weakness in the abdominals and improper or no conditioning can also contribute to injuries.
  • Aggressive abdominal exercises can cause and/or aggravate a core muscle injury.


  • Chronic groin pain is the primary symptom of a core muscle injury.
  • Sharp groin pain with exertion.
  • Basic movements like sitting down or getting out of bed can also present with pain or discomfort.
  • Pain on one side of the groin.
  • Pain or numbness that radiates into the inner thigh.
  • Pain when coughing or sneezing.
  • Tenderness or pressure on the lower abdominal area.
  • Pain decreases with rest.


A doctor will discuss symptoms and how the injury occurred. They will run a series of strength tests like a sit-up or trunk flex against resistance. If it is a sports hernia, there will be tenderness in the groin or above the pubis, along with discomfort and pain. Further tests will include MRI, ultrasound, or X-rays to rule out hip, low back, or pelvis injuries to confirm a core muscle injury.

Non-Surgical Treatment


  • In the first 7 to 10 days after the injury resting and icing the area is recommended.
  • If there is a bulge in the groin, compression or a wrap can help relieve symptoms.

Chiropractic and Physical therapy

  • Two weeks after the injury, chiropractic adjustments and physical therapy exercises are recommended to improve strength and flexibility in the abdominal and inner thigh muscles.
  • For most cases, 4 to 6 weeks of chiropractic and physical therapy will resolve any pain and allow the individual to return to their exercise or sports activity.

Anti-inflammatory Medications

  • A doctor could recommend non-steroidal anti-inflammatory medications to reduce swelling and pain.
  • If the symptoms persist over a prolonged period, a doctor may suggest a cortisone injection.

If the pain comes back when resuming the physical activities, surgery could be needed to repair the torn tissues.

Surgical Treatment

Repairing the torn tissues can be done with a traditional open procedure that involves one long incision or a minimally invasive endoscopic procedure. In an endoscopy, the surgeon makes smaller incisions and uses a small camera, called an endoscope, to see inside the abdomen. The results of traditional and endoscopic procedures are the same. Most individuals can return to sports and physical activities 6 to 12 weeks after surgery.

Body Composition

Muscle Gain

Individuals can’t lose fat forever. At some point, they need to work on developing muscle or work to preserve the muscle that is already present. This requires a different diet and exercise plan than one designed for fat loss. Instead of getting the body into a catabolic state, the body needs to be in an anabolic state where the body builds tissue instead of breaking it down. To build muscle, the body needs resources meaning proper nutrition and sufficient protein intake to increase muscle mass. Maintaining an energy surplus of around 15% is appropriate for developing musculature, meaning a moderately active individual with a BMR of 1,600 calories would want to their intake to about 2,852 calories a day.


Hoffman, Jay R et al. “Effect of protein intake on strength, body composition and endocrine changes in strength/power athletes.” Journal of the International Society of Sports Nutrition vol. 3,2 12-8. 13 Dec. 2006, doi:10.1186/1550-2783-3-2-12

Larson, Christopher M. “Sports hernia/athletic pubalgia: evaluation and management.” Sports health vol. 6,2 (2014): 139-44. doi:10.1177/1941738114523557

Poor, Alexander E et al. “Core Muscle Injuries in Athletes.” Current sports medicine reports vol. 17,2 (2018): 54-58. doi:10.1249/JSR.0000000000000453

Thorborg, Kristian et al. “Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management.” The Journal of orthopedic and sports physical therapy vol. 48,4 (2018): 239-249. doi:10.2519/jospt.2018.7850

Tyler, Timothy F et al. “Groin injuries in sports medicine.” Sports health vol. 2,3 (2010): 231-6. doi:10.1177/1941738110366820

Volleyball Injuries: Chiropractic Treatment and Rehabilitation

Volleyball Injuries: Chiropractic Treatment and Rehabilitation

Around a half-million high school students in the U.S. play volleyball. Whether the parent of a volleyball player or part of a recreational league, the goal is to be ready for the season, which means preventing and addressing volleyball injuries. It is a highly demanding sport with quick movements, jumping, twisting, diving, spiking, etc. Despite being fit and healthy, extensive training along with match play takes a toll on the body. Chiropractic can benefit volleyball players.

Common Volleyball Injuries

Volleyball Injuries: Chiropractic Treatment and Rehabilitation

Why Chiropractic Works

Chiropractic treatment and rehabilitation, especially by a sports chiropractor, is recommended for volleyball injuries because it addresses acute and chronic injuries to all areas of the body. Chiropractic treats the entire musculoskeletal system. Proper joint alignment from chiropractic adjustments in the spine and throughout the body maintains the biomechanic integrity. This reduces high-impact forces in the joints. Soft tissue treatments like instrument-assisted soft tissue mobilization can help resolve injuries by providing the tissues with more blood flow into the affected area allowing for faster healing. Most volleyball injuries result from overuse to the joints and muscles, resulting in repetitive strain. In volleyball, repetitive/overuse injuries are common in the knees, ankles, and shoulders. This comes from all the jumping, serving, and spiking.

Player Benefits

Body Soreness Is Reduced/Alleviated

Many athletes, including volleyball players, do not get the proper recovery time from training or playing.

  • Reduced recovery periods cause body soreness and stiffness that can overlap into an injury.
  • Chiropractic can reduce and alleviate body soreness.
  • Chiropractic promotes faster recovery.

Optimal Performance

Studies show that athletes that receive regular chiropractic care found speed and mobility performance enhanced.

  • Athletes require fast reflexes and optimal hand-eye coordination.
  • Speed, mobility, reflexes, and coordination depend on a healthy nervous system.
  • 90% of the central nervous system travels through the spine.
  • Spinal alignment can either allow for proper nerve flow or disrupt nerve flow.
  • Even when just one spinal segment is misaligned and out of place, the nervous system can impact reflexes, speed, mobility, and hand-eye coordination.
  • A properly functioning spine and nervous system will ensure the player is at their best.

Faster Injury Recovery Time

Healing the body properly takes time. Just like the body needs sleep/rest to function properly, so it is with injuries.

  • The issue for athletes is how much time healing takes.
  • Individual athletes receiving chiropractic care have been shown to heal faster.

Mobility and Strength

A chiropractic doctor can reduce the pressure around the nerve roots that exit the spine, which will help improve player performance. This includes:

  • Range of motion
  • Mobility and flexibility
  • Strength
  • Endurance

To find out how chiropractic can help, contact Injury Medical Chiropractic and Functional Medicine Clinic. We will perform a thorough musculoskeletal and nervous system examination.

Ankle Sprain Treatment

How Many Calories Over 24 hours

Myths that offer strategies that avoid the hard work and commitment that diet and exercise demand should be avoided. Individuals cannot expect to experience healthy body composition changes by increasing/decreasing meal frequency if they are living a sedentary lifestyle. It is not important how often or what time an individual takes in calories (has a meal). What is important is how many calories an individual has over a 24-hour period. A study looked at healthy individuals that ate one large meal a day for two weeks and then later ate the same meal but spread out over five smaller meals for another two weeks. It was concluded that there was no statistical difference in body weight gain or loss between the two eating methods. 2000 calories over 3 meals is the same 2000 calories consumed over 5 meals. There is no substitute for proper diet and exercise. The focus should be on what and how much you eat.


Eerkes, Kevin. “Volleyball injuries.” Current sports medicine reports vol. 11,5 (2012): 251-6. doi:10.1249/JSR.0b013e3182699037

Gouttebarge, Vincent et al. “Preventing musculoskeletal injuries among recreational adult volleyball players: design of a randomized prospective controlled trial.” BMC musculoskeletal disorders vol. 18,1 333. 2 Aug. 2017, doi:10.1186/s12891-017-1699-6

Kilic, O et al. “Incidence, etiology, and prevention of musculoskeletal injuries in volleyball: A systematic review of the literature.” European journal of sports science vol. 17,6 (2017): 765-793. doi:10.1080/17461391.2017.1306114

Seminati, Elena, and Alberto Enrico Minetti. “Overuse in volleyball training/practice: A review on the shoulder and spine-related injuries.” European journal of sports science vol. 13,6 (2013): 732-43. doi:10.1080/17461391.2013.773090

Wolfram, G et al. “Thermogenese des menschen bei unterschiedlicher mahlzeitenhäufigkeit” [Thermogenesis in humans after varying meal time frequency]. Annals of nutrition & metabolism vol. 31,2 (1987): 88-97. doi:10.1159/000177255

Bowling Injuries: Chiropractic Care and Rehabilitation

Bowling Injuries: Chiropractic Care and Rehabilitation

Bowling is a fun physical activity that is enjoyable for all ages. Today, there are college bowlers, recreational bowlers, amateur, semiprofessional, professional leagues, and tournaments worldwide. Although it might not be the first sport that comes to mind when thinking of injuries and chronic pain conditions, it can place significant stress on the muscles and tendons of the upper and lower body. It is important to know and understand how to avoid injuries.

Bowling Injuries: Chiropractic Care and Rehabilitation

How Bowling Injuries Happen

There are two main causes of injuries and chronic pain related to bowling. The first is poor mechanics, and the second is repetitive over-use. Both cause/develop painful symptoms that can turn into injuries that become chronic conditions. Many injuries are caused by:

  • Slip and fall accidents
  • Players dropping the ball on their feet
  • The majority of injuries come from overuse/repetition and improper body mechanics.
  • Overuse injuries result from repetitive and/or strenuous actions/movements that place profound stress on the body’s musculoskeletal system.

For example, a semi-pro and professional bowler will play fifty or more games a week. This means throwing a sixteen-pound ball for ten frames per game. When consistently repeated over and over, this can cause serious wear and tear to the body. With amateur and recreational bowlers, they don’t play as much, so they don’t experience overuse injury as much, but what they do experience is improper/poor form techniques that shift the body in non-ergonomic ways, wrong equipment like oversized/too-small shoes that can cause awkward postures and body motions, a ball that is too heavy causing an individual to overthrow and strain their arms, backs, hips, and legs. Or a ball with small finger holes that get stuck or too large, causing finger, hand, arm, shoulder pulls strains, and sprains.

Common Bowling Injuries

The most common injuries and conditions associated with bowling include:

Many of the injuries can lead to tendonitis or arthritis later in life.

Trigger/Bowler’s Finger

Symptoms include:

  • Hand pain after bowling, specifically in the fingers
  • A clicking or popping when moving the fingers
  • A finger gets locked in a bent position

Rest, and no bowling is recommended. How long a rest depends on how long the symptoms have been presenting. Physical therapy, along with chiropractic exercises, can help improve finger strength. Splinting the finger could be required to improve the condition. If all fails or does not generate adequate relief, hand surgery could be optioned with a trigger finger release. The surgery allows the finger to move more freely.

Bowler’s Thumb

This usually happens to bowlers that want to generate a lot of spin on the ball. If the thumb’s hole is too tight, it can pinch the ulnar nerve inside the thumb. If the thumb injury is not serious, rest and getting the correct ball size can correct the issue. This is where purchasing a personal bowling ball can help.

Finger Sprain

This is an injury to one or more of the ligaments in the fingers. It most often takes place in the collateral ligaments along the sides of the fingers inside the ball. The ligament/s gets stretched or torn when the finger is forced beyond its normal range of motion. Common symptoms of a finger sprain include swelling, tenderness, stiffness, and pain in the affected finger. This usually occurs from:

  • The weight of holding the ball with the fingers alone
  • A poor release
  • Using a ball that doesn’t properly fit the fingers
  • A finger sprain falls into grades on the severity of how much the ligament is stretched or torn:

Grade 1

Stretching or microscopic tearing.

Grade 2

Less than 90% of the ligament is torn.

Grade 3

More than 90% of the ligament is torn. Grade three sprains can be accompanied by joint instability and immobility.

Herniated Disc

A herniated disc is when the discs get injured/damaged from overuse, wear, and tear, or a traumatic injury to the spine. The disc can dry out, become less flexible, bulge out, or rupture. Bowlers are constantly:

  • Bending during the final approach and throw
  • Carrying a heavy ball
  • Shifting, twisting, and releasing, increasing the pressure within the discs

In bowling, the majority of herniated discs happen in the low back. The most common symptom is backaches and back pain. Lumbar herniated discs left untreated can cause sciatica.

Avoid and Prevent Injury

The best way to prevent injury is to stay aware of body position, mechanics, equipment, and what the body says.


Stretching is one of the best things to avoid injury before practicing, competing, or just playing. Stretching will increase flexibility, especially in the wrist, hand, arm, and low back.

Improving technique

Continually using poor techniques over and over is a perfect set-up for injury. Working with a coach will ensure the proper form. This is important when it comes to generating spin on the ball, as well as, making sure the grip does not place too much strain on the hands.

Using the right ball

The ball being used might not be the right fit for your hand or strength. The holes could be too far apart, causing strain on the fingers. Get as much information as possible and try out different styles and weights to get a comfortable feel for the right ball.

Bowling less

Hard-core bowlers could be overdoing it. Cutting back, and creating a balance will allow the body to recover thoroughly and not cause flare-ups.

Getting in shape

Studies show that individuals who bowl and do not exercise significantly increase the risk of a back injury than those who exercise their back and core. Bowling is not as strenuous as other sports, but it still requires the body to be able to handle the stress.

Body Health

Test Body Composition

Testing body composition regularly is the best way to ensure the body stays healthy. Tracking body composition tracks Lean Mass and Fat Mass gain or loss. The information provided allows the individual to make the necessary changes to ensure they stay fit and healthy.

Diet adjustment

Diet needs to be adjusted to match the individual’s current activity level, or risk running a caloric surplus. A great way to optimize diet is to use Basal Metabolic Rate which will make sure the body is getting enough nutrients to fuel muscle growth, and lose belly fat.

Physical activity that fits the new lifestyle

Increase physical activity levels that work with current lifestyle. This does not mean performing at high levels every day. Be active on a schedule that works for you. Two days of strength training a week offer great physical and mental benefits. The key is to maintain the balance between food consumption and exercise/physical activity that fits your current lifestyle.


Almedghio, Sami M et al. “Wii knee revisited: meniscal injury from 10-pin bowling.” BMJ case reports vol. 2009 (2009): bcr11.2008.1189. doi:10.1136/bcr.11.2008.1189

Kerr, Zachary Y et al. “Epidemiology of bowling-related injuries presenting to US emergency departments, 1990-2008.” Clinical pediatrics vol. 50,8 (2011): 738-46. doi:10.1177/0009922811404697

Kisner, W H. “Thumb neuroma: a hazard of ten pin bowling.” British journal of plastic surgery vol. 29,3 (1976): 225-6. doi:10.1016/s0007-1226(76)90060-6

Miller, S, and G M Rayan. “Bowling related injuries of the hand and upper extremity; a review.” The Journal of the Oklahoma State Medical Association vol. 91,5 (1998): 289-91.

Acute and Cumulative Soccer Injuries

Acute and Cumulative Soccer Injuries

Although many soccer injuries involve the legs and lower extremities, other body areas are susceptible to injury/s as well. Acute or cumulative is how soccer injuries are generally described. Acute injuries are traumatic. They are usually caused by a slip, trip, and fall, getting hit, and crashing into other players. Cumulative injuries involve repetitive stress on a muscle, joint, or connective tissue. This triggers progressive aches, pain, and physical impairment that gets worse with time. Understanding how and why they happen is the first step in injury prevention. The more common injuries experienced among soccer athletes include.

Acute and Cumulative Soccer Injuries


This is a form of mild traumatic brain injury mTBI caused by a sudden hit/impact to the head. Players are trained to head the ball; however, concussions can happen if not ready for impact or heading at an awkward position.

Ankle Sprains

Ankle sprains are when there is stretching and tearing of ligament/s that surround the ankle joint.

  • Lateral ankle sprains or outside of the ankle can happen when a player kicks the ball with the top of the foot.
  • A medial ankle sprain or inside of the ankle can happen when the toes are turned out when the foot is flexed up.

Achilles Tendonitis

This is a chronic injury that occurs from overuse with pain in the back of the ankle. Players are constantly performing repetitive and sudden movements that, over time, can cause this type of injury.

Achilles Tendon Rupture

A rupture involves a partial or complete tear of the Achilles tendon. Often players say with a popping sound. This happens when players perform fast, explosive movements. Rapid stopping, starting, shifting, jumping can all contribute.

Groin Pull/Strain

This is a type of strain that happens when the inner thigh muscles are stretched beyond their limit. As a result, a player can pull the groin when kicking and/or resistance from an opponent trying to take the ball or kick in the opposite direction.

Hamstring Injury

These injuries involve the three back muscles of the thigh and can vary from minor strains to complete ruptures/tears. This comes from running, sprinting, jumping, and stopping, leading to these types of injuries.

Iliotibial Band Syndrome

This is an overuse/repetitive injury that involves a tendon known as the IT band. This is the connective tissue that runs along the outside of the thigh. Constant running can create friction as the band gets pulled along the outside of the knee, which can cause tendonitis.

Plantar Fasciitis

This causes foot pain caused by inflammation of the tissue bands that run from the heel to the toes. Several factors can cause the condition. This could be players using inappropriate or not correctly fitting shoes, shoes that do not provide proper arch support or playing on a hard surface.

Calf Muscle Pull

This is when one of the muscles of the lower leg gets pulled from the Achilles tendon. Again, quick and spontaneous sprinting, running, or jumping is usually the cause.

Knee Injuries

The most common soccer injuries are those that involve the knee. This is because of the stopping and shifting directions quickly and suddenly. The explosive, spontaneous movements place extreme stress on the knees and the supporting ligaments. When the stress goes beyond the ligament’s limits, it can cause a sprain or tear in the joint. When there is an injury to the knee/s, it is diagnosed using a grading scale.

  • Grade 1 Mild sprain
  • Grade 2 Partial tear
  • Grade 3 Complete tear

Runner’s Knee

Patellofemoral pain syndrome, also known as runner’s knee, is a condition where the cartilage under the kneecap gets damaged from an injury or overuse. This happens when there is a misalignment in the knee and/or strained tendons.

ACL Injury

The anterior cruciate ligament or ACL is at the front of the knee. These are the most common knee injuries. This is because the ligaments are less retractable than muscles or tendons. And those in the knees are highly vulnerable to damage.

Cruciate Ligament Injury

This type of injury does not always cause pain but often causes a popping sound when it happens. Pain and swelling develop within 24 hours. This is followed by the loss of range of motion and tenderness around and along the joint.

Meniscus Injury

The Meniscus involves a C-shaped piece of cartilage that cushions the space between the femur and the shin bone. These tears are painful and are often the result of twisting, pivoting, decelerating, or quick/rapid impact.

Shin Splints

The term describes a variety of painful symptoms that develop in the front of the lower leg. This often happens from over/intense training, or the training gets changed. Players can also develop shin splints from training while not using appropriate shoes.

Stress Fractures

These types of fractures are usually the result of overuse or repeated impact on a bone. The result is severe bruising or a slight crack in the bone.


When tendons get inflamed, it is referred to as tendonitis. This comes with repetitive overuse but can also develop from a traumatic injury that causes micro-tears in the muscle fibers.

Soccer Injuries Prevention

Many of these injuries result from overuse, overtraining, improper conditioning, and/or not warming up properly. Here are few tips to help reduce the risk.

Warm-up for at least 30 minutes before playing

Pay special attention to stretching the:

  • Groin
  • Hips
  • Hamstrings
  • Achilles’ tendons
  • Quadriceps

Wear protective gear

This includes:

  • Mouthguards
  • Shin guards
  • Kinesio tape
  • Ankle supports
  • Eye protection
  • Ensure they are correctly sized and maintained.

Check the field

Check for anything that could cause injury/s. This includes:

  • Holes
  • Puddles
  • Broken glass
  • Stones
  • Debris

Avoid playing in bad weather

Or immediately after heavy rain when the field is especially slick and muddy.

Allow enough time to heal after an injury.

This also goes for minor soccer injuries. Trying too fast to get back increases the risk of worsening the injury, re-injury, and/or creating new injuries.

Body Composition

Athletes and Carb Loading

Carb loading is a strategy that athletes use.

Endurance athletes

Utilize carb-loading to help them increase energy storage for long runs, bike rides, swims, etc. When timed effectively, carb-loading has been shown to increase muscle glycogen, leading to improved performance.

Bodybuilders and fitness athletes

Use carbo-loading to build size and mass before competitions. The timing and efficacy of carb-loading vary from person to person. Make sure to experiment before the next big competition.


Fairchild, Timothy J et al. “Rapid carbohydrate loading after a short bout of near maximal-intensity exercise.” Medicine and science in sports and exercise vol. 34,6 (2002): 980-6. doi:10.1097/00005768-200206000-00012

Kilic O, Kemler E, Gouttebarge V. The “sequence of prevention” for musculoskeletal injuries among adult recreational footballers: A systematic review of the scientific literature. Phys Ther Sport. 2018;32:308-322. doi:10.1016/j.ptsp.2018.01.007

Lingsma H, Maas A. Heading in soccer: More than a subconcussive event?. Neurology. 2017;88(9):822-823. doi:10.1212/WNL.0000000000003679

Pfirrmann D, Herbst M, Ingelfinger P, Simon P, Tug S. Analysis of Injury Incidences in Male Professional Adult and Elite Youth Soccer Players: A Systematic Review. J Athl Train. 2016;51(5):410–424. doi:10.4085/1062-6050-51.6.03

Chiropractic Treatment For Tennis Injuries

Chiropractic Treatment For Tennis Injuries

Tennis is an intense sport that requires strength, agility, flexibility, stamina, endurance, and conditioning. And it’s a great way to stay in shape. However, with all of this intensity is the risk of injuries. Although they are lower compared to other sports injuries, injuries are more cumulative/repetitive based and wear and tear over time type. Tennis injuries can be painful and impair daily life. They can be treated and prevented with chiropractic medicine and strength training. Chiropractic can help the body heal quicker, and address underlying issues that led to the injury. This will help to worsen and prevent re-injury. The most common tennis injuries include…Chiropractic Treatment For Tennis Injuries

Wrist Tendonitis

This is an injury that can happen to beginner players that don’t have a great deal of arm/wrist strength, use a racquet that is too heavy, and begin developing an improper form to compensate. But it can also be caused by repetitive/overusing the wrist instead of the whole arm.  Symptoms are chronic stiffness and pain in the area surrounding the wrist joint. Chiropractic sports massage, physical rehabilitation, and learning proper form will help alleviate the pain and prevent worsening or developing new injuries.

Tennis Elbow

Tennis elbow is a condition that is caused by inflammation of the outside muscles in the forearm and tendons. This is usually an overuse injury from all the swinging and hitting, but using the improper technique could also be a cause. Chiropractic adjustments are highly recommended instead of steroid injections and other anti-inflammatories. The adjustments and massage relieve the discomfort and pain by naturally relaxing, stretching, and strengthening the muscles and tendons.

Shoulder Rotator Cuff Tendonitis

The rotator cuff belongs to a group of tendons and muscles that surround the shoulder joint. This allows the shoulder to perform 360-degree arm circles and is what stabilizes the shoulders. Tendonitis happens when the tendons inside the rotator cuff become inflamed. The inflammation causes pain with movement, especially overhead motions decreasing the range of motion in the shoulder. This injury is often caused by serving and hitting overheads with an improper technique. Chiropractic adjusting, heat and ice therapy, and electro-muscular stimulation loosen and stretch the muscles/tendons back to their proper form.

Knee Sprains and Strains

The knee goes through a lot in sports. And tennis is no exception, much like basketball and volleyball with all the jumping, pounding, shifting, twisting, losing balance, or extending beyond the normal range of motion causes injuries that result in:

  • Pain
  • Swelling
  • Bruising
  • Loss of the ability to move ​

Chiropractic will help relieve that pain and relax the damaged muscles. It also speeds the healing process by addressing the underlying issues.

Ankle Sprain

An ankle sprain also known as a twisted ankle happens when the ligaments attached to the joint become over-stretched or partially tear. These sprains happen from the:

  • Quick start and stop movements
  • Changing direction rapidly
  • Quick sprints all around the court
  • Causing the ankle to roll and/or twist.

A chiropractor will realign the ankle and provide physical therapy massage to allow the ligaments to heal properly and faster. Chiropractic treatment will allow the player to return to play quicker and prevent reinjury that if not treated correctly can become chronic. Having the proper personalized treatment plan will ensure the body heals correctly, prevent misalignments, loss of functionality, and/or range of motion.

PUSH Fitness

Aerobic Training

Aerobic exercise is a cornerstone for weight loss. Having the heart rate elevated for a continuous amount of time is the key. This is how calories are burned. Research has found that individuals involved in aerobic training lose more weight overall, including more fat mass than resistance training alone. When combined, aerobic and resistance training individuals gain more fat-free mass, including lean muscle. Aerobics causes the cardiorespiratory system to adapt. Maintaining heart function and health and keeps the body’s energy metabolism system running at optimal levels. Aerobic exercise for fitness and weight loss is a key element of maintaining the body’s health.


The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
phone: 915-850-0900
Licensed in Texas & New Mexico


Dines, Joshua S et al. “Tennis injuries: epidemiology, pathophysiology, and treatment.” The Journal of the American Academy of Orthopaedic Surgeons vol. 23,3 (2015): 181-9. doi:10.5435/JAAOS-D-13-00148

Minghelli, Beatriz, and Jéssica Cadete. “Epidemiology of musculoskeletal injuries in tennis players: risk factors.” The Journal of sports medicine and physical fitness vol. 59,12 (2019): 2045-2052. doi:10.23736/S0022-4707.19.09842-6

Stuelcken, Max et al. “Wrist Injuries in Tennis Players: A Narrative Review.” Sports medicine (Auckland, N.Z.) vol. 47,5 (2017): 857-868. doi:10.1007/s40279-016-0630-x

Willis, Leslie H et al. “Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults.” Journal of applied physiology (Bethesda, Md.: 1985) vol. 113,12 (2012): 1831-7. doi:10.1152/japplphysiol.01370.2011

Golf Injuries and Prevention

Golf Injuries and Prevention

The most common causes of golf injuries are playing and practicing too excessively, improper swinging mechanics, and little or no physical conditioning. Pain meds either over-the-counter or prescribed, bracing, and surgical procedures are how symptoms are treated instead of the root cause/s. If the cause/s are addressed then injury prevention comes naturally.


11860 Vista Del Sol, Ste. 128 Golf Injuries and Prevention


Driving requires a great deal of effort and power that puts tremendous stress on the body. When done too frequently, injuries can result. The body can take all kinds of forces thrown at it. But there is a limit as to how much it can take before an injury occurs.

Too many swinging reps while playing and practicing could cause trauma to the muscles and connective tissues, which leads to inflammation and pain. Swinging and hitting with bucket after bucket of balls to improve performance will raise the risk of injury. Try practicing swinging without hitting any balls through imagery/imagination. This has become a standard tool utilized by athletes. Practice the perfect swing mentally without the risk/threat of overusing your arms and back.


Improper body and swinging mechanics can lead to injury. The constant swinging, bending, squatting, and walking places added stress on muscles that can lead to a shoulder sprain/strain, elbow pain, and rib fractures. Back injuries can happen when bending far too forward while in swinging motion. Common swing mistakes that can contribute to low back pain.


This can happen when golfers are told to stick out their rear but what happens is that they over arch their lower backs which cause hyperlordosis. This is known as an S-Posture and it inhibits the abs and glutes. Or this also happens with a lower crossed syndrome. �

curve disorders M

Early Extension

This is a term that comes from a forward swinging movement where the lower body does not rotate from the top of the backswing to follow-through. The hips and pelvis do not turn with the body. Spinal posture is extended, the head rises up and the pelvis moves toward the ball’s position. When this happens the spine’s muscles over-activate and force the spine into a fast extension. Forward movement of the lower body toward the golf ball can be a sign of early extension. �

Early Extension


Ideal Position

Reverse C

This happens at the swing’s finish being in a full hyperextension position. It places added compression on the lower back right facet joints. �

11860 Vista Del Sol, Ste. 128 Golf Injuries and Prevention

Overextending, Flexing, and twisting excessively, awkwardly, and improperly increases chances of injury. A bit of advice is to have your swing analyzed by a golf pro/instructor to make sure you have proper form and technique. Preventing back injuries can be achieved through proper body mechanics by properly lifting the golf bag and properly teeing the ball.


Muscles will be weak and inflexible when there is no conditioning. This causes them to become highly susceptible to injury. The spine is exceptionally vulnerable to increased pressure during a golf swing. This happens from rotating while leaning forward. When the low back and abdominal muscles do not have adequate strength or flexibility the high reps of swinging will eventually cause pain.

With a golf-specific strength and flexibility program, the risk of injury is lessened along with improved performance. Programs like these don’t have to be complicated or take a long time. Stop potential golf injuries from happening by avoiding excessive practice sessions, swinging correctly, and regularly practicing golf-oriented strength and flexibility exercises.

Sports Injury Chiropractic Treatment



Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

Chiropractic Athletics: Athletes, Sports Injuries, Optimal Performance

Chiropractic Athletics: Athletes, Sports Injuries, Optimal Performance

Chiropractic athletics is a natural treatment focused on athletes and sports injuries. It is a non-surgical, non-drug option that can help individual athletes prevent injury/s from happening, maintain optimal athletic performance, and relives sports musculoskeletal injuries. Athletes of all types can benefit from chiropractic athletics.

Sports leagues and professional athletes including Major League Baseball and the National Football League have full-time chiropractors on their teams. Athletes from all over the world utilize chiropractic medicine. With the advancement in sports technology, intense training and superb athleticism come injuries that can turn into game-ending conditions. Because of this, there is a wide variety of treatment needs and is where chiropractic athletics comes in.


11860 Vista Del Sol, Ste. 128 Chiropractic Athletics: Athletes, Sports Injuries, Optimal Performance

Commonly athletes are referred to chiropractors for neck, lower back, and extremity conditions. Chiropractic athletics help them get them back into play after an injury faster, with added flexibility and agility. And for those without injuries chiropractic helps athletes prevent injuries by increasing strength and power to help perform at peak level.

Chiropractic sports doctors are highly trained with the tools and skills that will optimize the performance of an athlete’s musculoskeletal and nervous system. This training is what allows these athletic chiropractors to provide sports therapy/s that is focused on maintaining agility, flexibility, strength, and quick rehabilitation after an injury. Why chiropractic athletics should be essential?

Chiropractic Athletic Importance

Regular chiropractic improves range of motion. Athletes place intense pressure on their bodies when training, weight-lifting, and playing. This can shift the spine out of alignment affecting movement, along with the rest of the body, generating a high probability of injury.

Athletes have to deal with soreness, stiffness, and pain from their basic training regiment. An injury can easily compound the soreness into something more severe. Spinal alignment problems can cause the range of motion to be hindered and limited, inhibiting overall ability. Chiropractic athletics undoes the damage. Once a chiropractic regiment is in place injury prevention kicks in, all the while keeping the athlete moving pain-free. �


11860 Vista Del Sol, Ste. 128 Chiropractic Athletics: Athletes, Sports Injuries, Optimal Performance

Pain Reduction

Anyone especially the strongest athletes can have an episode of back pain, specifically in the low back. A chiropractor promotes proper alignment and movement of the delicate spine. Chiropractors can recommend treatments both professional and self-care that will reduce all types of back pain short and long-term. Research confirms that a manual spine manipulation is an effective form of pain relief.

Less Need for Pain Meds

Too often aches and pain are treated with pain meds, cortisone shots, and other drugs that provide short-term relief. Chiropractic is drug-free. This means athletes are not subject to side effects or dependencies that unfortunately arise from prescription med use.

Because of the increasing dependency on opioids, the American College of Physicians has updated their guidelines when it comes to low back pain, a very common reason for opioid prescriptions. Now, those with low back pain are encouraged to utilize various complementary and alternative medicine techniques that include chiropractic spinal manipulation before having to use prescription medication.


Chiropractic is non-surgical and can provide relief from injuries throughout the body. It can even serve as an alternative to surgery/s that would keep athletes on the sidelines because of a long recovery period. Treatments include:

  • Electrical muscle stimulation
  • Functional dry needling
  • Graston Technique
  • Active Release Technique

All of these can be used to treat athletic injury.

Athletic Benefits

Whether a neighborhood sports league or advanced competitive league athletes need chiropractic specialists for injury treatment to get them back to play. Kids are now traveling at a younger age meaning more practices and tournaments. Kids are also committing to only one sport early on. This is known as specializing. A study by The American Journal of Sports Medicine found that athletes that specialize too early are subject to continued injury/s. �


sports players

Chiropractic decreases recovery time

Normal wear and tear happens to all of us but can wear down faster especially in an extremely healthy athlete�s body.

  • A baseball pitcher uses a consistent repetitive throwing motion.
  • A volleyball player jumps, constantly hitting and blocking.
  • A skateboarder falls repeatedly, sometimes over one-hundred times trying to land a trick.

At some point and quite often an athlete experiences muscle fatigue and soreness. Practices and games have only a few days between them. Younger athletes and their growing bodies need a lot more than rest to keep them in shape. After practice or a game, a chiropractor can do some soft tissue massage or instrument-assisted soft tissue techniques to make the muscles, tendons, ligaments, and joints flexible, relaxed, with decreased lactic acid, and improved blood circulation.

Physical therapy and the equipment used like ultrasound or cold laser therapy can be used to help with areas that are highly inflamed. This along with adjustments can improve joint mobility. Chiropractic athletics also helps with proper rehydration and customized dietary plans to assist with recovery and maintaining top-level performance. �


professional athlete chiropractic treatment el paso tx.

Injury Repair

Each sport has its own area that is more prone to injury from the stress of the specific sport. According to the American Orthopedic Society for Sports Medicine:

  • Dancers deal with leg injuries
  • Golfers go through shoulder and arm injuries
  • Lacrosse players experience knee injuries and muscle strains

Chiropractic adjusting of joint segments, no longer moving, can enhance mechanical motion. Soft tissue techniques improve muscle tone and blood flow to injured areas and decrease tissue buildup around the injured areas. Chiropractic along with the aforementioned treatment options can significantly reduce inflammation and pain.

All of these treatment options can be enhanced with Kinesio Taping. It can add support and various taping techniques can assist in blood circulation to the injured area. A sports chiropractor has a complete understanding of sports injury repair and knows the proper guidelines for safely returning the athlete to their sport. �


Health and Wellness

Athletes have to focus on body awareness, health, diet, and optimal function. But they also need to be injury prepared through preventive awareness. Think of it as defensive driving. A chiropractor can assist an athlete with:

  • Proper diet/nutrition
  • Sleep
  • Proper training strategies that can become life-long habits
  • Body mechanic evaluation
  • Gait analysis

Continually keeping an athlete�s body in top form, allows them to train more efficiently and effectively.

A Vital Role

With athletes training year-round and specializing earlier, chiropractic assistance can keep an athlete at a top level of body function. Chiropractic combined with certified athletic trainers can help with muscle development, ligament, and tendon stability. These specialists play a vital role in obtaining and maintaining whole-body wellness.

Consider Chiropractic

Chiropractic athletics includes a whole health assessment to ensure there are no underlying issues that could be contributing to an injury, or that could cause future problems. Athletes, consider seeing a chiropractor regularly for those that want to maintain physical strength and range of motion, or if they want to recover from an injury without taking prescription meds and surgery. Sports performance will improve when the body is in alignment and pain-free!

Functional Fitness Fellas



Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

Sports Tips to Avoid Back Injuries El Paso, Texas

Sports Tips to Avoid Back Injuries El Paso, Texas

All individuals that participate in some form of sports or athletic training, professionals to weekend sports enthusiasts are at risk for back and neck injuries. Common injuries include strains, and sprains, pulls, and tears especially around the low back area. If left untreated these injuries can lead to chronic back pain or more severe conditions.

Although we can’t prevent all sports injuries, here are some sports tips to keep your spine healthy.


11860 Vista Del Sol, Ste. 126 Sports Tips to Avoid Back Injuries El Paso, Texas

1.� Warm-Up and Stretch

Properly warming up with stretching exercises increases blood circulation and improves the flexibility of muscles and ligaments. This is not only for helping enhance athletic performance but prevents injuries by keeping the muscles/ligaments loose so if any type of collision, tear, or pull occurs the stretched muscles stay relaxed and do not tense up or contract, which helps reduce the severity of an injury. To stretch properly:

  • Stretch slowly, gently and just to where you feel mild tension.
  • Hold the stretch for 10-30 seconds
  • Stretch time on each part of the body is also 10-30 seconds
  • Stretch after the game to relieve sore or tight muscles


2. Use Proper Sport Equipment

All sports have a risk of injury. In general, the more contact there is the higher the risk of injury.

To reduce the risk of injury athletes should wear protective equipment that goes with their sport like neck rolls, shoulder, elbow and knee pads.

Well made and supportive shoes combined with custom orthotics are a must.

Other types of equipment include:

  • Helmet
  • Pads elbow, wrist, chest, knee, shins
  • Mouthpiece
  • Faceguard
  • Protective cup
  • Eye protection


3. Stay Hydrated

Injuries caused by heat occur as a result of�high temperatures, humidity and excessive/overdoing it. To avoid these serious injuries:

  • Drink plenty of water before, during, and after playing.
  • Try to avoid play or practice during extreme heat and humidity.
  • Wear lightweight clothing/uniform with maximum ability to allow sweat to evaporate.
  • Take plenty of breaks or periods of rest to allow the body to recover and recuperate.


4. Don’t Overwork/Overdo it

Repetitive Motion Disorders like tennis elbow, bursitis, and tendonitis, happen when movements e.g. swinging motions that go with the sport like tennis, bowling, golf, etc are repeated over and over and cause injury/damage to those parts of the body. To avoid overuse injury try:

  • Take plenty of breaks during practice and games. Do not power through it!
  • Use proper/correct form and techniques. If unsure then take lessons to make sure you are doing it correctly.
  • See a doctor if any pain or muscle fatigue, inflammation, swelling, or compression of nerve tissue present.
  • Cross-training can strengthen muscle groups and those areas that take the most force.

11860 Vista Del Sol, Ste. 126 Sports Tips to Avoid Back Injuries El Paso, Texas

5. Stay Ready for Play with a Healthy Lifestyle

Besides sports, try to find ways to improve general health through a healthy lifestyle:

  • Get plenty of sleep, the body/mind needs to recover from all the activity.
  • Maintain a well-balanced diet.
  • Avoid excessive alcohol use.
  • Get into a sports chiropractic maintenance program to keep the body in tip-top shape.

Consult a doctor before beginning any new exercise program.

Staying fit, healthy and ready for play means preventing injuries from happening.� By being aware of how to prevent injuries with these basic tips, which feel free to take it further and raise the probability of avoiding back and all sports injuries.

As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused on treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.


*BEST* Heel Spurs Treatment | El Paso, Tx (2020)



NCBI Resources

Extension sports like gymnastics, tennis, swimming, diving, football, volleyball, basketball, track and field, cricket have the most pronounced extension/rotation on the spine. With a normal extension of the lumbar spine (or backward bending), the facet joints begin to approximate each other and compress. This is a normal biomechanical movement. However, if the extension ranges are excessive, the procedures will impinge quite aggressively and damage to the cartilage surfaces within the facet joint can result.


The Basic Science of Human Knee Menisci Structure, Composition, and Function

The Basic Science of Human Knee Menisci Structure, Composition, and Function

The knee is one of the most complex joints in the human body, consisting of the thigh bone, or femur, the shin bone, or tibia, and the kneecap, or patella, among other soft tissues. Tendons connect the bones to the muscles while ligaments connect the bones of the knee joint. Two wedge-shaped pieces of cartilage, known as the meniscus, provide stability to the knee joint. The purpose of the article below is to demonstrate as well as discuss the anatomy of the knee joint and its surrounding soft tissues.




  • Context: Information regarding the structure, composition, and function of the knee menisci has been scattered across multiple sources and fields. This review contains a concise, detailed description of the knee menisci�including anatomy, etymology, phylogeny, ultrastructure and biochemistry, vascular anatomy and neuroanatomy, biomechanical function, maturation and aging, and imaging modalities.
  • Evidence Acquisition: A literature search was performed by a review of PubMed and OVID articles published from 1858 to 2011.
  • Results: This study highlights the structural, compositional, and functional characteristics of the menisci, which may be relevant to clinical presentations, diagnosis, and surgical repairs.
  • Conclusions: An understanding of the normal anatomy and biomechanics of the menisci is a necessary prerequisite to understanding the pathogenesis of disorders involving the knee.
  • Keywords: knee, meniscus, anatomy, function




Once described as a functionless embryonic remnant,162 the menisci are now known to be vital for the normal function and long-term health of the knee joint.� The menisci increase stability for femorotibial articulation, distribute axial load, absorb shock, and provide lubrication and nutrition to the knee joint.4,91,152,153


Injuries to the menisci are recognized as a cause of significant musculoskeletal morbidity. The unique and complex structure of menisci makes treatment and repair challenging for the patient, surgeon, and physical therapist. Furthermore, long-term damage may lead to degenerative joint changes such as osteophyte formation, articular cartilage degeneration, joint space narrowing, and symptomatic osteoarthritis.36,45,92 Preservation of the menisci depends on maintaining their distinctive composition and organization.


Anatomy of Menisci


Meniscal Etymology


The word meniscus comes from the Greek word m?niskos, meaning �crescent,� diminutive of m?n?, meaning �moon.�


Meniscal Phylogeny and Comparative Anatomy


Hominids exhibit similar anatomic and functional characteristics, including a bicondylar distal femur, intra-articular cruciate ligaments, menisci, and asymmetrical collateral.40,66 These similar morphologic characteristics reflect a shared genetic lineage that can be traced back more than 300 million years.40,66,119


In the primate lineage leading to humans, hominids evolved to bipedal stance approximately 3 to 4 million years ago, and by 1.3 million years ago, the modern patellofemoral joint was established (with a longer lateral patellar facet and matching lateral femoral trochlea).164 Tardieu investigated the transition from occasional bipedalism to permanent bipedalism and observed that primates contain a medial and lateral fibrocartilaginous meniscus, with the medial meniscus being morphologically similar in all primates (crescent shaped with 2 tibial insertions).163 By contrast, the lateral meniscus was observed to be more variable in shape. Unique in Homo sapiens is the presence of 2 tibial insertions�1 anterior and 1 posterior�indicating a habitual practice of full extension movements of the knee joint during the stance and swing phases of bipedal walking.20,134,142,163,168


Embryology and Development


The characteristic shape of the lateral and medial menisci is attained between the 8th and 10th week of gestation.53,60 They arise from a condensation of the intermediate layer of mesenchymal tissue to form attachments to the surrounding joint capsule.31,87,110 The developing menisci are highly cellular and vascular, with the blood supply entering from the periphery and extending through the entire width of the menisci.31 As the fetus continues to develop, there is a gradual decrease in the cellularity of the menisci with a concomitant increase in the collagen content in a circumferential arrangement.30,31 Joint motion and the postnatal stress of weightbearing are important factors in determining the orientation of collagen fibers. By adulthood, only the peripheral 10% to 30% have a blood supply.12,31


Despite these histologic changes, the proportion of tibial plateau covered by the corresponding meniscus is relatively constant throughout fetal development, with the medial and lateral menisci covering approximately 60% and 80% of the surface areas, respectively.31


Gross Anatomy


Gross examination of the knee menisci reveals a smooth, lubricated tissue (Figure 1). They are crescent-shaped wedges of fibrocartilage located on the medial and lateral aspects of the knee joint (Figure 2A). The peripheral, vascular border (also known as the red zone) of each meniscus is thick, convex, and attached to the joint capsule. The innermost border (also known as the white zone) tapers to a thin free edge. The superior surfaces of menisci are concave, enabling effective articulation with their respective convex femoral condyles. The inferior surfaces are flat to accommodate the tibial plateau (Figure 1).28,175





Medial meniscus. The semicircular medial meniscus measures approximately 35 mm in diameter (anterior to posterior) and is significantly broader posteriorly than it is anteriorly.175 The anterior horn is attached to the tibia plateau near the intercondylar fossa anterior to the anterior cruciate ligament (ACL). There is significant variability in the attachment location of the anterior horn of the medial meniscus. The posterior horn is attached to the posterior intercondylar fossa of the tibia between the lateral meniscus and the posterior cruciate ligament (PCL; Figures 1 and and2B).2B). Johnson et al reexamined the tibial insertion sites of the menisci and their topographic relationships to surrounding anatomic landmarks of the knee.82 They found that the anterior and posterior horn insertion sites of the medial meniscus were larger than those of the lateral meniscus. The area of the anterior horn insertion site of the medial meniscus was the largest overall, measuring 61.4 mm2, whereas the posterior horn of the lateral meniscus was the smallest, at 28.5 mm2.82


The tibial portion of the capsular attachment is the coronary ligament. At its midpoint, the medial meniscus is more firmly attached to the femur through a condensation in the joint capsule known as the deep medial collateral ligament.175 The transverse, or �intermeniscal,� ligament is a fibrous band of tissue that connects the anterior horn of the medial meniscus to the anterior horn of the lateral meniscus (Figures 1 and and2A2A).


Lateral meniscus. The lateral meniscus is almost circular, with an approximately uniform width from anterior to posterior (Figures 1 and and2A).2A). It occupies a larger portion (~80%) of the articular surface than the medial meniscus (~60%) and is more mobile.10,31,165 Both horns of the lateral meniscus are attached to the tibia. The insertion of the anterior horn of the lateral meniscus lies anterior to the intercondylar eminence and adjacent to the broad attachment site of the ACL (Figure 2B).9,83 The posterior horn of the lateral meniscus inserts posterior to the lateral tibial spine and just anterior to the insertion of the posterior horn of the medial meniscus (Figure 2B).83 The lateral meniscus is loosely attached to the capsular ligament; however, these fibers do not attach to the lateral collateral ligament. The posterior horn of the lateral meniscus attaches to the inner aspect of the medial femoral condyle via the anterior and posterior meniscofemoral ligaments of Humphrey and Wrisberg, respectively, which originate near the origin of the PCL (Figures 1 and and22).75


Meniscofemoral ligaments. The literature reports significant inconsistencies in the presence and size of meniscofemoral ligaments of the lateral meniscus. There may be none, 1, 2, or 4.? When present, these accessory ligaments transverse from the posterior horn of the lateral meniscus to the lateral aspect of the medial femoral condyle. They insert immediately adjacent to the femoral attachment of the PCL (Figures 1 and and22).


In a series of studies, Harner et al measured the cross-sectional area of the ligaments and found that the meniscofemoral ligament averaged 20% of the size of the PCL (range, 7%-35%).69,70 However, the size of the insertional area alone without knowledge of the insertional angle or collagen density does not indicate their relative strength.115 The function of these ligaments remains unknown; they may pull the posterior horn of the lateral meniscus in an anterior direction to increase the congruity of the meniscotibial fossa and the lateral femoral condyle.75


Ultrastructure and Biochemistry


Extracellular Matrix


The meniscus is a dense extracellular matrix (ECM) composed primarily of water (72%) and collagen (22%), interposed with cells.9,55,56,77 Proteoglycans, noncollagenous proteins, and glycoproteins account for the remaining dry weight.� Meniscal cells synthesize and maintain the ECM, which determines the material properties of the tissue.


The cells of the menisci are referred to as fibrochondrocytes because they appear to be a mixture of fibroblasts and chondrocytes.111,177 The cells in the more superficial layer of the menisci are fusiform or spindle shaped (more fibroblastic), whereas the cells located deeper in the meniscus are ovoid or polygonal (more chondrocytic).55,56,178 Cell morphology does not differ between the peripheral and central locations in the menisci.56


Both cell types contain abundant endoplasmic reticulum and Golgi complex. Mitochondria are only occasionally visualized, suggesting that the major pathway for energy production of fibrochondrocytes in their avascular milieu is probably anaerobic glycolysis.112




In normal, healthy menisci, tissue fluid represents 65% to 70% of the total weight. Most of the water is retained within the tissue in the solvent domains of proteoglycans. The water content of meniscal tissue is higher in the posterior areas than in the central or anterior areas; tissue samples from surface and deeper layers had similar contents.135


Large hydraulic pressures are required to overcome the drag of frictional resistance of forcing fluid flow through meniscal tissue. Thus, interactions between water and the matrix macromolecular framework significantly influence the viscoelastic properties of the tissue.




Collagens are primarily responsible for the tensile strength of menisci; they contribute up to 75% of the dry weight of the ECM.77 The ECM is composed primarily of type I collagen (90% dry weight) with variable amounts of types II, III, V, and VI.43,44,80,112,181 The predominance of type I collagen distinguishes the fibrocartilage of menisci from articular (hyaline) cartilage. The collagens are heavily cross-linked by hydroxylpyridinium aldehydes.44


The collagen fiber arrangement is ideal for transferring a vertical compressive load into circumferential �hoop� stresses (Figure 3).57 Type I collagen fibers are oriented circumferentially in the deeper layers of the meniscus, parallel to the peripheral border. These fibers blend the ligamentous connections of the meniscal horns to the tibial articular surface (Figure 3).10,27,49,156 In the most superficial region of the menisci, the type I fibers are oriented in a more radial direction. Radially oriented �tie� fibers are also present in the deep zone and are interspersed or woven between the circumferential fibers to provide structural integrity (Figure 3).# There is lipid debris and calcified bodies in the ECM of human menisci.54 The calcified bodies contain long, slender crystals of phosphorous, calcium, and magnesium on electron-probe roentgenographic analysis.54 The function of these crystals in not completely understood, but it is believed that they may play a role in acute joint inflammation and destructive arthropathies.



Noncollagenous matrix proteins, such as fibronectin, contribute 8% to 13% of the organic dry weight. Fibronectin is involved in many cellular processes, including tissue repair, embryogenesis, blood clotting, and cell migration/adhesion. Elastin forms less than 0.6% of the meniscus dry weight; its ultrastructural localization is not clear. It likely interacts directly with collagen to provide resiliency to the tissue.**




Located within a fine meshwork of collagen fibrils, proteoglycans are large, negatively charged hydrophilic molecules, contributing 1% to 2% of dry weight.58 They are formed by a core protein with 1 or more covalently attached glycosaminoglycan chains (Figure 4).122 The size of these molecules is further increased by specific interaction with hyaluronic acid.67,72 The amount of proteoglycans in the meniscus is one-eighth that of articular cartilage,2,3 and there may be considerable variation depending on the site of the sample and the age of the patient.49



By virtue of their specialized structure, high fixed-charge density, and charge-charge repulsion forces, proteoglycans in the ECM are responsible for hydration and provide the tissue with a high capacity to resist compressive loads.� The glycosaminoglycan profile of the normal adult human meniscus consists of chondroitin-6-sulfate (40%), chondroitin-4-sulfate (10% to 20%), dermatan sulfate (20% to 30%), and keratin sulfate (15%; Figure 4).65,77,99,159 The highest glycosaminoglycan concentrations are found in the meniscal horns and the inner half of the menisci in the primary weightbearing areas.58,77


Aggrecan is the major proteoglycan found in the human menisci and is largely responsible for their viscoelastic compressive properties (Figure 5). Smaller proteoglycans, such as decorin, biglycan, and fibromodulin, are found in smaller amounts.124,151 Hexosamine contributes 1% to the dry weight of ECM.57,74 The precise functions of each of these small proteoglycans on the meniscus have yet to be fully elucidated.



Matrix Glycoproteins


Meniscal cartilage contains a range of matrix glycoproteins, the identities and functions of which have yet to be determined. Electrophoresis and subsequent staining of the polyacrylamide gels reveals bands with molecular weights varying from a few kilodaltons to more than 200 kDa.112 These matrix molecules include the link proteins that stabilize proteoglycan�hyaluronic acid aggregates and a 116-kDa protein of unknown function.46 This protein resides in the matrix in the form of disulfide-bonded complex of high molecular weight.46 Immunolocalization studies suggest that it is predominantly located around the collagen bundles in the interterritorial matrix.47


The adhesive glycoproteins constitute a subgroup of the matrix glycoproteins. These macromolecules are partly responsible for binding with other matrix molecules and/or cells. Such intermolecular adhesion molecules are therefore important components in the supramolecular organization of the extracellular molecules of the meniscus.150 Three molecules have been identified within the meniscus: type VI collagen, fibronectin, and thrombospondin.112,118,181


Vascular Anatomy


The meniscus is a relatively avascular structure with a limited peripheral blood supply. The medial, lateral, and middle geniculate arteries (which branch off the popliteal artery) provide the major vascularization to the inferior and superior aspects of each meniscus (Figure 5).9,12,33-35,148 The middle geniculate artery is a small posterior branch that perforates the oblique popliteal ligament at the posteromedial corner of the tibiofemoral joint. A premeniscal capillary network arising from the branches of these arteries originates within the synovial and capsular tissues of the knee along the periphery of the menisci. The peripheral 10% to 30% of the medial meniscus border and 10% to 25% of the lateral meniscus are relatively well vascularized, which has important implications for meniscus healing (Figure 6).12,33,68 Endoligamentous vessels from the anterior and posterior horns travel a short distance into the substance of the menisci and form terminal loops, providing a direct route for nourishment.33 The remaining portion of each meniscus (65% to 75%) receives nourishment from synovial fluid via diffusion or mechanical pumping (ie, joint motion).116,120



Bird and Sweet examined the menisci of animals and humans using scanning electron and light microscopy.23,24 They observed canal-like structures opening deep into the surface of the menisci. These canals may play a role in the transport of fluid within the meniscus and may carry nutrients from the synovial fluid and blood vessels to the avascular sections of the meniscus.23,24 However, further study is needed to elucidate the exact mechanism by which mechanical motion supplies nutrition to the avascular portion of the menisci.




The knee joint is innervated by the posterior articular branch of the posterior tibial nerve and the terminal branches of the obturator and femoral nerves. The lateral portion of the capsule is innervated by the recurrent peroneal branch of the common peroneal nerve. These nerve fibers penetrate the capsule and follow the vascular supply to the peripheral portion of the menisci and the anterior and posterior horns, where most of the nerve fibers are concentrated.52,90 The outer third of the body of the meniscus is more densely innervated than the middle third.183,184 During extremes of flexion and extension of the knee, the meniscal horns are stressed, and the afferent input is likely greatest at these extreme positions.183,184


The mechanoreceptors within the menisci function as transducers, converting the physical stimulus of tension and compression into a specific electrical nerve impulse. Studies of human menisci have identified 3 morphologically distinct mechanoreceptors: Ruffini endings, Pacinian corpuscles, and Golgi tendon organs.�� Type I (Ruffini) mechanoreceptors are low threshold and slowly adapting to the changes in joint deformation and pressure. Type II (Pacinian) mechanoreceptors are low threshold and fast adapting to tension changes.�� Type III (Golgi) are high-threshold mechanoreceptors, which signal when the knee joint approaches the terminal range of motion and are associated with neuromuscular inhibition. These neural elements were found in greater concentration in the meniscal horns, particularly the posterior horn.


The asymmetrical components of the knee act in concert as a type of biological transmission that accepts, transfers, and dissipates loads along the femur, tibia, patella, and femur.41 Ligaments act as an adaptive linkage, with the menisci representing mobile bearings. Several studies have reported that various intra-articular components of the knee are sensate, capable of generating neurosensory signals that reach spinal, cerebellar, and higher central nervous system levels.?? It is believed that these neurosensory signals result in conscious perception and are important for normal knee joint function and maintenance of tissue homeostasis.42

Dr Jimenez White Coat

The meniscus is cartilage which provides structural and functional integrity to the knee. The menisci are two pads of fibrocartilaginous tissue which spread out friction in the knee joint when it undergoes tension and torsion between the shin bone, or tibia, and the thigh bone, or femur. The understanding of the anatomy and biomechanics of the knee joint is essential towards the understanding of knee injuries and/or conditions. Dr. Alex Jimenez D.C., C.C.S.T. Insight

Biomechanical Function


The biomechanical function of the meniscus is a reflection of the gross and ultrastructural anatomy and of its relationship to the surrounding intra-articular and extra-articular structures. The menisci serve many important biomechanical functions. They contribute to load transmission,�� shock absorption,10,49,94,96,170 stability,51,100,101,109,155 nutrition,23,24,84,141 joint lubrication,102-104,141 and proprioception.5,15,81,88,115,147 They also serve to decrease contact stresses and increase contact area and congruity of the knee.91,172


Meniscal Kinematics


In a study on ligamentous function, Brantigan and Voshell reported the medial meniscus to move an average 2 mm, while the lateral meniscus was markedly more mobile with approximately 10 mm of anterior-posterior displacement during flexion.25 Similarly, DePalma reported that the medial meniscus undergoes 3 mm of anterior-posterior displacement, while the lateral meniscus moves 9 mm during flexion.37 In a study using 5 cadaveric knees, Thompson et al reported the mean medial excursion to be 5.1 mm (average of anterior and posterior horns) and the mean lateral excursion, 11.2 mm, along the tibial articular surface (Figure 7).165 The findings from these studies confirm a significant difference in segmental motion between the medial and lateral menisci. The anterior and posterior horn lateral meniscus ratio is smaller and indicates that the meniscus moves more as a single unit.165 Alternatively, the medial meniscus (as a whole) moves less than the lateral meniscus, displaying a greater anterior to posterior horn differential excursion. Thompson et al found that the area of least meniscal motion is the posterior medial corner, where the meniscus is constrained by its attachment to the tibial plateau by the meniscotibial portion of the posterior oblique ligament, which has been reported to be more prone to injury.143,165 A reduction in the motion of the posterior horn of the medial meniscus is a potential mechanism for meniscal tears, with a resultant �trapping� of the fibrocartilage between the femoral condyle and the tibial plateau during full flexion. The greater differential between anterior and posterior horn excursion may place the medial meniscus at a greater risk of injury.165



The differential of anterior horn to posterior horn motion allows the menisci to assume a decreasing radius with flexion, which correlates to the decreased radius of curvature of the posterior femoral condyles.165 This change of radius allows the meniscus to maintain contact with the articulating surface of both the femur and the tibia throughout flexion.


Load Transmission


The function of the menisci has been clinically inferred by the degenerative changes that accompany its removal. Fairbank described the increased incidence and predictable degenerative changes of the articular surfaces in completely meniscectomized knees.45 Since this early work, numerous studies have confirmed these findings and have further established the important role of the meniscus as a protective, load-bearing structure.


Weightbearing produces axial forces across the knee, which compress the menisci, resulting in �hoop� (circumferential) stresses.170 Hoop stresses are generated as axial forces and converted to tensile stresses along the circumferential collagen fibers of the meniscus (Figure 8). Firm attachments by the anterior and posterior insertional ligaments prevent the meniscus from extruding peripherally during load bearing.94 Studies by Seedhom and Hargreaves reported that 70% of the load in the lateral compartment and 50% of the load in the medial compartment is transmitted through the menisci.153 The menisci transmit 50% of compressive load through the posterior horns in extension, with 85% transmission at 90� flexion.172 Radin et al demonstrated that these loads are well distributed when the menisci are intact.137 However, removal of the medial meniscus results in a 50% to 70% reduction in femoral condyle contact area and a 100% increase in contact stress.4,50,91 Total lateral meniscectomy results in a 40% to 50% decrease in contact area and increases contact stress in the lateral component to 200% to 300% of normal.18,50,76,91 This significantly increases the load per unit area and may contribute to accelerated articular cartilage damage and degeneration.45,85



Shock Absorption


The menisci play a vital role in attenuating the intermittent shock waves generated by impulse loading of the knee with normal gait.94,96,153 Voloshin and Wosk showed that the normal knee has a shock-absorbing capacity about 20% higher than knees that have undergone meniscectomy.170 As the inability of a joint system to absorb shock has been implicated in the development of osteoarthritis, the meniscus would appear to play an important role in maintaining the health of the knee joint.138


Joint Stability


The geometric structure of the menisci provides an important role in maintaining joint congruity and stability.## The superior surface of each meniscus is concave, enabling effective articulation between the convex femoral condyles and flat tibial plateau. When the meniscus is intact, axial loading of the knee has a multidirectional stabilizing function, limiting excess motion in all directions.9


Markolf and colleagues have addressed the effect of meniscectomy on anterior-posterior and rotational knee laxity. Medial meniscectomy in the ACL-intact knee has little effect on anterior-posterior motion, but in the ACL-deficient knee, it results in an increase in anterior-posterior tibial translation of up to 58% at 90o of flexion.109 Shoemaker and Markolf demonstrated that the posterior horn of the medial meniscus is the most important structure resisting an anterior tibial force in the ACL-deficient knee.155 Allen et al showed that the resultant force in the medial meniscus of the ACL-deficient knee increased by 52% in full extension and by 197% at 60� of flexion under a 134-N anterior tibial load.7 The large changes in kinematics due to medial meniscectomy in the ACL-deficient knee confirm the important role of the medial meniscus in knee stability. Recently, Musahl et al reported that the lateral meniscus plays a role in anterior tibial translation during the pivot-shift maneuver.123


Joint Nutrition and Lubrication


The menisci may also play a role in the nutrition and lubrication of the knee joint. The mechanics of this lubrication remains unknown; the menisci may compress synovial fluid into the articular cartilage, which reduces frictional forces during weightbearing.13


There is a system of microcanals within the meniscus located close to the blood vessels, which communicates with the synovial cavity; these may provide fluid transport for nutrition and joint lubrication.23,24




The perception of joint motion and position (proprioception) is mediated by mechanoreceptors that transduce mechanical deformation into electric neural signals. Mechanoreceptors have been identified in the anterior and posterior horns of the menisci.*** Quick-adapting mechanoreceptors, such as Pacinian corpuscles, are thought to mediate the sensation of joint motion, and slow-adapting receptors, such as Ruffini endings and Golgi tendon organs, are believed to mediate the sensation of joint position.140 The identification of these neural elements (located mostly in the middle and outer third of the meniscus) indicates that the menisci are capable of detecting proprioceptive information in the knee joint, thus playing an important afferent role in the sensory feedback mechanism of the knee.61,88,90,158,169


Maturation and Aging of The Meniscus


The microanatomy of the meniscus is complex and certainly demonstrates senescent changes. With advancing age, the meniscus becomes stiffer, loses elasticity, and becomes yellow.78,95 Microscopically, there is a gradual loss of cellular elements with empty spaces and an increase in fibrous tissue in comparison with elastic tissue.74 These cystic areas can initiate a tear, and with a torsional force by the femoral condyle, the superficial layers of the meniscus may shear off from the deep layer at the interface of the cystic degenerative change, producing a horizontal cleavage tear. Shear between these layers may cause pain. The torn meniscus may directly injure the overlying articular cartilage.74,95


Ghosh and Taylor found that collagen concentration increased from birth to 30 years and remained constant until 80 years of age, after which a decline occurred.58 The noncollagenous matrix proteins showed the most profound changes, decreasing from 21.9% � 1.0% (dry weight) in neonates to 8.1% � 0.8% between the ages of 30 to 70 years.80 After 70 years of age, the noncollagenous matrix protein levels increased to 11.6% � 1.3%. Peters and Smillie observed an increase in hexosamine and uronic acid with age.131


McNicol and Roughley studied the variation of meniscal proteoglycans in aging113; small differences in extractability and hydrodynamic size were observed. The proportions of keratin sulfate relative to chondroitin-6-sulfate increased with aging.146


Petersen and Tillmann immunohistochemically investigated human menisci (ranging from 22 weeks of gestation to 80 years), observing the differentiation of blood vessels and lymphatics in 20 human cadavers. At the time of birth, nearly the entire meniscus was vascularized. In the second year of life, an avascular area developed in the inner circumference. In the second decade, blood vessels were present in the peripheral third. After 50 years of age, only the peripheral quarter of the meniscal base was vascularized. The dense connective tissue of the insertion was vascularized but not the fibrocartilage of the insertion. Blood vessels were accompanied by lymphatics in all areas.���


Arnoczky suggested that body weight and knee joint motion may eliminate blood vessels in the inner and middle aspects of the menisci.9 Nutrition of meniscal tissue occurs via perfusion from blood vessels and via diffusion from synovial fluid. A requirement for nutrition via diffusion is the intermittent loading and release on the articular surfaces, stressed by body weight and muscle forces.130 The mechanism is comparable with the nutrition of articular cartilage.22


Magnetic Resonance Imaging of The Meniscus


Magnetic resonance imaging (MRI) is a noninvasive diagnostic tool used in the evaluation, diagnosis, and monitoring of the menisci. MRI is widely accepted as the optimal imaging modality because of superior soft tissue contrast.


On cross-sectional MRI, the normal meniscus appears as a uniform low-signal (dark) triangular structure (Figure 9). A meniscal tear is identified by the presence of an increased intrameniscal signal that extends to the surface of this structure.



Several studies have evaluated the clinical utility of MRI for meniscal tears. In general, MRI is highly sensitive and specific for tears of the meniscus. The sensitivity of MRI in detecting meniscal tears ranges from 70% to 98%, and the specificity, from 74% to 98%.48,62,105,107,117 The MRI of 1014 patients before an arthroscopic examination had an accuracy of 89% for pathology of the medial meniscus and 88% for the lateral meniscus.48 A meta-analysis of 2000 patients with an MRI and arthroscopic examination found 88% sensitivity and 94% accuracy for meniscal tears.105,107


There have been discrepancies between MRI diagnoses and the pathology identified during arthroscopic examination.��� Justice and Quinn reported discrepancies in the diagnosis of 66 of the 561 patients (12%).86 In a study of 92 patients, discrepancies between the MRI and arthroscopic diagnoses were noted in 22 of the 349 (6%) cases.106 Miller conducted a single-blind prospective study comparing clinical examinations and MRI in 57 knee examinations.117 He found no significant difference in sensitivity between the clinical examination and MRI (80.7% and 73.7%, respectively). Shepard et al assessed the accuracy of MRI in detecting clinically significant lesions of the anterior horn of the meniscus in 947 consecutive knee MRI154 and found a 74% false-positive rate. Increased signal intensity in the anterior horn does not necessarily indicate a clinically significant lesion.154




The menisci of the knee joint are crescent-shaped wedges of fibrocartilage that provide increased stability to the femorotibial articulation, distribute axial load, absorb shock, and provide lubrication to the knee joint. Injuries to the menisci are recognized as a cause of significant musculoskeletal morbidity. Preservation of the menisci is highly dependent on maintaining its distinctive composition and organization.






In conclusion, the knee is the largest and most complex�joint in the human body. However, because the knee can commonly become damaged as a result of an injury and/or condition, it’s essential to understand the anatomy of the knee joint in order for patients to receive proper treatment.� The scope of our information is limited to chiropractic and spinal health issues. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.


Curated by Dr. Alex Jimenez


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Additional Topic Discussion: Relieving Knee Pain without Surgery


Knee pain is a well-known symptom which can occur due to a variety of knee injuries and/or conditions, including�sports injuries. The knee is one of the most complex joints in the human body as it is made-up of the intersection of four bones, four ligaments, various tendons, two menisci, and cartilage. According to the American Academy of Family Physicians, the most common causes of knee pain include patellar subluxation, patellar tendinitis or jumper’s knee, and Osgood-Schlatter disease. Although knee pain is most likely to occur in people over 60 years old, knee pain can also occur in children and adolescents. Knee pain can be treated at home following the RICE methods, however, severe knee injuries may require immediate medical attention, including chiropractic care.


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EXTRA EXTRA | IMPORTANT TOPIC: El Paso, TX Chiropractor Recommended

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Evaluation of Patients Presenting with Knee Pain: Part II. Differential Diagnosis

Evaluation of Patients Presenting with Knee Pain: Part II. Differential Diagnosis

The knee is the largest joint in the human body, where the complex structures of the lower and upper legs come together. Consisting of three bones, the femur, the tibia, and the patella which are surrounded by a variety of soft tissues, including cartilage, tendons and ligaments, the knee functions as a hinge, allowing you to walk, jump, squat or sit. As a result, however, the knee is considered to be one of the joints that are most prone to suffer injury. A knee injury is the prevalent cause of knee pain.

A knee injury can occur as a result of a direct impact from a slip-and-fall accident or automobile accident, overuse injury from sports injuries, or even due to underlying conditions, such as arthritis. Knee pain is a common symptom which affects people of all ages. It may also start suddenly or develop gradually over time, beginning as a mild or moderate discomfort then slowly worsening as time progresses. Moreover, being overweight can increase the risk of knee problems. The purpose of the following article is to discuss the evaluation of patients presenting with knee pain and demonstrate their differential diagnosis.


Knee pain is a common presenting complaint with many possible causes. An awareness of certain patterns can help the family physician identify the underlying cause more efficiently. Teenage girls and young women are more likely to have patellar tracking problems such as patellar subluxation and patellofemoral pain syndrome, whereas teenage boys and young men are more likely to have knee extensor mechanism problems such as tibial apophysitis (Osgood-Schlatter lesion) and patellar tendonitis. Referred pain resulting from hip joint pathology, such as slipped capital femoral epiphysis, also may cause knee pain. Active patients are more likely to have acute ligamentous sprains and overuse injuries such as pes anserine bursitis and medial plica syndrome. Trauma may result in acute ligamentous rupture or fracture, leading to acute knee joint swelling and hemarthrosis. Septic arthritis may develop in patients of any age, but crystal-induced inflammatory arthropathy is more likely in adults. Osteoarthritis of the knee joint is common in older adults. (Am Fam Physician 2003;68:917-22. Copyright� 2003 American Academy of Family Physicians.)


Determining the underlying cause of knee pain can be difficult, in part because of the extensive differential diagnosis. As discussed in part I of this two-part article,1 the family physician should be familiar with knee anatomy and common mechanisms of injury, and a detailed history and focused physical examination can narrow possible causes. The patient�s age and the anatomic site of the pain are two factors that can be important in achieving an accurate diagnosis (Tables 1 and 2). �

Table 1 Common Causes of Knee Pain

Children and Adolescents

Children and adolescents who present with knee pain are likely to have one of three common conditions: patellar subluxation, tibial apophysitis, or patellar tendonitis. Additional diagnoses to consider in children include slipped capital femoral epiphysis and septic arthritis.

Patellar Subluxation

Patellar subluxation is the most likely diagnosis in a teenage girl who presents with giving-way episodes of the knee.2 This injury occurs more often in girls and young women because of an increased quadriceps angle (Q angle), usually greater than 15 degrees.

Patellar apprehension is elicited by subluxing the patella laterally, and a mild effusion is usually present. Moderate to severe knee swelling may indicate hemarthrosis, which suggests patellar dislocation with osteochondral fracture and bleeding.

Tibial Apophysitis

A teenage boy who presents with anterior knee pain localized to the tibial tuberosity is likely to have tibial apophysitis or Osgood- Schlatter lesion3,4 (Figure 1).5 The typical patient is a 13- or 14-year-old boy (or a 10- or 11-year-old girl) who has recently gone through a growth spurt.

The patient with tibial apophysitis generally reports waxing and waning of knee pain for a period of months. The pain worsens with�squatting, walking up or down stairs, or forceful contractions of the quadriceps muscle. This overuse apophysitis is exacerbated by jumping and hurdling because repetitive hard landings place excessive stress on the insertion of the patellar tendon.

On physical examination, the tibial tuberosity is tender and swollen and may feel warm. The knee pain is reproduced with the resisted active extension or passive hyperflexion of the knee. No effusion is present. Radiographs are usually negative; rarely, they show avulsion of the apophysis at the tibial tuberosity. However, the physician must not mistake the normal appearance of the tibial apophysis for an avulsion fracture. �

Table 2 Differential Diagnosis of Knee Pain

Figure 1 Anterior View of the Structures of the Knee

Patellar Tendonitis

Jumper�s knee (irritation and inflammation of the patellar tendon) most commonly occurs in teenage boys, particularly during a growth spurt2 (Figure 1).5 The patient reports vague anterior knee pain that has persisted for months and worsens after activities such as walking down stairs or running.

On physical examination, the patellar tendon is tender, and the pain is reproduced by resisted knee extension. There is usually no effusion. Radiographs are not indicated.

Slipped Capital Femoral Epiphysis

A number of pathologic conditions result in referral of pain to the knee. For example, the possibility of slipped capital femoral epiphysis must be considered in children and teenagers who present with knee pain.6 The patient with this condition usually reports poorly localized knee pain and no history of knee trauma.

The typical patient with slipped capital femoral epiphysis is overweight and sits on the examination table with the affected hip slightly flexed and externally rotated. The knee examination is normal, but hip pain is elicited with passive internal rotation or extension of the affected hip.

Radiographs typically show displacement of the epiphysis of the femoral head. However, negative radiographs do not rule out the diagnosis in patients with typical clinical findings. Computed tomographic (CT) scanning is indicated in these patients.

Osteochondritis Dissecans

Osteochondritis dissecans is an intra-articular osteochondrosis of unknown etiology that is characterized by degeneration and recalcification of articular cartilage and underlying bone. In the knee, the medial femoral condyle is most commonly affected.7

The patient reports vague, poorly localized knee pain, as well as morning stiffness or recurrent effusion. If a loose body is present, mechanical symptoms of locking or catching of the knee joint also may be reported. On physical examination, the patient may demonstrate quadriceps atrophy or tenderness along the involved chondral surface. A mild joint effusion may be present.7

Plain-film radiographs may demonstrate the osteochondral lesion or a loose body in the knee joint. If osteochondritis dissecans is suspected, recommended radiographs include anteroposterior, posteroanterior tunnel, lateral, and Merchant�s views. Osteochondral lesions at the lateral aspect of the medial femoral condyle may be visible only on the posteroanterior tunnel view. Magnetic resonance imaging (MRI) is highly sensitive in detecting these abnormalities and is indicated in patients with a suspected osteochondral lesion.7 �

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A knee injury caused by sports injuries, automobile accidents, or an underlying condition, among other causes, can affect the cartilage, tendons and ligaments which form the knee joint itself. The location of the knee pain can differ according to the structure involved, also, the symptoms can vary. The entire knee may become painful and swollen as a result of inflammation or infection, whereas a torn meniscus or fracture may cause symptoms in the affected region. Dr. Alex Jimenez D.C., C.C.S.T. Insight


Overuse Syndromes

Anterior Knee Pain. Patients with patellofemoral pain syndrome (chondromalacia patellae) typically present with a vague history of mild to moderate anterior knee pain that usually occurs after prolonged periods of sitting (the so-called �theater sign�).8 Patellofemoral pain syndrome is a common cause of anterior knee pain in women.

On physical examination, a slight effusion may be present, along with patellar crepitus on the range of motion. The patient�s pain may be reproduced by applying direct pressure to the anterior aspect of the patella. Patellar tenderness may be elicited by subluxing the patella medially or laterally and palpating the superior and inferior facets of the patella. Radiographs usually are not indicated.

Medial Knee Pain. One frequently overlooked diagnosis is medial plica syndrome. The plica, a redundancy of the joint synovium medially, can become inflamed with repetitive overuse.4,9 The patient presents with acute onset of medial knee pain after a marked increase in usual activities. On physical examination, a tender, mobile nodularity is present at the medial aspect of the knee, just anterior to the joint line. There is no joint effusion, and the remainder of the knee examination is normal. Radiographs are not indicated.

Pes anserine bursitis is another possible cause of medial knee pain. The tendinous insertion of the sartorius, gracilis, and semitendinosus muscles at the anteromedial aspect of the proximal tibia forms the pes anserine bursa.9 The bursa can become inflamed as a result of overuse or a direct contusion. Pes�anserine bursitis can be confused easily with a medial collateral ligament sprain or, less commonly, osteoarthritis of the medial compartment of the knee. �

The patient with pes anserine bursitis reports pain at the medial aspect of the knee. This pain may be worsened by repetitive flexion and extension. On physical examination, tenderness is present at the medial aspect of the knee, just posterior and distal to the medial joint line. No knee joint effusion is present, but there may be slight swelling at the insertion of the medial hamstring muscles. Valgus stress testing in the supine position or resisted knee flexion in the prone position may reproduce the pain. Radiographs are usually not indicated.

Lateral Knee Pain. Excessive friction between the iliotibial band and the lateral femoral condyle can lead to iliotibial band tendonitis.9 This overuse syndrome commonly occurs in runners and cyclists, although it may develop in any person subsequent to activity involving repetitive knee flexion. The tightness of the iliotibial band, excessive foot pronation, genu varum, and tibial torsion are predisposing factors.

The patient with iliotibial band tendonitis reports pain at the lateral aspect of the knee joint. The pain is aggravated by activity, particularly running downhill and climbing stairs. On physical examination, tenderness is present at the lateral epicondyle of the femur, approximately 3 cm proximal to the joint line. Soft tissue swelling and crepitus also may be present, but there is no joint effusion. Radiographs are not indicated.

Noble�s test is used to reproduce the pain in iliotibial band tendonitis. With the patient in a supine position, the physician places a thumb over the lateral femoral epicondyle as the�patient repeatedly flexes and extends the knee. Pain symptoms are usually most prominent with the knee at 30 degrees of flexion.

Popliteus tendonitis is another possible cause of lateral knee pain. However, this condition is fairly rare.10


Anterior Cruciate Ligament Sprain. Injury to the anterior cruciate ligament usually occurs because of noncontact deceleration forces, as when a runner plants one foot and sharply turns in the opposite direction. Resultant valgus stress on the knee leads to anterior displacement of the tibia and sprain or rupture of the ligament.11 The patient usually reports hearing or feeling a �pop� at the time of the injury and must cease activity or competition immediately. Swelling of the knee within two hours after the injury indicates rupture of the ligament and consequent hemarthrosis.

On physical examination, the patient has a moderate to severe joint effusion that limits the range of motion. The anterior drawer test may be positive, but can be negative because of hemarthrosis and guarding by the hamstring muscles. The Lachman test should be positive and is more reliable than the anterior drawer test (see text and Figure 3 in part I of the article1).

Radiographs are indicated to detect possible tibial spine avulsion fracture. MRI of the knee is indicated as part of a presurgical evaluation.

Medial Collateral Ligament Sprain. Injury to the medial collateral ligament is fairly common and is usually the result of acute trauma. The patient reports a misstep or collision that places valgus stress on the knee, followed by the immediate onset of pain and swelling at the medial aspect of the knee.11

On physical examination, the patient with medial collateral ligament injury has point tenderness at the medial joint line. Valgus stress testing of the knee flexed to 30 degrees reproduces the pain (see text and Figure 4 in part I of this article1). A clearly defined endpoint on valgus stress testing indicates a grade 1�or grade 2 sprain, whereas complete medial instability indicates full rupture of the ligament (grade 3 sprain).

Lateral Collateral Ligament Sprain. Injury of the lateral collateral ligament is much less common than the injury of the medial collateral ligament. Lateral collateral ligament sprain usually results from varus stress to the knee, as occurs when a runner plants one foot and then turns toward the ipsilateral knee.2 The patient reports acute onset of lateral knee pain that requires prompt cessation of activity.

On physical examination, point tenderness is present at the lateral joint line. Instability or pain occurs with varus stress testing of the knee flexed to 30 degrees (see text and Figure 4 in part I of this article1). Radiographs are not usually indicated.

Meniscal Tear. The meniscus can be torn acutely with a sudden twisting injury of the knee, such as may occur when a runner suddenly changes direction.11,12 Meniscal tear also may occur in association with a prolonged degenerative process, particularly in a patient with an anterior cruciate ligament-deficient knee. The patient usually reports recurrent knee pain and episodes of catching or locking of the knee joint, especially with squatting or twisting of the knee.

On physical examination, a mild effusion is usually present, and there is tenderness at the medial or lateral joint line. Atrophy of the vastus medialis obliquus portion of the quadriceps muscle also may be noticeable. The McMurray test may be positive (see Figure 5 in part I of this article1), but a negative test does not eliminate the possibility of a meniscal tear.

Plain-film radiographs usually are negative and seldom are indicated. MRI is the radiologic test of choice because it demonstrates most significant meniscal tears.


Infection of the knee joint may occur in patients of any age but is more common in those whose immune system has been weakened by cancer, diabetes mellitus, alcoholism,�acquired immunodeficiency syndrome, or corticosteroid therapy. The patient with septic arthritis reports abrupt onset of pain and swelling of the knee with no antecedent trauma.13

On physical examination, the knee is warm, swollen, and exquisitely tender. Even slight motion of the knee joint causes intense pain.

Arthrocentesis reveals turbid synovial fluid. Analysis of the fluid yields a white blood cell count (WBC) higher than 50,000 per mm3 (50 ? 109 per L), with more than 75 percent (0.75) polymorphonuclear cells, an elevated protein content (greater than 3 g per dL [30 g per L]), and a low glucose concentration (more than 50 percent lower than the serum glucose concentration).14 Gram stain of the fluid may demonstrate the causative organism. Common pathogens include Staphylococcus aureus, Streptococcus species, Haemophilus influenza, and Neisseria gonorrhoeae.

Hematologic studies show an elevated WBC, an increased number of immature polymorphonuclear cells (i.e., a left shift), and an elevated erythrocyte sedimentation rate (usually greater than 50 mm per hour).

Older Adults


Osteoarthritis of the knee joint is a common problem after 60 years of age. The patient presents with knee pain that is aggravated by weight-bearing activities and relieved by rest.15 The patient has no systemic symptoms but usually awakens with morning stiffness that dissipates somewhat with activity. In addition to chronic joint stiffness and pain, the patient may report episodes of acute synovitis.

Findings on physical examination include decreased range of motion, crepitus, a mild joint effusion, and palpable osteophytic changes at the knee joint.

When osteoarthritis is suspected, recommended radiographs include weight-bearing anteroposterior and posteroanterior tunnel views, as well as non-weight-bearing Merchants and lateral views. Radiographs show�joint-space narrowing, subchondral bony sclerosis, cystic changes, and hypertrophic osteophyte formation.

Crystal-Induced Inflammatory Arthropathy

Acute inflammation, pain, and swelling in the absence of trauma suggest the possibility of a crystal-induced inflammatory arthropathy such as gout or pseudogout.16,17 Gout commonly affects the knee. In this arthropathy, sodium urate crystals precipitate in the knee joint and cause an intense inflammatory response. In pseudogout, calcium pyrophosphate crystals are the causative agents.

On physical examination, the knee joint is erythematous, warm, tender, and swollen. Even minimal range of motion is exquisitely painful.

Arthrocentesis reveals clear or slightly cloudy synovial fluid. Analysis of the fluid yields a WBC count of 2,000 to 75,000 per mm3 (2 to 75 ? 109 per L), a high protein content (greater than 32 g per dL [320 g per L]), and a glucose concentration that is approximately 75 percent of the serum glucose con- centration.14 Polarized-light microscopy of the synovial fluid displays negatively birefringent rods in the patient with gout and positively birefringent rhomboids in the patient with pseudogout.

Popliteal Cyst

The popliteal cyst (Baker�s cyst) is the most common synovial cyst of the knee. It originates from the posteromedial aspect of the knee joint at the level of the gastrocnemio-semimembranous bursa. The patient reports insidious onset of mild to moderate pain in the popliteal area of the knee.

On physical examination, palpable fullness is present at the medial aspect of the popliteal area, at or near the origin of the medial head of the gastrocnemius muscle. The McMurray test may be positive if the medial meniscus is injured. Definitive diagnosis of a popliteal cyst may be made with arthrography, ultrasonography, CT scanning, or, less commonly, MRI.

The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported.

In conclusion, although the knee is the largest joint in the human body where the structures of the lower extremities meet, including the femur, the tibia, the patella, and many other soft tissues, the knee can easily suffer damage or injury and result in knee pain. Knee pain is one of the most common complaints among the general population, however, it commonly occurs in athletes. Sports injuries, slip-and-fall accidents, and automobile accidents, among other causes, can lead to knee pain.

As described in the article above, diagnosis is essential towards determining the best treatment approach for each type of knee injury, according to their underlying cause. While the location and the severity of the knee injury may vary depending on the cause of the health issue, knee pain is the most common symptom. Treatment options, such as chiropractic care and physical therapy, can help treat knee pain. The scope of our information is limited to chiropractic and spinal health issues. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.

Curated by Dr. Alex Jimenez �

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Additional Topic Discussion: Relieving Knee Pain without Surgery

Knee pain is a well-known symptom which can occur due to a variety of knee injuries and/or conditions, including�sports injuries. The knee is one of the most complex joints in the human body as it is made-up of the intersection of four bones, four ligaments, various tendons, two menisci, and cartilage. According to the American Academy of Family Physicians, the most common causes of knee pain include patellar subluxation, patellar tendinitis or jumper’s knee, and Osgood-Schlatter disease. Although knee pain is most likely to occur in people over 60 years old, knee pain can also occur in children and adolescents. Knee pain can be treated at home following the RICE methods, however, severe knee injuries may require immediate medical attention, including chiropractic care.

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EXTRA EXTRA | IMPORTANT TOPIC: El Paso, TX Chiropractor Recommended

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