Back Clinic Sports Injury Chiropractic and Physical Therapy Team. Sports injuries occur when an athlete’s participation associated with a specific sport or physical activity leads to an injury or causes an underlying condition. Frequent types of sports injuries include sprains and strains, knee injuries, shoulder injuries, Achilles tendonitis, and bone fractures.
Chiropractic can help with injury prevention. Athletes from all sports can benefit from chiropractic treatment. Adjustments can help treat injuries from high-impact sports i.e. wrestling, football, and hockey. Athletes that get routine adjustments may notice improved athletic performance, improved range of motion along with flexibility, and increased blood flow.
Because spinal adjustments will reduce the irritation of the nerve roots between the vertebrae, the healing time from minor injuries can be shortened, which improves performance. Both high-impact and low-impact athletes can benefit from routine spinal adjustments. For high-impact athletes, it increases performance and flexibility and lowers the risk for injury for low-impact athletes i.e. tennis players, bowlers, and golfers.
Chiropractic is a natural way to treat and prevent different injuries and conditions that impact athletes. According to Dr. Jimenez, excessive training or improper gear, among other factors, are common causes of injury. Dr. Jimenez summarizes the various causes and effects of sports injuries on the athlete as well as explaining the types of treatments and rehabilitation methods that can help improve an athlete’s condition. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 540-8444.
Skateboarding is a popular activity among children, teenagers, and young adults. It is recreational, competitive, fun, and exciting but, like any sport, carries a risk of injury. There are around 70,000 skateboarding injuries requiring a visit to the emergency room every year. The most common injuries involve the shins, ankles, forearms, wrists, elbows, face, and skull, with many left untreated that worsen as they heal improperly, leading to further damages and complications. Chiropractic can treat the injuries, rehabilitate the muscles and joints, and strengthen the body to get the skater back on their board.
Skateboarding Injuries
Skateboarding injuries can range from scrapes, cuts, and bruises to sprains, strains, broken bones, and concussions.
Shin injuries often happen during flip/twist tricks where the board or axle hits the shin causing bruising and swelling.
Shoulder, wrist, and hand injuries are common when skaters lose their balance and fall with outstretched arms.
Ankle injuries include rolls/sprains, as well as dislocations and fractures.
Dislocations usually happen to the shoulders, wrists, and fingers.
Facial injuries include teeth knocked out, broken nose, or jaw are typically caused by fast forward hard falls.
Severe injuries include concussions and head injuries.
Injury causes
Skateboarding injuries typically occur from:
Skating on irregular surfaces locks up wheels and affects balance, causing falls.
Losing balance or losing control of the board and falling hard/slamming into the pavement.
Inexperience, slow reaction times, and less coordination lead to falls and slams.
Skating into another skater, a person walking or cycling, a car, or a road hazard.
Trying an advanced trick/maneuver too soon and beyond their skill level.
Help prevent further injuries and long-term effects.
Chiropractic Skateboarding Injury Treatment
References
Forsman, L, and A Eriksson. “Skateboarding injuries of today.” British journal of sports medicine vol. 35,5 (2001): 325-8. doi:10.1136/bjsm.35.5.325
Hunter, Jamie. “The epidemiology of injury in skateboarding.” Medicine and sport science vol. 58 (2012): 142-57. doi:10.1159/000338722
Partiali, Benjamin, et al. “Injuries to the Head and Face From Skateboarding: A 10-Year Analysis From National Electronic Injury Surveillance System Hospitals.” Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons vol. 78,9 (2020): 1590-1594. doi:10.1016/j.joms.2020.04.039
Shuman, Kristin M, and Michael C Meyers. “Skateboarding injuries: An updated review.” The Physician and sportsmedicine vol. 43,3 (2015): 317-23. doi:10.1080/00913847.2015.1050953
Wrestling is a sport that requires speed, strength, and endurance that involves intense physical contact, pushing and pulling the muscles, tendons, ligaments, and joints to their limits. Wrestlers’ are constantly contorting their bodies. Pushing the body to its limits increases the risk of developing wrestling injuries that include:
The most common injuries usually occur from forceful contact or twisting forces. And if a wrestler has been injured, there is an increase for re-injury. Wrestling tournaments typically take place over days, often with back-to-back matches, which significantly fatigues the body and increases injury risk. The most common wrestling injuries include:
Muscle strains of the lower extremities and/or the back.
Chronic problems can result from hours in the forward stance posture and repetitive motions.
Dislocations and sprains of the elbow or shoulder from take-downs.
Cauliflower ear – is a condition that can cause ear deformity and develops from friction or blunt trauma to the ears.
Skin infections occur from constant contact, sweating, bleeding, and rolling on the mats. Infections include herpes gladitorium, impetigo, folliculitis, abscesses, and tinea/ringworm.
Concussions are usually caused by hard falls/slams or violent collisions with the other wrestler.
Injuries can cause wrestlers to alter/change their technique, exacerbating the existing damage and potentially creating new injuries.
Chiropractic Rehabilitation and Strengthening
There can be a variety of pain generators/causes when it comes to wrestling injuries. Joints and muscles can get overstretched, muscles can spasm, and nerves can become compressed and/or irritated. For example, a neck muscle spasm could be caused by nerve irritation from a shifted vertebrae. To determine the specific cause or causes of the injury/pain, a detailed chiropractic examination will be performed that includes:
Range of motion testing
Ligament tests
Muscle palpation
Gait testing
Injuries often relate to the proper weight, neuromuscular control, core strength, proper technique, hygiene, and hydration management. Successful treatment depends on identifying the root cause of the wrestling injury. Chiropractic restores proper alignment through massage, specific manual adjustments, decompression, and traction therapies. Adjustments can include the back, neck, shoulder, hips, elbows, knees, and feet. Once correct body alignment is achieved, rehabilitative exercises and stretches are implemented to correct and strengthen muscle function. We work with a network of regional medical doctors specializing in referral situations and strive to return the athlete to their sport as soon as possible.
Wrestling Match
References
Boden, Barry P, and Christopher G Jarvis. “Spinal injuries in sports.” Neurologic clinics vol. 26,1 (2008): 63-78; viii. doi:10.1016/j.ncl.2007.12.005
Referred pain is the interpretation of feeling pain in a different location than the actual cause. For example, a pinched nerve in the spine/back causes pain not to show up not where it is pinching but further down in the buttock, leg, calf, or foot. Similarly, a pinched nerve in the neck could translate to shoulder or elbow pain. Referred pain is often caused by the muscles overcompensating weaker ones, like feeling pain outside the knee, with the actual injury stemming from hip joint dysfunction caused by weakened lateral hip muscles. The athletic referred pain could have been brought on by an acute sports injury, an overuse injury from the repetitive motion/s.
Athletic Referred Pain
Somatic referred pain originates from the muscles, skin, and other soft tissues and is not to be confused with visceral pain, which refers to the internal organs/viscera. However, the pain presents in regions supplied by the same nerve roots. Damaged or injured body structures can cause referred pain. This includes the muscles, nerves, ligaments, and bones.
Common Sites
Individuals can experience referred pain almost anywhere. Athletic referred pain commonly occurs in these areas:
The neck and shoulder where pain can be felt in the elbow, arm, and hand or cause headaches.
The back where pain can be felt in the hips, buttocks, and thighs.
The hip/s area, where pain can be felt in and around the low back and abdominal regions.
The groin, where pain can be felt in and around the abdominal region.
Problems with the vertebral discs, nerve root compression, muscle spasms, osteoarthritic changes, spinal fracture, or tumor/s can affect the body’s ability to transport sensory information, which can cause strange sensations and weakness of muscle tissues, and sometimes problems with coordination and movement. Part of an accurate diagnosis is knowing the patterns of referred pain in all the muscles and internal organs.
Pain Activation
Many nerve endings come together and share the same nerve cell group in the spinal cord. When signals travel through the spinal cord to the brain, some signals follow the same path as the pain signals from a different body part. Pain awareness is felt in a deeper center of the brain known as the thalamus, but the sensory cortex determines the perception of where the pain is coming from and the location of the pain. The intensity and sensation of the athletic referred somatic pain vary for different structures and depend on the inflammation level. For example:
Nerve pain tends to be sharp or shooting.
Muscle pain tends to be a deep dull aching or a burning sensation.
However, muscles can give a sensation of tingling where referred pain is presenting, but tingling is more commonly associated with a nerve injury.
Diagnosing referred pain injuries can be complex as there are various areas where the pain can show up. The source of damage needs to be identified; otherwise, achieving lasting pain relief will not last. A biomechanical analysis can help to find movement/motion patterns that may be causing pain and help identify the source.
Treatment
Athletic performance and spinal health are interconnected. Chiropractic treatment involves whole-body wellness that involves the spine and nervous system. Routine chiropractic care relieves neck, shoulder, arm, back, leg, and foot conditions/injuries and helps prevent disorders of joints and muscles. It calms the mind, provides pain relief, and educates individuals on being more aware of the body. Chiropractic adjustments improve blood flow and nerve function to increase agility, reaction times, balance, strength, and expedited healing of the body.
DRX9000 Decompression
References
Kapitza, Camilla, et al. “Application and utility of a clinical framework for spinally referred neck-arm pain: A cross-sectional and longitudinal study protocol.” PloS one vol. 15,12 e0244137. 28 Dec. 2020, doi:10.1371/journal.pone.0244137
Murray, Greg M. “Guest Editorial: referred pain.” Journal of applied oral science: Revista FOB vol. 17,6 (2009): i. doi:10.1590/s1678-77572009000600001
Weller, Jason L et al. “Myofascial Pain.” Seminars in neurology vol. 38,6 (2018): 640-643. doi:10.1055/s-0038-1673674
Wilke, Jan, et al. “What Is Evidence-Based About Myofascial Chains: A Systematic Review.” Archives of physical medicine and rehabilitation vol. 97,3 (2016): 454-61. doi:10.1016/j.apmr.2015.07.023
Bicycling at any level is excellent healthwise, but the specific physical repetitive motions and postures can wear on a cyclist’s body, causing strains and injury to the:
Muscles
Ligaments
Tendons
Nerves
Spine
Injuries can be caused by falls, overused muscles, joints, posture, and/or balance problems, whether riding a bicycle for fun, health, or sport. Chiropractic decompression can treat cycling-related injuries and help prevent common injuries by helping cyclists with conditioning and exercises. Chiropractic adjustments, combined with health coaching and nutrition planning, can maximize the body’s overall athletic ability and increase/improve:
Many cyclists suffer from back pain overuse injuries that are caused by:
Incorrect saddle/seat height or an uneven seat/saddle
Not bending the knee at the end of a pedal stroke forces the cyclist to rock the pelvis side to side to generate enough power, placing added stress on the low back muscles.
Handlebars that are too far forward can cause over-stretching of the spine.
Constantly tilting the head can cause neck and shoulder pain.
Staying in the same position for an extended period strains the spine.
Repetitive hip flexion causes the muscles to become tight and perform less efficiently, straining the rest of the body to make up for the lost support.
Hamstrings that become tight can shorten in length, causing the body to pull on the pelvis and the spine.
Lack of core strength allows more stress to penetrate the glutes, back, and hips.
Riding on bumpy or rough terrain increases body jarring and spinal compression.
Chiropractic Decompression
Chiropractic decompression for cyclists can rehabilitate the body from injuries, alleviate pain, improve blood and nerve circulation and maintain the body’s flexibility. Advanced decompression techniques personalized to the individual realign and release the body from obstructions and toxins in the neural pathways. Nutritional and supplementation recommendations are incorporated to enhance the body’s natural healing abilities, and exercise/stretches to sustain the adjustments.
Spinal Decompress
References
Schultz, Samantha J, and Susan J Gordon. “Recreational cyclists: The relationship between low back pain and training characteristics.” International journal of exercise science vol. 3,3 79-85. 15 Jul. 2010
Silberman, Marc R. “Bicycling injuries.” Current sports medicine reports vol. 12,5 (2013): 337-45. doi:10.1249/JSR.0b013e3182a4bab7
Streisfeld, Gabriel M et al. “Relationship Between Body Positioning, Muscle Activity, and Spinal Kinematics in Cyclists With and Without Low Back Pain: A Systematic Review.” Sports health vol. 9,1 (2017): 75-79. doi:10.1177/1941738116676260
Thompson, M J, and F P Rivara. “Bicycle-related injuries.” American family physician vol. 63,10 (2001): 2007-14.
Golfing Back Injuries: Golf is an enjoyable game that can be played at all ages. It involves the foundation of the body’s range of motion, the spine. Because of the repetitive nature of a golfer’s unique swing, the repetitive rotating/twisting of the spine slowly degrades the integrity of the spinal discs causing them to bulge, herniate, or rupture. The slightest shift causing misalignment can leave the spine vulnerable to further injury. Non-surgical motorized decompression combined with chiropractic musculoskeletal adjustments can restore and maintain optimal health.
Golfing Back Injuries
Golfing involves muscle memory. Going through the walk, bending to tee the ball, recoiling for the swing, swinging and following through, walking to the hole, and bending down to retrieve the ball are all repetitive motions that can lead to:
Soreness
Inflammation
Back, hip, leg, and foot pain.
Strains
Other injuries to the muscles and discs.
The bending and twisting are the least tolerated motions by the spine. More than half of injuries sustained involve the back and/or neck. Having the spine correctly aligned is vital to retaining accuracy, power, and injury prevention. Common injuries include:
Sacroiliac Joint/SI Joint Dysfunction
The sacroiliac joint is located between the spine and the hip. Symptoms of sacroiliac joint pain include:
Low back pain.
Hip pain
Pain in the buttocks.
Pain radiating down the legs.
Groin pain
Pelvis pain
Burning sensation in the pelvis.
Numbness and weakness in the pelvis and legs.
SI Joint Pain Causes
The sacroiliac joint requires supported stability when transferring a load from the torso to the legs, specifically during the swing.
If there is compression, misalignment, or weakness, the motion will begin to wear away this stability and leave the sacroiliac joint open to further injury.
Sacroiliac joint injuries often occur from minor multi-incidents and not one major trauma.
With time the SI joint becomes misaligned, exposing the cartilage between joints, causing inflammation known as Sacroiliitis.
Facet Joint Syndrome
The facet joints are located between two vertebrae, allowing the ability to bend and twist.
Healthy facet joints have cartilage all around them, allowing the vertebrae to move smoothly in all directions.
Facet joint syndrome causes pain between the vertebrae.
Facet Joint Syndrome Causes
The leading cause of facet joint syndrome is excessive and repetitive swing movement.
Misalignment can expose and irritate the joints, causing pain, swelling, and inflammation.
Multi-micro-traumas and not one major trauma are often the cause of injury/s.
Muscle spasms are common.
Symptoms
Highly reduced range of motion
Muscle pain
Numbness
Weakness
Cervical Facet Syndrome affects the neck, shoulders, arms, and hands.
Lumbar Facet Syndrome affects the buttocks, legs, and feet.
The treatment is computer-controlled to provide gentle and painless decompression.
The therapist enters the program cycle.
The decompression table goes through brief moments of pulling and relaxing.
The spine’s bones are stretched slowly and methodically.
As the vertebrae are separated, a vacuum is formed, pulling the gel-cushion center of the disc back inside, removing the pressure on the spinal nerves and alleviating pain and disability.
The vacuum also draws oxygen and nutrients into the injured and degenerated discs to optimize healing.
DRX 9000
Long Term Success
References
Cole, Michael H, and Paul N Grimshaw. “The Biomechanics of the Modern Golf Swing: Implications for Lower Back Injuries.” Sports medicine (Auckland, N.Z.) vol. 46,3 (2016): 339-51. doi:10.1007/s40279-015-0429-1
Dydyk, Alexander M., et al. “Sacroiliac Joint Injury.” StatPearls, StatPearls Publishing, 4 August 2021.
Hosea, T M, and C J Gatt Jr. “Back pain in golf.” Clinics in sports medicine vol. 15,1 (1996): 37-53.
Lindsay, David M, and Anthony A Vandervoort. “Golf-related low back pain: a review of causative factors and prevention strategies.” Asian journal of sports medicine vol. 5,4 (2014): e24289. doi:10.5812/asjsm.24289
Smith, Jo Armour, et al. “Risk Factors Associated With Low Back Pain in Golfers: A Systematic Review and Meta-analysis.” Sports health vol. 10,6 (2018): 538-546. doi:10.1177/1941738118795425
Sports chiropractic athletes: A sports chiropractor is a specialist that works with athletes to improve their performance. These doctors specialize in assessing and treating sports injuries. Treatment also prevents future damage/injury by providing a customized rehabilitation, strengthening, flexibility, and mobility program, that includes:
Exercise prescription
Ergonomic recommendations
Health coaching/counseling
Therapeutic sports massage
Sports chiropractic deals with preventing, diagnosing, and treating sports-athletic-based injuries to muscles, tendons, ligaments, and joints. Sports chiropractors have extensive training in evaluating muscular-skeletal problems related to sports participation overuse. Diagnosis is acquired through:
Chiropractors are masters of the human body and trained to use advanced diagnostics tools. A sports chiropractor evaluates individuals from all levels of sports and fitness, including:
Athletes – professional or recreational
Weekend warriors
Military personnel
The objective is to identify musculoskeletal problems related to sporting activity or overuse, alleviate pain, rehabilitate, and strengthen to prevent future injury. They can diagnose and treat sports-related injuries from common overuse injuries like:
Hip pain from frequently running on pavement.
Shoulder pain from damage caused by continued overhead throwing or hitting.
Low back and leg issues from twisting, bending, jumping, and reaching.
Balance
Athletes need a healthy balance of endurance, strength, and structure. Through biomechanics training, sports chiropractic restores the body’s natural balance and proper function. The goal is to get the athlete re-engaged and protected against further injury and play without any problems or limitations. Sports chiropractic athletes can return in a short amount of time from injuries that include:
Torn ACLs
MCL Sprain
Ankle Sprain
Achilles Tendonitis
Rotator cuff tears
Quadriceps Strains
Hamstrings Strains
Shin Splints
Sports Hernia
Neck Pain
Back Pain
Spondylolisthesis
Prevention Regimen
They can recommend prevention programs to prevent potential problems before an athlete gets hurt. A chiropractor will detect developing muscle imbalances before they turn into a chronic condition that can lead to damage to the rest of the body. Additional therapies include:
Massage
Hot/cold treatments
Ultrasound therapy
Low-level laser therapy
Adjustments, stretching, core training, therapeutic sports massage, health coaching, and nutritional counseling will strengthen the body, allowing for performing physical activities and sports at optimum levels.
Body Composition
Sports Performance
Working with sports chiropractic athletes means achieving a balance of lean mass to maintain sports performance and reduce the risk of injury. Athletes, doctors, and trainers monitor gains over time to maximize performance and watch for signs of potential injury. A method of monitoring for potential injury is the ECW/TBW Analysis. When training and engaging in sports, the body is under physical stress. The proper amount of rest and recovery are needed to allow muscles to recover and regrow. Inflammation is reflected in the ECW/TBW by monitoring changes over time. A steady increase can indicate a sign of overtraining or improper recovery. Monitoring this progression can alert doctors and trainers that an athlete needs a less intense workout or longer recovery to reduce the potential for overtraining injury.
References
Corcoran, Kelsey L et al. “Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis.” Pain medicine (Malden, Mass.) vol. 21,2 (2020): e139-e145. doi:10.1093/pm/pnz219
Naqvi U, Sherman Al. Muscle Strength Grading. [Updated 2021 Sep 2]. In: StatPearls [Internet]. Treasure Island (F.L.): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK436008/
Nelson, Luke et al. “A descriptive study of sports chiropractors with an International Chiropractic Sports Science Practitioner qualification: a cross-sectional survey.” Chiropractic & manual therapies vol. 29,1 51. 13 Dec. 2021, doi:10.1186/s12998-021-00405-1
Williams, Sean et al. “Kinesio taping in treatment and prevention of sports injuries: a meta-analysis of the evidence for its effectiveness.” Sports medicine (Auckland, N.Z.) vol. 42,2 (2012): 153-64. doi:10.2165/11594960-000000000-00000
Leg spasms and cramps are common conditions where the muscles in the leg suddenly become tight and painful. They present with no warning and can cause excruciating and debilitating pain. They usually occur in the calf muscles but can affect any area of the leg, including the feet and thighs. After the cramping has passed, pain and tenderness can remain in the leg for several hours. Although many leg spasm episodes go away by themselves, they can disrupt normal activities, exercise regimens, and sleep if they continue and are left untreated.
Leg Spasms and Symptoms
A leg spasm is a sudden, sharp contraction or tightening of a muscle in the leg. This can last a few seconds to a few minutes. Muscle cramps anywhere in the body cause sudden contraction of the muscle. This is an involuntary function and can include the following symptoms:
Soreness and discomfort can be mild to extreme.
Muscle tightening.
Hardening of the muscle.
Twitching of the muscle.
Pain.
Leg spasms are typically brief and go away on their own, but individuals are recommended to seek treatment if they are frequently experienced or last for extended periods.
Causes
Dehydration
Dehydration is a common cause of leg spasms and pain.
Lack of fluids can cause the nerve endings to become sensitized, triggering muscle contractions.
When the body sweats, it loses water and electrolytes.
When the body is low on electrolytes
Imbalances in:
Sodium
Calcium
Magnesium
Potassium
It can affect nerve transduction and lead to muscle spasms.
Hypothyroidism
If the body does not produce sufficient thyroid hormone, this is known as hypothyroidism.
Over time, this deficiency can damage the nerves that send signals from the brain and spine to the legs.
Tingling, numbness, and frequent cramping can result.
Spinal Misalignment
Spinal misalignment can compress nerve roots that run down the leg.
This can cause radiating leg pain and spasms, specifically in the back of the thigh.
Muscle and Connective Tissue Injuries
Injuries like tears, strains, and sprains can lead to leg spasms and frequent cramping.
Pregnancy
In the second and third trimesters of pregnancy, calcium and magnesium deficiency are common and can lead to leg spasms and cramps.
Treatment
The proper course of treatment for leg spasms depends on the severity and underlying cause/s. A chiropractor can identify the cause and develop a personalized treatment plan to relieve and eliminate leg cramps.
Chiropractic
Misalignments can compress the nerve roots radiating from the spine to the legs.
This can lead to radiating leg pain and/or leg spasms.
Realignment through chiropractic can relieve the pressure on compressed nerve roots, alleviating leg discomfort and pain.
A chiropractor will also recommend exercises and stretches to strengthen the legs and core muscles.
Physical Therapeutic Massage
A physical therapist will use various massage techniques to relax the leg muscles to prevent and reduce the severity of spasms.
Massage therapy will relieve any inflammation that accompanies leg spasms, decreasing pain and swelling in the area.
As a part of the treatment plan, a health coach will evaluate the individual’s diet and suggest changes that will help address any nutritional deficiencies contributing to leg spasms and cramps.
Body Composition
Track Inflammation and Fluid Imbalances From Injury or Surgery
Inflammation can occur with little to no visible symptoms following surgery or injury. Precision measurement of body water can detect water retention and inflammation to aid rehabilitation treatment. InBody effectively distinguishes water in the following compartments that comprise total body water.
Intracellular-ICW-within the tissues.
Extracellular-ECW-within the blood and interstitial fluids.
The Edema Index can be used to detect fluid imbalances resulting from inflammation from injury or recovery after surgery.
Assessing fluid balance in the body and specific segments can help identify inflammation and guide treatment to reduce the risk of re-injury or post-surgery complications. These measurements are provided for the whole body and can determine where fluid imbalances may be occurring for more precise analysis.
References
Araújo, Carla Adriane Leal de et al. “Oral magnesium supplementation for leg cramps in pregnancy. An observational controlled trial.” PloS one vol. 15,1 e0227497. 10 Jan. 2020, doi:10.1371/journal.pone.0227497
Garrison, Scott R et al. “Magnesium for skeletal muscle cramps.” The Cochrane database of systematic reviews vol. 2012,9 CD009402. 12 Sep. 2012, doi:10.1002/14651858.CD009402.pub2
Kang, Seok Hui et al. “Clinical Significance of the Edema Index in Incident Peritoneal Dialysis Patients.” PloS one vol. 11,1 e0147070. 19 Jan. 2016, doi:10.1371/journal.pone.0147070
Luo, Li et al. “Interventions for leg cramps in pregnancy.” The Cochrane database of systematic reviews vol. 12,12 CD010655. 4 Dec. 2020, doi:10.1002/14651858.CD010655.pub3
Mekhail, Nagy et al. “Long-term safety and efficacy of closed-loop spinal cord stimulation to treat chronic back and leg pain (Evoke): a double-blind, randomized, controlled trial.” The Lancet. Neurology vol. 19,2 (2020): 123-134. doi:10.1016/S1474-4422(19)30414-4
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