ClickCease
+1-915-850-0900 spinedoctors@gmail.com
Select Page

Chronic Pain

Back Clinic Chronic Pain Chiropractic Physical Therapy Team. Everyone feels pain from time to time. Cutting your finger or pulling a muscle, pain is your body’s way of telling you something is wrong. The injury heals, you stop hurting.

Chronic pain works differently. The body keeps hurting weeks, months, or even years after the injury. Doctors define chronic pain as any pain that lasts for 3 to 6 months or more. Chronic pain can affect your day-to-day life and mental health. Pain comes from a series of messages that run through the nervous system. When hurt, the injury turns on pain sensors in that area. They send a message in the form of an electrical signal, which travels from nerve to nerve until it reaches the brain. The brain processes the signal and sends out the message that the body is hurt.

Under normal circumstances, the signal stops when the cause of pain is resolved, the body repairs the wound on the finger or a torn muscle. But with chronic pain, the nerve signals keep firing even after the injury is healed.

Conditions that cause chronic pain can begin without any obvious cause. But for many, it starts after an injury or because of a health condition. Some of the leading causes:

Arthritis

Back problems

Fibromyalgia, a condition in which people feel muscle pain throughout their bodies

Infections

Migraines and other headaches

Nerve damage

Past injuries or surgeries

Symptoms

The pain can range from mild to severe and can continue day after day or come and go. It can feel like:

A dull ache

Burning

Shooting

Soreness

Squeezing

Stiffness

Stinging

Throbbing

For answers to any questions you may have please call Dr. Jimenez at 915-850-0900


A Look Into Pelvic Dysfunction & Lower Abdominal Pain

A Look Into Pelvic Dysfunction & Lower Abdominal Pain

Introduction

The lower half helps stabilize the body and provides movement from the legs and rotation in the hips. The lower abdominal organs help control bowel movement while the muscles allow movement by regulating internal abdominal pressure. Combined with the back muscles, the lower abdomen can keep the body stable while protecting the lumbar section of the spine. When external factors begin to affect the lower back or disrupt the lower abdominal organs, it can trigger different symptoms that correspond to other sections of the body, like knee or leg pain being associated with menstrual cramping in the lower abdominals or even having pelvic pain that is an associated mediator to having constipation. Today’s article looks at pelvic pain, how it affects the lower abdominals, and ways to treat pelvic dysfunction in the body. We refer patients to certified, skilled providers specializing in chiropractic treatments that help those suffering from pelvic pain. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is critical for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

 

Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

Lobzova.NYCOMEC.05.25.2017

How Does Pelvic Pain Occur?

 

Have you suffered from frequent urination or irregular periods? Have you felt excruciating pain when bending down? Or feeling muscle weakness in the lower extremities of the body? Many of these symptoms are correlated to pelvic pain and can trigger different symptoms affecting the body’s lower half. Research studies have mentioned that pelvic pain in its chronic form is a non-cyclic pain located in the pelvis, and the multiple causations can make it difficult to source where the pain is coming from. The overlapping profiles of pelvic pain can be traced through the numerous nerve pathways that are connected to the spine that can become aggravated and become the mediators for pelvic pain. For example, a person having low back pain might experience uncontrollable urinary discharge in their pelvic region. This could be due to the lower sacral nerve root being impaired and causing an overlap of the profiles resulting from mechanical legions to the lumbar spine, thus increasing the risk associated with the pelvis. 

 

How Does It Affect The Lower Abdominals?

The pelvic region ensures that the body’s lower half is stable and protects the lower abdominal organs from disruptive factors like pelvic pain. Research studies have shown that pelvic pain is a relatively common pain associated with comorbidities affecting the body. Some of the various associated symptoms of pelvic pain can cause a correlation to disturbances of the bladder and sexual function in both sexes while also triggering abdominal and low back pain. Additional research studies have found that chronic pelvic pain can cause a correlated issue with PBS or painful bladder syndrome. What PBS does is that it can make a person have a frequent need to urinate and can cause the pelvic muscles to become tense and sensitive. This coincidentally causes the lower sacral nerves to be aggravated and become a mediator for the genital region to be hypersensitive.


Pelvic Pain Overview-Video

Are you feeling stiffness or tenderness in the groin region? How about going to the bathroom constantly? Or have you been experiencing low back pain? Many of these symptoms correlate to pelvic pain and other symptoms associated with the body. The video above overviews pelvic pain and how it affects the body’s lower extremities. The pelvic region consists of lower sacral nerve roots connected to several different nerve pathways that correspond to the primary nerves and provide an extensive neurological connection to the other areas in the pelvis. When mediators cause an increased risk in the pelvic region, the pelvic splanchnic nerves start to trigger muscle dysfunction in the lower abdominal organs. This causes numerous combinations of symptoms and disorders that causes overlapping of profiles in the body. The lower sacral nerve that is aggravated in the pelvic region could be the causation of pelvic and leg pain.


Treatments For Pelvic Dysfunction

 

Since the pelvic region has many nerve roots that are intertwined and connect to the major nerves in the spinal cord, it can become aggravated by accompanying the lower lumbar and upper sacral nerve roots to be impaired. Research studies have found that pelvic pain can cause an overlap in risk profiles that involves either the visceral or somatic system and the encompassed structures that help the nervous system form a causal relationship to the spine and lower extremities. When the nerve roots become irritated and affect the pelvic region, treatments like chiropractic therapy and physical therapy can help relieve the pelvic area and even help alleviate other symptoms. Physical therapy helps strengthen the hip and abdominal muscles from becoming weak and can reduce overlapping pathologies. Chiropractic therapy can help manipulate the L-1 through 5 vertebrae in the lumbar region of the spine, causing low back pain and bladder dysfunction. Research studies have mentioned that spinal manipulation can help reduce lower sacral nerve root compression triggering low back pain associated with leg pain. This overlap of risk profiles may cause pelvic pain affecting the body and causing organ dysfunction.

 

Conclusion

The lower half of the body consists of the lower abdominal organs and the pelvic region that allows bowel movement and keeps the body stable when in motion. When external factors begin to affect the lower back or the lower abdominal organs, it can cause a triggering effect on different sections of the body. Pelvic pain can affect the internal organs in the lower abdominal and pelvic region and cause comorbidities affecting the body’s lower back and bladder function. Treatments that help strengthen the hips and abdominal muscles or manipulate the spine to reduce the encased nerves trapped in the pelvic muscles will provide relief to the body’s lower extremities and improve functionality.

 

References

Browning, J E. “Chiropractic Distractive Decompression in Treating Pelvic Pain and Multiple System Pelvic Organic Dysfunction.” Journal of Manipulative and Physiological Therapeutics, U.S. National Library of Medicine, Aug. 1989, https://pubmed.ncbi.nlm.nih.gov/2527938/.

Dydyk, Alexander M, and Nishant Gupta. “Chronic Pelvic Pain – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 11 Nov. 2011, https://www.ncbi.nlm.nih.gov/books/NBK554585/.

Grinberg, Keren, et al. “New Insights about Chronic Pelvic Pain Syndrome (CPPS).” International Journal of Environmental Research and Public Health, MDPI, 26 Apr. 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246747/.

Hwang, Sarah K. “Advances in the Treatment of Chronic Pelvic Pain: A Multidisciplinary Approach to Treatment.” Missouri Medicine, Journal of the Missouri State Medical Association, 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143566/.

Lee, Dae Wook, et al. “Chronic Pelvic Pain Arising from Dysfunctional Stabilizing Muscles of the Hip Joint and Pelvis.” The Korean Journal of Pain, The Korean Pain Society, Oct. 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5061646/.

Disclaimer

Insight On Chest Pains & Viscerosomatic Dysfunction

Insight On Chest Pains & Viscerosomatic Dysfunction

Introduction

In the body’s upper half, the cardiovascular system’s heart helps pump nutrient-riched oxygenated blood all around the body to the corresponding muscles, tissues, and organs to keep the body functional. The heart is protected by the ribcage and muscles surrounding the heart organ from any external factors that can cause harm to the body. When these factors do cause an effect on the body, it can lead to many issues like thoracic back paincardiovascular problems, gut disorders, and even chest pains. These issues affect a person, causing them to feel crummy and dampen their outlook. Today’s article will look at chest pains, how it affects the gut and heart in the body, and how viscerosomatic dysfunction is associated with chest pains. We refer patients to certified, skilled providers specializing in osteopathic and cardiovascular treatments that help those suffering from chest pains and cardiovascular disorders. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is critical for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

 

Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

04 Carnahan-Microbiome-CV-Disease

What Are Chest Pains?

 

Have you noticed your heart is beating irregularly? How about acid reflux that is affecting your chest constantly? Have you felt muscle stiffness or tenderness in the middle regions of your back? Or have you felt your chest harden and stiffen after something impacted you? Many of these symptoms are tell-tale signs of you experiencing chest pains in your upper body. Research studies have defined chest pains as a common type of visceral pain that is a dull, deep pressure that squeezes the chest. This results in the visceral afferent nerves aggravated as they cause shoulder pain, jaw pain, or thoracic back pain since the nerve root reaches the spinal cord. Additional research studies have found that chest pains can have a variety of cardiac disorders as they can cause dysfunction in the muscles and skeletal joints within the chest walls or the thoracic regions of the spine. When the thoracic region of the spine becomes affected due to chest pains, it can cause herniation on the spinal discs, thus resulting in unwanted pain and discomfort to the individual. Chest pain can even affect the gut system and the heart itself.

 

How Does It Affect The Gut & The Heart?

Research studies have mentioned that chest pains can affect the gut system and the heart organ itself due to environmental changes that can affect the gut system. The gut microbiota helps metabolize homeostasis in the body for the gut system. When the gut has been impaired, the harmful bacteria travel through the systemic circulation and heighten the inflammatory effects that cause the development of cardiovascular diseases in the heart. At the same time, additional research studies have mentioned that any symptoms accompanying angina pain are conceptualized as a warning to individuals developing coronary artery disease. When this happens, not all ischemic episodes in the heart are indistinguishable when it comes to chest pains and can result from abnormalities of the thoracic regions.


Viscerosomatic Reflexes Overview-Video

Have you experienced irregular chest pains that pop up randomly? How about discomfort in the thoracic regions of your back? Do you feel gastrointestinal inflammatory issues like acid reflux or IBS (irritable bowel syndrome) cause you pain? These symptoms are associated with chest pains in the body due to viscerosomatic dysfunction. Research studies have found that visceral pain is a complex disorder since it can affect one internal organ in the body. In contrast, the corresponding nerve or muscle gets involved as well. Visceral pain is also associated with GI disturbances and changes in the body’s temperature, blood pressure, and heart rate, which are considered autonomic signs that the body is dysfunctioning. The video above gives an insightful overview explanation of what the viscerosomatic reflexes and nerves do when they are not aggravated.


Viscerosomatic Dysfunction Associated With Chest Pains

 

Since visceral pain is complex and can affect the internal organs, research studies have found that viscerosomatic dysfunction in the thoracic-upper abdominal regions can cause the thoracic and esophagus to become hypersensitive to environmental factors that irritate the airways that connect the entrance of the gut to the esophageal tube. Additional research studies have even found that non-cardiac chest pains are another form of viscerosomatic dysfunction that causes the esophageal opening of the stomach to become dysmotility and hypersensitive causing gastroesophageal reflux disease. This causes many individuals to develop chest pains and can affect a person’s mortality. Adjusting certain habits affecting the chest, gut, or back can reduce the effects that viscerosomatic dysfunction is causing to the person’s body so that they can get their sense of purpose back.

 

Conclusion

The body’s upper half has the cardiovascular system, where the heart makes sure to pump blood and nutrients to every muscle, tissue, and organ required to keep the body functional. When environmental factors cause issues affecting the body, it can cause various problems in the gut, chest, and heart; this is known as visceral pain and is a complex disorder that can affect the upper abdominal-thoracic region of the body. Visceral pain can cause the gut system to develop gastroesophageal reflux disease, chest pains, and cardiovascular disorders that can make the thoracic region of the spine herniated and stiff if it is not taken care of. When individuals start to take care of themselves and reduce the visceral pain from the affected organ, their bodies will begin to heal naturally and make them continue their health and wellness journey.

 

References

Brumovsky, P R, and G F Gebhart. “Visceral Organ Cross-Sensitization – an Integrated Perspective.” Autonomic Neuroscience: Basic & Clinical, U.S. National Library of Medicine, 16 Feb. 2010, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2818077/.

Börjesson, M. “Visceral Chest Pain in Unstable Angina Pectoris and Effects of Transcutaneous Electrical Nerve Stimulation. (TENS). A Review.” Herz, U.S. National Library of Medicine, Apr. 1999, https://pubmed.ncbi.nlm.nih.gov/10372297/.

Johnson, Ken, and Sassan Ghassemzadeh. “Chest Pain – StatPearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 1 Aug. 2021, https://www.ncbi.nlm.nih.gov/books/NBK470557/.

Sikandar, Shafaq, and Anthony H Dickenson. “Visceral Pain: The Ins and Outs, the Ups and Downs.” Current Opinion in Supportive and Palliative Care, U.S. National Library of Medicine, Mar. 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272481/.

Stochkendahl, Mette J, et al. “Diagnosis and Treatment of Musculoskeletal Chest Pain: Design of a Multi-Purpose Trial.” BMC Musculoskeletal Disorders, BioMed Central, 31 Mar. 2008, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2315652/.

Tang, W H Wilson, et al. “Gut Microbiota in Cardiovascular Health and Disease.” Circulation Research, U.S. National Library of Medicine, 31 Mar. 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390330/.

Disclaimer

Viscerosomatic Pain & The Spine

Viscerosomatic Pain & The Spine

Introduction

The body has many nerve roots that are intertwined and coming out from the spinal cord, which is part of the nervous system. One of the main components of the nervous system is the vagus nerve, which is part of the parasympathetic nervous system as it helps inform the brain about the state of the inner organs in the body. The vagus nerve helps maintain the body’s metabolism and homeostasis from diseases and injuries that occur either inside or outside the body. Many inner organs, muscles, or tissues get affected when a person has suffered from an injury or developed infections in their body. They can cause many symptoms that can dysfunction the body. It can affect the spine, nerve roots, internal organs, and joints, making the individual feel a sense of hopelessness. Today’s article will look at the unique connection of viscerosomatic reflexes and how it affects the body, as well as how viscerosomatic pain can affect the spine causing the individual many spinal issues. We refer patients to certified, skilled providers specializing in osteopathic and chiropractic treatments. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is critical for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

 

Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

Lobzova.NYCOMEC.05.25.2017

What Are Viscerosomatic Reflexes?

 

Have you experienced pain in your arms, legs, or back? How about feeling dysfunctional in your urinary tract? Have you noticed that not only your chest has started to hurt but also your gut and lower back? Many of these are signs of you having pain due to your viscerosomatic reflexes in your body. Research studies have defined viscerosomatic as regular visceral activity in the body stimulated by the somatosensory nerves that can help recognize abnormal viscerosomatic reflexes. These nerves are connected to the central nervous system, which travels through the spinal cord and can affect the body. The best example is when a doctor is giving a reflex test and uses a rubber mallet to hit the knee to see if a person still has reflexes in their body. Since the vagus nerve is part of the parasympathetic nervous system, when it becomes damaged, it can cause numerous effects on the body research studies have found that any visceral disturbances that are affecting the human body can cause an increase in muscle tension and decrease the pain in the corresponding spinal ligament that can restrict the muscle mobility to the tissues and affecting either the motor or sympathetic nerve. This causes the body to experience pain affecting one part of the body to the corresponding affected nerve.

 

How Does It Affect The Body?

Since the body has so many connections like the gut-brain axis, which helps regulate the body’s metabolism and homeostasis, the endocrine system that allows the transport of hormones to the rest of the muscles, tissues, and organs through the nerve roots, and the nerve roots themselves are connected as they help with the sensory-motor function with the arms and legs, so the body can move around. When these connections are being damaged and start to affect the rest of the body, it can lead to other health problems that do affect the body. Research studies have found that when the body is suffering from visceral pain in the organs can affect different areas. A couple of examples include:

  • Bladder issues affecting the perineal area
  • Cardiovascular disorders causing arm and neck pain
  • GI disorders causing discomfort

Even though visceral pain’s effects are not life-threatening, it can dampen a person’s mood by causing a negative impact associated with distress, sleep, and work disturbances, and even causing sexual dysfunction in the body.


An Overview Of Viscerosomatic Reflexes-Video

Have you experienced cardiovascular issues that are causing arm and neck pain? Have you been feeling some discomfort in your gut or your pelvic area? Have you been experiencing pain that is negatively impacting your quality of life? This could be due to viscerosomatic pain affecting your body and causing these symptoms. The video above explains how the viscerosomatic reflexes are connected to their corresponding muscles and organs. When the body is suffering from issues that affect the related muscles, it is known as viscerosomatic pain. Research studies have shown that individuals suffering from viscerosomatic pain will have multifaceted problems in the viscerosomatic reflexes. This type of pain does affect the spinal neurons causing the visceral neurons to become overly sensitive in the body and the affected areas.


How Does Viscerosomatic Pain Affect The Spine?

 

Research studies have found that viscerosomatic can affect the spine by affecting the gut system. Many individuals that are suffering from IBS (irritable bowel syndrome) will often complain about being in pain in their torso areas. They don’t realize that processing the visceral and somatic stimuli can cause the gut to become hypersensitive and affect the spinal cord neurons to overlap. Another research study has mentioned that pelvic pain in an individual can cause more symptoms that involve many organ systems causing visceral symptoms combined with somatovisceral convergence. When viscerosomatic pain affects many body parts, it can be difficult for a diagnosis to be conducted. 

 

Conclusion

The body has many nerve roots that connect the body by branching out of the spine and providing sensory-motor functions to the corresponding muscles and tissues. When the body becomes injured, it can cause nerve not only damage to the body but also affect the muscles and organs. This is known as viscerosomatic pain and can be challenging to diagnose due to its being multifaceted with multiple symptoms. This pain can cause the affected organs to become hypersensitive and impact a person’s quality of life. When the body starts healing from viscerosomatic pain, the effects will become less for the individual as they heal the affected organs.

 

References

Bath, Megan, and Justin Owens. “Physiology, Viscerosomatic Reflexes.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 8 May 2022, https://www.ncbi.nlm.nih.gov/books/NBK559218/.

Hoffman, Donna. “Understanding Multisymptom Presentations in Chronic Pelvic Pain: The Inter-Relationships between the Viscera and Myofascial Pelvic Floor Dysfunction.” Current Pain and Headache Reports, U.S. National Library of Medicine, Oct. 2011, https://pubmed.ncbi.nlm.nih.gov/21739128/.

Sengupta, Jyoti N. “Visceral Pain: The Neurophysiological Mechanism.” Handbook of Experimental Pharmacology, U.S. National Library of Medicine, 2009, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156094/.

Sikandar, Shafaq, and Anthony H Dickenson. “Visceral Pain: The Ins and Outs, the Ups and Downs.” Current Opinion in Supportive and Palliative Care, U.S. National Library of Medicine, Mar. 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272481/.

Silva, Andréia Cristina de Oliveira, et al. “Effect of Osteopathic Visceral Manipulation on Pain, Cervical Range of Motion, and Upper Trapezius Muscle Activity in Patients with Chronic Nonspecific Neck Pain and Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Pilot Study.” Evidence-Based Complementary and Alternative Medicine : ECAM, Hindawi, 11 Nov. 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252226/.

Verne, G Nicholas, et al. “Viscerosomatic Facilitation in a Subset of IBS Patients, an Effect Mediated by N-Methyl-D-Aspartate Receptors.” The Journal of Pain, U.S. National Library of Medicine, Sept. 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489925/.

Disclaimer

Spinal Issues Alleviated Through Decompression

Spinal Issues Alleviated Through Decompression

Introduction

The spine is located in the back of the body, ensuring that it’s standing, on the move constantly, and resting when needed. This S-shaped curve helps protect the spinal cord from various injuries and helps transmit the signals from the brain and throughout the rest of the body. When injuries start to affect the spinal cord, it can lead to many chronic issues affecting the spine, neck, and lower back. Fortunately, there are available treatments that help alleviate spinal problems in the body, therefore providing relief for the individual. Today’s article emphasizes spinal stenosis, how it affects the spine, and how decompression can help restore the spine for many suffering individuals. Patients are referred to qualified, skilled providers who specialize in spinal decompression therapy. We go hand in hand with our patients by referring them to our associated medical providers based on their examination when it’s appropriate. We find that education is valuable for asking crucial questions to our providers. Dr. Jimenez DC provides this information as an educational service only. Disclaimer

 

Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

SpineMed

What Is Spinal Stenosis?

 

Have you felt radiating pain traveling along your back? How about muscle weakness in certain parts of your body? Do you feel weird sensations on your legs, neck, or lower back? These are signs that you could be encountering spinal stenosis along your spine, causing these symptoms. Research studies have defined spinal stenosis as a frequent condition in the cervical and lumbar portions of the spine that compressed the nerve roots connected to the spinal column. Spinal stenosis usually occurs when a person has experienced traumatic injuries and degenerative changes that affect the spinal canal either with mechanical force or spinal issues like disc herniation. Additional information has found that when many people are suffering from spinal stenosis, it can become progressively worse if it is not treated beforehand and can cause symptoms affecting the spine. Some of the signs that spinal stenosis can cause to a person depending on how severe it has affected their spine; which can include:

  • Radiating pain goes from dull to electric-shooting pain depending on the area in which spinal stenosis occurs.
  • Pins and needles sensations run from the legs, arms, or neck that occasionally flare-up.
  • Numbness that affects the arms and legs
  • Muscle weakness reduces the motor functions of the legs and arms while causing coordination problems to the person.

 

How Does It Affect The Spine?

Since spinal stenosis causes nerve root compression and narrowing of the spinal canal, it can affect many people dealing with excruciating pain along their spine. Research studies have shown that when spinal stenosis affects the spine, it causes degeneration of the spinal discs between the spinal joints to become unstable, hypermobile, and even hypertrophy. What this does is that it reduces the spinal canal, causing intermittent neurogenic claudication, which makes a person lose their balance and fall. Additional research has shown that when intermittent neurogenic claudication is associated with spinal stenosis, it affects the nerve roots through mechanical compression. This results in factors like venous congestion, diminished arterial blood flow to the spine, and even decreased nerve root impulse conduction to the spinal column. All is not lost as there are available treatments for many people who suffer from spinal stenosis.


An Overview On Spinal Stenosis-Video

Have you been feeling various pains that range from dull to excruciating along your back? Do you feel muscle weakness located in the arms or legs? Or have you been experiencing weird tingling sensations that cause numbness to your arms or legs? These are symptoms of spinal stenosis and can affect your overall health while causing you pain. Fortunately, spinal decompression might be the answer that you are seeking. The video above explains the causes of spinal stenosis and how to treat them non-surgical. Spinal decompression helps the spinal column gently move and stretch the spinal discs back to their position and restore their original functionality. This will cause the spinal canal to be relieved and alleviate the symptoms affecting the spine’s motor functions. Not only that, but many suffering individuals will notice that other issues like back, neck, and leg pain are reduced in their bodies. Spinal decompression for alleviating spinal stenosis has given many beneficial factors for people that need relief. This link will explain how spinal decompression offers impressive results for many individuals who suffer from spinal stenosis or other spinal issues.


How Decompression Help Restore The Spine

 

With many treatments available for relieving spinal stenosis, research shows that non-surgical treatments like physiotherapy and spinal decompression can help reduce the pain symptoms caused by spinal stenosis and help improve the functionality back to the legs and lower back. Decompression does to the spine because it uses mechanical and manual traction to help loosen the stiff muscles and cause tension to reset the spinal discs back in place. Additional research has also shown that laminectomy, a form of surgical decompression, has been used to alleviate spinal stenosis by releasing the neural structures affected along the spine. With these treatments, many suffering individuals will feel much better and slowly regain their sense of purpose in the world without being in pain.

 

Conclusion

The spine helps the body protect the spinal cord while keeping it standing straight. When some injuries or issues affect the spine, it can lead to spinal problems like spinal stenosis. Spinal stenosis occurs when the nerve roots are compressed and narrow the spinal canal. The symptoms that spinal stenosis causes to the body can affect the sensory and motor functions to cause numbness and various pain ranging from dull to sudden sharp pain. Therefore, with decompression therapy, many individuals will feel relief from spinal stenosis as the spinal column becomes wider and allows the spinal discs to return to their proper position. Many people who use decompression treatments will feel much better and notice that their functionality is coming back, so they can keep on moving.

 

References

Bjerke, Benjamin. “What Is Spinal Stenosis?” Spine, Spine-Health, 25 Nov. 2019, https://www.spine-health.com/conditions/spinal-stenosis/what-spinal-stenosis.

Estefan, Martin, and Gaston O Camino Willhuber. “Laminectomy.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 1 May 2022, https://www.ncbi.nlm.nih.gov/books/NBK542274/.

Lee, Seung Yeop, et al. “Lumbar Stenosis: A Recent Update by Review of Literature.” Asian Spine Journal, Korean Society of Spine Surgery, Oct. 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591458/.

Lurie, Jon, and Christy Tomkins-Lane. “Management of Lumbar Spinal Stenosis.” BMJ (Clinical Research Ed.), British Medical Journal Publishing Group, 4 Jan. 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6887476/.

Munakomi, Sunil, et al. “Spinal Stenosis And Neurogenic Claudication.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 12 Feb. 2022, https://www.ncbi.nlm.nih.gov/books/NBK430872/.

Raja, Avais, et al. “Spinal Stenosis – StatPearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 19 Dec. 2021, https://www.ncbi.nlm.nih.gov/books/NBK441989/.

Disclaimer

Disc Bulge & Herniation Chiropractic Care Overview

Disc Bulge & Herniation Chiropractic Care Overview

Disc bulge and disc herniation are some of the most common conditions affecting the spine of both young and middle-aged patients. It is estimated that approximately 2.6% of the US population annually visits a clinician to treat spinal disorders. Roughly $ 7.1 billion alone is lost due to the time away from work.

Disc herniation is when the whole or part of the nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. This is also known as the slipped disc and frequently occurs in the lower back, sometimes also affecting the cervical region. Herniation of the intervertebral disc is defined as a localized displacement of disc material with 25% or less of the disc circumference on an MRI scan, according to the North American Spine Society 2014. The herniation may consist of nucleus pulposus, annulus fibrosus, apophyseal bone or osteophytes, and the vertebral endplate cartilage in contrast to disc bulge.

There are also mainly two types of disc herniation. Disc protrusion is when a focal or symmetrical extension of the disc comes out of its confines in the intervertebral space. It is situated at the intervertebral disc level, and its outer annular fibers are intact. A disc extrusion is when the intervertebral disc extends above or below the adjacent vertebrae or endplates with a complete annular tear. In this type of disc extrusion, a neck or base is narrower than the dome or the herniation.

A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. Here, the displacement is more than 25% of the circumference of the intervertebral disc. It also does not extend below or above the margins of the disc because the annulus fibrosus attachment limits it. It differs from disc herniation because it involves less than 25% of the disc’s circumference. Usually, the disc bulge is a gradual process and is broad. The disc bulge can be divided into two types. In a circumferential bulge, the whole disc circumference is involved. More than 90 degrees of the rim is involved asymmetrically in asymmetrical bulging.

Normal Intervertebral Disc Anatomy

Before going into detail about the definition of disc herniation and disc bulge, we need to look at the standard intervertebral disc. According to spine guidelines in 2014, a standard disc is something that has a classic shape without any evidence of degenerative disc changes. Intervertebral discs are responsible for one-third to one-fourth of the height of the spinal column.

One intervertebral disc is about 7 -10 mm thick and measures 4 cm in anterior-posterior diameter in the lumbar region of the spine. These spinal discs are located between two adjacent vertebral bodies. However, no discs can be found between the atlas and axis and the coccyx. About 23 discs are found in the spine, with six in the cervical spine, 12 in the thoracic spine, and only five in the lumbar spine.

Intervertebral discs are made of fibro cartilages, forming a fibrocartilaginous joint. The outer ring of the intervertebral disc is known as the annulus fibrosus, while the inner gel-like structure in the center is known as the nucleus pulposus. The cartilage endplates sandwich the nucleus pulposus superiorly and inferiorly. The annulus fibrosus comprises concentric collagen fiber sheets arranged in a radial tire-like structure into lamellae. The fibers are attached to the vertebral endplates and oriented at different angles. With their cartilaginous part, the endplates anchor the discs in their proper place.

The nucleus pulposus is composed of water, collagen, and proteoglycans. Proteoglycans attract and retain moisture, giving the nucleus pulposus a hydrated gel-like consistency. Interestingly, throughout the day, the amount of water found in the nucleus pulposus varies according to the person’s level of activity. This feature in the intervertebral disc serves as a cushion or a spinal shock-absorbing system to protect the adjacent vertebra, spinal nerves, spinal cord, brain, and other structures against various forces. Although the individual movement of the intervertebral discs is limited, some form of vertebral motion like flexion and extension is still possible due to the features of the intervertebral disc.

Effect of Intervertebral Disc Morphology on Structure and Function

The type of components present in the intervertebral disc and how it is arranged determine the morphology of the intervertebral disc. This is important in how effectively the disc does its function. As the disc is the most important element which bears the load and allows movement in the otherwise rigid spine, the constituents it is made up of have a significant bearing.

The complexity of the lamellae increases with advancing age as a result of the synthetic response of the intervertebral disc cells to the variations in the mechanical load. These changes in lamellae with more bifurcations, interdigitation and irregular size and number of lamellar bands will lead to the altered bearing of weight. This in turn establishes a self-perpetuated disruption cycle leading to the destruction of the intervertebral discs. Once this process is started it is irreversible. As there is an increased number of cells, the amount of nutrition the disc requires is also increasingly changing the normal concentration gradient of both metabolites and nutrients. Due to this increased demand, the cells may also die increasingly by necrosis or apoptosis.

Human intervertebral discs are avascular and hence the nutrients are diffused from the nearby blood vessels in the margin of the disc. The main nutrients; oxygen and glucose reach the cells in the disc through diffusion according to the gradient determined by the rate of transport to the cells through the tissues and the rate of demand. Cells also increasingly produce lactic acid as a metabolic end product. This is also removed via the capillaries and venules back to the circulation.

Since diffusion depends on the distance, the cells lying far from the blood capillaries can have a reduced concentration of nutrients because of the reduced supply. With disease processes, the normally avascular intervertebral disc can become vascular and innervated in degeneration and in disease processes. Although this may increase the oxygen and nutrient supply to the cells in the disc, this can also give rise to many other types of cells that are normally not found in the disc with the introduction of cytokines and growth factors.

The morphology of the intervertebral disc in different parts of the spine also varies although many clinicians base the clinical theories based on the assumption that both cervical and lumbar intervertebral discs have the same structure. The height of the disc was the minimum in the T4-5 level of the thoracic column probably due to the fact that thoracic intervertebral discs are less wedge-shaped than those of cervical and lumbar spinal regions.

From the cranial to caudal direction, the cross-sectional area of the spine increased. Therefore, by the L5-S1 level, the nucleus pulposus was occupying a higher proportion of the intervertebral disc area. The cervical discs have an elliptical shape on cross-section while the thoracic discs had a more circular shape. The lumbar discs also have an elliptical shape though it is more flattened or re-entrant posteriorly.

What is a Disc Bulge?

The bulging disc is when the disc simply bulges outside the intervertebral disc space it normally occupies without the rupture of the outer annulus fibrosus. The bulging area is quite large when compared to a herniated disc. Moreover, in a herniated disc, the annulus fibrosus ruptures or cracks. Although disc bulging is more common than disc herniation, it causes little or no pain to the patient. In contrast, the herniated disc causes a lot of pain.

Causes for Disc Bulging

A bulging disc can be due to several causes. It can occur due to normal age-related changes such as those seen in degenerative disc disease. The aging process can lead to structural and biochemical changes in the intervertebral discs and lead to reduced water content in the nucleus pulposus. These changes can make the patient vulnerable to disc bulges with only minor trauma. Some unhealthy lifestyle habits such as a sedentary lifestyle and smoking can potentiate this process and give rise to more severe changes with the weakening of the disc.

General wear and tear due to repeated microtrauma can also weaken the disc and give rise to disc bulging. This is because when the discs are strained, the normal distribution of weight loading changes. Accumulated micro-trauma over a long period of time can occur in bad posture. Bad posture when sitting, standing, sleeping, and working can increase the pressure in the intervertebral discs.

When a person maintains a forward bending posture, it can lead to overstretching and eventually weakness of the posterior part of the annulus fibrosus. Over time, the intervertebral disc can bulge posteriorly. In occupations that require frequent and repetitive lifting, standing, driving, or bending, the bulging disc may be an occupational hazard. Improper lifting up of items, and improper carrying of heavy objects can also increase the pressure on the spine and lead to disc bulges eventually.

The bulging intervertebral discs usually occur over a long period of time. However, the discs can bulge due to acute trauma too. The unexpected sudden mechanical load can damage the disc resulting in micro-tears. After an accident, the disc can become weakened causing long-term microdamage ultimately leading to bulging of the disc. There may also be a genetic component to the disc bulging. The individual may have a reduced density of elastin in the annulus fibrosus with increased susceptibility to disc diseases. Other environmental facts may also play a part in this disease process.

Symptoms of Disc Bulging

As mentioned previously, bulging discs do not cause pain and even if they do the severity is mild. In the cervical region, the disease will cause pain running down the neck, deep pain in the shoulder region, pain radiating along the upper arm, and forearm up to the fingers.

This may give rise to a diagnostic dilemma as to whether the patient is suffering from a myocardial infarction as the site of referred pain and the radiation is similar. Tingling feeling on the neck may also occur due to the bulging disc.

In the thoracic region, there may be pain in the upper back that radiates to the chest or the upper abdominal region. This may also suggest upper gastrointestinal, lung, or cardiac pathology and hence need to be careful when analyzing these symptoms.

The bulging discs of the lumbar region may present as lower back pain and tingling feeling in the lower back region of the spine. This is the most common site for disc bulges since this area holds the weight of the upper body. The pain or the discomfort can spread through the gluteal area, thighs, and to the feet. There may also be muscle weakness, numbness or tingling sensation. When the disc presses on the spinal cord, the reflexes of both legs can increase leading to spasticity.

Some patients may even have paralysis from the waist down. When the bulging disc compresses on the cauda equine, the bladder and bowel functions can also change. The bulging disc can press on the sciatic nerve leading to sciatica where the pain radiates in one leg from the back down to the feet.

The pain from the bulging disc can get worse during some activities as the bulge can then compress on some of the nerves. Depending on what nerve is affected, the clinical features can also vary.

Diagnosis of Disc Bulging

The diagnosis may not be apparent from clinical history due to similar presentations in more serious problems. But the chronic nature of the disease may give some clues. Complete history and a physical examination need to be done to rule out myocardial infarction, gastritis, gastro-oesophageal reflux disease, and chronic lung pathology.

MRI of Disc Bulge

Investigations are necessary for the diagnosis. X-ray spine is performed to look for gross pathology although it may not show the bulging disc directly. There may be indirect findings of disk degeneration such as osteophytes in the endplates, gas in the disc due to the vacuum phenomenon, and the loss of height of the intervertebral disc. In the case of moderate bulges, it may sometimes appear as non-focal intervertebral disc material that is protruded beyond the borders of the vertebra which is broad-based, circumferential, and symmetrical.

Magnetic resonance imaging or MRI can exquisitely define the anatomy of the intervertebral discs especially the nucleus pulposus and its relationships. The early findings seen on MRI in disc bulging include the loss of normal concavity of the posterior disc. The bulges can be seen as broad-based, circumferential, and symmetrical areas. In moderate bulging, the disc material will protrude beyond the borders of the vertebrae in a non-focal manner. Ct myelogram may also give detailed disc anatomy and may be useful in the diagnosis.

Treatment of Disc Bulging

The treatment for the bulging disc can be conservative, but sometimes surgery is required.

Conservative Treatment

When the disc bulging is asymptomatic, the patient does not need any treatment since it does not pose an increased risk. However, if the patient is symptomatic, the management can be directed at relieving the symptoms. The pain is usually resolved with time. Till then, potent pain killers such as non-steroidal anti-inflammatory drugs like ibuprofen should be prescribed. In unresolved pain, steroid injections can also be given to the affected area and if it still does not work, the lumbar sympathetic block can be tried in most severe cases.

The patient can also be given the option of choosing alternative therapies such as professional massage, physical therapy, ice packs, and heating pads which may alleviate symptoms. Maintaining correct posture, tapes, or braces to support the spine are used with the aid of a physiotherapist. This may fasten the recovery process by avoiding further damage and keeping the damaged or torn fibers in the intervertebral disc without leakage of the fluid portion of the disc. This helps maintain the normal structure of the annulus and may increase the recovery rate. Usually, the painful symptoms which present initially get resolved over time and lead to no pain. However, if the symptoms get worse steadily, the patient may need surgery

If the symptoms are resolved, physiotherapy can be used to strengthen the muscles of the back with the use of exercises. Gradual exercises can be used for the return of function and for preventing recurrences.

Surgical Treatment

When conservative therapy does not work with a few months of treatment, surgical treatment can be considered. Most would prefer minimally invasive surgery which uses advanced technology to correct the intervertebral disc without having to grossly dissect the back. These procedures such as microdiscectomy have a lower recovery period and reduced risk of scar formation, major blood loss, and trauma to adjacent structures when compared to open surgery.

Previously, laminectomy and discectomy have been a mainstay of treatment. However, due to the invasiveness of the procedure and due to increased damage to the nerves these procedures are currently abandoned by many clinicians for disc bulging.

Disc bulging in the thoracic spine is being treated surgically with costotransversectomy where a section of the transverse process is resected to allow access to the intervertebral disc. The spinal cord and spinal nerves are decompressed by using thoracic decompression by removing a part of the vertebral body and making a small opening. The patient may also need a spinal fusion later on if the removed spinal body was significant.

Video-assisted thoracoscopic surgery can also be used where only a small incision is made and the surgeon can perform the surgery with the assistance of the camera. If the surgical procedure involved removing a large portion of the spinal bone and disc material, it may lead to spinal instability. This may need bone grafting to replace the lost portion with plates and screws to hold them in place.

What is a Disc Herniation?

As mentioned in the first section of this article, disc herniation occurs when there is disc material displaces beyond the limits of the intervertebral disc focally. The disc space consists of endplates of the vertebral bodies superiorly and inferiorly while the outer edges of the vertebral apophyses consist of the peripheral margin. The osteophytes are not considered a disc margin. There may be irritation or compression of the nerve roots and dural sac due to the volume of the herniated material leading to pain. When this occurs in the lumbar region, this is classically known as sciatica. This condition has been mentioned since ancient times although a connection between disc herniation and sciatica was made only in the 20th century. Disc herniation is one of the commonest diagnoses seen in the spine due to degenerative changes and is the commonest cause of spinal surgery.

Classifications of Disc Herniation

There are many classifications regarding intervertebral disc herniation. In focal disc herniation, there is a localized displacement of the disc material in the horizontal or axial plane. In this type, only less than 25% of the circumference of the disc is involved. In broad-based disc herniation, about 25 – 50 % of the disc circumference is herniated. The disc bulge is when 50 – 100 % of the disc material is extended beyond the normal confines of the intervertebral space. This is not considered a form of disc herniation. Furthermore, the intervertebral disc deformities associated with severe cases of scoliosis and spondylolisthesis are not classified as a herniation but rather adaptive changes of the contour of the disc due to the adjacent deformity.

Depending on the contour of the displaced material, the herniated discs can be further classified as protrusions and extrusions. In disc protrusion, the distance measured in any plane involving the edges of the disc material beyond intervertebral disc space (the highest measure is taken) is lower than the distance measured in the same plane between the edges of the base.

Imaging can show the disc displacement as a protrusion on the horizontal section and as an extrusion on the sagittal section due to the fact that the posterior longitudinal ligament contains the disc material that is displaced posteriorly. Then the herniation should be considered an extrusion. Sometimes the intervertebral disc herniation can occur in the craniocaudal or vertical direction through a defect in the vertebral body endplates. This type of herniation is known as intravertebral herniation.

The disc protrusion can also be divided into two focal protrusion and broad-based protrusion. In focal protrusion, the herniation is less than 25% of the circumference of the disc whereas, in broad-based protrusion, the herniated disc consists of 25 – 50 % of the circumference of the disc.

In disc extrusion, it is diagnosed if any of the two following criteria are satisfied. The first one is; that the distance measured between the edges of the disc material that is beyond the intervertebral disc space is greater than the distance measured in the same plane between the edges of the base. The second one is; that the material in the intervertebral disc space and material beyond the intervertebral disc space is having a lack continuity.

This can be further characterized as sequestrated which is a subtype of the extruded disc. It is called disc migration when disk material is pushed away from the site of extrusion without considering whether there is continuity of disc or not. This term is useful in interpreting imaging modalities as it is often difficult to show continuity in imaging.

The intervertebral disc herniation can be further classified as contained discs and discs that are unconfined. The term contained disc is used to refer to the integrity of the peripheral annulus fibrosus which is covering the intervertebral disc herniation. When fluid is injected into the intervertebral disc, the fluid does not leak into the vertebral canal in herniations that are contained.

Sometimes there are displaced disc fragments that are characterized as free. However, there should be no continuity between disc material and the fragment and the original intervertebral disc for it to be called a free fragment or a sequestered one. In a migrated disc and in a migrated fragment, there is an extrusion of disc material through the opening in the annulus fibrosus with a displacement of the disc material away from the annulus.

Even though some fragments that are migrated can be sequestered the term migrated means just to the position and it is not referred to the continuity of the disc. The displaced intervertebral disc material can be further described with regard to the posterior longitudinal ligament as submembranous, subcapsular, subligamentous, extra ligamentous, transligamentous, subcapsular, and perforated.

The spinal canal can also get affected by an intervertebral disc herniation. This compromise of the canal can also be classified as mild, moderate, and severe depending on the area that is compromised. If the canal at that section is compromised only less than one third, it is called mild whereas if it is only compromised less than two-thirds and more than one third it is considered moderate. In a severe compromise, more than two-thirds of the spinal canal is affected. For the foraminal involvement, this same grading system can be applied.

The displaced material can be named according to the position that they are in the axial plane from the center to the right lateral region. They are termed as central, right central, right subarticular, right foraminal, and right extraforaminal. The displaced intervertebral disc material’s composition can be further classified as gaseous, liquefied, desiccated, scarred, calcified, ossified, bony, nuclear, and cartilaginous.

Before going into detail on how to diagnose and treat intervertebral disc herniation, let us differentiate how cervical disc herniation differs from lumbar herniation since they are the most common regions to undergo herniation.

Cervical Disc Herniation vs. Thoracic Disc Herniation vs Lumbar Disc Herniation

Lumbar disc herniation is the most commonest type of herniation found in the spine which is approximately 90% of the total. However, cervical disc herniation can also occur in about one-tenth of patients. This difference is mainly due to the fact that the lumbar spine has more pressure due to the increased load. Moreover, it has comparatively large intervertebral disc material. The most common sites of intervertebral disc herniation in the lumbar region are L 5 – 6, in the Cervical region between C7, and in the thoracic region T12.

Cervical disc herniation can occur relatively commonly because the cervical spine acts as a pivoting point for the head and it is a vulnerable area for trauma and therefore prone to damage in the disc. Thoracic disc herniation occurs more infrequently than any of the two. This is due to the fact that thoracic vertebrae are attached to the ribs and the thoracic cage which limits the range of movement in the thoracic spine when compared to the cervical and lumbar spinal discs. However, thoracic intervertebral disc herniation can still occur.

Cervical disc herniation gives rise to neck pain, shoulder pain, pain radiating from the neck to the arm, tingling, etc. Lumbar disc herniation can similarly cause lower back pain as well as pain, tingling, numbness, and muscle weakness seen in the lower limbs. Thoracic disc herniation can give rise to pain in the upper back radiating to the torso.

Epidemiology

Although disc herniation can occur in all age groups, it predominantly occurs between the fourth and fifth decade of life with the mean age of 37 years. There have been reports that estimate the prevalence of intervertebral disc herniation to be 2 – 3 % of the general population. It is more commonly seen in men over 35 years with a prevalence of 4.8% and while in women this figure is around 2.5%. Due to its high prevalence, it is considered a worldwide problem as it is also associated with significant disability.

Risk Factors

In most instances, a herniated disc occurs due to the natural aging process in the intervertebral disc. Due to the disc degeneration, the amount of water that was previously seen in the intervertebral disc gets dried out leading to the shrinking of the disc with the narrowing of the intervertebral space. These changes are markedly seen in degenerative disc disease. In addition to these gradual changes due to normal wear and tear, other factors may also contribute to increasing the risk of intervertebral disc herniation.

Being overweight can increase the load on the spine and increase the risk of herniation. A sedentary life can also increase the risk and therefore an active lifestyle is recommended in preventing this condition. Improper posture with prolonged standing, sitting, and especially driving can put a strain on the intervertebral discs due to the additional vibration from the vehicle engine leading to microtrauma and cracks in the disc. The occupations which require constant bending, twisting, pulling and lifting can put a strain on the back. Improper weight lifting techniques are one of the major reasons.

When back muscles are used in lifting heavy objects instead of lifting with the legs and twisting while lifting can make the lumbar discs more vulnerable to herniation. Therefore patients should always be advised to lift weights with their legs and not the back. Smoking has been thought to increase disc herniation by reducing the blood supply to the intervertebral disc leading to degenerative changes of the disc.

Although the above factors are frequently assumed to be the causes for disc herniation, some studies have shown that the difference in risk is very small when this particular population was compared with the control groups of the normal population.

There have been several types of research done on genetic predisposition and intervertebral disc herniation. Some of the genes that are implicated in this disease include vitamin D receptor (VDR) which is a gene that codes for the polypeptides of important collagen called collagen IX (COL9A2).

Another gene called the human aggrecan gene (AGC) is also implicated as it codes for proteoglycans which is the most important structural protein found in the cartilage. It supports the biochemical and mechanical function of the cartilage tissue and hence when this gene is defective, it can predispose an individual to intervertebral disc herniation.

Apart from these, there are many other genes that are being researched due to the association between disc herniation such as matrix metalloproteinase (MMP) cartilage intermediate layer protein, thrombospondin (THBS2), collagen 11A1, carbohydrate sulfotransferase, and asporin (ASPN). They may also be regarded as potential gene markers for lumbar disc disease.

Pathogenesis of Sciatica and Disc Herniation

The sciatic pain originated from the extruded nucleus pulposus inducing various phenomena. It can directly compress the nerve roots leading to ischemia or without it, mechanically stimulate the nerve endings of the outer portion of the fibrous ring and release inflammatory substances suggesting its multifactorial origin. When the disc herniation causes mechanical compression of the nerve roots, the nerve membrane is sensitized to pain and other stimuli due to ischemia. It has been shown that in sensitized and compromised nerve roots, the threshold for neuronal sensitization is around half of that of a normal and non-compromised nerve root.

The inflammatory cell infiltration is different in extruded discs and non-extruded discs. Usually, in non-extruded discs, the inflammation is less. The extruded disc herniation causes the posterior longitudinal ligament to rupture which exposes the herniated part to the vascular bed of the epidural space. It is believed that inflammatory cells are originating from these blood vessels situated in the outermost part of the intervertebral disc.

These cells may help secrete substances that cause inflammation and irritation of the nerve roots causing sciatic pain. Therefore, extruded herniations are more likely to cause pain and clinical impairment than those that are contained. In contained herniations, the mechanical effect is predominant while in the unconfined or the extruded discs the inflammatory effect is predominant.

Clinical Disc Herniation and What to Look for in the History

The symptoms of the disc herniation can vary a great deal depending on the location of the pain, the type of herniation, and the individual. Therefore, history should focus on the analysis of the main complaint among the many other symptoms.

The chief complaint can be neck pain in cervical disc herniation and there can be referred pain in the arms, shoulders, neck, head, face, and even the lower back region. However, it is most commonly referred to as the interscapular region. The radiation of pain can occur according to the level at the herniation is taking place. When the nerve roots of the cervical region are affected and compressed, there can be sensory, and motor changes with changes in the reflexes.

The pain that occurs due to nerve root compression is called radicular pain and it can be described as deep, aching, burning, dull, achy, and electric depending on whether there is mainly motor dysfunction or sensory dysfunction. In the upper limb, the radicular pain can follow a dermatomal or myotomal pattern. Radiculopathy usually does not accompany neck pain. There can be unilateral as well as bilateral symptoms. These symptoms can be aggravated by activities that increase the pressure inside the intervertebral discs such as the Valsalva maneuver and lifting.

Driving can also exacerbate pain due to disc herniation due to stress because of vibration. Some studies have shown that shock loading and stress from vibration can cause a mechanical force to exacerbate small herniations but flexed posture had no influence. Similarly, activities that decrease intradiscal pressure can reduce the symptoms such as lying down.

The main complaint in lumbar disc herniation is lower back pain. Other associated symptoms can be a pain in the thigh, buttocks, and anogenital region which can radiate to the foot and toe. The main nerve affected in this region is the sciatic nerve causing sciatica and its associated symptoms such as intense pain in the buttocks, leg pain, muscle weakness, numbness, impairment of sensation, hot and burning or tingling sensation in the legs, dysfunction of gait, impairment of reflexes, edema, dysesthesia or paresthesia in the lower limbs. However, sciatica can be caused by causes other than herniation such as tumors, infection, or instability which need to be ruled out before arriving at a diagnosis.

The herniated disc can also compress on the femoral nerve and can give rise to symptoms such as numbness, tingling sensation in one or both legs, and a burning sensation in the legs and hips. Usually, the nerve roots that are affected in herniation in the lumbar region are the ones exiting below the intervertebral disc. It is thought that the level of the nerve root irritation determines the distribution of leg pain. In herniations at the third and fourth lumbar vertebral levels, the pain may radiate to the anterior thigh or the groin. In radiculopathy at the level of the fifth lumbar vertebra, the pain may occur in the lateral and anterior thigh region. In herniations at the level of the first sacrum, the pain may occur in the bottom of the foot and the calf. There can also be numbness and tingling sensation occurring in the same area of distribution. The weakness in the muscles may not be able to be recognized if the pain is very severe.

When changing positions the patient is often relieved from pain. Maintaining a supine position with the legs raised can improve the pain. Short pain relief can be brought by having short walks while long walks, standing for prolonged periods, and sitting for extended periods of time such as in driving can worsen the pain.

The lateral disc herniation is seen in foraminal and extraforaminal herniations and they have different clinical features to that of medial disc herniation seen in subarticular and central herniations. The lateral intervertebral disc herniations can when compared to medial herniations more directly irritate and mechanically compress the nerve roots that are exiting and the dorsal root ganglions situated inside the narrowed spinal canal.

Therefore, lateral herniation is seen more frequently in older age with more radicular pain and neurological deficits. There is also more radiating leg pain and intervertebral disc herniations in multiple levels in the lateral groups when compared to medial disc herniations.

The herniated disc in the thoracic region may not present with back pain at all. Instead, there are predominant symptoms due to referred pain in the thorax due to irritation of nerves. There can also be predominant pain in the body that travels to the legs, tingling sensation and numbness in one or both legs, muscle weakness, and spasticity of one or both legs due to exaggerated reflexes.

The clinician should look out for atypical presentations as there could be other differential diagnoses. The onset of symptoms should be inquired about to determine whether the disease is acute, sub-acute, or chronic in onset. Past medical history has to be inquired about in detail to exclude red flag symptoms such as pain that occurs at night without activity which can be seen in pelvic vein compression, and non-mechanical pain which may be seen in tumors or infections.

If there is a progressive neurological deficit, with bowel and bladder involvement is there, it is considered a neurological emergency and urgently investigated because cauda equine syndrome may occur which if untreated, can lead to permanent neurological deficit.

Getting a detailed history is important including the occupation of the patient as some activities in the job may be exacerbating the patient’s symptoms. The patient should be assessed regarding which activities he can and cannot do.

Differential Diagnosis

  • Degenerative disc disease
  • Mechanical pain
  • Myofascial pain leading to sensory disturbances and local or referred pain
  • Hematoma
  • Cyst leading to occasional motor deficits and sensory disturbances
  • Spondylosis or spondylolisthesis
  • Discitis or osteomyelitis
  • Malignancy, neurinoma or mass lesion causing atrophy of thigh muscles, glutei
  • Spinal stenosis is seen mainly in the lumbar region with mild low back pain, motor deficits, and pain in one or both legs.
  • An epidural  abscess can cause symptoms similar to radicular pain involving spinal disc herniation
  • Aortic aneurysm which can cause low back pain and leg pain due to compression can also rupture and lead to hemorrhagic shock.
  • Hodgkin’s lymphoma in advanced stages can lead to space-occupying lesions in the spinal column leading to symptoms like that of intervertebral disc herniation
  • Tumors
  • Pelvic endometriosis
  • Facet hypertrophy
  • Lumbar nerve root schwannoma
  • Herpes zoster infection results in inflammation along with the sciatic or lumbosacral nerve roots

Examination in Disc Herniation

Complete physical examination is necessary to diagnose intervertebral disc herniation and exclude other important differential diagnoses. The range of motion has to be tested but may have a poor correlation with disc herniation as it is mainly reduced in elderly patients with a degenerative disease and due to disease of the joints.

A complete neurological examination is often necessary. This should test muscle weakness and sensory weakness. In order to detect muscle weakness in small toe muscles, the patient can be asked to walk on tiptoe. The strength of muscle can also be tested by comparing the strength to that of the clinician. There may be dermatomal sensory loss suggesting the respective nerve root involvement. The reflexes may be exaggerated or sometimes maybe even absent.

There are many neurologic examination maneuvers described in relation to intervertebral disc herniation such as the Braggart sign, flip the sign, Lasegue rebound sign, Lasegue differential sign, Mendel Bechterew sign, Deyerle sign both legs or Milgram test, and well leg or Fajersztajin test. However, all these are based on testing the sciatic nerve root tension by using the same principles in the straight leg raising test. These tests are used for specific situations to detect subtle differences.

Nearly almost all of them depend on the pain radiating down the leg and if it occurs above the knee it is assumed to be due to a neuronal compressive lesion and if the pain goes below the knee, it is considered to be due to the compression of the sciatic nerve root. For lumbar disc herniation detection, the most sensitive test is considered to be radiating pain occurring down the leg due to provocation.

In the straight leg raising test also called the Lasegue’s sign, the patient stays on his or her back and keeps the legs straight. The clinician then lifts the legs by flexing the hip while keeping the knee straight. The angle at which the patient feels pain going down the leg below the knee is noted. In a normal healthy individual, the patient can flex the hip to 80- 90? without having any pain or difficulty.

However, if the angle is just 30 -70? degrees, it is suggestive of lumbar intervertebral disc herniation at the L4 to S1 nerve root levels. If the angle of hip flexion without pain is less than 30 degrees, it usually indicates some other causes such as tumor of the gluteal region, gluteal abscess, spondylolisthesis, disc extrusion, and protrusion, malingering patient, and acute inflammation of the dura mater. If pain with hip flexion occurs at more than 70 degrees, it may be due to tightness of the muscles such as gluteus maximus and hamstrings, tightness of the capsule of the hip joint, or pathology of sacroiliac or hip joints.

The reverse straight leg raising test or hip extension test can be used to test higher lumbar lesions by stretching the nerve roots of the femoral nerve which is similar to the straight leg raising test. In the cervical spine, in order to detect stenosis of the foramina, the Spurling test is done and is not specific to cervical intervertebral disc herniation or tension of the nerve roots. The Kemp test is the analogous test in the lumbar region to detect foraminal stenosis. Complications due to the disc herniation include careful examination of the hip region, digital rectal examination, and urogenital examination is needed.

Investigation of Disc Herniation

For the diagnosis of intervertebral disc herniation, diagnostic tests such as Magnetic resonance imaging (MRI), Computed tomography (CT), myelography, and plain radiography can be used either alone or in combination with other imaging modalities. Objective detection of disc herniation is important because only after such a finding the surgical intervention is even considered. Serum biochemical tests such as prostate-specific antigen (PSA) level, Alkaline phosphatize value, erythrocyte sedimentation rate (ESR), urine analysis for Bence Jones protein, serum glucose level, and serum protein electrophoresis may also be needed in specific circumstances guided by history.

Magnetic Resonance Imaging (MRI)

MRI is considered the best imaging modality in patients with history and physical examination findings suggestive of lumbar disc herniation associated with radiculopathy according to North American Spinal Society guidelines in 2014. The anatomy of the herniated nucleus pulposus and its associated relationships with soft tissue in the adjacent areas can be delineated exquisitely by MRI in cervical, thoracic, and lumbosacral areas. Beyond the confines of the annulus, the herniated nucleus can be seen as a focal, asymmetric disc material protrusion on MRI.

On sagittal T2 weighted images, the posterior annulus is usually seen as a high signal intensity area due to radial annular tear associated with the herniation of the disc although the herniated nucleus is itself hypointense. The relationship between the herniated nucleus and degenerated facets with the nerve roots which are exiting through the neural foramina are well-demarcated on sagittal images of MRI. Free fragments of the intervertebral disc can also be distinguished from MRI images.

There may be associated signs of intervertebral disc herniation on MRI such as radial tears on the annulus fibrosus which is also a sign of degenerative disc disease. There may be other telling signs such as loss of disc height, bulging annulus, and changes in the endplates. Atypical signs may also be seen with MRI such as abnormal disc locations, and lesions located completely outside the intervertebral disc space.

MRI can detect abnormalities in the intervertebral discs superiorly to other modalities although its bone imaging is a little less inferior. However, there are limitations with MRI in patients with metal implant devices such as pacemakers because the electromagnetic field can lead to abnormal functioning of the pacemakers. In patients with claustrophobia, it may become a problem to go to the narrow canal to be scanned by the MRI machine. Although some units contain open MRI, it has less magnetic power and hence delineates less superior quality imaging.

This is also a problem in children and anxious patients undergoing MRI because good image quality depends on the patient staying still. They may require sedation. The contrast used in MRI which is gadolinium can induce nephrogenic systemic fibrosis in patients who had pre-existing renal disease. MRI is also generally avoided in pregnancy especially during the first 12 weeks although it has not been clinically proven to be hazardous to the fetus. MRI is not very useful when a tumor contains calcium and in distinguishing edema fluid from tumor tissue.

Computed Tomography (CT)

CT scanning is also considered another good method to assess spinal disc herniation when MRI is not available. It is also recommended as a first-line investigation in unstable patients with severe bleeding. CT scanning is superior to myelography although when the two are combined, it is superior both of them. CT scans can show calcification more clearly and sometimes even gas in images. In order to achieve a superior imaging quality, the imaging should be focused on the site of pathology and thin sections taken to better determine the extent of the herniation.

However, a CT scan is difficult to be used in patients who have already undergone laminectomy surgical procedures because the presence of scar tissue and fibrosis causes the identification of the structures difficult although bony changes and deformity in nerve sheath are helpful in making a diagnosis.

The herniated intervertebral discs in the cervical disc can be identified by studying the uncinate process. It is usually projected posteriorly and laterally to the intervertebral discs and superiorly to the vertebral bodies. The uncinate process undergoes sclerosis, and hypertrophy when there is an abnormal relationship between the uncinate process and adjacent structures as seen in degenerative disc disease, intervertebral disc space narrowing, and general wear and tear.

Myelopathy can occur when the spinal canal is affected due to disc disease. Similarly, when neural foramina are involved, radiculopathy occurs. Even small herniated discs and protrusions can cause impingement of the dural sac because the cervical epidural space is narrowed naturally. The intervertebral discs have attenuation a little bit greater than the sac characterized in the CT scan.

In the thoracic region, a CT scan can diagnose an intervertebral disc herniation with ease due to the fact that there is an increased amount of calcium found in the thoracic discs. Lateral to the dural sac, the herniated disc material can be seen on CT as a clearly defined mass that is surrounded by epidural fat. When there is a lack of epidural fat, the disc appears as a higher attenuated mass compared to the surrounding.

Radiography

Plain radiography is not needed in diagnosing herniation of the intervertebral discs, because plain radiographs cannot detect the disc and therefore are used to exclude other conditions such as tumors, infections, and fractures.

In myelography, there may be deformity or displacement of the extradural contrast-filled thecal sac seen in herniation of the disc. There may also be features in the affected nerve such as edema, elevation, deviation, and amputation of the nerve root seen in the myelography image.

Diskography

In this imaging modality, the contrast medium is injected into the disc in order to assess the disc morphology. If pain occurs following injection that is similar to the discogenic pain, it suggests that that disc is the source of the pain. When a CT scan is also performed immediately after discography, it is helpful to differentiate the anatomy and pathological changes. However, since it is an invasive procedure, it is indicated only in special circumstances when MRI and CT have failed to reveal the etiology of back pain. It has several side effects such as headache, meningitis, damage to the disc, discitis, intrathecal hemorrhage, and increased pain.

Treatment of Herniated Disc

The treatment should be individualized according to the patient-guided through history, physical examination, and diagnostic investigation findings. In most cases, the patient gradually improves without needing further intervention in about 3 – 4 months. Therefore, the patient only needs conservative therapy during this time period. Because of this reason, there are many ineffective therapies that have emerged by attributing the natural resolution of symptoms to that therapy. Therefore, conservative therapy needs to be evidence-based.

Conservative Therapy

Since the herniation of the disc has a benign course, the aim of treatment is to stimulate the recovery of neurological function, reduce pain, and facilitate early return to work and activities of daily living. The most benefits of the conservative treatment are for younger patients with hernias that are sequestered and in patients with mild neurological deficits due to small disc hernias.

Bed rest has long been considered a treatment option in herniation of the disc. However, it has been shown that bed rest has no effect beyond the first 1 or 2 days. The bed rest is regarded as counterproductive after this period of time.

In order to reduce the pain, oral non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can be used. This can relieve the pain by reducing inflammation associated with the inflamed nerve. Analgesics such as acetaminophen can also be used although they lack the anti-inflammatory effect seen in NSAIDs. The doses and the drugs should be appropriate for the age and severity of the pain in the patient. If pain is not controlled by the current medication, the clinician has to go one step up on the WHO analgesics ladder. However, the long-term use of NSAIDs and analgesics can lead to gastric ulcers, liver, and kidney problems.

In order to reduce the inflammation, other alternative methods such as applying ice in the initial period and then switching to using heat, gels, and rubs may help with the pain as well as muscle spasms. Oral muscle relaxants can also be used in relieving muscle spasms. Some of the drugs include methocarbamol, carisoprodol, and cyclobenzaprine.

However, they act centrally and cause drowsiness and sedation in patients and it does not act directly to reduce muscle spasm. A short course of oral steroids such as prednisolone for a period of 5 days in a tapering regime can be given to reduce the swelling and inflammation in the nerves. It can provide immediate pain relief within a period of 24 hours.

When the pain is not resolved adequately with maximum effective doses, the patient can be considered for giving steroid injections into the epidural space. The major indication for the steroid injection into periradicular space is discal compression causing radicular pain that is resistant to conventional medical treatment. A careful evaluation with CT or MRI scanning is required to carefully exclude extra discal causes for pain. The contraindications for this therapy include patients with diabetes, pregnancy, and gastric ulcers. Epidural puncture is contraindicated in patients with coagulation disorders and therefore the foraminal approach is used carefully if needed.

This procedure is performed under the guidance of fluoroscopy and involves injecting steroids and an analgesic into the epidural space adjacent to the affected intervertebral disc to reduce the swelling and inflammation of the nerves directly in an outpatient setting. As much as 50% of the patients experience relief after the injection although it is temporary and they might need repeat injections at 2 weekly intervals to achieve the best results. If this treatment modality becomes successful, up to 3 epidural steroidal injections can be given per year.

Physical therapy can help the patient return to his previous life easily although it does not improve the herniated disc. The physical therapist can instruct the patient on how to maintain the correct posture, walking, and lifting techniques depending on the patient’s ability to work, mobility, and flexibility.

Stretching exercises can improve the flexibility of the spine while strengthening exercises can increase the strength of the back muscles. The activities which can aggravate the condition of the herniated disc are instructed to be avoided. Physical therapy makes the transition from intervertebral disc herniation to an active lifestyle smooth. The exercise regimes can be maintained for life to improve general well-being.

The most effective conservative treatment option that is evidence-based is observation and epidural steroid injection for the relief of pain in the short-term duration. However, if the patients so desire they can use holistic therapies of their choice with acupuncture, acupressure, nutritional supplements, and biofeedback although they are not evidence-based. There is also no evidence to justify the use of trans electrical nerve stimulation (TENS) as a pain relief method.

If there is no improvement in the pain after a few months, surgery can be contemplated and the patient must be selected carefully for the best possible outcome.

Surgical Therapy

The aim of surgical therapy is to decompress the nerve roots and relieve the tension. There are several indications for surgical treatment which are as follows.

Absolute indications include cauda equina syndrome or significant paresis. Other relative indications include motor deficits that are greater than grade 3, sciatica that is not responding to at least six months of conservative treatment, sciatica for more than six weeks, or nerve root pain due to foraminal bone stenosis.

There have been many discussions over the past few years regarding whether to treat herniation of intervertebral disc disease with prolonged conservative treatment or early surgical treatment. Much research has been conducted in this regard and most of them show that the final clinical outcome after 2 years is the same although the recovery is faster with early surgery. Therefore, it is suggested that early surgery may be appropriate as it enables the patient to return to work early and thereby is economically feasible.

Some surgeons may still use traditional discectomy although many are using minimally invasive surgical techniques over recent years. Microdiscectomy is considered to be the halfway between the two ends. There are two surgical approaches that are being used. Minimally invasive surgery and percutaneous procedures are the ones that are being used due to their relative advantage. There is no place for the traditional surgical procedure known as a laminectomy.

However, there are some studies suggesting microdiscectomy is more favorable because of its both short-term and long-term advantages. In the short term, there is a reduced length of operation, reduced bleeding, relief of symptoms, and reduced complication rate. This technique has been effective even after 10 years of follow-up and therefore is the most preferred technique even now. The studies that have been performed to compare the minimally invasive technique and microdiscectomy have resulted in different results. Some have failed to establish a significant difference while one randomized control study was able to determine that microdiscectomy was more favorable.

In microdiscectomy, only a small incision is made aided by an operating microscope and the part of the herniated intervertebral disc fragment which is impinging on the nerve is removed by hemilaminectomy. Some part of the bone is also removed to facilitate access to the nerve root and the intervertebral disc. The duration of the hospital stay is minimal with only an overnight stay and observation because the patient can be discharged with minimal soreness and complete relief of the symptoms.

However, some unstable patients may need more prolonged admission and sometimes they may need fusion and arthroplasty. It is estimated that about 80 – 85 % of the patients who undergo microdiscectomy recover successfully and many of them are able to return to their normal occupation in about 6 weeks.

There is a discussion on whether to remove a large portion of the disc fragment and curetting the disc space or to remove only the herniated fragment with minimal invasion of the intervertebral disc space. Many studies have suggested that the aggressive removal of large chunks of the disc could lead to more pain than when conservative therapy is used with 28% versus 11.5 %. It may lead to degenerative disc disease in the long term. However, with conservative therapy, there is a greater risk of recurrence of around 7 % in herniation of the disc. This may require additional surgery such as arthrodesis and arthroplasty to be performed in the future leading to significant distress and economic burden.

In the minimally invasive surgery, the surgeon usually makes a tiny incision in the back to put the dilators with increasing diameter to enlarge the tunnel until it reaches the vertebra. This technique causes lesser trauma to the muscles than when seen in traditional microdiscectomy. Only a small portion of the disc is removed in order to expose the nerve root and the intervertebral disc. Then the surgeon can remove the herniated disc by the use of an endoscope or a microscope.

These minimally invasive surgical techniques have a higher advantage of lower surgical site infections and shorter hospital stays. The disc is centrally decompressed either chemically or enzymatically with the use of chymopapain, laser, or plasma (ionized gas) ablation and vaporization. It can also be decompressed mechanically by using percutaneous lateral decompression or by aspirating and sucking with a shaver such as a nucleosome. Chemopapin was shown to have adverse effects and was eventually withdrawn. Most of the above techniques have shown to be less effective than a placebo. Directed segmentectomy is the one that has shown some promise in being effective similar to microdiscectomy.

In the cervical spine, the herniated intervertebral discs are treated anteriorly. This is because the herniation occurs anteriorly and the manipulation of the cervical cord is not tolerated by the patient. The disc herniation that is due to foraminal stenosis and that is confined to the foramen are the only instances where a posterior approach is contemplated.

The minimal disc excision is an alternative to the anterior cervical spine approach. However, the intervertebral disc stability after the procedure is dependent on the residual disc. The neck pain can be significantly reduced following the procedure due to the removal of neuronal compression although significant impairment can occur with residual axial neck pain. Another intervention for cervical disc herniation includes anterior cervical interbody fusion. It is more suitable for patients with severe myelopathy with degenerative disc disease.

Complications of the Surgery

Although the risk of surgery is very low, complications can still occur. Post-operative infection is one of the commonest complications and therefore needs more vigorous infection control procedures in the theatre and in the ward. During the surgery, due to poor surgical technique, nerve damage can occur. A dural leak may occur when an opening in the lining of the nerve root causes leakage of cerebrospinal fluid which is bathing the nerve roots. The lining can be repaired during the surgery. However, headache can occur due to loss of cerebrospinal fluid but it usually improves with time without any residual damage. If blood around the nerve roots clots after the surgery, that blood clot may lead to compression of the nerve root leading to radicular pain which was experienced by the patient previously. Recurrent herniation of the intervertebral disc due to herniation of disc material at the same site is a devastating complication that can occur long term. This can be managed conservatively but surgery may be necessary ultimately.

Outcomes of the Surgery

There has been extensive research done regarding the outcome of lumbar disc herniation surgery. Generally, the results from the microdiscectomy surgery are good. There is more improvement of leg pain than back pain and therefore this surgery is not recommended for those who have only back pain. Many patients improve clinically over the first week but they may improve over the following several months. Typically, the pain disappears in the initial recovery period and it is followed by an improvement in the strength of the leg. Finally, the improvement of the sensation occurs. However, patients may complain of feeling numbness although there is no pain. The normal activities and work can be resumed over a few weeks after the surgery.

Novel Therapies

Although conservative therapy is the most appropriate therapy in treating patients, the current standard of care does not address the underlying pathology of herniation of the intervertebral discs. There are various pathways that are involved in the pathogenesis such as inflammatory, immune-mediated, and proteolytic pathways.

The role of inflammatory mediators is currently under research and it has led to the development of new therapies that are directed at these inflammatory mediators causing damage to the nerve roots. The cytokines such as TNF ? are mainly involved in regulating these processes. The pain sensitivity is mediated by serotonin receptor antagonists and ?2 adrenergic receptor antagonists.

Therefore, pharmacological therapies that target these receptors and mediators may influence the disease process and lead to a reduction in symptoms. Currently, cytokine antagonists against TNF ? and IL 1? have been tested. Neuronal receptor blockers such as sarpogrelate hydrochloride etc have been tested in both animal models and in clinical studies for the treatment of sciatica. Cell cycle modifiers that target the microglia that are thought to initiate the inflammatory cascade have been tested with the neuroprotective antibiotic minocycline.

There is also research on inhibiting the NF- kB or protein kinase pathway recently. In the future, the treatment of herniation of the intervertebral disc will be much more improved thanks to the ongoing research. (Haro, Hirotaka)

 

El Paso Chiropractor Near Me

Dr. Alex Jimenez DC, MSACP, RN, CCST

 

A disc bulge and/or a herniated disc is a health issue that affects the intervertebral discs found in between each vertebra of the spine. Although these can occur as a natural part of degeneration with age, trauma or injury as well as repetitive overuse can also cause a disc bulge or a herniated disc. According to healthcare professionals, a disc bulge and/or a herniated disc is one of the most common health issues affecting the spine. A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. A herniated disc is when a part of or the whole nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. Treatment of these health issues focuses on reducing symptoms. Alternative treatment options, such as chiropractic care and/or physical therapy, can help relieve symptoms. Surgery may be utilized in cases of severe symptoms. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

Curated by Dr. Alex Jimenez D.C., C.C.S.T.

 

References

  • Anderson, Paul A. et al. Randomized Controlled Trials Of The Treatment Of Lumbar Disk Herniation: 1983-2007. Journal Of The American Academy Of Orthopaedic Surgeons, vol 16, no. 10, 2008, pp. 566-573. American Academy Of Orthopaedic Surgeons, doi:10.5435/00124635-200810000-00002.
  • Fraser I (2009) Statistics on hospital-based care in the United States. Agency for Healthcare Research and Quality, Rockville
  • Ricci, Judith A. et al. Back Pain Exacerbations And Lost Productive Time Costs In United States Workers. Spine, vol 31, no. 26, 2006, pp. 3052-3060. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/01.brs.0000249521.61813.aa.
  • Fardon, D.F., et al., Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology,  and the American Society of Neuroradiology. Spine J, 2014. 14(11): p. 2525-45.
  • Costello RF, Beall DP. Nomenclature and standard reporting terminology of intervertebral disk herniation. Magn Reson Imaging Clin N Am. 2007;15 (2): 167-74, v-vi.
  • Roberts, S. Disc Morphology In Health And Disease. Biochemical Society Transactions, vol 30, no. 5, 2002, pp. A112.4-A112. Portland Press Ltd., doi:10.1042/bst030a112c.
  • Johnson, W. E. B., and S. Roberts. Human Intervertebral Disc Cell Morphology And Cytoskeletal Composition: A Preliminary Study Of Regional Variations In Health And Disease. Journal Of Anatomy, vol 203, no. 6, 2003, pp. 605-612. Wiley-Blackwell, doi:10.1046/j.1469-7580.2003.00249.x.
  • Gruenhagen, Thijs. Nutrient Supply And Intervertebral Disc Metabolism. The Journal Of Bone And Joint Surgery (American), vol 88, no. suppl_2, 2006, p. 30. Ovid Technologies (Wolters Kluwer Health), doi:10.2106/jbjs.e.01290.
  • Mercer, S.R., and G.A. Jull. Morphology Of The Cervical Intervertebral Disc: Implications For Mckenzies Model Of The Disc Derangement Syndrome. Manual Therapy, vol 1, no. 2, 1996, pp. 76-81. Elsevier BV, doi:10.1054/math.1996.0253.
  • KOELLER, W et al. Biomechanical Properties Of Human Intervertebral Discs Subjected To Axial Dynamic Compression. Spine, vol 9, no. 7, 1984, pp. 725-733. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-198410000-00013.
  • Lieberman, Isador H. Disc Bulge Bubble: Spine Economics 101. The Spine Journal, vol 4, no. 6, 2004, pp. 609-613. Elsevier BV, doi:10.1016/j.spinee.2004.09.001.
  • Lappalainen, Anu K et al. Intervertebral Disc Disease In Dachshunds Radiographically Screened For Intervertebral Disc Calcifications. Acta Veterinaria Scandinavica, vol 56, no. 1, 2014, Springer Nature, doi:10.1186/s13028-014-0089-4.
  • Moazzaz, Payam et al. 80. Positional MRI: A Valuable Tool In The Assessment Of Cervical Disc Bulge. The Spine Journal, vol 7, no. 5, 2007, p. 39S. Elsevier BV, doi:10.1016/j.spinee.2007.07.097.
  • Lumbar Disc Disease: Background, History Of The Procedure, Problem. Emedicine.Medscape.Com, 2017, http://emedicine.medscape.com/article/249113-overview.
  • Vialle, Luis Roberto et al. LUMBAR DISC HERNIATION. Revista Brasileira de Ortopedia 45.1 (2010): 1722. PMC. Web. 1 Oct. 2017.
  • Herniated Nucleus Pulposus: Background, Anatomy, Pathophysiology. http://emedicine.medscape.com/article/1263961-overview.
  • Vialle, Luis Roberto et al. LUMBAR DISC HERNIATION. Revista Brasileira De Ortopedia (English Edition), vol 45, no. 1, 2010, pp. 17-22. Elsevier BV, doi:10.1016/s2255-4971(15)30211-1.
  • Mullen, Denis et al. Pathophysiology Of Disk-Related Sciatica. I. Evidence Supporting A Chemical Component. Joint Bone Spine, vol 73, no. 2, 2006, pp. 151-158. Elsevier BV, doi:10.1016/j.jbspin.2005.03.003.
  • Jacobs, Wilco C. H. et al. Surgical Techniques For Sciatica Due To Herniated Disc, A Systematic Review. European Spine Journal, vol 21, no. 11, 2012, pp. 2232-2251. Springer Nature, doi:10.1007/s00586-012-2422-9.
  • Rutkowski, B. Combined Practice Of Electrical Stimulation For Lumbar Intervertebral Disc Herniation.Pain, vol 11, 1981, p. S226. Ovid Technologies (Wolters Kluwer Health), doi:10.1016/0304-3959(81)90487-5.
  • Weber, Henrik. Spine Update The Natural History Of Disc Herniation And The Influence Of Intervention.Spine, vol 19, no. 19, 1994, pp. 2234-2238. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-199410000-00022.
  • Disk Herniation Imaging: Overview, Radiography, Computed Tomography.Emedicine.Medscape.Com, 2017,
  • Carvalho, Lilian Braighi et al. Hrnia De Disco Lombar: Tratamento. Acta Fisitrica, vol 20, no. 2, 2013, pp. 75-82. GN1 Genesis Network, doi:10.5935/0104-7795.20130013.
  • Kerr, Dana et al. What Are Long-Term Predictors Of Outcomes For Lumbar Disc Herniation? A Randomized And Observational Study. Clinical Orthopaedics And Related Research, vol 473, no. 6, 2014, pp. 1920-1930. Springer Nature, doi:10.1007/s11999-014-3803-7.
  • Buy, Xavier, and Afshin Gangi. Percutaneous Treatment Of Intervertebral Disc Herniation. Seminars In Interventional Radiology, vol 27, no. 02, 2010, pp. 148-159. Thieme Publishing Group, doi:10.1055/s-0030-1253513.
  • Haro, Hirotaka. Translational Research Of Herniated Discs: Current Status Of Diagnosis And Treatment. Journal Of Orthopaedic Science, vol 19, no. 4, 2014, pp. 515-520. Elsevier BV, doi:10.1007/s00776-014-0571-x.

 

 

The Effects of Low Laser Therapy on Repairing The Calcaneal Tendon | El Paso, TX

The Effects of Low Laser Therapy on Repairing The Calcaneal Tendon | El Paso, TX

The body is a well-working machine that can endure anything that is thrown in its way. However, when it gets an injury, the body’s natural healing process will ensure that the body can get back to its daily activities. The healing process of an injured muscle varies throughout the body. Depending on how severe the damage is and how long the healing process will take, the body can recover to a mere few days to a few months. One of the most gruelly healing processes that the body has to endure is a ruptured calcaneal tendon.

The Calcaneal Tendon

The calcaneal tendon or the Achilles tendon is a thick tendon that is located in the back of the leg. This muscle-tendon is what makes the body move while walking, running, or even jumping. Not only that, the calcaneal tendon is the strongest tendon in the body, and it connects the gastrocnemius and soleus muscles at the heel bone. When the calcaneal tendon is ruptured, the healing process can last from weeks to months until it is fully healed. 

 

 

The Healing Effects of Low Laser Therapy

One of the ways that can help the damaged calcaneal tendons’ healing process is low laser therapy. Studies have shown that low laser therapy can speed up the damaged tendon repair after a partial lesion. Not only that but the combination of ultrasound and low laser therapy has been studied to be the physical agents for treating tendon injuries. The studies showed that the combination of low laser therapy and ultrasound has beneficial properties during the recovery process of treating calcaneal tendon injuries.

 

 

The study found that when patients are being treated for their calcaneal tendons, their hydroxyproline levels around the treated area are significantly increased with ultrasound and low laser therapy. The body’s natural biochemical and biomechanical structures on the injured tendon increase, thus affecting the healing process. Another study has shown that low laser therapy can help reduce fibrosis and prevent oxidative stress in the traumatized calcaneal tendon. The study even showed that after the calcaneal tendon is traumatized, inflammation, angiogenesis, vasodilation, and the extracellular matrix are formed in the affected area. So when patients are being treated with low laser therapy for about fourteen to twenty-one days, their histological abnormalities are alleviated, reducing collagen concentration and fibrosis; preventing oxidative stress from increasing in the body.

 

Conclusion

Overall, it is said that the effects of low laser therapy can help speed up the healing process of repairing the calcaneal tendon. The promising results have been proven since low laser therapy can help repair the damaged tendon, reducing oxidative stress and preventing fibrosis from escalating, causing more problems on the injured tendon. And with the combination of ultrasound, the calcaneal tendon can recover faster so the body can continue its everyday activities without any prolonged injuries.

 

References:

Demir, Huseyin, et al. “Comparison of the Effects of Laser, Ultrasound, and Combined Laser + Ultrasound Treatments in Experimental Tendon Healing.” Lasers in Surgery and Medicine, U.S. National Library of Medicine, 2004, https://pubmed.ncbi.nlm.nih.gov/15278933/.

Fillipin, Lidiane Isabel, et al. “Low-Level Laser Therapy (LLLT) Prevents Oxidative Stress and Reduces Fibrosis in Rat Traumatized Achilles Tendon.” Lasers in Surgery and Medicine, U.S. National Library of Medicine, Oct. 2005, https://pubmed.ncbi.nlm.nih.gov/16196040/.

Oliveira, Fla’via Schlittler, et al. Effect of Low Level Laser Therapy (830 Nm … – Medical Laser. 2009, http://medical.summuslaser.com/data/files/86/1585171501_uLg8u2FrJP7ZHcA.pdf.

Wood, Viviane T, et al. “Collagen Changes and Realignment Induced by Low-Level Laser Therapy and Low-Intensity Ultrasound in the Calcaneal Tendon.” Lasers in Surgery and Medicine, U.S. National Library of Medicine, 2010, https://pubmed.ncbi.nlm.nih.gov/20662033/.

Chronic Pain and Nutritional Habits

Chronic Pain and Nutritional Habits

Low-back, neck, shoulder, hip, leg, and foot pain are all causes of everyday discomfort and a bad mood. Chronic pain exacerbates the discomfort and bad mood times 10. Chiropractic treatment can help realign the spine and alleviate the pain. However, to maintain pain relief, individuals need to make healthy lifestyle adjustments. One of the most important adjustments is eating habits. Those dealing with chronic pain may not realize their diet is contributing to the pain.

At Injury Medical Chiropractic and Functional Medicine Clinic, we have a combined team of chiropractors, physical therapists, a health coach, and a nutritionist to help educate, develop, and support a personalized treatment plan on spinal health, posture, physical activity/exercise, balance, and eating habits.

Chronic Pain and Nutritional Habits

Salt, Sugar, and Fat Affects the Body

A sedentary lifestyle is a significant contributor to chronic pain, but unhealthy eating habits also play a role. Poor diet adds weight to the body. This stresses the body’s biomechanical structure. It also aggravates inflammation. Too much salt, sugar, and fats ingested through processed foods, fast food, and unhealthy habits affect the body’s regulating systems. They can affect everything from the nervous system, nerves, proper circulation, even the limbic system. The inflammation and stress generate and exacerbate chronic pain symptoms.

Changing unhealthy eating habits is up to the individual.

Individuals can be advised to cut back or cut out unhealthy diet choices; however, it is easier said than done. A doctor, health coach, and nutritionist have no control over what individuals do when they leave the clinic. Individuals themselves can have little control over their own eating habits. Many have an addiction to unhealthy food, which is a disease in itself. To help change poor eating habits, individuals need to be educated on how their eating habits affect the total body and mental health.

Nutrition Discussion

Chronic pain associated with inflammation linked to a poor diet is the first step in the diagnosis and developing an optimal treatment plan. It could be as simple as informing an individual that eating cheeseburgers are causing the inflammation that is hurting their back. However, there is more to it, but individuals are more inclined to avoid the foods causing the inflammation upon hearing a full explanation. Targeting specific foods is the first step in alleviating pain.

The temptation is always there, especially when stress comes into the picture. This is why it is important to have ready-to-go adjustments/alternatives that keep the individual eating healthy, despite the chaos going on around them. A treatment plan will include quick alternatives that can happen in stages. An example could be:

  • Having one cheeseburger and not two.
  • Having a burger without cheese.
  • Eating a burger without the buns.
  • Switching to a plant-based burger.
  • There are many options to be explored to improve eating habits in small steps.

Willpower also has to be addressed in a controlled and supportive setting. This is where the whole team comes in. Many individuals’ eating habits are part of who they and adjusting them can be an uphill challenge. To educate on:

  • Methods of accountability
  • Keeping a journal
  • Having the family or friends eat healthy with them
  • These are techniques and methods to increase willpower to make healthy changes.

Body Composition


Foods Can Support Body Detoxing

The proper foods can support the body in detoxifying toxins and counter the negative effects like brain fog, neurodegenerative disorders, and chronic pain. The foods help to:

  • Neutralize oxidative stress
  • Lower inflammation
  • Increase immunity
  • Strengthen the musculoskeletal system
  • Foods and nutrients that detoxify can be a part of a healthy lifestyle.
References

Bjørklund, Geir et al. “Insights on Nutrients as Analgesics in Chronic Pain.” Current medicinal chemistry vol. 27,37 (2020): 6407-6423. doi:10.2174/0929867326666190712172015

Elma, Ömer et al. “Chronic Musculoskeletal Pain, and Nutrition: Where Are We and Where Are We Heading?.” PM & R: the journal of injury, function, and rehabilitation vol. 12,12 (2020): 1268-1278. doi:10.1002/pmrj.12346

Gómez-Pinilla, Fernando. “Brain foods: the effects of nutrients on brain function.” Nature reviews. Neuroscience vol. 9,7 (2008): 568-78. doi:10.1038/nrn2421

Extinguish Chronic Inflammation With Chiropractic

Extinguish Chronic Inflammation With Chiropractic

Chronic inflammation is quite common and can cause a variety of painful back conditions. Fortunately, chiropractic treatment can extinguish the inflammation at its core/root cause and bring long-lasting relief. Inflammation can be a significant factor in causing body and back pain. The proper and lasting treatment goes beyond anti-inflammatory medications. The objective is to extinguish the inflammation completely.  
 

Inflammation

The number of diseases associated with chronic inflammation is increasing exponentially. An estimated 60% of Americans deal with at least one chronic condition caused completely or in part by inflammation. Inflammation is the body’s immune response to something that is not right in the body. Typically, there is:
  • Swelling
  • Redness
  • Warmth/heat signaling an inflammatory response from injury or infection
Chronic inflammation can present through a series of symptoms, including:
  • General fatigue
  • Pain throughout the body
  • Off feeling/not focused
Inflammatory conditions can include:
  • Skin changes like a rash
  • Joint swelling
  • Lymph node swelling
  • Endocrine, heart, lung, and neurological complications
 
Inflammation can generate inflammatory back pain as well when this happens. This is because the immune system is trying to protect the body from whatever is trying to infiltrate. The cells and chemicals fight the attack and try to heal whatever is going on. Sometimes, there is nothing going on but the immune system becomes hyper-reactive and attacks itself. This is the case of autoimmune disease, or what becomes chronic inflammation. Chronic inflammation lasts longer than 3 months and can lead to diseases like:
  • Diabetes
  • Heart disease
  • Autoimmune inflammation can manifest in rheumatological disorders like rheumatoid arthritis

Inflammation and Inflammatory Conditions

Autoimmune inflammation that presents as ankylosing spondylitis and rheumatoid arthritis is in a different category. This is when the body begins attacking itself. This can be triggered by a viral infection, which stimulates the immune system. This can cause:
  • Joint destruction
  • Ligament pain
  • Soft tissue swelling
  • Some conditions are hereditary

Inflammatory Spinal Conditions

Inflammation can travel into the body�s spinal and neurological systems. This results in painful conditions that can affect an individual’s quality of life.

Ankylosing Spondylitis

Ankylosing spondylitis usually starts in the lower back and can spread up. It is a form of arthritis that causes the vertebrae to fuse together. It can also cause inflammation in the urological and ophthalmological systems. It is believed to have a somewhat genetic connection. There is a marker called HLA B27 that is usually positive in patients and is more common in young males.

Rheumatoid Arthritis

Rheumatoid arthritis/RA causes inflammation in synovial joints. These produce a fluid that helps lubricate and nourish the joints. RA is found most commonly in the hands, wrists, and knees, but can also present in the spine�s facet joints that connect vertebrae. There is some genetic association but is common with smoking and obesity. It is diagnosed with lab work, like inflammation markers, rheumatoid factor, and physical examination. RA pain typically presents in the cervical spine or neck region.  
11860 Vista Del Sol, Ste. 128 Extinguish Chronic Inflammation With Chiropractic
 

Transverse Myelitis and Multiple Sclerosis

These conditions are closely tied and caused by inflammation in the central nervous system/CNS. The immune system attacks the nerve cells and removes the fatty substance that insulates the nerves and helps them transmit impulses to and from the central nervous system. This causes:
  • Pain
  • Weakness
  • Numbness
  • Bladder/bowel issues
Transverse myelitis affects the spinal cord whereas multiple sclerosis can affect the brain and the spinal cord. Transverse myelitis is typically acute, whereas multiple sclerosis is long-term and can have an increasing/decreasing course of progressive symptoms. And transverse myelitis can be a symptom of multiple sclerosis. Certain lifestyle choices/habits can cause or worsen inflammation. Obesity, smoking, and an unhealthy diet can have a significant impact on chronic inflammation.  

Spinal Structures Affected

Inflammation can affect every area of the spine. From the lower back to inflammation of the vertebrae themselves. Injuries to the spine, that include the:
  • Bones
  • Discs
  • Ligaments
  • Joints
This can cause swelling and a build-up of fluid that can be found on an MRI. This is the preferred method of detecting inflammation. When the term itis is used this usually indicates a type of inflammation. For example, neuritis means inflammation of the nerve/s. This can be seen with nerve compression where the nerve is swollen on an MRI.  
11860 Vista Del Sol, Ste. 128 Extinguish Chronic Inflammation With Chiropractic
 

Extinguish Spinal Inflammation

Causes of inflammation can be traced back to lifestyle choices, but can also be alleviated through healthy lifestyle adjustments that turn into habits.

Nutritional Health Coaching

Recommended is to avoid or decrease processed foods, trans fats, and sugar. Consider supplementing vitamin D, magnesium, and omega 3s.

Quit Smoking

Quitting smoking will improve circulation and extinguish vascular inflammation.

Regular Physical Activity/Exercise

Aerobic exercises improve cardiac function and circulation as well as exercises that support the spine ergonomically. Core and pelvic stabilization are necessary for lower back pain.

Medication

For acute inflammation caused by injuries steroids and NSAIDs can help with severe pain and inflammation.  
 

Chiropractic Extinguisher

When the spine and the body’s joints are in proper alignment, and the nerves are functioning at optimal levels the body’s biomechanics return to normal. This stops neuropeptides from producing and helps extinguish inflammation.

Surgery

With the spine, surgery is not recommended as a first-line treatment unless it is an emergency or there is potential for permanent neurological damage. If medication, chiropractic, physical therapy, supplements, lifestyle changes, and/or complementary treatments like acupuncture do not help and quality of life and function are significantly impacted, then elective surgery can be considered.

Body Composition Spotlight

 

 

All-around Exercise Regimen

As individuals continue to struggle with obesity and functional fitness with age, exercise becomes more important than ever. It is crucial to combine diet and regular physical activity/exercise to lose weight, have a favorable impact on body composition and lifespan. A well-rounded exercise regimen that incorporates all types of fitness. Aerobic exercise helps maintain an elevated heart rate and helps get rid of fat-free mass. Resistance training helps to build lean muscle mass. Combining the two, with concurrent training, or utilizing a HIIT workout when there is not enough time will work wonders. Being better equipped and understanding why exercise is important for the body’s health, different types of exercise, and which ones are best suited for each individual’s needs will keep the body in top form for the long term.

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
References
What Is Inflammation?:�StatPearls.�(November 2020) �Chronic Inflammation��https://www.ncbi.nlm.nih.gov/books/NBK493173/ Types of Inflammatory Spinal Conditions:�Current Opinion in Rheumatology.�(January 2014) �When and Where Does Inflammation Begin in Rheumatoid Arthritis?��https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033623/
Activity Modification and Chiropractic To Help With Chronic Pain

Activity Modification and Chiropractic To Help With Chronic Pain

Chronic pain and a healthy spine can require activity modification. This is so an individual can participate in activities in a way to help prevent pain from presenting. This could include:
  • Avoiding staying in static positions for too long
  • Continuous stretches throughout the day
  • Planning ahead when participating in physical activities that cause pain
  • Dietary adjustments to reduce inflammation and gain strength/flexibility
  • Customized exercise program
  • Health coaching guide
11860 Vista Del Sol, Ste. 128 Activity Modification and Chiropractic To Help With Chronic Pain
 

Activity Modification

Chiropractic treatment not only involves correcting spinal alignment but also continuing an individual’s health education. The objective is to treat the source, not the symptoms. The goal with activity modification is to change the habit into a positive technique. Rigorous spinal adjustments will only help to a point if the habit continues. Whether there are any underlying conditions or it is an individual’s lifestyle, variables like: These are the primary factors when it comes to spinal health. With recurring spinal problem/s, a chiropractor needs to trace back any kinetic behavior that could have contributed to inflammation causing pain symptoms. Recognizing poor kinetic habits and teaching activity modification are core objectives of chiropractic medicine.  
 

Identification

Poor habits need to be identified. Two common are forward head posture and anterior pelvic tilt. These are signs of bad habits that affect spine health. Misaligned biomechanics can be a first clue in understanding why the individual continues to experience pain. Consistent shifting of the body to not stay in one position for too long is recommended, but when there is recurring pain this is where a chiropractor can show an individual better methods and techniques of shifting to avoid the pain. Poor posture could be traced to sitting at a disproportionate desk with no ergonomic support. And a constant forward head position on the cervical spine, nerves, shoulders, can generate enormous strain.  

Modification

Precision adjustments will alleviate the effects of spinal misalignment. But modifications need to become second nature. Chiropractic modification approaches will correct poor posture and body mechanics. A chiropractor will educate an individual to be mindful of certain movements and reinforce proper positioning. Once an individual is familiar with a healthy way of moving/shifting to restore optimal mechanics, then the individual can learn to engage in other activities with the newfound activity modification tools. This will help break the cycle of chronic spinal misalignments.  
11860 Vista Del Sol, Ste. 128 Activity Modification and Chiropractic To Help With Chronic Pain
 

Positive Change

Corrective relief and teaching proactive wellness is the primary role of chiropractic medicine. Activity modification can be an individual’s first line of defense for changing poor habits responsible for chronic pain and recurring musculoskeletal problems. Educating individuals on how to preserve spinal adjustments and adopting long-term, healthy habits will promote overall wellness.

Chiropractic Care Crossfit Rehabilitation


 

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*
References
Geneen, Louise J et al. �Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews.��The Cochrane database of systematic reviews�vol. 4,4 CD011279. 24 Apr. 2017, doi:10.1002/14651858.CD011279.pub3
Chiropractic Testing and Treatment for Chronic Pain

Chiropractic Testing and Treatment for Chronic Pain

Finding ways to manage chronic pain is a priority. Chiropractic testing and treatment could be an option that is effective and affordable. Various chiropractic care can help manage chronic pain caused by a condition like herniated disc/s. Chiropractic testing involves diagnosing the root cause/origin of the pain. Getting a proper diagnosis usually involves:

  • X-rays
  • CT scan
  • MRI
  • DNA
11860 Vista Del Sol, Ste. 128 Chiropractic Testing and Treatment for Chronic Pain

Chiropractic testing

The correct diagnosis is essential to creating an optimal treatment plan. It is a complicated disorder that can be difficult to treat because it can present with no apparent cause. But, researchers are working to find answers to many of the questions surrounding chronic pain. When treating spine-related pain other tests can include:

  • Discography
  • Bone scans
  • Nerve studies
  • Electromyography
  • Nerve conduction study
  • Myelography

A pain specialist might consult with and refer the individual to a neurosurgeon or orthopedic spine surgeon to determine if the pain requires surgery. This is because untreated and not fully treated chronic pain is one of the leading causes of limited mobility and flexibility. Other associated issues are:

There are some experts that believe tests like MRIs are overused. There is a fear that too many tests could expose individuals to unnecessary radiation and increase medical expenses. However, determining the cause/s holds the key to a successful treatment plan. Therefore, choosing the right diagnostic strategy will help in:

  • Creating the most effective and optimal treatment plan
  • Quality of life improvement
  • Prevent potential complications
  • Reduce the cost of diagnosis
  • Reduce the cost of treatment

Chiropractic Management

Chronic pain does not respond to typical pain management techniques. Chiropractic management deals with chronic pain inflammation and muscle tension. Chiropractors use a variety of non-surgical techniques like:

Soft Tissue

  • Manual release therapy stretches the muscle/s while pressure is applied
  • Trigger point therapy applies pressure on the area of the tensest muscle/s
  • Instrument-assisted soft tissue therapy uses a tool/s to apply gentle pressure.
11860 Vista Del Sol, Ste. 128 Chiropractic Testing and Treatment for Chronic Pain

Manual Therapy

When the joints are not moving correctly, a chiropractor may utilize this technique to regain a full range of joint motion. This is accomplished through joint mobilization which is slow, gentle stretches of the affected joint and manipulation, which are quick but gentle movement/thrusts that stretch the joint.

Exercise Therapy combined with Self-care

A chiropractor will provide simple therapeutic exercises and stretches that can be done at home to help with the pain and to help with prevention. Also provided:

  • Safe lifting techniques
  • Posture exercises/tips
  • Dietary strategies to manage pain and prevent re-injury

Once diagnosed with a pain condition, a chiropractor will develop a unique customized treatment plan. Don’t be afraid to talk with your chiropractor. The more they know the better the treatment plan. Once the pain is fully addressed, patients will be able to gradually increase daily activities.


Piriformis Syndrome 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*

Chronic Pain Treatment/Management

Chronic Pain Treatment/Management

There are various chronic treatment/management options available. Chronic pain treatment focuses on treating and managing the root cause and underlying condition that is causing the pain. The physical and psychological aspects of chronic pain need to be balanced in order for a treatment plan to work.

 

11860 Vista Del Sol, Ste. 128 Chronic Pain Treatment/Management

That is why a complete treatment plan can sometimes be necessary to address both the physical and psychological factors generating the pain. Because of this treatment plans often involve different pain specialists working in conjunction with a customized treatment/management plan according to the individual’s needs. This can include a combination of treatment protocols, like:

  • Health coaching
  • Psychological therapy
  • Chiropractic
  • Physical therapy
  • Medication
  • Acupuncture
  • Yoga, Pilates

Treatment/Management

The focus of chronic pain treatment is to:

  • Lessen pain frequency and intensity
  • Help individuals get back to work
  • Improve mobility and flexibility
  • Maintain quality of life
  • Reduce or eliminate reliance on pain meds
  • Reduce possible re-injury or new injury
  • Reduce mental and emotional symptoms like anxiety and depression

Pain Meds

 

hands of woman holding opioids

Non-Opioids

Nonsteroidal anti-inflammatory medications are usually the first treatment for chronic mild to moderate pain. Examples are ibuprofen, aspirin, and naproxen. These medications work by blocking enzymes and reduce prostaglandins throughout the body that cause pain and swelling. Acetaminophen used in Tylenol is similar to these medications but works differently. Instead, these meds block the production of inflammatory chemicals in the brain.

Opioids

Opioids are narcotics and can be extremely powerful pain relievers. These are used to relieve severe pain symptoms temporarily. Narcotics work by blocking the pain signals before they get to the brain. However, these meds are highly addictive and can lead to abuse. Doctors prescribe narcotics when non-opioids and all forms of non-pharmacological treatment/s fail or don’t work in providing sufficient pain relief. Examples include:

  • Buprenorphine
  • Fentanyl
  • Hydrocodone
  • Oxycodone
  • Hydromorphone
  • Methadone
  • Morphine
  • Tramadol

Anticonvulsants

Anticonvulsants or anti-epileptics are used to treat seizures. They can also help in relieving pain that is associated with nerve injury/damage and fibromyalgia. Examples include:

Muscle Relaxants

Muscle relaxants can be used for chronic pain but there is division among medical experts as to how effective they are and of their addictiveness. Plus there are few studies supporting their use in individuals with chronic pain.

Corticosteroids

Corticosteroids are hormone-based medications that help reduce inflammation. They are generated naturally in the body while some are synthesized in a laboratory. Injectable steroids can help relieve pain brought on from pinched nerves or joint disorders.

Antirheumatics

Antirheumatic meds are used to control and manage rheumatoid arthritis symptoms. They prevent or inhibit the immune system and help reduce joint damage. Examples include:

  • Methotrexate
  • Leflunomide
  • Hydroxychloroquine
  • Sulfasalazine

Antidepressants

Antidepressants are used to treat anxiety disorders and depression disorders but are also used to relieve chronic pain. They are used to treat pain caused by:

  • Arthritis
  • Migraine
  • Nerve damage
  • Fibromyalgia

These medications increase the brain’s chemical levels like serotonin, dopamine, and norepinephrine. They can also be used even when an individual has no depression symptoms. Examples include:

  • Amitriptyline
  • Venlafaxine
  • Paroxetine.

Alternative Treatment

Alternative treatment/management can also help with the pain. It’s recommended to discuss any type of alternative treatment with a doctor or medical professional. Doctors encourage alternative treatments along with keeping a journal of how an individual feels after a series of treatment sessions. If the individual feels better, and the treatment is working, then consider continuing for an extended period. Here are some alternative treatments/therapies to think about.

  • Acupuncture: Works by releasing endorphins, the natural pain-relieving chemicals, and affects the brain region that controls serotonin, the chemical that regulates mood.
  • Massage: Helps relieve pain by keeping muscles, ligaments loose and proper blood flow throughout the body
  • Meditation: Has been shown to help improve pain perception and reducing depressive symptoms
  • Hypnosis: Has been found to be useful in treating cancer and back pain
11860 Vista Del Sol, Ste. 128 Chronic Pain Treatment/Management

Psychological Therapy

Psychotherapy, also known as talking therapy could be part of a chronic pain treatment plan. What it does is to help improve the associated symptoms/conditions which include:

  • Depression
  • Anxiety
  • Fear of pain

Psychotherapy has shown promising results and has various forms. They are:

Acceptance/Commitment Therapy

Acceptance commitment therapy is short-term psychotherapy. There are two approaches to pain perception. One, it teaches the individual to accept things beyond what they control. Second, it encourages the individual to feel things the way they are, work towards relief instead of questioning and being skeptical. It opens an individual’s psychological perspective. It can be used to treat low back, leg, and neck pain.

Cognitive-Behavioral Therapy

This therapy educates individuals on pain, mood, behavior, and how they all relate to each other. It also trains an individual on relaxation strategies. Individuals learn techniques to replace negative thoughts concerning their pain with positive thoughts. Cognitive-behavioral therapy has been shown to be effective in treating pain caused by:

  • Spinal cord injury
  • Chronic migraines
  • Fibromyalgia
  • Rheumatoid arthritis
  • Irritable bowel syndrome
  • Osteoarthritis
  • Multiple sclerosis
  • HIV/AIDS
  • Cancer

Early and aggressive treatment/management of chronic pain can make a significant difference. Knowledge is power so make sure you understand all options before deciding which to take.


Sciatica Pain Treatment Relief


 

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*

Chronic Pain Diagnosis

Chronic Pain Diagnosis

Getting an accurate chronic pain diagnosis is essential to creating the most optimal, highly customized treatment plan for the individual. Depending on the severity and cause of pain, individuals could require various pain specialists/therapists combined with a primary physician. These could include:

  • Chiropractor
  • Physical therapist
  • Neurosurgeon
  • Pain medicine specialist
  • Physiatrist
  • Rheumatologist
  • Orthopedic spine surgeon

Chronic Pain Diagnosis

 

11860 Vista Del Sol, Ste. 128 Chronic Pain Diagnosis

Over time chronic pain symptoms can change or alter and need reevaluation. This could mean having to adjust treatment and management but that is exactly what it is, an adjustment to the treatment plan flowing with the symptoms as they come and go while keeping to the objective of. Chronic pain diagnosis entails a series of tests, as well as, a full review of symptoms and medical history. A doctor will ask a series of questions concerning symptoms and pain triggers. These questions could include:

  • When did the pain begin?
  • Describe and rate the pain, is it shooting, electrical, burning, throbbing, dull, or sharp?
biomarker el paso tx.
  • Has there ever been an injury at or around the problem area?
  • What activities/actions/movements relieve and worsen the pain?
  • Is there a history of mental illness, like depression or anxiety?
11860 Vista Del Sol, Ste. 128 Chronic Pain Diagnosis

Labs

Tests will be ordered to identify physical/non-physical causes that could be the cause or contributor. Possible tests include:

Blood

Blood tests are used in the diagnosis of infections and inflammation. Individuals with infection/s or inflammatory disorders have high levels of white blood cells and inflammatory reactive substances like C-reactive protein. Blood tests also help determine the presence of rheumatoid arthritis, gout, or cancer. If rheumatoid arthritis is present, the blood analysis will show positive results for proteins known as rheumatoid factor.

Urine

Urinalysis is commonly used to check for gout. This is a type of arthritis that causes high blood levels of uric acid. A doctor may order a urine test for a patient using prescription pain meds.

Spinal tap

A doctor inserts a needle into the lower back and a sample of cerebrospinal fluid is collected. Cerebrospinal fluid is clear and protects the brain and spinal cord. A cerebrospinal fluid analysis helps to diagnose disorders of the central nervous system and certain cancers. �

Musculoskeletal/Neurological tests

A musculoskeletal exam looks at posture, joint mobility, muscle stiffness, tightness, and swelling in or around the area, as well as the rest of the body. An example is a diagnosis of carpal tunnel syndrome. A detailed spine examination is done to identify deformities and moving/walking posture. A neurological examination is used to check:

  • Muscle strength
  • Touch reaction
  • Balance
  • Overall sensation

A neurological exam can also be used to test:

  • Memory
  • Alertness
  • Mood
  • Behavior

Imaging

Imaging provides detailed images of the body’s organs and bones. Doctors use these to:

  • Spot fractures or inflammatory alterations in the bone/s
  • Focus on details of a bone and surrounding structures
  • Differentiate between growths, infections, or fractures
  • Identify nerve/s injury or damage

X-Rays

X-rays are standard in the diagnosis of fractures. An arthrogram is an x-ray that uses a contrasting agent to check and identify joint disorders.

MRI

Magnetic resonance imaging uses a magnetic field and radio waves to create detailed images. Magnetic resonance imaging helps in diagnosing:

  • Low back pain
  • Fibromyalgia
  • Osteoarthritis
  • Migraine
  • Pelvic pain
  • Peripheral neuropathy

Electrodiagnostic

EMG – Electromyography

EMG’s are used to diagnose disorders of the muscles and nerves. Electrical activity in the muscles is recorded to see how the impulses/electrical signals are transmitting from the nerves to muscles. �

neurological studies el paso tx.

An EMG could be required if an individual has:

  • Numbness
  • Muscle weakness
  • Muscle pain
  • Tics

Electromyography is also used to identify conditions that can cause chronic pain like:

  • ALS – Amyotrophic lateral sclerosis
  • Carpal tunnel syndrome
  • Radiculopathy from pinched nerves in the spine
  • Muscular dystrophy

Nerve Conduction

A nerve conduction study measures the speed of electrical signals passing through a nerve. It can identify:

  • Carpal tunnel syndrome
  • Herniated disk disease
  • Sciatic nerve injury/damage/abnormality

A doctor can order both an EMG and NCS in combination.


Back Pain Chiropractic Care

 


 

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*

Anybody Can Have Chronic Pain

Anybody Can Have Chronic Pain

Anybody can have chronic pain. Adults typically complain of joint pain, low back pain, and neurogenic pain. While children and teenagers are more likely to have more headaches, abdominal pain, leg, and hand pain. Regardless there are individuals that have a higher risk because of their age, gender, and job. It isn’t always clear what causes chronic pain. There are several possibilities: �

 

11860 Vista Del Sol, Ste. 128 Anybody Can Have Chronic Pain
  • Injury – Even after the injury has healed, the nerves keep sending pain signals to and from the brain. Doctors are still not sure why this occurs.
  • Disease – Conditions can cause chronic pain like fibromyalgia and osteoarthritis.
  • Nerve problems – Part of the nervous system can be injured, the nerves themselves. This is called neuropathic pain.
  • Unknown Cause/s – Pain that presents with no obvious injury, disease, or nerve problem.

Military Veterans

Chronic pain is quite common in veterans according to a National Veterans Affairs Study. Around one in five veterans receiving primary care have chronic pain. While one in ten has chronic pain syndrome. Veterans recently served in a war, tend to report a variety of causes for their pain. This includes:

  • Multiple injuries
  • Brain trauma
  • Muscle injuries
  • Bone/s injuries

Athletes

Most sports require a certain level of fitness. Athletes train with all types of activities to help maintain their body’s. Unfortunately, they are still not immune to chronic pain. Chronic pain is common with:

  • Gymnasts
  • Football players
  • Soccer players
  • Runners
  • Basketball players
  • Ballet dancers

Common chronic conditions for athletes:

 

  • Low back pain
  • Leg pain
  • Stress fractures or cracks inside a bone
  • Tendinitis
  • Diabetes
  • Recurrent fractures
  • Spinal stenosis is a narrowed spinal canal, which creates added pressure on the nerves that travel through the low spine into the legs
chiropractor takes notes on lady with back pain in gym

Seniors

Age is a high-risk factor for chronic pain. Around 30-40% of individuals older than sixty-five have or are beginning to deal with chronic pain. The severity in anybody forty-five to sixty-five is the greatest. Common conditions that cause chronic pain in older adults are:

  • Cancer
  • Arthritis and gout
  • Heart disease
  • Kidney disease
  • Damaged nerves
  • Stroke
  • Shingles
11860 Vista Del Sol, Ste. 128 Anybody Can Have Chronic Pain

Women

Men and women experience pain differently. Several factors contribute to this. These include:

  • Hormones
  • Menstruation
  • Puberty
  • Reproductive health

Women have a higher risk of developing disorders that cause chronic pain. Examples include:

  • Arthritis
  • Brittle bones
  • Migraines
  • Irritable bowel syndrome

Anybody dealing with chronic pain, finding relief can be difficult and time-consuming. Individuals are often sent back and forth between primary care, specialists, and therapists for a solution.

Improved Nervous System

When there is a communication breakdown between the brain and the body�s tissues, organs, and cells it can lead to a variety of health problems. There are many chronic and even degenerative health conditions that are impacted by the nervous system. Studies have shown that chiropractic is a highly effective treatment for numerous neurological conditions which include:

  • Ataxia
  • Autism
  • Cerebral palsy
  • Epilepsy
  • Multiple sclerosis
  • Parkinson�s
  • Tourette�s Syndrome
  • Vertigo

Anybody can seek treatment and they will experience the benefits. Chiropractic provides a safe, effective treatment for an improved nervous system function. The type, frequency, and intensity of treatment depend on the patient and condition. Chiropractic positively affects the nervous system and as a result, positively affects the whole body.


Chronic Body Pain 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*

Causes of Chronic Pain

Causes of Chronic Pain

Several conditions and factors can cause chronic pain. Usually, these are conditions that accompany normal aging, which affect bones and joints. The top three are osteoarthritis, rheumatoid arthritis, and fibromyalgia. Other common causes are nerve damage and injuries that fail to heal properly.

Spinal Cord and the Nerves of the Corresponding Organs

 

11860 Vista Del Sol, Ste. 128 Causes of Chronic Pain

Fibromyalgia

Individuals with fibromyalgia experience unexplained pain in almost every part of their bodies. Doctors and scientists are still trying to figure out what causes fibromyalgia. Currently, scientists think a part of the condition comes from an imbalance of certain chemicals in the brain. They believe the imbalances play a critical role. Fibromyalgia can create:

  • Tender areas
  • Muscle pain
  • Headaches
  • Long-term back pain
  • Long-term neck pain

Osteoarthritis

Osteoarthritis causes severe sporadic or non-stop aches and pain in the knees, hips, spine, and feet. Associated symptoms include joint stiffness, swelling, and limited joint mobility. Individuals with osteoarthritis could have some pain throughout their lives. According to the CDC, around fifteen million adults with arthritis have severe pain in their joints.

facetogenic neuropathic, osteoarthritis and headaches pain el paso tx.

Rheumatoid Arthritis

Rheumatoid arthritis causes continual aching that affects multiple joints. The hands, wrists, and knees are the most affected joints. Individuals with rheumatoid arthritis can present alternate symptoms, like joint stiffness, swelling, and fever.

Multiple Sclerosis

Multiple sclerosis is a disease of the brain and the spinal cord. What happens is the immune system targets and damages the protective covering of the nerves themselves. The brain can’t properly and effectively communicate with the body. Multiple sclerosis causes pain in the legs, feet, arms, and hands. Associated symptoms include burning, prickling, or stabbing pain just about every day. �

11860 Vista Del Sol, Ste. 128 Causes of Chronic Pain

Sciatica

Sciatica can cause mild to sharp, electrical burning pain that travels from the lower back through the buttocks to the back of the leg and even into the foot. Chronic sciatica lasts for three months or more. The condition is more common in adults age 40 and older.

Carpal Tunnel Syndrome

Carpal tunnel syndrome causes pain and numbness in the:

  • Hand
  • Wrist
  • Forearm
  • Thumb
  • Index finger
  • Middle finger
  • Ring finger

Common causes include:

Injury Trauma

Around half of the cases involving chronic pain are linked to physical trauma and injury. Individuals hospitalized after a serious injury often report chronic pain symptoms within the first year. Scientists are still unsure of how injuries lead to chronic pain. They believe several factors increase the risk. These include:

  • Pre-injury depression
  • Anxiety
  • Alcohol use
  • Family history of chronic pain

Individuals that have sustained multiple injuries are at higher risk for chronic pain. �

Spinal Injuries

One of the most common causes of chronic back pain. The lower back is the area likely to be affected. Certain types of chronic pain can have more than one cause. For example, general back pain could be caused by a single factor or a combination of factors like:

  • Poor posture
  • Improper lifting of heavy objects
  • Improper carrying of heavy objects
  • Being overweight places added strain on the back and knees
  • Abnormal curvature of the spine
  • Wearing high heels too often
  • Sleeping on a worn-out mattress
  • Degenerative disc changes

Combat Injuries

More than half of combat-related injuries are the result of explosions, from landmines, and shrapnel. Nearly all injured soldiers have to deal with some type of pain and many have a traumatic brain injury. A traumatic brain injury can cause chronic headaches. Delayed treatment and repeated injuries in injured soldiers make up for most chronic pain cases. �

11860 Vista Del Sol, Ste. 128 Causes of Chronic Pain

Sports Injuries

Sports injuries and chronic pain is nothing new. Studies found that 1 in 2 football players deal with chronic pain in their retirement. This along with sleep problems and mild-severe depression. Both can contribute to chronic pain. Athletes are continuously exposed to high-risk injury situations. Having the pressure of performing optimally and winning can take a toll on an athlete’s health. �

Weight

Obesity does not directly cause chronic pain, but it does raise the risk. Around 40% of individuals that are obese also experience mild to severe chronic pain. Plus, individuals that are severely overweight are more likely to develop a condition that can cause chronic pain like diabetes, arthritis, and fibromyalgia. �

The source of chronic pain can be very complex. It can start with an injury or illness and develop slowly without the individual realizing it until it has become a full-blown chronic condition. This fact alone makes recommending a single course of treatment risky and is why health care providers recommend a number of different types of treatment options.


Chiropractic Care on Personal Injury

 


 

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*

How Does Pain Become Chronic?

How Does Pain Become Chronic?

How does pain become chronic? Pain can be a complex condition, as it involves both physiological and psychological components. When an individual experiences an injury, the damaged tissues trigger and send pain signals to the brain. This is how the body alerts that there is something wrong, and thus prevents further damage. Those pain signals travel to the brain, stimulate the nerves, and cause a sensation known as pain.

 

11860 Vista Del Sol, Ste. 128 How Does Pain Become Chronic?

Nerves and the brain

Nerves control the body�s functions like the organs, sensation, and movement. The nervous system receives information and generates the correct response. Two major types of nerves are sensory and motor. Sensory nerves relay information like touch, temperature, and pain to the brain and spinal cord. Motor nerves relay signals from the brain back to the muscles, which causes them to contract voluntarily or reflexively.

The peripheral nervous system is the combined millions of nerves throughout the body. The peripheral nervous system’s nerves relay signals/messages to the central nervous system, which is comprised of the brain and spinal cord. �

When pain becomes chronic the brain fails to process these signals correctly and the individual continues to feel pain after the injury has healed or improved. As time goes on the nerves that send the pain signals are more methodical in their signaling. This means more signals than normally will be sent and are far more intense. Conditions like cancer and diabetes can cause tissue and nerve damage throughout the body.

Acute vs. Chronic

Acute pain has a short duration of around three months or less. The causes are usually clear and not as difficult to diagnose. The underlying factor/s like an injury is resolved the pain also goes away. As the pain is gone, the individual no longer has problems carrying out daily activities. A few causes of acute pain are:

  • Surgical procedures
  • Dental procedures
  • Bone fractures
  • Burns
  • Open wounds
  • Childbirth

Chronic pain is defined as pain that lasts three to six months with some conditions going for years. Individuals can experience chronic pain weeks and months possibly years after the injury took place. And it can happen without any apparent cause. Many cases often involve more than one factor. This causes significant problems with daily activities. When pain becomes chronic it is often associated with conditions like cancer, diabetes, and arthritis.

CP and CPS

Chronic pain is defined as any type of pain that persists for six months or longer. Chronic pain syndrome is a collection of conditions that are associated with chronic pain. These conditions can make the pain worse or cause other complications like sleep problems, anger, anxiety, and depression. �

11860 Vista Del Sol, Ste. 128 How Does Pain Become Chronic?

Causes

Doctors don’t know exactly what causes chronic pain syndrome. It often starts with an injury or painful condition such as:

  • Arthritis
  • Broken bones
  • Back pain
  • Cancer
  • Headaches
  • Joint problems
  • Muscle strains and sprains
  • Repetitive strain injuries
  • Fibromyalgia
  • Nerve injury/damage
  • Lyme disease
  • Ulcers
  • Inflammatory bowel disease
  • Irritable bowel syndrome
  • Surgery

Diagnosis

A doctor will go over an individual’s medical history, illnesses, or injuries that could have started the pain. They will ask questions to learn more about the type of pain being felt and how long. Questions can include:

  • When did the pain begin?
  • Where on the body does it hurt?
  • What does the pain feel like – Throbbing, Pounding, Shooting, Sharp, Pinching, Stinging, Burning
  • The severity of the pain on a scale of 1 to 10
  • What sets the pain off?
  • What makes it worse?
  • Have any treatments helped?

Imaging tests can show if there is joint damage or other problems:

  • Computed tomography is a powerful X-ray that generates detailed images.
  • Magnetic resonance imaging uses magnets and radio waves to take pictures of the organs and structures.
  • X-rays use radiation in very low doses to create images of the body’s structures.

Talk with a chiropractor to understand how a customized treatment plan for chronic pain is developed.


Chronic Hand Pain 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*