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.
Get insights into chiropractic care and see how it can facilitate recovery and help you regain your strength from ACL tears.
Introduction
Imagine twisting your knee during a soccer game, hearing a dreaded “pop,” and suddenly finding yourself unable to walk without pain. This is the reality for many who suffer an anterior cruciate ligament (ACL) injury, a common yet debilitating condition that can derail daily routines and athletic pursuits. With an estimated 150,000 ACL injuries annually in the United States, resulting in approximately $500 million in healthcare expenses, the impact is substantial (The Joint Chiropractic, 2017). While surgery and physical therapy are standard treatments, chiropractic care offers a complementary, non-invasive approach that may enhance recovery and restore function.
This comprehensive guide explores the clinical rationale for using chiropractic care to manage ACL injuries, drawing on evidence and insights from Dr. Alexander Jimenez, a distinguished chiropractor and family practice nurse practitioner in El Paso, Texas. We’ll explore how ACL injuries impact daily life, the role of chiropractic interventions, and Dr. Jimenez’s distinctive contributions, particularly in personal injury cases. With a touch of dark humor to lighten the mood—because who hasn’t felt like their knee is staging a mutiny?—this post aims to inform and engage readers at a high school reading level. However, the conclusion will adopt a serious tone, emphasizing the importance of professional care and including a disclaimer for clarity.
Understanding ACL Injuries
What Is the ACL?
The anterior cruciate ligament (ACL) is one of four major ligaments in the knee, connecting the femur (thigh bone) to the tibia (shin bone). It prevents excessive forward movement of the tibia and provides rotational stability, which is crucial for activities such as running, jumping, or pivoting (Vale Health Clinic, 2021). The knee joint also includes the patella (kneecap), the fibula, tendons, and cartilage (menisci), all of which work together to ensure smooth motion and stability.
Causes and Risk Factors
ACL injuries often result from sudden, high-stress movements, such as:
Sudden Stops or Changes in Direction: Common in sports like soccer, basketball, and skiing.
Jumping and Landing Incorrectly: A misstep can overstress the ligament.
Direct Trauma: Such as a collision in contact sports or accidents like car crashes.
Women are 7-8 times more likely to suffer ACL injuries due to anatomical differences, hormonal influences, and neuromuscular control variations (Vale Health Clinic, 2021). Everyday activities, like slipping on ice or tripping, can also cause ACL tears, making them relevant beyond athletics.
Symptoms and Diagnosis
An ACL tear typically presents with:
A popping sensation at the time of injury.
Severe pain and swelling within hours.
Instability or a feeling that the knee “gives out.”
Difficulty walking or bearing weight.
Diagnosis involves physical exams, such as the Lachman’s Test, Pivot Shift Test, and Anterior Drawer Test, which assess knee stability (Vale Health Clinic, 2021). Imaging, like X-rays to rule out fractures or an MRI to confirm ligament damage, is often used. Arthroscopy, a minimally invasive procedure, may provide a detailed view of the injury.
Impact on Daily Life
An ACL injury can turn simple tasks into Herculean challenges. Walking becomes a wobbly adventure, climbing stairs feels like scaling Everest, and sports may be sidelined indefinitely. For non-athletes, routine activities like carrying groceries or playing with kids become painful obstacles. Emotionally, the loss of mobility can lead to frustration or depression, especially for active individuals. Untreated, ACL injuries may lead to chronic instability, bone friction, and osteoarthritis, underscoring the need for effective treatment (Tri State Clinic North Chiropractic, 2018).
For complete ACL tears, particularly in active individuals or athletes, surgical reconstruction is often recommended. This involves replacing the torn ligament with a graft, typically from the patient’s patellar tendon, hamstring, or a donor. Surgery aims to restore knee stability and function but carries risks like infection, graft failure, or anesthesia complications. Recovery typically spans 6 to 12 months, requiring extensive rehabilitation (Physiopedia, n.d.).
Physical Therapy
For both post-surgical and non-surgical cases, physical therapy is crucial. It focuses on:
Restoring Range of Motion: Gentle exercises to regain flexibility.
Strengthening Muscles: Targeting quadriceps, hamstrings, and calves to support the knee.
Improving Proprioception: Balance and coordination training to prevent re-injury.
Physical therapy is effective but can be time-intensive, and some patients experience persistent pain or incomplete recovery.
Limitations of Traditional Approaches
While effective, traditional treatments have challenges:
Surgical Risks: Complications can delay recovery or affect outcomes.
Long Recovery Time: It may take up to a year to return to full activity.
Persistent Symptoms: Some patients report ongoing pain or instability.
Cost and Accessibility: Surgery and prolonged therapy can be expensive and inaccessible for some.
These limitations highlight the potential role of complementary therapies, such as chiropractic care, in enhancing recovery and addressing residual issues.
The Role of Chiropractic Care in ACL Injury Recovery
Chiropractic Techniques for ACL Injuries
Chiropractic care offers non-invasive methods to support ACL injury recovery, either as a standalone treatment for partial tears or as a complement to surgery. Key techniques include:
Chiropractic manipulation involves adjustments to the knee and surrounding joints (e.g., hip, ankle) to restore alignment and mobility, thereby reducing stiffness and improving function (Vale Health Clinic, 2021).
Therapeutic Ultrasound: Uses sound waves to generate heat, stimulating blood flow and promoting tissue healing.
Soft Tissue Therapy: Techniques such as massage or Active Release Technique help relieve muscle tension and break down scar tissue, thereby enhancing circulation (Kaizo Health, 2023).
Cold Laser Therapy: Reduces inflammation and accelerates tissue repair by stimulating cellular activity.
Enhancing Nervous System Function: Chiropractic adjustments optimize nervous system communication, which controls healing processes (The Joint Chiropractic, 2017).
For post-surgical patients, chiropractic care can accelerate recovery by addressing scar tissue and restoring joint mechanics, as demonstrated in a case study where a patient regained full function after completing a 12-week multimodal chiropractic program (Solecki & Herbst, 2011).
Benefits of Chiropractic Care
Non-Invasive: Avoids surgical risks and drug side effects.
Cost-Effective: Often covered by insurance with shorter wait times (Vale Health Clinic, 2021).
Holistic Approach: Addresses the whole body, not just the knee.
Prevention Focus: Reduces the risk of re-injury through biomechanical corrections.
However, the effectiveness of chiropractic care depends on the severity of the injury. Severe tears typically require surgical intervention, and chiropractic care is most beneficial as a complementary or preventative approach.
A notable case involved a 25-year-old man who suffered a complete ACL rupture, medial meniscus tear, and lateral meniscus tear after a basketball injury. Following surgical reconstruction, he underwent a 12-week chiropractic rehabilitation program including Active Release Technique, Graston Technique, and Kinesio Taping. Outcomes included:
Pain Relief: Numeric Pain Scale score dropped to 0/10.
Functional Recovery: Full restoration of range of motion and muscle strength.
Return to Activity: Resumed sports without complications.
Long-Term Success: No pain reported at one-year follow-up (Solecki & Herbst, 2011).
This case demonstrates the potential of chiropractic care in post-surgical recovery, particularly when a multimodal approach is employed.
Supporting Research
Knee Injury Management: A study in the Journal of Manipulative and Physiological Therapeutics found that chiropractic manipulation and soft tissue therapy reduced pain and improved function in patients with knee injuries, including ACL tears (Haldeman et al., 2008).
Muscle Activation: Research on gluteal muscle activation during walking suggests that strengthening supporting muscles, a common chiropractic focus, can enhance pelvic and knee stability, aiding recovery (Bullock-Saxton et al., 1993).
Preventative Benefits: Chiropractic care that addresses muscular imbalances and movement patterns may reduce the risk of ACL injuries (MSK Centre, 2023).
While the evidence is promising, more large-scale studies are needed to confirm the efficacy of chiropractic care for ACL injuries, particularly for non-surgical cases.
References
Bullock-Saxton, J. E., Janda, V., & Bullock, M. I. (1993). Reflex activation of gluteal muscles in walking: An approach to restoration of muscle function for patients with low-back pain. Spine, 18(6), 704-708. https://pubmed.ncbi.nlm.nih.gov/8516698/
Haldeman, S., Kohlbeck, F. J., & McGregor, M. (2008). Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: A review of sixty-four cases after cervical spine manipulation. Journal of Manipulative and Physiological Therapeutics, 31(1), 1-12.
MSK Centre. (2023, September 18). Minimize risks: Proven ACL injury prevention. https://mskcentre.ca/treatments/chiropractic/acl-injury-prevention/
Solecki, T. J., & Herbst, E. M. (2011). Chiropractic management of a postoperative complete anterior cruciate ligament rupture using a multimodal approach: A case report. Journal of Chiropractic Medicine, 10(1), 47-53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110400/
Insights from Dr. Alexander Jimenez
Background and Expertise
Dr. Alexander Jimenez, DC, APRN, FNP-BC, is a dual-licensed chiropractor and family practice nurse practitioner based in El Paso, Texas, with over 25 years of experience. His clinic, Injury Medical & Chiropractic Clinic, specializes in treating musculoskeletal conditions, including sports injuries like ACL tears. Dr. Jimenez’s unique qualifications allow him to integrate chiropractic care with advanced medical diagnostics, offering a holistic approach to recovery (A4M, n.d.).
Approach to ACL Injuries
While specific protocols for ACL injuries are not detailed on his website, Dr. Jimenez’s practice emphasizes:
Advanced Diagnostics: Using imaging (e.g., MRI, X-rays) and dual-scope procedures to assess injury severity and tailor treatments.
Multimodal Treatments: Combining chiropractic adjustments, soft tissue therapies, and rehabilitative exercises to address pain, mobility, and stability.
Functional Medicine: Incorporating nutrition and lifestyle changes to support healing and reduce inflammation.
Patient-Centered Care: Creating individualized plans based on the patient’s activity level and goals.
His focus on sports injuries suggests that he applies techniques, such as those described earlier, including manipulation, ultrasound, and Kinesio Taping, to ACL cases (Dr. Alex Jimenez, 2020).
Patient Testimonials
Patients praise Dr. Jimenez for his transformative care. One testimonial noted, “After my ACL surgery, I was struggling with persistent pain and stiffness. Dr. Jimenez’s chiropractic care helped me regain my strength and get back to my normal activities much faster than I expected” (Dr. Alex Jimenez, 2023). His ability to address complex injuries makes him a trusted provider in El Paso.
In El Paso, personal injury cases, such as those from car accidents or workplace incidents, often involve musculoskeletal injuries like ACL tears. Chiropractic care is a valuable option for these patients, offering non-invasive pain relief and functional restoration. Dr. Jimenez’s clinic is a go-to resource for personal injury victims, providing comprehensive care that addresses both immediate symptoms and long-term recovery (Dr. Alex Jimenez, 2019).
Dr. Jimenez’s Role as a Liaison
Dr. Jimenez’s dual licensure enables him to:
Provide Accurate Diagnoses: Using advanced imaging and diagnostic evaluations to document injuries thoroughly.
Offer Comprehensive Treatment: Combining chiropractic care with medical management for optimal outcomes.
Support Legal Documentation: Providing detailed medical reports is crucial for insurance claims and legal proceedings.
This makes him an invaluable ally for personal injury victims navigating the complex interplay of medical and legal systems (A4M, n.d.).
Case Example
Consider a car accident victim with an ACL sprain. Dr. Jimenez might use diagnostic imaging to confirm the injury, apply chiropractic adjustments to restore knee alignment, and prescribe exercises to strengthen supporting muscles. Simultaneously, he provides detailed medical records to help the patient’s legal claim, ensuring they receive appropriate compensation and care.
Correcting Muscle Imbalances: Strengthening weaker muscles like hamstrings to balance quadriceps dominance.
Improving Biomechanics: Adjusting joints to ensure proper movement patterns during activities like jumping or pivoting.
Enhancing Flexibility: Increasing joint range of motion to reduce stress on the ACL (MSK Centre, 2023).
Dr. Jimenez emphasizes preventative strategies, offering education on proper techniques and regular check-ups to catch issues early (Dr. Alex Jimenez, 2016).
Long-Term Knee Health
Regular chiropractic care supports long-term knee health by:
Maintaining Joint Alignment: Preventing undue stress on ligaments.
Strengthening Supporting Muscles: Enhancing stability through targeted exercises.
Promoting Overall Wellness: Integrating nutrition and lifestyle changes to reduce inflammation and support joint function.
For athletes, these interventions can enhance performance and resilience, allowing them to stay active safely.
ACL injuries can be a major setback, turning everyday tasks into painful challenges and sidelining athletes from their passions. Chiropractic care offers a promising complement to traditional treatments, utilizing techniques such as joint manipulation, therapeutic ultrasound, and rehabilitative exercises to alleviate pain, restore function, and facilitate recovery. Dr. Alexander Jimenez, with his dual expertise and integrative approach, stands out as a leading practitioner in El Paso, Texas, helping patients navigate both medical and legal aspects of their injuries.
For those facing an ACL injury, whether from sports or an accident, consulting a chiropractor like Dr. Jimenez can be a game-changer. His clinic, Injury Medical & Chiropractic Clinic, is dedicated to holistic healing, offering personalized care plans that address the root causes of pain and dysfunction. Contact the clinic at 915-850-0900 to explore how chiropractic care can support your recovery journey.
Disclaimer: This blog post is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider, such as an orthopedic specialist or chiropractor, for any questions regarding an ACL injury or other medical condition. Do not disregard professional medical advice or delay seeking it because of information in this post.
Can understanding the mechanics of the throwing motion help to understand why it may cause shoulder pain, the symptoms of a shoulder problem, the diagnosis, and the treatment options available?
Throwing a Ball and Shoulder Pain
The throwing motion is a complex shoulder movement that requires the mechanics of muscles, tendons, joints, ligaments, and bones. They all must move in a synchronized and stable pattern to move the shoulder joint. When these mechanics are interrupted or altered, inflammation can result in pain symptoms. (Wardell M., Creighton D., & Kovalcik C., 2022)
The labrum stabilizes the ball in the socket of the shoulder.
The shoulder blade rotation coordinates with the arm to ensure mobility. (Itoigawa Y. et al., 2023)
The throwing motion generates high torque and acceleration forces acting on the shoulder joint and the surrounding muscles, ligaments, and tendons.
Causes of Pain
Pain when throwing can come from the:
Shoulder blade
Shoulder joint – cartilage and labrum
Rotator cuff muscles and tendons
Nerves that control the muscles’ function
The shoulder blade is attached to the upper back by ligaments, muscles, and tendons. The various muscles and tendons that control the movement of the shoulder blade impact movements. Abnormalities of any area can lead to shoulder dysfunction and pain when throwing. (Wardell M., Creighton D., & Kovalcik C., 2022) The most common is the tightness of the posterior shoulder capsule, causing a loss of normal internal rotation of the shoulder. If this is causing pain, individuals may notice that they can’t reach up as high on the side with the painful shoulder when reaching behind their back.
Symptoms
Whether an athlete or playing catch in the backyard, shoulder function abnormalities can cause significant pain. Some symptoms include.
Aching Pain
Often deep in the shoulder or extending down the upper arm.
Dead Arm
Lack of strength in the throwing motion.
Pain at Night
Pain can awaken you from sleep.
Diagnosis
Finding a healthcare provider familiar with sports injuries can be helpful. They can best determine if a structural abnormality needs to be addressed. (American Academy of Orthopaedic Surgeons, 2021)
Treatment
Most can improve with nonsurgical treatments. The earliest phase of treatment is resting the joint and reducing inflammation. Treatments can include:
Ice
Anti-inflammatory medications
Cortisone injection
Once the inflammation has subsided, the source of the discomfort can be addressed.
Physical Therapy
Therapy can include:
A structured shoulder stretching and strengthening program will help.
The physical therapist will focus on scapular mobility when managing shoulder joint problems.
Stretching to improve internal rotation or any other lost motion can help allow a more normal throwing motion.
Strength exercises are often aimed at the rotator cuff, as these muscles initiate proper shoulder movements and stabilize the shoulder joint.
Maintaining flexibility and strength of the periscapular muscles (muscles that attach to the scapula bone) is important to ensure that the scapular movements are coordinated with the throwing motion.
If improvements are not made within three months of therapy, or individuals can’t return to competitive sports within six months. In that case, the individual may need to return to their healthcare provider or see an orthopedic specialist who may recommend surgery. (American Academy of Orthopaedic Surgeons, 2024)
Injury Medical Chiropractic and Functional Medicine Clinic
As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions.
Wellness & Nutrition: Personalized plans to optimize health and prevent disease.
Chronic Pain Management: Non-invasive solutions for fibromyalgia, sciatica, and low back pain.
Personal Injury & Auto Accident Care: Tailored rehabilitation for whiplash, soft tissue injuries, and more.
Sports Injuries & Orthopedic Care: Treatment for sprains, strains, and complex injuries.
Functional Medicine: Root-cause analysis for chronic disorders, incorporating nutrition, lifestyle, and environmental factors.
Neuromusculoskeletal Health: Care for neck pain, migraines, herniated discs, and scoliosis.
Our clinic integrates Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine to create customized care plans that promote natural healing, mobility, and long-term wellness. By focusing on flexibility, agility, and strength, we empower patients to thrive, regardless of age or health challenges.
At El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately focus 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. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes.
Lumbar Spine Injuries in Sports: Chiropractic Healing
References
Wardell, M., Creighton, D., & Kovalcik, C. (2022). Glenohumeral Instability and Arm Pain in Overhead Throwing Athletes: A Correlational Study. International journal of sports physical therapy, 17(7), 1351–1357. https://doi.org/10.26603/001c.39800
Itoigawa, Y., Koga, A., Morikawa, D., Kubota, A., Uehara, H., Maruyama, Y., Takazawa, Y., & Ishijima, M. (2023). Posterior shoulder stiffness was associated with shoulder pain during throwing in college baseball players: assessment of shear wave elastography. European journal of orthopaedic surgery & traumatology: orthopedie traumatologie, 33(4), 1237–1244. https://doi.org/10.1007/s00590-022-03286-z
American Academy of Orthopaedic Surgeons. (2021). Shoulder Injuries in the Throwing Athlete. https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-injuries-in-the-throwing-athlete/
American Academy of Orthopaedic Surgeons. (2024). Shoulder Impingement/Rotator Cuff Tendinitis. https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-impingementrotator-cuff-tendinitis
What are some leg-strengthening exercises that will expedite recovery for athletes and physically active individuals who have undergone leg surgery?
Post Surgery Leg Strengthening
Leg muscles may weaken after hip, knee, ankle, or foot surgery. This happens because those muscles are not used as much during recovery. Gaining back strength and muscle endurance after an injury or surgery is an important step in recovery. Leg exercises can help regain mobility and prevent complications like blood clots and pressure sores after surgery or an injury, which is why engaging in post-surgery leg strengthening is important once the doctor gives the ok.
Benefits
Post-surgery leg strengthening exercises have several benefits, including
Rebuilds strength and confidence
Retraining for optimal mobility and flexibility
Prevents pressure sores
Prevents blood clots
When the leg muscles are contracted, they move blood like a pump, maintaining proper circulation. Moving in a bed after surgery also helps prevent pressure sores from forming and blood clots. A physical therapy team will determine the right leg exercises for each individual and their injury/condition. This is an important step when moving forward after surgery. (Hoogeboom T. J. et al., 2014)
This isometric exercise means the muscles contract while no motion occurs at the hip joints. To perform:
Lie on your back and tighten your buttock muscles.
Hold the muscles tight for 5 seconds, then relax.
Repeat 10 or 15 times.
Gluteal sets can be done several times per day.
Heel Slide
Heel slides can help regain strength in the major muscles of the leg. To perform:
Lie on your back.
Bend the knee of the surgical leg and slowly slide the heel toward your butt.
Slide as far as possible and hold for 5 seconds.
Slowly return to the starting position and repeat.
Short Arc Quad
The short arc quad, or SAQ, is a simple way to get the quadricep muscles working. To perform:
Lie on your back with a towel roll, small ball, or something similar under the knee.
Slowly straighten the knee.
Tighten the quad muscle on the top of the thigh.
Hold for 3 seconds, then relax.
Repeat 10 to 15 times.
Quad Set
This exercise helps get the quad muscles working. It also helps control the position of the kneecap. To perform:
Lie on your back.
Place a small towel roll under the knee.
Try to press the back of the knee flat against the floor.
Hold for 10 seconds and release.
Repeat 10 to 15 times.
Individuals can complete quad sets bilaterally or with both knees simultaneously. This makes the stronger leg help strengthen the weaker side.
Straight Leg Raise
To perform:
Lie on your back.
Lift your leg straight off the floor until it is at the height of the opposite bent knee.
Hold for 10 seconds and slowly lower.
Repeat 10 to 15 times.
Be sure to keep the knee straight for the entire exercise. Keep the opposite knee bent for comfort. To ensure the knee is straight, individuals can complete a quad set first and then the straight leg raise. The exercise can be more challenging by increasing repetitions or adding a 2- to 3-pound ankle weight on the thigh. For even more challenge, add the ankle weight to the ankle.
Hamstring Strengthening
Working out the hamstrings after injury or surgery is important. The hamstring muscles bend the knee and extend the hip backward. To perform:
Lie on your stomach.
Bend one knee to raise the lower limb straight in the air.
Hold for 5 seconds and lower slowly.
Repeat 10 to 15 times.
Once the exercise is easy to do, increase the repetitions to 30. Individuals can also try adding a 2- to 3-pound ankle weight.
Physical therapy can help individuals regain mobility after injury or surgery. A therapist may prescribe exercises as part of an at-home exercise program. Over time, progress will go from simple exercises to more challenging ones to improve balance and mobility. (Madara K. C. et al., 2019)
Injury Medical Chiropractic & Functional Medicine Clinic
Before starting this or any other exercise program, consult a doctor and a physical therapist to find the right exercises for your situation. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Are You Recovering From Ankle Sprains?
References
Hoogeboom, T. J., Dronkers, J. J., Hulzebos, E. H., & van Meeteren, N. L. (2014). Merits of exercise therapy before and after major surgery. Current opinion in anaesthesiology, 27(2), 161–166. https://doi.org/10.1097/ACO.0000000000000062
Madara, K. C., Marmon, A., Aljehani, M., Hunter-Giordano, A., Zeni, J., Jr., & Raisis, L. (2019). PROGRESSIVE REHABILITATION AFTER TOTAL HIP ARTHROPLASTY: A PILOT AND FEASIBILITY STUDY. International Journal of Sports Physical Therapy, 14(4), 564–581.
Finger pulley injuries are unique digital injuries distinct from sprains or dislocations. They occur specifically in rock climbers and occasionally in baseball pitchers. What are the symptoms, diagnoses, and treatments available?
Finger Pulley Injury
A finger pulley injury, common in activities like climbing, involves damage to the fibrous bands (pulleys) that hold tendons against bones. This causes pain, swelling, and potentially bowstringing of the tendons.
Finger pulleys are structures that hold tendons against the bones of the fingers.
Injury symptoms include pain, swelling, and a popping sound heard at the time of the injury.
Finger pulley injuries, or ruptures of the digital pulley, are seen almost exclusively in rock climbers. (Miro P. H. et al., 2021)
This activity stresses the digits when maneuvering along uneven surfaces while supporting the entire body’s weight. The injuries result from the mechanics of the finger tendons and joints and the position the fingers hold while rock climbing. Rock climbing has grown in popularity. The only other sport in which this injury has been described is baseball, in pitchers. The forces acting on the finger are very different in these activities, but both place high stress on the finger pulleys.
Digital Pulleys
Everyone has structures in their fingers called digital pulleys. These pulleys hold the tendons against the bones of the fingers. Each finger has eight pulleys, but only two are considered critical to prevent the finger tendons’ bowstringing (when one pulley gives out or ruptures). This can result in various injury outcomes, from a simple strain of the pulley to ruptures of multiple pulleys in a single digit. Pain, stiffness, and an inability to fully flex the finger can occur. (Carruthers K. H., Skie M., & Jain M. 2016) In severe situations, when the tendons are bowstringing, the tendon may lift away from the finger when making a fist.
Symptoms
Pain and Tenderness
Localized pain and tenderness at the finger’s base, particularly when gripping or bending. Pain on the palm side of finger and tenderness with pressure
Swelling
Swelling and bruising around the affected finger joint, especially on the palm side.
Stiffness and pain when bending the fingers or difficulty gripping. Difficulty forming a fist
Bowstringing
Visible displacement of the tendon from its normal position, causing a bulge at the finger’s base.
Most commonly, the middle or index digit is the injured finger. The two critical pulleys in the finger are designated the A2 and A4. (Carruthers K. H., Skie M., & Jain M. 2016) Individuals may see swelling, redness, and inflammation at the base of the finger (A2) and/or in the space between the two finger joints closest to the tip of the finger (A4). In rock climbers, either or both of those pulleys may be injured. In baseball pitchers, the injury is typically isolated to the A4 pulley.
Causes
Overuse and Repetitive Strain: Frequent or intense gripping or crimping, common in rock climbing and other activities, can cause pulley injuries.
Dynamic or Sudden Movements: Desperate or dynamic moves or poor technique can lead to injury.
Excessive Force: Pulleys can rupture when the force exerted on them is too great.
Mechanism of injury: The A2 pulley is the most commonly injured, followed by the A4 pulley.
Diagnosis
Emergency treatment is generally unnecessary. However, it is important to have suspected digital pulley injuries examined by a specialist within several days to a week after the injury. The most important aspect of an evaluation is determining whether the injury has caused the bowstringing of the tendons. Imaging tests may be performed to help with the diagnosis and plan treatment. An ultrasound is recommended as the initial imaging technique. (Miro P. H. et al., 2021)
If an ultrasound is inconclusive, an MRI may be advised. Sometimes, an MRI is performed with the finger held straight and then bent to see if the tendons are bowstringing. An X-ray can also help exclude other causes of finger pain, including sprains and fractures.
Treatment
Conservative Care
Immobilization, physical therapy, and pulley-protective measures, such as splints or taped fingers, are often used.
Surgery
Surgery may be necessary for severe grade IV injuries where conservative care fails.
Only in situations where there are multiple pulley ruptures or if there is delayed treatment should surgery be necessary.
Rehabilitation
Focuses on regaining flexibility, strength, and grip function through exercises and physical therapy.
If the tendons do not bowstring, treatment usually protects the injured finger until swelling and pain subside. If there is bowstringing of the tendons, more careful management of the injury is needed. Individuals who suspect a pulley injury rest or splint the finger and use nonsteroidal anti-inflammatory drugs as necessary for pain until they can get a medical evaluation. (Carruthers K. H., Skie M., & Jain M. 2016) Physical therapy, along with immobilization, the H-tape method, and a protective pulley splint, are recommended for most injuries. (Miro P. H. et al., 2021) Specialized splints and therapy techniques can allow the pulleys to heal properly.
Returning to activity varies significantly with the severity of the injury. With mild pulley strains, full activity can be resumed as soon as swelling and pain have subsided. Treatment for full ruptures being treated non-surgically is typically between one and three months. For individuals requiring surgical reconstruction of a pulley injury, restrictions may apply up to a year after the surgery.
Injury Medical Chiropractic & Functional Medicine Clinic
To prevent complications, a healthcare provider should evaluate pulley injuries as soon as possible. Treatment most often consists of physical therapy, but surgery may be necessary. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Sports Injury Treatments
References
Miro, P. H., vanSonnenberg, E., Sabb, D. M., & Schöffl, V. (2021). Finger Flexor Pulley Injuries in Rock Climbers. Wilderness & environmental medicine, 32(2), 247–258. https://doi.org/10.1016/j.wem.2021.01.011
Carruthers, K. H., Skie, M., & Jain, M. (2016). Jam Injuries of the Finger: Diagnosis and Management of Injuries to the Interphalangeal Joints Across Multiple Sports and Levels of Experience. Sports Health, 8(5), 469–478. https://doi.org/10.1177/1941738116658643
Can understanding what knee tests are used help a healthcare provider diagnose the cause of individuals experiencing knee pain?
Knee Pain Tests
A knee examination is the first step in determining the cause of knee pain. Different knee tests may be performed during the exam to help the healthcare provider find the cause and develop an optimal treatment plan. These tests evaluate knee function and range of motion and look for conditions and injuries such as arthritis, meniscus tears, ACL tears, other ligament injuries, and kneecap issues.
Checking If There is Fluid in the Knee
Many individuals know if their knee is swollen, as they can see or feel the swelling. However, if there is excess fluid in the knee joint, the healthcare provider may compress the joint to feel for excess fluid. Fluid is often visible above the kneecap and can be compressed in this area. Fluid may also be detected in the back of the knee, referred to as a Baker’s cyst if the fluid has collected into a cluster. (Frush T. J., & Noyes F. R. 2015)
Arthritis Tests
Certain characteristic findings can detect knee arthritis:
Crepitus
Crepitus is the sensation when rough cartilage or exposed bone is rubbing when the knee is bent. (Lo G. H. et al., 2018)
The examiner will feel and listen for grinding as the knee is bent back and forth.
Deformity
As knee cartilage wears away, the knees can become progressively knock-kneed or bow-legged.
Limited Motion
If arthritis, bone spurs, and swelling prevent normal mobility, the knee’s range of motion often becomes limited.
Torn Meniscus Tests
Tests used to determine if there is a meniscus tear include:
Joint Line Tenderness
Joint line tenderness is a non-specific test in which the area of the meniscus is felt. It is considered a positive test when there is pain in this area.
McMurray’s test
This test is performed with the patient lying flat. The examiner bends the knee and rotates the shin bone.
This test is performed with the patient squatting.
The test is performed with the leg fully externally rotated or internally rotated, depending on whether the lateral or medial meniscus is being tested.
A click is heard or felt over the area of the tear.
ACL Tear Tests
These knee pain tests are for an anterior cruciate ligament (ACL) tear:
Lachman Test
The Lachman test is one of the most reliable to diagnose an ACL tear.
With the knee slightly bent, the examiner stabilizes the thigh while pulling the shin forward.
The shin shifts too far forward with a torn ACL.
Anterior Drawer Test
This test is performed with the patient lying flat.
The knee is bent 90 degrees, and then the shin is pulled forward to check the stability of the ACL.
Pivot Shift Test
The pivot shift test can be difficult, especially if the patient is experiencing discomfort and cannot relax the knee.
This test places stress on the knee joint and assesses the rotational stability of the ACL.
Other Ligament Injuries
For a suspected injury to other ligaments, including the posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL), the following tests may be used:
Posterior Drawer Test
The posterior drawer is performed similarly to the anterior drawer test, in which the patient lies flat.
The knee is bent 90 degrees; the shin is pushed backward to check stability and function and detect if the posterior cruciate ligament (PCL) has been injured.
Collateral Ligament Stability
Side-to-side stability of the knee detects problems with the MCL and LCL.
The shin is shifted to each side, with the patient lying flat and the knee slightly bent.
The LCL or MCL damage causes the knee to open up too much, a condition known as varus (LCL) or valgus (MCL) instability. (Ohori T. et al., 2017)
Kneecap Tests
Tests for kneecap issues include:
Patellar Grind
In this test, also called Clarke’s sign, the patient lies on their back with the leg extended.
The examiner pushes the kneecap down to reproduce the knee pain while the patient flexes the thigh muscles.
Damaged cartilage can cause a grinding sensation/crepitus.
Patellar Tenderness
The examiner can slightly lift the kneecap and place direct pressure on parts of the underside.
The examiner looks for regions of sensitivity or pain.
Patellar Apprehension
This test indicates an unstable kneecap.
The examiner places pressure on the kneecap in a certain direction, and the patient may feel like the kneecap is going to pop out.
Injury Medical Chiropractic and Functional Medicine Clinic
Knee pain tests typically check the range of motion, discomfort symptoms, and sounds that could indicate a specific type of knee injury. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Overcoming an ACL Injury
References
Frush, T. J., & Noyes, F. R. (2015). Baker’s Cyst: Diagnostic and Surgical Considerations. Sports health, 7(4), 359–365. https://doi.org/10.1177/1941738113520130
Lo, G. H., Strayhorn, M. T., Driban, J. B., Price, L. L., Eaton, C. B., & Mcalindon, T. E. (2018). Subjective Crepitus as a Risk Factor for Incident Symptomatic Knee Osteoarthritis: Data From the Osteoarthritis Initiative. Arthritis care & research, 70(1), 53–60. https://doi.org/10.1002/acr.23246
Gupta, Y., Mahara, D., & Lamichhane, A. (2016). McMurray’s Test and Joint Line Tenderness for Medial Meniscus Tear: Are They Accurate?. Ethiopian journal of health sciences, 26(6), 567–572. https://doi.org/10.4314/ejhs.v26i6.10
Ohori, T., Mae, T., Shino, K., Tachibana, Y., Fujie, H., Yoshikawa, H., & Nakata, K. (2017). Varus-valgus instability in the anterior cruciate ligament-deficient knee: effect of posterior tibial load. Journal of experimental orthopaedics, 4(1), 24. https://doi.org/10.1186/s40634-017-0087-3
Yips are involuntary wrist muscle spasms that affect athletes. They are often associated with golf, baseball, and sports that involve swinging and throwing motions, such as bowling, darts, cricket, and others. Can understanding the information and causes help diagnose and find the right therapy or training?
Yips
Yips are involuntary wrist spasms that athletes experience. The term is also used to refer to performance anxiety without physical spasms. Researchers believe they are caused by muscle overuse that leads to dystonia (a condition that causes muscles to contract involuntarily), and combined with psychological factors like performance anxiety and overthinking, can make them worse. (Beacon Health Systems, 2024)
The most common symptom is muscle spasms, often in the hands and wrists. That’s why it is the most common among athletes who play sports that require precision hand and wrist movements. Yips affect fine motor skills. (Aoyama, T. et al., 2021) In addition to muscle spasms, symptoms can also include: (Beacon Health Systems, 2024)
Twitching
Tremors
Freezing up
Psychological distress
Causes
Healthcare providers, trainers, coaches, and researchers know that psychological and physical factors cause yips. Underlying physical causes include overusing wrist muscles, which leads to dystonia or involuntary muscle movements. Also known as task-specific dystonia, it can also affect individuals who engage in repetitive muscle movements, like factory and assembly line workers, store check-out clerks, musicians, etc. (Clarke P., Sheffield D., and Akehurst S. 2020). Performance anxiety and psychological stress can worsen dystonia. (Aoyama, T. et al., 2021) Athletes can become so focused on their movements that they overthink their actions and perform worse. Individuals who have anxiety, self-consciousness, or stress about a game or performance often find that their involuntary wrist spasms are worse. (Clarke P., Sheffield D. and Akehurst S. 2020)
Increased Risk
Yips are most common in athletes who use their hands and wrists for their sport and are likely to impact more experienced, competing, and older athletes. (Beacon Health Systems, 2024) They are more common in athletes focused on smaller movements or shorter distances. For example, golfers commonly experience involuntary wrist spasms when putting, and baseball players are likelier to experience them when throwing less than 20 meters. (Clarke P., Sheffield D. and Akehurst S. 2020)
Diagnosis
There is no official diagnosis for yips. However, a coach, athletic trainer, sports doctors, and others can observe the pattern of symptoms and behavior and provide an informed diagnosis.
Once trigger/s are identified, they can be addressed. Treatments that can help include: (Beacon Health Systems, 2024)
Alternate Hand Positions
This can provide relief from dystonia and overthinking.
Using Different Equipment or Stabilizers
This allows the immobilization of certain muscles and the activation of different muscles.
Mindfulness
Reducing anxiety and distress can help relax the body.
Practicing mindfulness before games or tournaments can help reduce psychological triggers.
Botox Injections
Botox injections can treat certain types of dystonia.
Sports Psychology
A sports psychologist is a healthcare provider who studies individual athletes’ sports performance and how it affects their minds and skills.
A sports psychologist can help individuals create a program that reduces stress or anxiety around games and performance.
Injury Medical Chiropractic and Functional Medicine Clinic
Yips are common among athletes. It is important to address the physical and psychological components to treat the condition. Talking with a coach or a sports psychologist, other athletes, and supporting staff like trainers can help you find a solution. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Sports Injuries
References
Beacon Health Systems. (2024). Yips. https://www.beaconhealthsystem.org/library/diseases-and-conditions/yips/
Clarke, P., Sheffield, D., & Akehurst, S. (2020). Personality Predictors of Yips and Choking Susceptibility. Frontiers in psychology, 10, 2784. https://doi.org/10.3389/fpsyg.2019.02784
Aoyama, T., Ae, K., Souma, H., Miyata, K., Kajita, K., Kawamura, T., & Iwai, K. (2021). Difference in Personality Traits and Symptom Intensity According to the Trigger-Based Classification of Throwing Yips in Baseball Players. Frontiers in sports and active living, 3, 652792. https://doi.org/10.3389/fspor.2021.652792
Elbow pain from lifting is a common symptom among individuals who lift weights, heavy objects, children, grocery bags, etc. Depending on the underlying cause, can conservative treatments relieve and heal elbow pain?
Elbow Pain Caused By Lifting
Elbow pain from lifting can result from weight training, repetitive daily tasks, or job duties like lifting small children or heavy objects. Pain can manifest at the sides or the front of the elbow. Most minor injury cases can be treated with ice, rest, and medications at home. However, pain after lifting can also be a sign of a serious injury, such as a tendon rupture/tear.
Minor Pain From Lifting
Lifting puts pressure on the tendons connecting the wrist and upper arm to the bones in the elbow joint. Minor elbow pain can occur from temporary inflammation in any of these structures after lifting an object. Tendonitis occurs when a tendon becomes inflamed, often from overuse or lifting something too heavy, and ranges from mild to severe. Mild tendonitis typically causes pain during the activity and improves with rest. (American Academy of Orthopaedic Surgeons, 2020) Common forms of tendonitis include:
Tennis elbow – tendonitis on the outside of the elbow
Golfer’s elbow – tendonitis on the inside of the elbow.
Add ice to the affected area for up to 20 minutes daily to decrease elbow pain.
Rest
Avoid lifting heavy objects as much as possible when pain is present.
Wearing A Brace
If the pain is at the tendons on the inside or outside of your elbow, try wearing a wrist brace to limit the use of your wrist muscles that connect to this area.
Stretching
Gently stretching the wrist flexors and extensors can help reduce elbow pain after lifting. Stretches can be performed several times daily, even after symptoms have resolved. (American Academy of Orthopaedic Surgeons, 2024)
Hold the arm out in front with the palm down. Keep the elbow straight.
Bend the wrist down so that the fingers are pointing toward the ground.
With the other hand, gently pull the wrist further down until a stretch is felt along the back of the forearm.
Hold this position for 15 seconds.
Repeat five times.
Next, bend the wrist upward so the fingers point toward the ceiling.
Using the other hand, gently pull the hand backward until the stretch is felt along the front of the forearm.
Mild cases can improve after a few days of self-care, whereas more pronounced elbow symptoms can take several weeks, months, or even a year. (Kheiran A. Pandey, A. & Pandey R. 2021) If self-care doesn’t work, physical therapy may be recommended. A physical therapy team can use various modalities and treatments to help reduce pain and inflammation from elbow injuries. The therapy can include targeted exercises to strengthen weak muscles and stretch tight muscles that might contribute to the condition. In addition, the therapy team will help individuals modify their lifting technique to help prevent further injury.
A biceps tendon rupture is a rare but serious injury usually caused from lifting. In addition to other visible signs of the injury, there will be a bulge at the top of the upper arm because the muscle bunches up as it is no longer attached to the elbow. (American Academy of Orthopaedic Surgeons, 2022) Individuals may hear an audible popping sound if an elbow ligament or tendon gets torn while lifting. (Johns Hopkins Medicine, 2024)
Treatment
Treatment depends on the severity of the injury, but most cases resolve on their own with rest and, if necessary, physical therapy. Conditions that cause severe pain require orthopedic surgeon expertise. These physicians specialize in treating musculoskeletal system injuries. Imaging such as X-rays, MRIs, or CT scans are often used to determine the extent of damage. Individuals with tendon or ligament tears in the elbow may need surgery to regain full range of motion and strength in their arm. After surgery, physical therapy will help restore function.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other associated medical professionals to integrate a treatment plan to improve the body’s flexibility and mobility and resolve musculoskeletal issues.
Shoulder Pain Chiropractic Treatment
References
American Academy of Orthopaedic Surgeons. (2020). Sprains, strains, and other soft-tissue injuries. https://orthoinfo.aaos.org/en/diseases–conditions/sprains-strains-and-other-soft-tissue-injuries/
Kheiran, A., Pandey, A., & Pandey, R. (2021). Common tendinopathies around the elbow; what does current evidence say?. Journal of clinical orthopaedics and trauma, 19, 216–223. https://doi.org/10.1016/j.jcot.2021.05.021
American Academy of Orthopaedic Surgeons. (2024). Therapeutic exercise program for epicondylitis (tennis elbow/golfer’s elbow). https://orthoinfo.aaos.org/globalassets/pdfs/2024-therapeutic-exercise-program-for-lateral-and-medial-epicondylitis.pdf
American Academy of Orthopaedic Surgeons. (2023). What are NSAIDs? https://orthoinfo.aaos.org/en/treatment/what-are-nsaids/
American Academy of Orthopaedic Surgeons. (2022). Biceps tendon tear at the elbow. https://orthoinfo.aaos.org/en/diseases–conditions/biceps-tendon-tear-at-the-elbow
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Digital Pulleys
