Back Clinic Treatments. There are various treatments for all types of injuries and conditions here at Injury Medical & Chiropractic Clinic. The main goal is to correct any misalignments in the spine through manual manipulation and placing misaligned vertebrae back in their proper place. Patients will be given a series of treatments, which are based on the diagnosis. This can include spinal manipulation, as well as other supportive treatments. And as chiropractic treatment has developed, so have its methods and techniques.
Why do chiropractors use one method/technique over another?
A common method of spinal adjustment is the toggle drop method. With this method, a chiropractor crosses their hands and pressed down firmly on an area of the spine. They will then adjust the area with a quick and precise thrust. This method has been used for years and is often used to help increase a patient’s mobility.
Another popular method takes place on a special drop table. The table has different sections, which can be moved up or down based on the body’s position. Patients lie face down on their back or side while the chiropractor applies quick thrusts throughout the spinal area as the table section drops. Many prefer this table adjustment, as this method is lighter and does not include twisting motions used in other methods.
Chiropractors also use specialized tools to assist in their adjustments, i.e., the activator. A chiropractor uses this spring-loaded tool to perform the adjustment/s instead of their hands. Many consider the activator method to be the most gentle of all.
Whichever adjustment method a chiropractor uses, they all offer great benefits to the spine and overall health and wellness. If there is a certain method that is preferred, talk to a chiropractor about it. If they do not perform a certain technique, they may recommend a colleague that does.
Flexibility is critical for athletes and non-athletes alike. It allows people to move freely and easily in their everyday life and can also help prevent injury or aggravated conditions during physical activities. One of the best methods to maximize flexibility is through stretching. However, research suggests that not all stretching techniques are created equal. Proprioceptive neuromuscular facilitation, or P.N.F., stretching is depends on reflexes to produce deeper stretches which increase flexibility.
What is P.N.F. stretching?
Proprioceptive neuromuscular facilitation (PNF) is a more complex form of endurance training which involves both the stretching and contraction of the muscle group being targeted. PNF stretching was initially developed as a form of rehabilitation, and to that effect, it’s very effective. It’s also great for targeting specific muscle groups, and also, while it helps increase flexibility, it also enhances muscle power.
As stated by the International PNF Association, P.N.F. stretching was developed by Dr. Herman Kabat in the 1940’s as a means to take care of neuromuscular ailments, including polio and multiple sclerosis. Proprioceptive neuromuscular facilitation techniques have since gained recognition with healthcare professionals, such as chiropractors, physical therapists and other fitness professionals. Based on research from the University of Queensland, PNF stretching may be the best stretching procedure for increasing range of motion.
How Does Proprioceptive Neuromuscular Facilitation Function?
While there are multiple PNF stretching techniques, all of these rely on extending a muscle to its own limitation. Doing so causes the inverse myotatic reflex, a protective reflex that calms the muscle to prevent injury. P.N.F. induces the brain to think “I do not need that muscle to rip” and sends a message to let the muscle relax a bit more than it would normally.
You know the feeling when you stretch a muscle? It feels great when you stretch it until you move nearer to the end of its range of movement and it starts to feel extremely tight and even painful. It’s similar to a flexible band that does not want to stretch any farther.This is known as the myotatic reflex, which is the human body’s natural method of protecting your muscles from stretching too far. It is possible to conquer this to an extent by gradually extending and exhaling to decrease tension in the muscle.
However, proprioceptive neuromuscular facilitation, or PNF, stretching tricks your nervous system into relaxing the myotatic reflex, enabling your muscles to extend further than what’s attainable using a conventional style of stretching. All PNF stretching requires is that you stretch a muscle and then forcefully contract that muscle before stretching it again. As you proceed into the stretch after the contraction, you will be able to stretch farther that you did earlier. This permits you to create more length in the muscle and receives a much greater flexibility benefit from the stretch. P.N.F. stretching consists of several techniques which can help achieve the same effect as described above.
Hold-Relax Stretch
This type of PNF stretch relies on the concept of autogenic inhibition. By stretching the muscle and after using an isometric contraction of the muscle, it’s possible to decrease the activity (or tone) of the muscle and deceive the myotatic reflex to permit for a more significant stretch. To perform this technique, stretch a muscle as far as you can, remember, it shouldn’t be painful, and then hold the stretch for 10 seconds. Next, contract that muscle as forcefully as possible against an immovable object. Hold this for 5 minutes. Now move into a stretch, using a partner’s assistance if needed, which ought to be deeper than what you attained before. Repeat the stretch-contraction order three times for each muscle.
Contract-Relax, Antagonist-Contract Stretch
Your system is wired so that two muscles cannot shorten at precisely the exact same time, otherwise they’d fight against one another, and you would not be able to move. So when you consciously contract a muscle, your nervous system automatically sends an indication to the opposing muscle, or antagonist, that it ought to relax so that your joint can proceed. This is called reciprocal inhibition. This variant of PNF benefits from reciprocal inhibition. It resembles the hold-relax stretch but entails a forceful contraction of the opposing muscle to the one being extended in order to move deeper into the stretch.
To perform this technique, stretch a muscle as far as you can, again, remember it shouldn’t be painful, and hold the stretch for 10 seconds. Next, contract that muscle as aggressively as you can against an immovable object, such as your partner’s chest. Hold this for 5 seconds. Now use the opposing muscle to pull yourself back to the stretch. Again for the hamstring stretch, this would be your hip flexors. Your partner won’t have to supply as much assistance as the hold-relax stretch technique, but can give an excess drive and will help you maintain the stretch if needed. Repeat the sequence three times for each muscle.
Contract-Relax Stretch
Finally, the third type of PNF stretch closely resembles the hold-relax stretch but rather entails contracting the muscle through an active assortment of motion. To perform this technique for a hamstring stretch, for instance, you’d extend the muscle for 10 seconds and slowly lower your leg into a table. Now increase your leg back around 90 degrees and also have a partner move you into the next stretch.
Dr. Alex Jimenez’s Insight
Proprioceptive Neuromuscular Facilitation, or PNF, is a rehabilitation stretching technique used to help increase flexibility as well as improve muscle elasticity. P.N.F. has been demonstrated to have a positive effect on active and passive range of motion because it can increase the length of the muscle and neuromuscular efficiency. Stretching has long been seen as beneficial to enhance performance and decrease risk of injury during physical activities. Proprioceptive neuromuscular facilitation stretching can also improve function and range of motion following an injury. Proper protocol should be followed when performing PNF stretching to attain and maintain the benefits of these techniques.
A Word of Caution Regarding PNF Stretching
Certain precautions need to be taken when performing proprioceptive neuromuscular facilitation, or PNF, stretches because they can place additional amounts of stress, pressure and/or tension on the targeted muscle group, which can boost the risk of soft tissue injury. To help reduce this risk, it’s important to incorporate a conditioning stage before a maximum, or extreme effort is utilized.
Additionally, before undertaking any form of stretching it is extremely important that a comprehensive warm up is completed. Warming up prior to stretching does a variety of valuable things, but mainly its objective is to prepare the body and mind for more strenuous physical activities. Among the ways it accomplishes this is by helping to increase the body’s core temperature whilst also increasing the body’s muscle dimensions. This is imperative to ensure the maximum benefit is obtained from your stretching. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
Specially certified healthcare professionals utilize the active release techniques, A.R.T., to diagnose and treat soft tissue injuries created by scar tissue. This manual, hands on treatment divides adhesions which limit normal range of motion causing strain and painful symptoms.
What is Active Release Technique (ART)?
Active Release Techniques (ART) is a guide treatment administered by trained healthcare practitioners to particular soft tissue structures of the human body. The ART soft tissue control process relies on scientific proof that muscles, nerves, blood vessels, and connective tissue develop adhesions inside and between them as a result of various injuries that include: acute, or sudden injury, cumulative, or chronic injury, and pressure because of poor posture. These adhesions cause the motion of joints or muscles to be altered, leading to a vast array of signs and symptoms, including fatigue, pain and reduced range of movement, as well as tingling sensations and numbness.
What is the History of A.R.T.?
Michael Leahy, D.C., now practicing in Colorado Springs, Colorado, began developing A.R.T. in 1984. Prior to practicing chiropractic care, Dr. Leahy was an aeronautical engineer with the US Air Force. This technology background enabled Dr. Leahy to strategize soft tissue injuries in a new perspective, turning into the active release technique. Dr. Leahy is now widely considered a top rated soft tissue authority in the United States and the entire world.
What is ART Treatment Like?
After a diagnosis has been achieved according to a medical history and evaluation, treatment can be rendered by the appropriate healthcare professional with experience and certification in the active release technique, ART. Since soft tissue injuries made by scar tissue cannot be detected by a machine, for instance, X-ray or MRI, or by any orthopedic tests, A.R.T. is itself a diagnostic tool. The healthcare practitioner can determine where the adhesions are and also how intense the soft tissue injury is, only by touch.
ART is usually performed using direct contact from the doctor to the patient’s skin. The practitioner will locate the area to be worked on and either have the individual actively move a body part or they will passively move the body part for the individual.
The active release technique (ART) is a hands on treatment in which muscle, fascia, ligament, tendon, nerve, or capsule is held with pressure and tension on the tissue involved (not the skin) in a shortened position, while the arrangement is lengthened through a full, comfortable range of active movement and force is maintained throughout the movement. There is no skin tension or slipping on the epidermis.
Active release technique differs from massage in the use of movement of the limb, or spine under pressure and tension, along with the attention to anatomical detail and potential nerve entrapments in the area. Instead of treating a general region, an active release technique healthcare provider uses their hands to feel damaged or abnormal tissues in muscle, fascia, tendons, ligaments or nerves. Abnormalities present as having a different feel and affect the motion and operation in which a patient can perform.
The qualified and experienced healthcare professional’s contact, coupled with the motion of the patient, allows the adhesions to separate. The therapy protocols, currently amounting to over 500 specific moves, are unique to ART or active release techniques. They allow healthcare practitioners to identify and correct the specific health issues which are impacting each patient.
Active release techniques, or ART, goes right after the adhesion in order to break up the scar tissues producing the painful symptoms and malfunction. Considering these sites are extremely sensitive to begin with, A.R.T. might cause some discomfort described by many patients as a “good hurt”. However, pressure or tension is never applied beyond the patient’s tolerance.
How Long Does ART Treatment Last?
Each individual’s active release technique differs. On average, between 2 to 6 visits, each lasting about 15 to 30 minutes, are needed for correction of soft tissue problems. Factors that affect this range include the intensity of the health issue, the individual’s willingness to take part in their treatment and the patient’s overall health status. Patients need to have an active part in their recovery to help lower the chances of reoccurrence. This may entail strengthening a certain tissue or altering certain physical activities.
ART is considered one of the best and most successful treatments for soft tissue injuries. However, like any other therapy, ART can not fix everything. If significant improvement isn’t seen throughout the course of treatment, other treatments options will be considered to fully resolve the patients injuries or conditions. Healthcare professionals generally will not encourage ongoing sessions if no improvement is observed within a specific number of visits.
Who Can Benefit from A.R.T.?
Anybody who is in pain due to a soft tissue injury can benefit from the active release technique. ART is utilized in a clinical setting on professional and olympic athletes, office workers, laborers, housewives, young athletes, in addition to many others. These individuals all have in common their altered movement patterns, but their mechanism or trigger often differs. A.R.T. effectively heals muscles, tendons and ligaments throughout the body that are very congested with scar tissue by freeing up their ability to function and thereby decreasing pain and other painful symptoms.
Active release techniques can also be effective in treating plantar nerve entrapments in which a nerve is entangled by scar tissue and has pressure or tension exerted during specific positions or movements. Through a healthcare provider’s extensive training, they’re taught where the nerves are likely entrapped and how best to reduce the adhesions. This provides individuals who suffer from sciatica, carpal tunnel syndrome and other peripheral nerve entrapments a fast and effortless solution for their complaints. Palliative therapies such as ART ought to be researched before a person has decided they cannot be properly treated due to their current health and wellness. If it is a soft tissue structure that is causing your pain, it could most likely be fixed.
How Does ART Help?
Active release technique promotes faster healing, recovery of normal tissue function, and may also prevent future injuries. For the athlete, it is going to make it possible for them to train better and more frequently. For the employee, it can keep them injury free, if used as a preventative therapy.
Abnormal tissue, or scar tissue, can go unnoticed by an athlete as well as for the office employee and it may manifest into an injury. Symptoms of damaged tissue include tightening and shortening of the muscle. What was once simple could become a chore, for instance, stiffer golf swing rotation, or fighting to reach your seatbelt. A reduction of mobility, limited range of motion, poor biomechanics, overcompensation along other body parts, and loss of strength could all be identified and adjusted with ART. Many times, a patient will not understand why scar tissue is building up until it is too late. No apparent injury is necessary for this to happen.
Possibly an IT band pain can be traced back to some dysfunctional hip. Tingling sensations or numbness in the hand may be from constant insult to the nerve from poor computer desk setup along with the shoulder, neck, forearm posture causing the nerve to be entrapped up the arm or neck; it doesn’t even have to develop in your hand.
How Does ART Improve Performance?
Performance of almost any activity, such as golfing, typing, walking or running could be improved considerably with the active release technique, or ART, by restoring proper muscle function and motion to permit the entire body to perform at its most efficient level. Adhesions create drag and tension which requires additional energy and effort to accomplish a desired movement. Reaction times may also be enhanced as muscle function is improved.
Who Can Provide Active Release Technique?
Only certified healthcare professionals in active release techniques, such as chiropractors or physical therapists, can efficiently render treatment. Regrettably, there are a number of people who claim they provide ART but don’t really get the true training needed to provide safe and efficient therapy. It’s essential to find a qualified and experienced healthcare practitioner in A.R.T..
Dr. Alex Jimenez’s Insight
Active release technique is a type of soft tissue therapy which helps relieve tight muscles and nerve trigger points, tremendously reducing joint stress and muscular pains. Relieving muscle stiffness and trigger points can make a big difference towards improving overall health and wellness. Furthermore, the active release technique, or A.R.T., can help turn on muscles which may have been turned off due to trauma from an injury or an aggravated condition. ART is primarily used to treat health issues which affect muscles, fascia, tendons, ligaments and even nerves, which contribute to the formation of scar tissue, strains and sprains as well as pain and inflammation.
The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
Low back pain occurs due to a variety of causes, which is why it is often poorly diagnosed and treated. As there are many mechanisms by which lower back pain happens, such as trauma, overuse from weight lifting for example, and repetitive motion, it’s important to mention that this article will only focus on sciatic nerve pain, or sciatica.
Sciatica refers to pain and other symptoms which radiate or travel down the leg, associated with numbness, tingling or burning sensations, and weakness in one or both lower extremities. Many patients complain of sharp, intense pain and discomfort when sitting and driving, affecting their capacity to bear weight properly when one has to walk or move. Their pain can shoot down the length of the sciatic nerve, into the buttocks, down the back of the leg, into the calf, and lastly, into the ankle and foot. The sciatic nerve, which is the longest nerve in the body, can become compressed or entrapped by certain muscles leading to sciatica.
Based on the location of this impingement, the individual will present with a variety of symptoms. If the health issue is diagnosed to originate in the low back, then the problem normally occurs around the hole in which the nerve exits the spine, resulting in symptoms surrounding the entire lower extremity. If the health issue is correctly diagnosed to originate from the buttocks, it most often includes the piriformis muscle because the sciatic nerve travels beneath it as it makes its way down the length of the leg. The source of this type of sciatica may involve different muscles just below the piriformis, otherwise known as a group of muscles called the hip rotators.
If the health issue is not in the lower back, or buttocks, then the problem is very likely to have occurred in the hamstrings, primarily at one of the muscles where the plantar nerve divides the hamstrings at the back of the thigh. The sciatic nerve may also manifest symptoms when compressed in the calf, however, these symptoms will often only be reported below the knee.
ART and PNF Treatment for Sciatic Nerve Pain
In regards to treatment, sciatica can be worked out by performing active release techniques, or ART, through the release of the entire nerve where it is being compressed. The objective when using ART for sciatic nerve pain would be to maneuver the nerve while trapping the muscle(s) in their own position. The nerve is then pulled from beneath the muscle. Also, using rehabilitation exercises through specific stretches and strengthening exercises of the muscle groups involved may allow for faster healing alongside chiropractic care to boost the communication between the spine and the positioning of the nerve entrapment/compression.
One of the most common stretching methods for sciatica is PNF or proprioceptive neuromuscular facilitation. PNF is a sort of stretch that produces a rebound relaxation of the muscle. PNF is a more advanced kind of flexibility training that involves both the contraction and stretching of the muscle group being targeted. PNF is a stretching technique utilized to increase range of motion and flexibility. PNF increases range of motion by increasing the length of the muscle and increasing neuromuscular efficiency. PNF stretching has been found to increase ROM in trained, as well as untrained, individuals. Effects can last 90 minutes or more after the stretching has been completed. PNF stretching was initially created as a form of rehabilitation, and to that effect, it is very effective. It’s also excellent for targeting specific muscle groups as well as increasing flexibility and enhancing muscle power and strength.
Four theoretical physiological mechanisms for increasing range of motion were identified using PNF stretching: autogenic inhibition, reciprocal inhibition, stress relaxation, and the gate control theory.�Autogenic Inhibition is what occurs in a contracted or stretched muscle in the form of a decrease in the excitability because of inhibitory signals sent from the same muscle.�Reciprocal inhibition is what occurs in the TM when the opposing muscle is contracted voluntarily in the form of decreased neural activity. It occurs when an opposing muscle is contracted in order to maximize its contraction force, and it relaxes.�Stress relaxation is what occurs when the musculotendinous unit (MTU), which involves the muscles and the connected tendons, is under a constant stress.�The gate control theory is what occurs when two kinds of stimuli, such as pain and pressure, activate their respective receptors at the same time.
How to Perform a PNF Stretch
The practice of doing a PNF stretch involves the next steps. The muscle group to be stretched is first placed so that the muscles are stretched and under pressure. The individual then contracts the muscle, using a band for 5 to 6 seconds while a partner, or immovable object, applies sufficient resistance to inhibit motion. Please be aware, the effort of contraction ought to be relevant to the individual’s amount of conditioning. The contracted muscle group is then relaxed and a controlled stretch is used for approximately 20 to 30 seconds. The muscle band is then allowed 30 seconds to recover and the process is repeated 2 to 4 more times.
Information differs marginally regarding time recommendations for PNF stretching, determined by which healthcare professional you’re speaking to. Although there are conflicting responses to the question of how long should a patient contract the specific muscle group for and how long should they rest for between each stretch, it’s been found through a study of research and patient experience, that the above timing recommendations offer the most advantages from proprioceptive neuromuscular facilitation stretching.
Furthermore, certain precautions will need to be taken when performing PNF stretches because they may put additional stress on the targeted muscle group, which can boost the possibility of soft tissue injury. To reduce this risk, it’s essential for the patient to include a conditioning phase before a maximum, or intense effort is utilized.
About the Active Release Technique or ART
The active release technique, or ART, is among the newest treatments in the world of chiropractic. ART is used to target muscle, nerve, and tendon problems. It is also used to treat blood vessel problems. Quite a few studies have been conducted and these have generated positive results which reveal that ART is really an effective treatment method. A lot of individuals nowadays try ART since so many are experiencing muscle problems.
Oftentimes, individuals, particularly the older ones, wake up and they feel that their body is quite hard to move. There are also those who start to feel their range of motion getting more and more limited with time. A number of the most common body parts that suffer from limited selection of motion include the neck, the arms, and the back. For many individuals, there is also restricted range of motion. There are numerous factors that cause restricted range of movement. The active release technique can be used to improve limited mobility as well as improve sciatica symptoms associated with a variety of health issues.
How ART Affects Limited Range of Motion
ART therapists initial assess the muscles that they are supposed to take care of. They check the texture, the stiffness, and needless to say, their freedom. Since the groundwork is conducted, the therapists would then attempt to elongate the muscles so as to break the adhesions. The stretching is usually conducted with the management of vein in consideration. Also, the practitioner would need to ask the patient to move the affected body parts in ways prescribed by the practitioner. So essentially, ART is a joint-venture. Practitioner and patients work together in order to generate great medical outcomes.
Dr. Alex Jimenez’s Insight
The active release techniques, or ART, and the proprioceptive neuromuscular facilitator, or PNF, stretches are therapeutic procedures commonly utilized for the common practice of releasing tension in the soft tissues as well as increasing the range of motion of the human body. Although a variety of treatment options are available to help treat sciatica, ART and PNF can be used by qualified and experienced healthcare professionals to safely and effectively improve and manage sciatic nerve pain. Moreover, alternative treatment options, such as chiropractic care, and strengthening exercises can also be used in combination with these therapeutic methods to help speed up the recovery process.
The Future of ART and PNF
It’s important to remember that both ART and PNF should only be run by accredited practitioners. Healthcare professionals are not just expected to find basic instruction and permit but they are also expected to have attended numerous workshops and seminars about the subject. In some countries, credential tests even must be passed. In addition, it ought to be noted that ART and PNF must be conducted on muscle stiffness not due to blunt trauma. The condition should also not involve inflammation.
There are many healthcare professionals who focus on ART and PNF. A few of these include chiropractors, physical therapists, massage therapists, medical physicians, and even athlete trainers. The active release technique and the proprioceptive neuromuscular facilitation stretches helps people do things that they used to do. It helps them become more efficient at work as well as be practical in their daily lives. Due to the health benefits of ART and PNF, more and more people from the medical and therapeutic world are learning how to concentrate on it. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
It has been compared to the worst possible type of pain anyone can imagine. Other people say it’s even worse than labor because the pain doesn’t seem to have an end to it. These are some of the most common descriptions of sciatica, where a severe case of this excruciating nerve pain can bring anyone to their knees. That’s why lots of patients don’t simply say they have sciatica, they’re victims of its symptoms.
Sciatic nerve pain, or sciatica, is associated with many well-known symptoms, however, is sciatica really that common? What type of treatments are available to help alleviate sciatic nerve pain?And does a person’s everyday activities play a part in whether they will develop sciatica in the first place? Dwight Tyndall, MD, FAAOS answers several of the most commonly asked questions patients need to know regarding their sciatica.�Dr. Tyndall is a pioneer in the area of outpatient spine surgery, however, he is also a strong proponent of non-surgical treatment methods, including chiropractic care, to manage back pain and sciatica. Dr. Tyndall shares his perspectives on sciatic nerve pain and discusses what may indicate a need for surgery in severe cases of sciatica.
What is Sciatica?
According to Dr. Tyndall, sciatica is both a spinal disorder and a catch-all term for a group of symptoms. Sciatic nerve pain, best referred to as sciatica, is a spinal condition characterized by nerve pain which radiates down the length of the sciatic nerve. The sciatic nerve is the largest nerve in the entire human body, and it’s made up of spinal nerves from the vertebrae level L4 in the lumbar spine down to the vertebrae level S1 in the sacrum. Anything which impacts those nerves can lead to sciatica. Moreover, sciatica’s symptoms may be grouped under the medical term dysesthesia, meaning any sort of abnormal sensation. Most patients describe sciatica as an odd feeling radiating out of their lower back into their buttocks and down to their thigh and calf, often radiating as far down into the foot.
What are the Symptoms of Sciatica?
Dr. Tyndall explains that sciatica’s hallmark symptom include pain in the low back or buttocks which radiates down one or both legs. Signs and symptoms which shouldn’t be ignored include pain which doesn’t respond to non-surgical treatment options and/or pain which greatly restricts an individuals activity level and quality of life. Some red flags which may signal the need for surgical interventions associated with sciatic nerve pain include: reduced motor function in one part of the leg, usually a drop foot at which the patient can’t lift thei foot off the ground, weakness in one or both legs and bladder or bowel changes.
Is Sciatica the Same as Lumbar Radiculopathy?
“Most people see sciatica to be more severe than lumbar radiculopathy, but radiculopathy, which comes from the Latin radix significance origin, is a condition that affects the nerve during its origin as it exits the spinal cord. Sciatica and lumbar radiculopathy can be brought on by a pinched nerve from the spinal column due to a disc herniation or stenosis, but kidney problems or a sinus issue, like endometriosis, may also pose sciatica-like symptoms,” states Dr. Dwight Tyndall.
Who’s at Risk of Developing Sciatica?
“By my clinical experience, men and women have exactly the same identical risk of developing sciatica. Obesity also doesn’t play a role, either. Concerning age classes, however, sciatica has been estimated to peak during the ages of 30 and 40, and the risk usually declines as people begin reach their 50’s,” added Dr. Tyndall.
How Common is Sciatica?
As mentioned by Dr. Dwight Tyndall, sciatica and low back pain frequently occur together, but sciatica is much less common. While 80 percent of individuals experience low back pain at any point in their lives, just 2 to 3 percent will actually develop sciatica.
When Should a Person with Sciatica See a Healthcare Professional?
According to Dr. Tyndall, an individual with symptoms of sciatic nerve pain will need to see a healthcare professional if their pain is not reacting to over-the-counter (OTC) medications, or if these create weakness in the leg. Also, a person ought to see a doctor if their pain is so severe that their well-being is affected. Should the sciatica include bladder or bowel changes, the individual must seek immediate medical attention for their health issues. Furthermore, it’s important for a person with sciatica to seek the help of a healthcare professional to rule out any possible underlying causes which may be responsible for their symptoms.
What Type of Healthcare Professional Can Help Treat Sciatica?
According to Dr. Tyndall, any healthcare professional qualified and experienced in spine health issues, such as a chiropractor, can help diagnose, treat and even prevent sciatica. A doctor of chiropractic, or chiropractor, is a healthcare professional who utilizes spinal adjustments and manual manipulations, among other non-invasive treatment methods, to help correct any spinal misalignments, or subluxations, which may be causing sciatic nerve pain. A chiropractor may also recommend a series of stretches and exercises, as well as lifestyle modifications, to help speed up the patient’s recovery process. Chiropractic care is often the preferred alternative treatment option to help alleviate sciatica without the need for drugs and/or medications or surgery. However, if a patient is experiencing any of the red flag symptoms mentioned above, it may be necessary to visit a spine surgeon in order to discuss the treatment options. Always make sure to consider surgical interventions as a final alternative if your sciatica doesn’t respond to non-surgical treatment methods.
What are the Causes of Sciatica?
“There are many external factors, but among the greatest is your occupation. Someone who operates in a manual labor industry, like construction, has a higher likelihood of developing sciatica since they put more wear and tear on their back. Tiger Woods is an example of this. He acquired sciatica because his career as a golfer placed significant stress on his spine. There is a genetic element as well, as a few young men and women who do not operate in a strenuous job develop sciatica, however, the genetic tie is not clearly defined. Lastly, pregnancy may also result in sciatica. As the infant develops, it can put pressure on the lumbar spine, pelvis, and sciatic nerve. However, delivering the infant is usually enough to eliminate sciatica caused by pregnancy,” says Dr. Tyndall.
How Often is Sciatica Likely to Re-Occur?
“This question isn’t easy to answer because many factors contribute to whether a person will develop sciatica more than once. Sciatica is likely to re-occur if the spinal disc that led to sciatica the very first time is severely damaged. The more damaged the disk, the more likely it is to re-herniate and lead to sciatica again. Also, if the patient continues to work in a high-physical stress environment, the risk of re-ocurrence increases.
How is Sciatica Diagnosed?
“The physical examination is essential to a sciatica diagnosis. The straight-leg raise test is the traditional diagnostic tool during a physical examination. In this test, a patient be asked to lift up their leg when lying down. If that induces pain down their leg, the patient could have sciatica. Other physical tests healthcare professionals frequently utilize are knee extension tests, where the patient expands their knee to a straight position, like a straight-leg lift. Additionally, healthcare professionals will as patients to walk on their tip toes or on their heel to measure their potency. Other healthcare professionals will also observe how strong they are going down stairs or simply walking. Many doctors can determine a sciatica analysis from a physical examination, but if imaging studies are needed to learn more, the physician may recommend a magnetic resonance imaging (MRI) scan.
What Treatments are Effective for Sciatica?
As mentioned before by Dr. Dwight Tyndall, there is a variety of treatment options available to help alleviate the symptoms of sciatica. Approximately 80 percent of patients will improve with non-surgical treatment options. Several OTC medications, such as NSAIDs (eg, ibuprofen), are also effective in the management of sciatic nerve pain. If the sciatica does not subside, the doctor may prescribe a low-dose steroid pack (to be obtained over one week). If this doesn’t manage the sciatic nerve pain, then the patient may receive an epidural steroid injection (you will first need an MRI to pin-point the injection region).
Other non-surgical treatment options which are commonly utilized to help alleviate the symptoms of sciatica, include, acupuncture, chiropractic care and physical therapy, and needless to say, time normally works wonders such as pain. Chiropractic care is the most commonly used alternative treatment option for the treatment of sciatica. Chiropractic care focuses on the diagnosis, treatment and prevention of a variety of injuries and/or conditions associated with the musculoskeletal and nervous system. Through spinal adjustments and manual manipulations, a doctor of chiropractic, or chiropractor, can help reduce unnecessary pressure in the structures surrounding the spine, improving strength, mobility and flexibility. Chiropractic care and physical therapy alike, can also help improve a patient’s overall health and wellness, aside from improving their sciatica, through physical activities and nutritional advice.
Is Surgery Ever Necessary to Treat Sciatica?
“It may certainly be so, however, the good thing is that the vast majority of people with sciatica don’t need surgery. And, your doctor may ask you to explore non-surgical treatment options, however, your tolerance for pain is the real predictor as to when you have to consider another option for treatment. Surgery may be necessary if symptoms worsen despite trying non-surgical alternatives, if you have weakness in your leg, or if you experience bladder and/or bowel changes,” explained Dr. Dwight Tyndall.
“The surgical procedure to treat sciatica is also called a lumbar microdiscectomy. It is a normal procedure with very positive individual outcomes when used accordingly. A lumbar microdiscectomy is similar to a traditional lumbar discectomy. Technological advances, like the advent of surgical microscopes, allow surgeons to create smaller incisions that are minimally traumatic to the body and result in a much quicker recovery for the patient”, added Dr. Tyndall.
Can Surgery be Performed in an Outpatient Setting?
“Yes, lumbar microdiscectomy can surely be carried out in an outpatient setting. Many patients like the cozy environment and are able to go home the exact same day of operation,” concluded�Dwight Tyndall, MD, FAAOS.
Is Sciatica Preventable?
As thoroughly explained by Dr. Dwight Tyndall, sciatica can be preventable if the individual doesn’t put significant and repeated stress in their back, which will reduce the chance of damaging or injuring a nerve. Nonetheless, in the present society, through our tasks and daily stresses of modern life, it’s difficult to accomplish that. Fortunately, with the abundance of treatment choices available, people can get relief from sciatic nerve pain with the appropriate healthcare professional’s help.
Dr. Alex Jimenez’s Insight
Many people will experience symptoms of low back pain at least once throughout their lifetime, however, only a few individuals will develop true sciatica symptoms. Sciatica is medically referred to as a collection of symptoms, rather than a single condition, and it’s generally characterized by pain and discomfort, followed by tingling or burning sensations and numbness along the length of the sciatic nerve. The sciatic nerve is the largest nerve in the human body and it travels from the lower back down the buttocks and thighs into the legs and feet. Sciatic nerve pain, or sciatica, has become a common health issue for many people, therefore, its important to be educated regarding this prevalent complaint in order to follow up with the most appropriate treatment.
The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
Active release therapy, more specifically referred to as the active release technique, is a patented system designed by Dr. P. Michael Leahy which focuses on the treatment of developed scar tissue in damaged muscles all across the human body. When Dr. Leahy first developed the technique about two decades ago, he realized that the damage in the complex soft tissues of the muscles might perhaps be able to be sensed as well as addressed directly through movement in the form of specialized techniques. With its proven ability to cure pain, its own acronym, ART, provides the active release therapy with some ironical link to being a true art form in chiropractic care.
When athletes overwork their muscles from playing sports or even through just everyday activities, many individuals don’t understand how scar tissue can develop on our muscles in the first place. The scar issue forms in order to help heal damaged muscles, however, it can ultimately create painful symptoms which may last long after these have healed. Scar tissue most commonly develops as a result of pulled muscles or muscle tears, or even from a lack of oxygen, called hypoxia.
As the scar tissue builds in the damaged or injured muscles, if the individual does not maintain a proper level of mobility in the affected area, it can progressively cause muscles to become stiff or tight and weak, eventually leading to health issues such as tendonitis or nerve problems. This explains why some people with pain or limited range of motion, often will need to visit a healthcare professional immediately. Fortunately, many doctors are certified to treat these type of problems using active release therapy.
Using the Active Release Technique to Relieve Pain
Together with providing tension to the targeted sore muscle and utilizing specific body motions, the painful symptoms associated with scar tissue improves through active release therapy. As of now, there are approximately 500 different active release techniques designed to alleviate the tightness or stiffness and weakness in all of the body’s soft tissues, from the muscles to the nerves. Many of these movements are particularly chosen for each individual based on the specific muscle issue and location.
Active release techniques can also be helpful for small traumatic injuries caused by accumulative trauma or repetitive strain. More specifically, ART functions to break up fibrous tissues called adhesions. These adhesions result from a tear onto a tendon, ligament or muscle. Adhesions commonly develop in different ways, including from trauma as a result of acute injury or from repetitive motion injury caused by overuse, most commonly from sports injuries. It may also be a result of poor posture which has been aggravated by continuous pressure in addition to tension produced in the soft tissues for extended amounts of time.
Such adhesions, when left untreated, can also limit blood flow as well as shorten muscles, causing the well-known symptoms. Worsened symptoms can also result in pain, discomfort or weakness and at times numbness, most notably when scar tissue applies pressure on the nerves. When adhesions occur, the patient will surely complain of distress much more due to the simple fact that they will not be able to engage in the physical activities they were used to performing in before.
The active release technique, or ART,� works by implementing a couple of movements and motions on the affected muscle, tendon or fascia. In comparison to other soft tissue therapies, it’s said to achieve better end results. Primarily, ART aims to help improve the symptoms of the damaged or injured area by applying pressure and force on it. From there, the individual will be tasked to perform a technique which will help release the tension from the treatment. This can essentially improve motion for the treated region.
The combination of this tension out of the active release technique and that of the movement of muscles and its soft tissues will loosen and break up the adhesions. Because of this, there’ll be lesser pain felt on the injured region. This technique works well with active strengthening in addition to biomechanics training. The combination of these therapies will make patients feel improved body awareness, strength, flexibility and mobility even after a few ART sessions.
How Different is ART from Traditional Soft Tissue Treatments?
When compared with traditional manners of soft tissue therapy, ART boasts of a very comprehensive strategy. The active release technique is performed by certified healthcare practitioners who’ve underwent a very rigorous training procedure. Healthcare professionals must participate in sit-in classes and they must also have hands-on testing. Their certificate doesn’t stop after they pass the 90 percent mark on the hands on test though. They’ll also have to maintain their ART certification by getting annual recertification. This may work by honing the healthcare professional’s abilities and at the exact time, this will boil to the benefit of patients undergoing the therapy.
How Successful is ART as a Treatment?
Current research has demonstrated how effective the procedure is when it comes to treating hamstring pain and dysfunction in addition to hip pain, turf toe and lymph nodes. While the efficacy of ART has been demonstrated along these areas, several studies are still being made to check into its potential for treating disorders for other body components.
Using the Active Release Technique for Sciatica
Sciatica is an issue which affects a large number of people. It is essentially a pain syndrome, characterized by a collection of common symptoms which are caused when the sciatic nerve, the largest and most important nerve supplying the lower spine and the lower extremities, is compressed by the small muscles in the pelvis. The piriformis muscle is the one most implicated in the compression of the sciatic nerve, particularly because it moves through this muscle when emerging from the pelvis and entering the lower limbs. The active release technique, or ART, may be used in the treatment of sciatica brought on by piriformis syndrome.
Pathophysiology of Sciatica
When sciatica is caused by the compression of the sciatic nerve by the piriformis muscle, the latter generally goes into a spasm for an extended period of time, leading to the compression of this fundamental nerve. The spasm may result in a compromise in the blood supply to the muscle itself as well as the nerve, which will further complicate the issue. Nerve communications are important in order for the human body to maintain its outmost efficiency. Sciatica often can also be caused by disc injuries and herniations, as generally is a differential diagnosis to piriformis syndrome. Specific orthopedic tests can help, doctors of chiropractic, or chiropractors, evaluate the source of the patient’s sciatica prior to commencing any type treatment.
Consequences of Sciatic Nerve Pain
There are a number of effects that could arise as a result of sciatica. Reduction in overall body ranges of movement can be anticipated, accompanied by searing or sharp pain that can be excruciating. This can make it very difficult for an individual’s quality of life, especially when carrying out daily tasks like going to school and work, might become impossible due to the seriousness of the health issue. When the issue isn’t treated on time, it might cause permanent damage to the sciatic nerve.
Conventional Treatments for Sciatic Nerve Pain
There are a range of conventional treatments that may be utilized based on the intensity of the sciatic nerve pain, or sciatica. One of these is an injection of a drug/medication that can relax the muscle so that it stops compressing the nerve. Additionally, it has been proven that drugs and/or medications, such as steroids, may also have an impact on reducing the pain and impairment related to the symptoms. When the pharmacological methods don’t result in any progress, surgical ones can be attempted. The most usual of these is a surgery to release the nerve from the muscle by cutting away a portion of it. Although these have been listed as conventional treatments which may be used to treat sciatica, alternative treatment options and secondary opinions should be considered before considering surgical interventions. Only when no other treatment has demonstrated any improvements, should surgery be considered by a patient.
The Role of Active Release Techniques for Sciatica
The active release technique, or ART, is a form of therapy that focuses on the manipulation of soft tissues, including nerves, fascia and muscles, so as to achieve relief of painful symptoms, in this case for sciatica. For sciatic nerve pain, ART is utilized to reduce spasm and remove adhesions of the muscle that may be entrapping the sciatic nerve. Since the adhesions are removed through specific manual methods, the nerve can slide under the soft tissues, and sciatica symptoms can solve relatively quickly. There are a range of things that a patient can do in order to increase the efficacy of the active release technique. Early start to treatment assists in long-term resolution of sciatica symptoms.
Dr. Alex Jimenez’s Insight
The active release technique, also known as active release therapy or ART, is a soft tissue treatment based on a series of movement and motion techniques utilized to relieve pain and discomfort as well as promote the healing of muscles, joints and nerves, among other soft tissues. When performed by a certified healthcare professional, including a chiropractor, ART can help break down adhesions which may have developed following scar tissue formation after a damaged or injured muscle has healed. The active release technique has become one of the most common therapy for soft tissue treatment.
ART therapy is usually provided by skilled therapists like chiropractors, who have to keep their accreditation through continuing education on a yearly suface. This treatment is a specialized procedure that needs quite a bit of expertise and skill so as to work and supply rapid results. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
Whiplash Injuries: If you have ever had to deal with the pain of whiplash, you know how it can impact every aspect of your life. Whiplash can cause chronic pain and keep you from doing many activities you enjoy. Daily tasks can be painful or even impossible to carry out. Even milder cases can make turning your head from side to side complex.
Chiropractic is a very effective treatment for whiplash injuries that helps with pain management and enables you to heal faster. Your chiropractor can recommend exercises you can do at home between treatments and other lifestyle changes that will facilitate your healing and improve flexibility.
Whiplash Injuries
What Is Whiplash?
Whiplash is a term that describes an injury that is typically focused on the neck and spine. It is caused when the head and neck are thrown in one direction unexpectedly and quickly, then thrust in the opposite direction. The head is rapidly whipped, usually front to back. It can be whipped from side to side, though.
Most people associate whiplash with car accidents, but even turning one way while a child tugs your arm in another direction can cause it. Anything that jerks your head suddenly can cause whiplash.
What Damage Does Whiplash Cause?
The damage that is caused by whiplash is called vertebral subluxation. This type of subluxation is caused by injury, and a chiropractor can diagnose the injury and treat it. It is the most common source of discomfort and pain caused by injuries due to whiplash. There are different kinds caused by tension and emotional stress, poor sleeping, lousy posture, weak muscles, and inadequate diet.
The injury from whiplash is in the neck and spine, but the pain can extend to the head, arms, shoulders, hips, and legs. You can experience frequent headaches, numbness, and tingling in your hands and have difficulty walking or moving about. The pain can range from stiffness and soreness to stabbing and sharpness. The injury can affect various nerves, causing blurred vision, dizziness, low back pain, ear ringing, and even problems with your internal organs.
Chiropractic Treatment For Whiplash
Chiropractors will use different techniques to relieve the pain of whiplash and help with healing.
Chiropractic Adjustment The chiropractor performs spinal manipulation to move the joints into alignment gently. This will help to align the body to relieve pain and encourage healing.
Muscle Stimulation and Relaxation This involves stretching the affected muscles, relieving tension, and helping them relax. Finger pressure techniques may also be combined with trying to alleviate pain.
McKenzie Exercises These exercises help with disc derangement that whiplash causes. They are first performed in the chiropractor’s office, but the patient can be taught how to do them at home. This helps the patient have some degree of control in their healing.
Each whiplash case is different. Instances of varying whiplash have various symptoms. A chiropractor will evaluate the patient and determine the appropriate treatment case-by-case basis. The chiropractor will determine the best course of treatment that will relieve your pain and restore your mobility and flexibility.
Whiplash can be far more severe than you may realize. Any accident that causes whiplash injuries can result in the vertebrae moving out of alignment. This can damage and irritate the spinal nerves. Even whiplash from years ago can still affect you if you never saw a chiropractor. Your spine can still be out of alignment, and injury or trauma from years ago can cause problems that seem unrelated.
Injury Medical Clinic: Accident Treatment & Recovery
Physicians, neurologists, and other healthcare professionals may often run a cranial nerve examination as part of a neurological evaluation to analyze the operation of the cranial nerves. This involves a highly formalized series of tests that evaluate the status of each cranial nerve. A cranial nerve test begins with observation of the patient partly due to the fact that cranial nerve lesions may ultimately affect the symmetry of the face or eyes, among other signs and symptoms.
The visual fields for neural lesions or nystagmus�are tested via an evaluation of particular eye movements. The sensation of the face is tested by asking patients to execute different facial movements, like puffing out their cheeks. Hearing is tested through voice and tuning forks. The position of the individual’s uvula is also examined because asymmetry in its placement could indicate a lesion of the glossopharyngeal nerve. After the capability of the individual to use their shoulder to test the accessory nerve (XI), the patient’s tongue operation is generally assessed by detecting various tongue movements.
Damage or Injury of the Cranial Nerves
Compression
Cranial nerves may be compressed due to increased intracranial pressure, a profound effect of an intracerebral haemorrhage, or tumour which presses against the cranial nerves and interferes with the communication of impulses along the length of a nerve. In some instances, a loss of functionality of one cranial nerve may on occasion be the first symptom of an intracranial or skull base cancer.
An increase in intracranial pressure can lead to dysfunction of the optic nerves (II) because of the compression of the surrounding veins and capillaries, resulting in swelling of the eyeball, known as papilloedema. A cancer, such as an optic glioma, can also affect the optic nerve (II). A pituitary tumour can compress the optic tracts or the optic chiasm of the optic nerve (II), causing visual field loss. A pituitary tumour may also extend into the cavernous sinus, compressing the oculuomotor nerve (III), the trochlear nerve (IV) and the abducens nerve (VI), often leading to double-vision and strabismus. These cranial nerves may also be impacted by herniation of the temporal lobes of the brain via the falx cerebri.
The cause of trigeminal neuralgia, where one side of the face experiences painful signs and symptoms, is believed to be due to the compression of a cranial nerve by an artery as the nerve exits from the brain stem. An acoustic neuroma, especially at the junction between the pons and medulla, may compress the facial nerve (VII) and the vestibulocochlear nerve (VIII), resulting in hearing and sensory loss on the affected side.
Stroke
Occlusion of blood vessels which supply the cranial nerves or their nuclei, or an ischemic stroke, might cause specific signs and symptoms which could localize where the occlusion happened. A clot in a blood vessel draining the cavernous sinus, also known as the cavernous sinus thrombosis, may affect the oculomotor (III), the trochlear (IV), and the opthalamic branch of the trigeminal nerve (V1) and the abducens nerve (VI).
Inflammation
Inflammation caused by an infection may impair the operation of any of the cranial nerves. Infection of the facial nerve (VII), for instance, can result in Bell’s palsy. Multiple sclerosis, an inflammatory process which can produce a loss of the myelin sheathes that encircle the cranial nerves, may cause a variety of shifting signs and symptoms which can ultimately affect multiple cranial nerves.
Other
Trauma to the skull, bone disease like Paget’s disease, and damage or injury to the cranial nerves through neurosurgery, by way of instance, through tumor removal, are other potential causes of cranial nerve health issues.
Dr. Alex Jimenez’s Insight
There are 12 pairs of cranial nerves which exit the brain, one in each side. These cranial nerves are named and numbered (I-XII) according to their location in the brain as well as their specific function in the body. Common conditions, such as multiple sclerosis, may affect one or more of the cranial nerves, resulting in dysfunction of the specific regions innervated by them. Signs and symptoms associated with health issues affecting specific cranial nerves can help healthcare professionals determine the source of the problem. Testing the cranial nerves involves a number of steps in order to be certain which function of the human body has been ultimately affected.
Clinical Significance of the Cranial Nerves
Most commonly, humans are believed to have twelve pairs of cranial nerves which have been assigned Roman numerals I-XII for identification. The numbering of the cranial nerves is based on the order in which they emerge from the brain, or from the front to the back of the brainstem. These include: the olfactory nerve (I), the optic nerve (II), the oculomotor nerve (III), the trochlear nerve (IV), the trigeminal nerve (V), the abducens nerve (VI), the facial nerve (VII), the vestibulocochlear nerve (VIII), the glossopharyngeal nerve (IX), the vagus nerve (X), the accessory nerve (XI), and the hypoglossal nerve (XII). Below we will narrow down the clinical significance of the cranial nerves.
Olfactory Nerve (I)
The olfactory nerve (I) communicates the sensation of smell to the brain. Lesions resulting in anosmia, or loss of the sense of smell, have been previously described to occur through trauma, damage or injury to the head, especially in the instance that a patient hits the back of their head. In addition, frontal lobe masses, tumors, and SOL have also been associated with the loss of the sense of smell. Healthcare professionals have previously identified that the loss of the sense of smell is one of the first symptoms seen in Alzheimer’s and early dementia patients.
Healthcare professionals may test the function of the olfactory nerve (I) by having the patient close their eyes and cover one nostril at a time in order to have them breathe out through their nose while placing a scent under the nostril and having them breathe in. The doctor will ask the patient, “do you smell anything?”, and record the findings. This tests whether the nerve is operating appropriately. If the patient says yes, the doctor will then ask the patient to identify the scent. This tests whether the processing pathway, known as the temporal lobe, is functioning accordingly.
Optic Nerve (II)
The optic nerve (I) communicates visual information to the retina. Lesions to this cranial nerve can be the result of CNS disease, such as MS, or CNS tumors and SOL. Most health issues associated with the visual system emerge from direct trauma, metabolic or vascular diseases. FOV lost in the periphery can also indicate that SOL may be affecting the optic chiasm, including a pituitary tumor.
A healthcare professional will often test the function of the optic nerve (II) by asking whether the patient can see. If the patient describes having vision in each eye, the optic nerve is functional. Doctors may also perform visual acuity testing using the Snellen chart, first one eye at a time, then the two eyes together, or they may perform distance vision testing. Near vision testing will often involve the Rosenbaum chart, first one eye at a time, then the two eyes together. Additional associated testing for the visual system can include, the ophthalmoscopic or funduscopic exam, which assess the A/V ratio and vein/artery health as well as assess cup to disc ratio of the visual system. Other testing methods include field of vision testing, intraoccular pressure testing and the iris shadow test.
Oculomotor Nerve (III), Trochlear Nerve (IV), and Abducens Nerve (VI)
The oculomotor nerve (III), the trochlear nerve (IV), the abducens nerve (VI) and the ophthalmic division of the trigeminal nerve (V1) travel through the cavernous sinus to the superior orbital fissure, passing out of the skull into the orbit. These cranial nerves control the tiny muscles that move the eye and also offer sensory innervation to the eye and orbit.
The clinical significance of the oculomotor nerve (III) includes diplopia, lateral strabismus (unopposed lateral rectus m.), head rotation away from the side of the lesion, a dilated pupil (unopposed dilator pupillae m.), and ptosis of the eyelid (loss of function of the levator palpebrae superioris m.). Lesions to the oculomotor nerve (III) can occur due to inflammatory diseases, such as syphilitic and tuberculous meningitis, aneurysms of the posterior cerebral or superior cebellar aa., and SOL in the cavernous sinus or displacing the cerebral peduncle to the opposite side. Testing this cranial nerve is performed by moving a light in front of the patient’s pupil from the lateral side and hold for 6 seconds. The doctor should watch for direct (ispilateral eye) and consensual (contralateral eye) pupillary constriction in order to distinguish dysfunction of the oculomotor nerve (III).
The clinical significance of the trochlear nerve (IV) is characterized where the patient presents diplopia and difficulty while maintaining a downward gaze, often complaining of having difficulties when walking down stairs, resulting in more frequent tripping and/or falling, followed by extortion of the affected eye (unopposed inferior oblique m.) and a head tilt to the unaffected side. Lesions to the trochlear nerve (IV) can commonly be the result of inflammatory diseases, aneurysms of the posterior cerebral or superior cerebellar aa., SOL in the cavernous sinus or superior orbital fissure and surgical damage during mesencephalon procedures. Head tilts in superior oblique palsy (CN IV failure) may also be identified.
The clinical significance of the abducens nerve (VI) includes diplopia, medial strabismus (unopposed medial rectus m.), and head rotation towards the side of the lesion. Lesions to this cranial nerve can be the result of aneurysms of the posterior inferior cerebellar or basilar aa., SOL in the cavernous sinus or 4th ventricle, such as a cerebellar tumor, fractures of the posterior cranial fossa, and increased intracranial pressure. Testing this cranial nerve is performed through the H-Pattern testing, where the healthcare professional will have the patient follow an object no bigger than 2 inches. It’s essential for the doctor to follow these specific guidelines as patient’s can have difficulties focusing on items that are too large, and it’s also important for the doctor not to hold the object too close to the patient. Convergence and accommodation testing is performed by bringing the object close to the bridge of the patient’s nose and back out at least 2 times. The physician must look for pupillary constriction response as well as convergence of the eyes.
Trigeminal Nerve (V)
The trigeminal nerve (V) is made up of three different parts: The . When put together, these nerves provide sensation to the skin of the face and also controls the muscles of mastication, or chewing. Cranial nerve dysfunction along any of the separate sections of the trigeminal nerve (V) can manifest as decreased bite strength on the ipsilateral side of the lesion, loss of sensation along the distribution of V1, V2, and V3, and loss of corneal reflex. Lesions to the trigeminal nerve (V) can be the result of aneurysms or SOL affecting the pons, particularly tumors at the cerebellopontine angle, skull fractures on the facial bones or damage to the foramen ovale, and Tic doloureux, most frequently referred to as trigeminal neuralgia, characterized by sharp pain along the distributions of the different parts of the trigeminal nerve (V). Physicians may utilize analgesic, anti-inflammatory or contralateral stimulation to control the signs and symptoms.
Testing the trigeminal nerve (V) includes pain & light touch testing along the ophthalmic (V1), the maxillary (V2), as well as the Mandibular (V3) nerves of the cranial nerve.�Testing is best done toward the more medial or proximal areas of
the face, where the V1, the V2 and the V3 are better delineated. A healthcare professional may also assess dysfunction along this cranial nerve using the blink/corneal reflex testing, performed by puffing air or doing a small tissue tap from the lateral side of the eye on the cornea. If normal, the patient blinks. The CN V provides the sensory (afferent) arc of this reflex. Bite strength may also be tested by having the patient bite down on a tongue depressor while the doctor tries to remove it. The jaw jerk/Masseter reflex may also be performed with the patient�s mouth slightly open, by placing the thumb on a patient�s chin and tapping the own thumb with a reflex hammer. Strong closure of the mouth indicates UMN lesion. CN V provides both the motor and sensory of this reflex.
Facial Nerve (VII) and Vestibulocochlear Nerve (VIII)
The facial nerve (VII) and the vestibulocochlear nerve (VIII) both input the inner auditory canal in the temporal bone. The facial nerve subsequently extends to the side of the face then distributes to control and reach all of the muscles in charge of facial expressions. The vestibulocochlear nerve reaches the organs which control equilibrium and hearing in the temporal bone.
As with all cranial nerves, signs and symptoms along the facial nerve (VII) describe the location of the lesion. Lesion in the lingual nerve will manifest as loss of taste, general sensation in the tongue and salivary secretion. Lesion proximal to the branching of the chorda tympani, such as in the facial canal, will result in the same signs and symptoms, without the loss of general sensation of the tongue, partly due because the V3 has not yet joined the facial nerve (VII). Corticobulbar innervation is asymmetric to the upper and lower parts of the facial motor nucleus. In the instance of an UMN lesion, or a lesion to the corticobulbar fibers, the patient will experience paralysis of the muscles in charge of facial expression in the contralateral lower quadrant. If there is an LMN lesion, or a lesion to the facial nerve itself, the patient will experience paralysis of the muscles of facial expression in the ipsilateral half of the face, otherwise known as Bell’s palsy.
A healthcare professional will test the facial nerve (VII) initially by asking the patient to mimic or follow specific instructions to make certain facial expressions. The doctor should make sure to evaluate all four quadrants of the face by asking the patient to raise their eyebrows, puff their cheeks, smile and then close their eyes tightly. Subsequently, the doctor will test the facial nerve (VII) by checking the strength of the buccinator muscle against resistance. The healthcare professional will achieve this by asking the patient to hold air in their cheeks as they press gently from the outside. The patient should be able to hold air in against the resistance.
Signs and symptoms of dysfunction in the vestibulocochlear nerve (VIII) often involve changes in hearing alone, most commonly as a result of infections in the otitis media and/or as a result of skull fractures. The most common lesion to this nerve is caused by an acoustic neuroma which affects the CN VII and the CN VIII, particularly the cochlear and vestibular divisions, as a result of proximity in the internal auditory meatus. Signs and symptoms of the health issue include nausea, vomiting, dizziness, hearing loss, tinnitus, and Bell’s palsy, etc.
Testing the vestibulocochlear nerve (VIII) for dysfunction commonly involves an otoscopic exam, the scratch test, which determines whether a patient can hear equally on both sides, the Weber test, tests for lateralization, a 256 Hz tuning fork placed on top of the patient�s head in the center, which can help point out whether a patient hears it louder on one side than the other, and finally the Rinne test, which compares air conduction to bone conduction. Normally, air conduction should last twice as long as bone conduction.
Glossopharyngeal Nerve (IX), Vagus Nerve (X) and Accessory Nerve (XI)
The glossopharyngeal (IX), the vagus nerve (X) and the accessory nerve (XI) all emerge from the skull to enter the neck. The glossopharyngeal nerve (IX) provides innervation to the upper throat and the back of the tongue, the vagus nerve (X) offers innervation to the muscles at the voicebox, and proceeds down to provide parasympathetic innervation to the chest and abdomen. The accessory nerve (XI) controls the trapezius and sternocleidomastoid muscles at the neck and shoulder.
The glossopharyngeal nerve (IX) is rarely damaged alone, due to it�s proximity to the CN X and XI. A healthcare professional should perform a test to look for signs of CN X & XI damage as well if CN IX involvement is suspected.
Patients with clinical signs and symptoms caused by vagus nerve (X) dysfunction may experience dysarthria, or difficulty speaking clearly, as well as dysphagia, or difficulty swallowing. These may present as food or liquid coming out of their nose or frequent chocking or coughing when eating and/or drinking. Further clinical presentations include hyperactivity of a visceral motor component, leading to the hypersecretion of gastric acid and resulting in ulcers. Hyper-stimulation of the general sensory component can cause coughing, fainting, vomiting and reflex visceral motor activity. The visceral sensory component of this nerve only provides general feelings of un-wellness but visceral pain may transfer on to the sympathetic nerves.
Testing for the glossopharyngeal nerve (IX) and the vagus nerve (X) can include the gag reflex, where the�CN IX provides the afferent (sensory) arc and the�CN X provides the efferent (motor) arc. Approximately 20 percent�of patients have a minimal or absent gag reflex. Other tests may include wwallowing, gargling, etc., as it requires CN X function. Healthcare professionals may also test palatal elevation because it requires CN X function. Furthermore, the doctor will see whether the palate elevates and uvula deviates
contralateral to damaged side. Finally, the healthcare professional will test the auscultation of the heart, since the R CN X innervates SA node (more rate regulation) and the L CN X the AV node (more rhythm regulation).
Lesions in the accessory nerve (XI)�may occur due to radical surgeries in the neck area, such as the removal of the laryngeal carcinomas. Testing for the accessory nerve (XI) may include the strength test SCM m. Patients with clinical signs and symptoms due to lesions in the accessory nerve (XI) will experience difficulties turning their head against the resistance of a healthcare professional, particularly toward the side opposite of the lesion. Testing for the accessory nerve (XI) may also include the strength test trapezius m. Patients with clinical signs and symptoms due to lesions in the accessory nerve (XI) will experience difficulties with shoulder elevation on the side of the lesion.
Hypoglossal Nerve (XII)
The hypoglossal nerve (XII) originates from the skull to reach the tongue in order to control essentially all of the muscles involved in the movements of the tongue. The clinical significance of health issues associated to the hypoglossal nerve (XII) can manifest as a deviating tongue towards the side of an inactive genioglossus m. upon tongue protrusion. This may often be contralateral to a corticobulbar, or UMN, lesion or from an ipsilateral to a hypoglossal n., or LMN, lesion.
Testing for the hypoglossal nerve (XII) involves the healthcare professional asking a patient to stick out their tongue. The doctor will look for any deviation which may signal a health issue along the length of the hypoglossal nerve (XII). Another test the doctor may perform as a part of the evaluation may include the physician asking the patient to place their tongue inside their cheek and apply light resistance, one side at a time. The patient should be able to resist moving their tongue with pressure.
The clinical significance of the signs and symptoms which manifest as a result of cranial nerve dysfunction are essential in order for the healthcare professional to properly diagnose the patient’s specific health issue. The clinical findings described above are often unique to the affected cranial nerve and the tests and evaluations for each can help confirm a diagnosis. Proper diagnosis is fundamental in order for the doctor to continue with the patient’s appropriate treatment. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
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