by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic
Fibromyalgia, a chronic disease that causes pain and swelling in more than a dozen points all over the body, affects as many as 5 million people. Because doctors are still unsure of the cause of fibromyalgia, treatment can be frustrating (and often a process of trial and error).
�Fibromyalgia symptoms are only about 30% amenable to current pharmaceutical strategies on the market,� says Kathleen Holton, PhD, MPH, lead author of Potential Dietary Links in Central Sensitization in Fibromyalgia.
That�s why many patients are taking matters into their own hands and experimenting with alternative treatments, including dietary changes. Forty-two percent of fibro patients reported that symptoms worsened after eating certain foods, and though much of the research is in its preliminary phases, there�s some evidence that simple diet tweaks may ease fibro pain.
Read on to get 5 food rules for fibromyalgia patients (just be sure to consult your doctor before drastically changing your diet).
Load up on vitamin D
Many adults are deficient in vitamin D�to begin with, but this sunshine vitamin can be vital to fibro patients. “Vitamin D deficiency can mimic some of the symptoms of fibromyalgia. All patients should be screened for deficiency,” says Holton. Studies show that vitamin D deficiencies can cause bone and muscle pain, and upping levels of this hard-to-get vitamin may help. A 2008 study found that pain patients with low levels ofvitamin D required almost double the dose of painkillers as those with adequate levels. Holton recommends taking a supplement, especially during the wintertime.
Avoid additives
Common food additives, like monosodium glutamate (MSG) and aspartame, can act as excitotoxin molecules, a chemical group that has the ability to activate neurons that increase sensitivity to pain. Anecdotally, easing off these additives can help, and one very small study of four patients found that eliminating MSG and aspartame resulted in a reduction of fibromyalgia symptoms. The research is far from definitive, but it may be worth trying if you notice your symptoms worsen after Chinese takeout or too many diet drinks.
Say yes to fish
Omega-3 fatty acids, found in fatty fish, like salmon, walnuts, and flaxseed, are known to reduce inflammation and help prevent cardiovascular diseases. However, their soreness-reducing traits may also help pain patients. A 2007 study found that after just 3 months of supplementing omega-3 fatty acids, symptoms such as morning stiffness and painful, tender joints decreased. Though this study did not include fibromyalgia patients (it included rheumatoid arthritis (RA), irritable bowel syndrome (IBD), and dysmenorrheal patients), the results show promise. Fibro patients often have co-morbidities such as IBD and RA, so omega-3s may benefit them as well. Try adding salmon or walnuts to your diet, or, if you don�t like those foods, try adding flaxseeds to your cereal or oatmeal.
Nix the caffeine
Because sleeplessness is commonly associated with fibro, it may be tempting to fuel up on coffee to get through the day. This, however, may be a mistake. “Some patients use caffeine to compensate for not sleeping well, which can lead to a circular problem where the �solution� of taking caffeine to stay awake is actually causing the problem of not sleeping at night,” says Holton. Caffeine can set you up for a crash and, if sipped later in the day, may disrupt sleep schedules. Holton recommends antioxidant-packed decaffeinated green tea as a healthier alternative.
Veg out
Some researchers speculate that oxidative stress may be a cause of fibro symptoms. Oxidative stress occurs when the body doesn�t produce enough antioxidants to battle cell-damaging free radicals in the body. Most fruits and veggies are packed with important antioxidants, like vitamins A, C, and E, which fight free radicals to keep your body normalized. Certain studies also show a raw, vegan diet can improve symptoms, but that�s difficult for most people to follow. If you do choose to eat meat, though, opt for a small portion of grass-fed beef. “It is an excellent source of iron and vitamin B12, both nutrients which are extremely important in keeping your pain-processing nervous system healthy,” says Holton.
Sourced through Scoop.it from: www.prevention.com
Fibromyalgia can cause symptoms of pain and discomfort along with fatigue and concentration issues. Living with the condition can be difficult, however, there are many alternative treatment options, such as chiropractic, which can help people with the condition, find relief from their symptoms. In addition, following a balanced diet and the proper nutrition can help speed up the process of relief.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic, Scoop.it
Fibromyalgia is a widespread condi�tion. Some investigators estimate as many as 2% of the general population in the United States suffers from FM, with women affected 10 times more than men.1 With the combination of symptoms faced by the FM patient, finding the solution to this problem is a tough task.
Medical science is yet to discover the cause for this condition. Because there are so many different symptoms associated with fibromyalgia, there are just as many theories for what causes it. Since those with FM often experience an altered mood � such as depression � many experts focus on the psychologi�cal aspect of the disease. Others feel that FM is more a physiological entity, and has its origins in physical trauma or chronic postural alterations. Some suggest that FM is a central nervous system disorder, with imbalances in neurochemicals � since those with FM are hypersensitive to even the slightest stimuli. They often have a pain response to normally non-painful pressure or activity. It�s not out of the question that a combination of psycho�logical and physical triggers can result in the onset of many of FM symptoms.
Chiropractors often offer their skills to FM patients, hoping to relieve some of their symptoms. In fact, evidence suggests that those with FM consult with chiropractors quite regularly. According to a study conducted at a tertiary Mayo Clinic, 37% of the 300+ FM patients surveyed had visited a chiropractor in the previous 6 months.
But does chiropractic work for them? Some recent studies indicate it does. In one example, chiropractors surveyed FM patients before, during and after a series of treatments to see if they responded favorably to chiroprac�tic adjustments combined with a specific soft tissue technique known as ischemic compression. In this prelimi�nary study, 60% of the subjects who were treated with this protocol experi�enced a significant improvement � with respect to pain reduction, improved sleep and decreased fatigue. What was especially encouraging was the improvements were reported to be maintained in a 1-month follow up.3 Although pure scientific research on the chiropractic treatment of fibromyal�gia is lacking, some early studies are showing that chiropractors could help improve these patients� quality of life.4 Chiropractors are trained as neuromus�culoskeletal specialists, and one of the main focuses of chiropractic care is the positive effects it can have on a person�s nervous system. Since all information from the outside world is collected and analyzed by the nervous system, it�s logical to assume that if a person with FM is sensitive to a stimulus that others are not, there may be something wrong with this system.
Vertebral subluxations are focal areas of spinal restriction and/or malposition. When present, these lesions can not only irritate the nerves that exit the spine (peripheral nervous system), but the irritation caused by subluxations will also feed back into the brain (central nervous system). Information from the joints of the spine is passed on to an important structure in the brain called the cerebellum. This part of the brain has been known traditionally to be important for body awareness, balance and coordination. However, more recent studies have shown the cerebellum to be intimately involved with maintaining proper cognitive function and playing a significant role in emotional stability. Therefore, irritation of the joints in the spine caused by vertebral subluxation may be linked to any of the symptoms associ�ated with fibromyalgia.
More studies are needed to show the positive effects that chiropractors can have with FM patients. However, having chiropractic care alongside other traditional treatment methods (including exercise, massage techniques and cognitive behavioral therapy5) is likely to give these patients a better chance for recovery.
Sourced through Scoop.it from: www.upchiro.com
Fibromyalgia is a chronic disorder involving widespread pain and sensitivity in the entire musculoskeletal system. In addition to pain, patients also report long-term fatigue, and/or disturbed sleep and mood. Other disorders commonly associated with FM may include: irritable bowel syndrome, TMJ pain and dysfunction, psychological condi�tions and some autoimmune diseases.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic, Scoop.it
A new study from Egypt reports that chiropractic care can be an effective treatment strategy for fibromyalgia treatment with chiropractic care.
The study involved 120 people between the ages of 40 and 65 who had suffered with severe fibromyalgia for four years or more. Each person rated their pain as a 4 or higher on a pain scale and also had limited movement in their cervical (neck area) spine, specifically in their C1-C2 area.
Treatment Study
All of the individuals participating in this study engaged in 12 weeks of therapy which included:
- An education program (one two-hour session per week) designed to provide the participant with more information about fibromyalgia and available treatment options;
- Cognitive behavioral therapy (one two-hour session per week) which involved discussion regarding pain management via relaxation exercises, challenging treatment-prohibitive beliefs about fibromyalgia, and positive reinforcement about what types of actions can be taken to ease fibromyalgia symptoms; and
- An exercise program (three one-hour sessions per week plus 20-minute session twice daily at home) which included relaxation techniques, as well as active and passive stretches.
One-half of the individuals were also randomly assigned to a treatment group, which meant that they also engaged in upper cervical chiropractic adjustments. This involved a high-velocity, low-amplitude thrust to the C1-2 motion segment three times per week for the first month. This was then reduced to once a week sessions for the remaining eight weeks.
Conclusion of Study
At the beginning of the study, the conclusion of the study, and at one year post-study, each participant was asked to complete various questionnaires to help the researchers determine what effect, if any, the chiropractic had on easing fibromyalgia symptoms and reducing its impact on their lifestyle. Specifically, questions were asked regarding physical function abilities, work days missed due to fibromyalgia symptoms, sleep disturbances, level of pain, fatigue, depression, and anxiety.
The individuals who participated in the cervical chiropractic care group showed more improvement and better results than the control group who had no chiropractic intervention. This was validated by questionnaire scores that improved by 15 or more percent. The researchers concluded that adding chiropractic to your current fibromyalgia treatment regimen may offer even more benefits when it comes to getting to the root off the problem.
Sourced through Scoop.it from: www.chironexus.net
Fibromyalgia is a painful condition which affects the primary nerves of the body, present in a wide number of the population. There are several available treatment options for the condition but recent studies have concluded, chiropractic treatment can benefit fibromyalgia sufferers. From spinal adjustments to manual manipulations, chiropractic care can provide relief from the painful symptoms of the condition.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Auto Accident Injuries, Migraines, Neck Pain, Personal Injury, Posture, Scoop.it
Whiplash is the common result of a traffic collision. While the symptoms for this type of injury usually ease on their own without the need of specific treatment, it is suggested to manage the natural mobility of the neck and seek medical attention immediately. In many instances, people will turn to the use of painkillers to ease the pain but these only disguise the problem temporarily as they don�t directly treat the issue.
Whiplash-associated injuries are the result of a sudden, back-and-forth motion of the head as a result of an extreme force acting against the body. Because of the force from the impact of a car crash, the muscles, ligaments and other complex tissues found within the neck can stretch, or sprain, beyond the normal range, occasionally causing tears.
Symptoms of Whiplash
Since the symptoms of whiplash often manifest immediately after the auto accident, for some individuals, these can take up to several days, weeks, even months to develop. The common symptoms for whiplash include: pain and discomfort along with stiffness in the neck, usually worsening with each day, pain and stiffness may also be felt in the shoulders, down the arms, and in the upper and/or lower area of the back; turning or bending the neck may be difficult and painful; headaches; dizziness, blurred vision, pain in the jaw or pain when swallowing and abnormal sensations along the skin of the face; and finally, some individuals may experience fatigue and can have irritability and difficulty concentrating.
The appearance of any of these symptoms could indicate the presence of a whiplash-associated injury. It�s important to seek medical attention as soon as possible to receive a proper diagnosis and determine the true cause of the symptoms. If any of the above mentioned symptoms persist, be sure to tell a doctor immediately.
Who Can Get Whiplash?
Neck sprains, or whiplash, are actually significantly common. Many individuals who experience an undesired and unexpected automobile accident develop symptoms of neck pain with or without other injuries. It�s been previously concluded that women tend to be more prone than men to suffer from whiplash-associated injuries as the structures of their body can be relatively different.
After being involved in a minor auto collision where the vehicle only experienced minimal damage, many people are often surprised to still have developed symptoms of whiplash. Including slow vehicle bumps may cause a sufficient enough jerking motion of the neck to cause symptoms.
Although more uncommon, a whiplash-associated injury can also occur as a result of a sports injury or from strenuous physical activity. Some people have also reported injury from an everyday activity where the neck is suddenly jerked after a trip or fall.
Diagnosing Whiplash
A healthcare specialist who focuses and emphasizes in auto accident injuries is most qualified to diagnosing the presence of whiplash from the description of the incident, the symptoms the individual may be experiencing and through a careful evaluation. Because whiplash is a soft-tissue injury, many doctors may be unable to make a clear diagnosis, however, some healthcare specialists are specifically trained to identify whiplash. A careful examination of the structures of the neck, back, shoulders and arms can help determine if there�s been damage or injury to the spine or to the spinal cord or spinal nerves. Further tests may be recommended.
Treatments for Neck Sprains
First of all, the individual must continue to stay active and appropriately stretch and/or exercise their neck. The goal is to keep moving the neck as normally as possible. Initially, the symptoms may be painful and the individual may require some time to rest their neck. Nonetheless, gently exercising the neck as soon as the individual is able to can help. It�s important to now allow the structures of the neck to stiffen up and become tight.
The individual can also gradually increase the range of motion in their neck. Every few hours, gentle movements of the neck in each direction, several times a day can help avoid stiffness in the muscles and other tissues of the neck. Continuing with normal activities is crucial at this point, natural movements of the neck will not cause further damage.
Practicing healthy postural habits can also be beneficial to ease the symptoms of whiplash. While at work or during any other situation of prolonged sitting, the individual should check the posture they are sitting in. Make sure you are sitting upright, not with your head flexed forward along with a stooped back. Several stretches and exercises, such as yoga and pilates, have been used to improve neck posture, however, there is not enough evidence to support the benefits of these techniques when improving posture. In addition, a firm supporting pillow can also help ease the symptoms when sleeping. The individual should avoid using more than one pillow at this time, to avoid further injury.
Chiropractic treatment is a common form of alternative treatment that is frequently used to treat whiplash and many other types of injuries and conditions. Chiropractic care focuses on musculoskeletal injuries and condition, particularly soft-tissue injuries like whiplash, including nervous system dysfunctions. A chiropractor often utilizes gentle spinal adjustments and manual manipulations to carefully restore the natural alignment of the spine and its surrounding structures in the case a subluxation is present. By doing so, these gentle treatments can relieve the stress and pressure being placed against the tissues around the spine, ultimately reducing the painful symptoms. Additionally, the chiropractic adjustments a chiropractor performs can help strengthen the muscles and other tissues of the affected area, helping to restore the original flexibility and mobility of the structures of the body.
A chiropractor may additionally recommend a series of stretches and/or exercises to help speed up the rehabilitation process and improve the individual�s condition through muscle strength, flexibility and mobility. As with any other type of treatment for an injury or condition, time and patience are required to ensure a proper recovery. Depending on the severity of the individual�s whiplash, the recovery process can differ for each person.
Preventing Whiplash with Head Restraints
Vehicles today are being built to minimize the impact from the force of a collision against the body, particularly in the region of the neck and back. All vehicles include head restraints on the vehicle seats which can further help avoid whiplash and other types of neck injuries or conditions. �The head restraint should be placed as high as the top of the head. A properly adjusted head restraint can help reduce the chance of experiencing a serious whiplash injury or other type of neck damage as this can help stop or reduce the head from jolting backwards in an automobile accident. Safety is important and although an auto collision can be an unwanted incident, preventing harm through a few simple methods can make a tremendous difference.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Sourced through Scoop.it from: www.dralexjimenez.com
By Dr. Alex Jimenez
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic, Fibromyalgia, Scoop.it, Treatments
Is the pain of fibromyalgia getting you down? Are you having trouble dealing with persistent backaches, leg cramps, and foot pain? If so, then chiropractic care may be just the thing for you.
Chiropractic care is becoming increasingly popular among fibromyalgia sufferers because of the pain and stress relief that it offers. It can often provide relief in short periods of time and help you to get back to enjoying life fast. This article will outline the basics of chiropractic care and help you to decide if it could be an effective treatment for you.
What is Chiropractic Care?
Though often termed an alternative treatment, chiropractic care is now becoming more accepted by the mainstream medical community. Almost 20% of American men and women have used the services of a chiropractor at some point in their lives. 80% of those who use chiropractors report significant pain relief, better functioning, and an increased sense of wellbeing. But what theories are chiropractic care based on and what exactly does a chiropractor do?
Chiropractic care is based on the theory that illness and pain are caused by misalignments in your skeletal structure. It sees the body as a connected system, which relies on your bones, joints, muscles, ligaments, and tendons to keep it functioning efficiently. When your skeletal structure is sound, your body should feel healthy and happy. But if parts of your skeleton are slightly off balance, it could cause serious problems, like chronic pain.
Chiropractors aim to solve pain and related symptoms by correcting the imbalances in your skeletal structure. Through a series of techniques, including stretches, adjustments, and manipulations, your chiropractor will restore your skeletal balance, thereby eliminating any pain symptoms.
Chiropractic Care and Fibromyalgia
Recently, fibromyalgia patients have been seeking chiropractic care increasingly often. Because fibromyalgia causes numerous tender points all over the body, many fibromyalgia patients suffer from back pain, neck pain, and leg cramps. In an attempt to solve these problems, many sufferers have looked to chiropractors. Because simple adjustments to the neck and spine can restore the carriage of the whole body, a lot of fibromyalgia sufferers find that alignments of the spine can significantly reduce pain all over their bodies.
Upper Cervical Spinal Stenosis
Many fibromyalgia patients suffer from a condition called upper cervical spinal stenosis. This causes the coverings of the upper spine, known as meninges, to become compressed. This can cause severe, debilitating pain all over the body. Chiropractors can adjust the head and neck so the spine is no longer compressed, helping to relieve the widespread pain symptoms of fibromyalgia.
Sourced through Scoop.it from: www.fibromyalgia-symptoms.org
Chiropractic care is becoming increasingly popular among fibromyalgia sufferers because of the pain and stress relief that it can provide for those with the condition. It can often offer relief in short periods of time and help you to get back to enjoying life fast. Understanding the basics of�chiropractic care can help you to decide if it could be an effective treatment for you and your symptoms of fibromyalgia.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Auto Accident Injuries, Migraines, Neck Pain, Personal Injury
An automobile accident often results in minimum vehicle damage, however, on the other side of the spectrum, the injuries an individual sustains from a car wreck can be devastating. Various types of accidents can affect a person�s well-being and auto accidents are considered to be some of the most troublesome towards an individual�s health. Apart from causing financial losses, suffering a complicating injury or underlying condition as a result of the auto accident can alter an individual�s lifestyle.
First Steps After an Accident
With that intention, it�s crucial to seek professional assistance to properly manage the physical, mental and material damage an individual may have suffered after a traffic collision. First, the victim of an auto accident should seek immediate medical attention to address any serious injuries as soon as possible. If the accident is minor in nature, and the vehicle itself is equipped with a first-aid kit, the individual may utilize these as a means before professional help arrives. Trauma and shock are often the biggest complications of accidents and it is crucial to treat them as early as possible. The auto accident victim must be kept calms and composed at all times to avoid further injuries.
The next essential step following an automobile accident is to immediately take the victim to the nearest medical facility available. Most frequently, those involved in a car wreck will be transported to the emergency room, or ER, where they will receive basic care for their wounds. Sometimes, the injuries sustained during the incident may appear minor and although there may be no bone fractures or open wounds, there could be the risk of soft-tissue injuries, which are not clearly visible without proper evaluations and testing. Because the professional staff of the ER are often only capable of treating immediately threatening wounds and may prescribe medications to temporarily relieve the painful symptoms following an auto accident, it�s crucial to ensure that the involved individual seeks a full examination from a qualified doctor who specializes in auto accident injuries to rule out the possibility of other, much more serious types of injuries or conditions. This could certainly prevent aggravating an injury and, in some situations, it could also make a difference between life and death.
The Importance of Visiting A Doctor
Aside from reducing the risk of further complications, there are various other reasons why it�s important to seek immediate medical attention from a car accident specialist. Healthcare professionals whom specialize in car accident injuries can help properly diagnose an individual�s injuries or conditions. According to the findings, these capable healthcare professionals can effectively plan the next course of treatment. Furthermost, many doctors and even primary healthcare centers have the required diagnostic tools for pathological tests, such as X-rays. These can be extremely useful because many injuries may not be immediately visible following an automobile accident.
For example, damage or injury to the bone, joints, muscles and ligaments, as well as complications to other types of tissues in the body, can be common after an accident, however, because these may often not result in open-wounds, they may be overlooked. If left untreated, a majority of these complications could lead to further damage or injury. Due to the tremendous force from a car wreck, fractures occur frequently. A basic X-ray, MRI or other types of scans may be needed to rule out the possibility of a bone fracture in the body.
Many auto accidents could also lead to damage or injury to vital organs, such as the lungs, liver, kidney and commonly, the brain. Brain concussions, internal bleeding and puncture wounds to vital organs could be life-threatening and should therefore be immediately ruled out with the use of the above mentioned diagnostic tools.
In other cases, the victim involved may be in need of a blood transfusion. Serious accidents could lead to blood loss and getting medical help as early as possible is also crucial in these instances. Qualified doctors and most primary medical centers have the required quantity and group of blood an individual might need after a serious automobile accident.
Insurance Related Issues
A majority of auto accident victims end up filing personal injury claims under the�insurance companies in order to receive the proper compensation they need and deserve for their injuries. It’s essential for the involved victims to take photographs of the accidents. The healthcare professional providing�treatment to the affected individuals of a car crash can help provide the insurance company with the necessary information required to complete a personal insurance claim. That�s why it�s also important to seek medical attention immediately after an accident. This will help strengthen the insurance claim quite significantly. A preliminary investigation report from the police would also be needed because it will add a legal dimension to the entire accident which could additionally help get the best possible insurance claim. �For those who choose to delay their treatment, not only are they at risk of worsening symptoms from injuries or underlying conditions, if they delay their treatment further, they could have a difficult time with the insurance company.
A majority of chiropractors, as well as other healthcare professionals, are specialized and experienced in treating injuries and trauma caused by an automobile accident. Their professional approach offers some of the best treatments, whether it�s relieving pain caused by pressure being placed on the spinal nerves or numbness caused by stress being imposed on spinal nerves, chiropractors are trained to handle injuries and conditions professionally, especially automobile accident injuries.
Symptoms Following an Auto Accident
When a person suffers an automobile accident, there are several common symptoms one must look out for. The presence of any of the following symptoms could indicate a possible injury or condition and must therefore be immediately examined. The most common symptoms include: pain and discomfort on the neck, back, and upper extremities, tingling sensations and numbness in various parts of the body, dizziness, nausea and loss of consciousness.
Being aware of these symptoms is essential as some of these could signal the need for immediate medical attention. For example, pain and discomfort along with dizziness could occur because of hemorrhage to the brain due to concussion from the sudden impact of an auto accident. Being aware of the consequences certain symptoms indicate could help avoid undesirable circumstances.
Different Treatments for Injury
Fortunately, there are many different types of treatments and therapies available to help an individual recover from their automobile accident injures. Depending on the type of injury, the severity of the harm and the overall condition of the victim, various treatment methods are available to accommodate the individual.
Without a doubt, pain and other symptoms caused by injury from an auto collision is a big concern for those who suffer from these circumstances. Many doctors often prescribe pain killers or NSAIDS to help relieve the painful symptoms, however, these can have various side effects and, because they don�t directly treat the underlying issue, prescribed medications only function temporarily to reduce the pain and discomfort. Different types of injections are also available and used regularly for treating pain from trauma and other issues associated with auto accidents, however, as mentioned before, these can also have side effects and may only offer temporary relief without actually treating the problem. When it comes to finding the proper treatment in case of an auto accident, the individual must keep in mind to seek help from a specialist who can offer to restore their overall health without simply masking the issue.
Many healthcare specialists utilize a procedure known as Cervical Facet Radiofrequency Neurotomy, or CFRN. This complex procedure can be beneficial for some patients. CFRN works by artificially interrupting the signals being sent by certain nerves to the brain which could trigger pain in individuals who suffered an auto accident. This procedure has been found to be useful in reducing the levels of pain an individual experiences which could be unbearable for some people. Pain which is beyond the threshold limit could lead to extreme trauma and shock. This could lead to further complications but, in many cases, it could trigger other issues including heart related problems and neurological disorders.
Physical therapy is considered to be a common and useful primary treatment option for victims of an automobile accident. Many individuals have reported relief from their back pain, neck pain, whiplash and various other types or injuries that could impact vital organs and other types of tissues. Physical therapists may also include heat and cold therapy, according to the individual�s type of injuries. The application of heat therapy helps decrease transmissions of pain signals to the brain, increases the flow of oxygen and can help restore flexibility to the affected regions. The application of cold therapy can also help reduce pain and discomfort, but additionally, cold therapy can help decrease swelling.
Last but not least, chiropractic treatment is recognized as the most popular, alternative treatment option to care for injuries and/or conditions caused after an automobile accident. Chiropractors focus on the body as a whole by restoring the natural alignment of the spine. Chiropractors specialize on a wide variety of musculoskeletal injuries and conditions as well as nervous system dysfunctions. From neck pain and whiplash to low back pain, chiropractic care commonly utilizes spinal adjustments and manual manipulations to carefully re-align the spine and its surrounding structures. After a thorough examination and diagnosis to determine the individual�s specific type of complications, a treatment plan may be developed accordingly to gradually rehabilitate the individual and restore their original health.
Additionally, a chiropractor may also recommend several types of stretches and exercises to increase the individual�s strength, improve their flexibility and mobility and ultimately speed up the rehabilitation process. A combination of the appropriate stretching and strengthening exercises along with chiropractic treatment could be extremely useful in helping the individual overcome the hardships of an automobile accident.
Recovering from Auto Injuries
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Sourced through Scoop.it from: www.dralexjimenez.com
By Dr. Alex Jimenez
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic, Scoop.it
Sleep disturbances are among the most common symptoms of fibromyalgia, a chronic condition affecting the spinal cord and brain that causes people to feel pain and fatigue, and affects concentration. In fact, along with the tiredness, pain, and psychosocial distress, sleep disturbances are a core feature. In the last few years, it has become increasingly clear that treating the associated sleep disturbance improves the daytime symptoms of the condition.
Here are eight things you need to know about fibromyalgia and sleep.
1. It is estimated that 2 percent to 10 percent of the population suffers from this painful condition.
2. Three quarters of those with fibromyalgia have sleep complaints. The most common is a feeling of non-refreshing or non-restorative sleep.
3. Insomnia, characterized by an inability to either fall asleep or stay asleep, is very common. Treating the insomnia with cognitive behavioral therapy and good sleep hygiene has been shown to improve symptoms of the condition.
4. People with fibromyalgia show less deep sleep, increased lighter stages of sleep, and more frequent arousals during the night than do others. Many of the newer medications approved for use in these patients, such as pregabalin (Lyrica), work in part by increasing deep sleep.
5. In several studies of normal sleepers, disrupting deep sleep nightly for 7 to 14 days with either noise or awakenings resulted in symptoms indistinguishable from patients with fibromyalgia.
6. The incidence of restless legs syndrome has been found to be in excess of 50 percent of people with fibromyalgia, as opposed to 7% of the general population. Patients experience improvement in their symptoms of fatigue and sleepiness when restless leg syndrome is treated.
7. �The incidence of sleep apnea in fibromyalgia was found to be 61 percent in men and 32 percent in women, according to�a 2013 study published in Clinical and Experimental Rheumatology. A particular variant of sleep apnea called upper airway resistance syndrome is very common in women. Treating sleep-disordered breathing improves both pain and fatigue.
8.� Sodium oxybate (Xyrem) is a drug used in narcolepsy that works in part by increasing deep sleep. In 2010 the FDA rejected its use for fibromyalgia as being too risky. It is chemically very similar to the date rape drug GHB and they felt that the risks of wide dissemination outweighed the benefits.
In practice, many patients visit doctors for their associated sleep disturbance. Whether it is insomnia, restless legs syndrome, or sleep apnea, I can say that treating the associated sleep disturbance has a very positive effect on their fibromyalgia. Many doctors see an improvement in fatigue, cognitive function, and pain when the sleep disorder is addressed.
Sourced through Scoop.it from: www.everydayhealth.com
Fibromyalgia is a painful, chronic condition which affects the overall function of the nerves. Along with pain and fatigue, two of the most common symptoms, the condition can also cause sleep disturbances. Among the various known statistics of the condition, treating the symptoms of fibromyalgia can help a person gain back their sleep.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
![Causes of Piriformis Syndrome and Sciatica]()
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Complex Injuries, Scoop.it, Sports Injuries
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The piriformis muscle is commonly known among athletes and healthcare professionals as a significant muscle in the posterior hip. This muscle functions to control hip joint rotation and abduction and it is also a distinguishable muscle due to its inversion of action in rotation. The piriformis muscle also raises awareness as the various causes of piriformis syndrome, a condition suspected to be a potential source of pain and dysfunction, not only in athletes, but in the general population as well.
Anatomy of the Piriformis Muscle
The piriformis muscle originates on the anterior surface of the sacrum and it is securely held to it by three tissue attachments found between the first, second, third and fourth anterior sacral foramina. Occasionally, its origin may be so broad that it joins the capsule of the sacroiliac joint with the sacrotuberous and/or sacrospinous ligament. The piriformis muscle is a thick and strong muscle that travels out of the pelvis through the greater sciatic foramen, dividing the foramen into the suprapiriform and infra-piriform foramina. As it courses through the greater sciatic foramen, the muscle decreases to a point where it forms a tendon that attaches to the superior-medial surface of the greater trochanter, frequently integrating with the tendon of the obturator internus and gemelli muscles.
The nerves and blood vessels found within the suprapiriform foramen are known as the superior gluteal nerves and vessels, and those found in the infra-piriforma fossa are known as the inferior gluteal nerves and vessels, including the sciatic nerve. Because of its broad size in the greater sciatic foramen, there�s a risk the numerous vessels and nerves that exit the pelvis may become compressed.
The piriformis muscle is closely associated with other short hip rotators as well, such as the superior gemellus, obturator internus, inferior gemellus and obturator externus. The primary difference between this muscle and other short rotators is its connection to the sciatic nerve. The piriformis muscle passes behind the nerve while the other rotators pass before it.
Anatomical Variants
Several anatomical variations have been previously diagnosed among the piriformis muscle. First, there may be additional medial attachments to the first and fifth sacral vertebrae and to the coccyx. Second, the tendon may merge with the gluteus medius or minimus or with the gemellus. Also, in approximately less than 20 percent of cases, the piriformis muscle may be divided into two different segments, through which part or all of the sciatic nerve may travel. Then, the muscle may blend with the posterior hip joint capsule as a conjoined tendon with the obturator internus. Additionally, the distal attachment of the piriformis muscle has been demonstrated to vary in proportion and position on the supero-medial surface of the greater trochanter. It can stretch across 25 to 64 percent of the anterior-posterior length along the greater trochanter, with 57 percent of it attaching more anteriorly and 43 percent more posteriorly. Last but not least, researchers studied its insertion point broadly and discovered that four types of insertions existed and these were characterized based on the relationship to the obturator internus. The variation of placement and width of the distal attachment of the piriformis muscle may influence the effectiveness of the concept known as the inversion of action.
Furthermore, the connection between the piriformis muscle and the sciatic nerve has been a highly debated complication. It�s been previously concluded that there are several anatomical variations among the piriformis muscle and its connection to the sciatic nerve. The sub-types of this variation include: type 1-A, where the muscle is pear shaped with the nerve running anteriorly and inferiorly to this, found in 70 to 85 percent of cases; type 2-B, where the piriformis muscle is divided into two sections with the common peroneal nerve running between the two parts and the tibial nerve travels anteriorly and below, found in 10 to 20 percent of cases; type 3-C, where the peroneal portion loops over the top of the muscle and the tibial portion is found below, found in 2 to 3 percent of cases; and type 4-D, where the undivided nerve passes through the piriformis muscle, found in approximately 2 percent of cases.
Moreover, it is also speculated that two other, very rare variations may occur, demonstrated by letters E and F in the diagram. Type 1-A is the most common variation, displaying the sciatic nerve as it passes below the piriformis muscle.
Function of the Piriformis Muscle
The fundamental functions of the piriformis muscle are to provide hip external rotation and allow abduction at 90 degrees of hip flexion. During weight-bearing, the piriformis muscle restricts femoral internal rotation in the stance phase of walking and running. Also, it assists the short hip rotators in compressing the hip joint and stabilizing it. Because it can exert an oblique force on the sacrum, it may produce a strong rotary shearing force on the sacroiliac joint. Otherwise, this would dislocate the ipsilateral base of the sacrum forward and the apex of the sacrum backwards.
Since the piriformis muscle is the furthest behind of the hip external rotators because of its attachment on the anterior surface of the sacrum, it has the greatest influence to apply a rotation effect on the hip joint. Occasionally, healthcare specialists have found issues with the piriformis muscle where it appears to be tight and hypertonic, while the other short hip rotators which are found closer to the axis of rotation become inhibited and hypotonic.
Inversion of action
The most argumentative complication relating to the function of the piriformis muscle is its reversal-of-function role, best referred to as the inversion of action role. Researchers have suggested that as the hip approaches angles of 60 to 90 degrees and greater, the tendon of the piriformis muscle shifts on the greater trochanter. As a result, its line of pull becomes ineffective as a hip external rotator, however, it does contribute to internal hip rotation. Consequently, it reverses its rotation function at high hip flexion angles.
Nonetheless, more recent studies conducted through anatomical dissection have demonstrated that the attachment of the piriformis muscle onto the greater trochanter can change and, in some instances, it may insert in a position by which it may be unable to reverse its function, for example, in a more posteriorly placed attachment. Thus, stretching the piriformis muscle into external rotation when the hip is flexed beyond 90 degrees, based on the inversion of action role, would be ineffective as a treatment or misleading as an examination technique.
The role of the piriformis muscle at several joint angles is an essential consideration for healthcare professionals who evaluate and treat the causes of piriformis syndrome. Frequently, it�s recommended to stretch the hip into flexion, adduction and external rotation to stretch the piriformis muscle over the glutes by utilizing the reversal of function concept.
MSK Dysfunction and Causes of Piriformis Syndrome
Many decades ago, it was suggested that in some cases, sciatica symptoms may originate outside the spine as a result of the piriformis muscles. This hypothesis was supported soon after when specialists successfully improved an individual�s symptoms of sciatica by surgically dividing the piriformis muscle. Based on cadaver anatomical dissections, the researchers believed that the spasm of the piriformis muscle could be responsible for the irritation of the sciatic nerve.
The medical term piriformis syndrome then became associated to sciatica symptoms, believed to be caused by a usually traumatic abnormality in the piriformis muscle with a focus on ruling out more common causes of sciatica, such as nerve root impingement caused by a disc herniation. It soon became an accepted interpretation but with no consensus about the exact clinical signs and diagnostic tests to differentiate it from other sources of sciatica.
Understanding the Causes of Piriformis Syndrome
Piriformis syndrome can be defined as the interaction between the piriformis muscle and the sciatic nerve, where these may irritate the nerves and develop posterior hip pain with distal referral down the posterior thigh, resembling symptoms of true sciatica. Differentiating�the damage to this region typically follows exceptions of the more well-known causes of sciatica and buttock pain.
More specifically, reports of buttock pain with distal referral of symptoms are not unique to the causes of piriformis syndrome. Similar symptoms are prevalent with the more medically evident lower back pain syndromes and pelvic dysfunctions. Therefore, a complete evaluation of these areas must be performed to rule out any underlying pathology. It has been suggested that the causes of piriformis syndrome can be held responsible for approximately 5 to 6 percent of sciatica cases. In the majority of instances, it develops in middle-aged individuals, an average or 38 years and it�s more common among women.
Pathogenesis of Piriformis Syndrome
The causes of Piriformis syndrome can be associated to three primary causing factors: First, the referred pain may be the result of myofascial trigger points. Second, the entrapment of the nerve against the greater sciatic foramen as it passes through the infrapiriform fossa or within a variating piriformis muscle. And third, sacroiliac joint dysfunction causing piriformis muscle spasms.
Other researchers presented an additional number of factors behind the causes of piriformis syndrome as follows: gluteal trauma in the sacroiliac or gluteal regions, anatomical variations, myofascial trigger points, hypertrophy of the piriformis muscle or spasms of the piriformis muscle, secondary to spinal surgery such as laminectomy, space occupying lesions such as neoplasm, bursitis, abscess and myositis, intragluteal injections and femoral nailing.
Symptoms
The general symptoms described with the causes of piriformis syndrome include: a tight or cramping sensation in the buttock and/or hamstring, gluteal pain in up to 98 percent of cases, �calf pain in up to 59 percent of cases, aggravation through sitting and squatting if the trunk is inclined forward or the leg is crossed over the unaffected leg and possible peripheral nerve signs such as pain and paresthesia in the back, groin, buttocks, perineum and back of the thigh in up to 82 percent of cases.
Physical findings and examinations
It�s important to keep in mind that hip flexion with active external rotation or passive internal rotation may aggravate the symptoms of dysfunction. Additional findings for the evaluated causes of piriformis syndrome have demonstrated a positive SLR that is less than 15 degrees on the normal side. Other tests used to evaluate the causes of piriformis syndrome include, positive Freiberg�s sign, used in 32 to 63 percent of cases, involves the reproduction of pain on a passively forced internal rotation of the hip in the supine position, believed to result from passive stretching of the piriformis muscle and pressure of the sciatic nerve at the sacrospinous ligament. Pacers sign, used in 30 to 74 percent of cases, involves reproducing pain and weakness on resisted abduction and external rotation of the thigh in a sitting position. Pain in a FAIR position used to evaluate dysfunction, involves the reproduction of pain when the leg is held in flexion, adduction and internal rotation. Furthermore, an accentuated lumbar lordosis and hip flexor tightness predisposes an individual to increased compression of the sciatic nerve against the sciatic notch by a shortened piriformis. Electro-diagnostic tests may also prove useful to diagnose piriformis muscle complications.
When palpable spasm within the surrounding piriformis muscle occur and there is obturator internus pain and external tenderness over the greater sciatic notch, found in approximately 59 to 92 percent of cases, the individual must perform the Sims position to follow up an evaluation. The piriformis line should overlie the superior border of the piriformis muscle and extend immediately from above the greater trochanter to the cephalic border of the greater sciatic foramen at the sacrum. The examination will continue where the line is divided into equal thirds. The fully rendered thumb presses on the point of maximum trigger-point tenderness, which is usually found just lateral to the junction of the middle and last thirds of the line.
Investigations
Conventional imaging, such as X-ray, CT scan and MRI, tend to be ineffective in diagnosing the presence and causes of piriformis syndrome. However, some value may exist in electro-diagnostic testing. The purpose of these tests is to find conduction faults in the sciatic nerve. Findings such as long-latency potentials, for instance the H reflex of the tibial nerve and/or peroneal nerve, may be normal at rest but become delayed in positions where the hip external rotators are tightened.
It�s been confirmed that the tibial division of the sciatic nerve is usually spared, the inferior gluteal nerve that supplies the gluteus maximus may be affected and the muscle can become atrophied. However, testing of the peroneal nerve may provide more conclusive results as they�re more likely to be the impinged portion of the sciatic nerve. The H-wave may become inactive during the painful position of forced adduction-internal rotation of the affected leg.
Piriformis Syndrome Myths
Researchers discussed that piriformis syndrome is a commonly over-used term used to describe any non-specific gluteal tenderness with radiating leg pain. It was argued that only in rare cases is the piriformis muscle involved in nerve compression of the sciatic nerve which may then accurately qualify as one of the causes of piriformis syndrome. It was cited that there is only limited evidence and cases where the diagnosis of the causes of piriformis syndrome can be made, foremostly, where there is compressive damage to the sciatic nerve by the piriformis muscle. In several isolated studies, the sciatic nerve was seen to be compressed by the piriformis muscle in instances such as hypertrophy of the muscle, general anatomical abnormalities such as a bifid piriformis muscle and due to compression by fibrous bands.
Also, trauma and scarring to the piriformis muscle can involve the sciatic nerve. It is possible that rare cases of true piriformis syndrome have been caused by direct heavy trauma to the piriformis muscle due to a blunt trauma to the muscle. This is termed as post- traumatic piriformis syndrome.
Researchers supported this argument by stating that it is more likely that, given the anatomical relationship of the piriformis muscle to the various nerves in the deep gluteal region, the buttock pain�may be caused by an entrapment of the gluteal nerves and the hamstring pain may be due to an entrapment of the posterior cutaneous nerve of the thigh, rather than an entrapment of the sciatic nerve alone. This demonstrates the medically analyzed circumstance in the absence of distal sciatic neurological signs. Whether the piriformis muscle is the cause of the compression has not been clearly established. It is possible that the obturator internus/gemelli complex is an alternative cause of neural compression. The researchers have suggested utilizing the term deep gluteal syndrome rather than piriformis syndrome.
Treatment
When one of the several causes of piriformis syndrome is discovered and a healthcare specialist feels that an appropriate diagnosis has been made, the treatment will generally depend on the cause behind the dysfunction. If the piriformis muscle is tight and it spasms, then initially conservative treatment will focus on stretching and massaging the tight muscle to clear the piriformis muscle from being the source of the pain. If this fails, then the following have been suggested and may be attempted: local anesthetic block, typically performed by an anesthesiologist who has expertise in pain management and in performing nerve blocks; steroid injections into the piriformis muscle; botulinum toxin injections in the piriformis muscle; and surgical neurolysis.
Therapist-directed interventions, such as stretching of the piriformis muscle and direct trigger point massage, can also be used as treatment. It�s been encouraged that piriformis muscle stretches are done in positions of hip flexion greater than 90 degrees, adduction and external rotation to utilize the inversion of action effect of the piriformis muscle to isolate the stretch to this muscle independent of the other hip external rotators.
However, recent evidence utilizing ultrasound investigation determined that there was no connection between hip flexion angle and the thickness of the piriformis muscle tendon in both internal and lateral hip rotation stretching, which implies that the piriformis muscle does not invert its action. Furthermore, researchers who performed cadaveric studies concluded that the piriformis muscle insertion is different and a lot more complex than it was first believed to be. It is possible that the piriformis muscle may invert its action only in some individuals but not in others.
Accordingly�due to the disagreements and confusions over the concept of inversion of action, it is suggested that healthcare professionals should perform two variations of a piriformis muscle stretch: stretches in flexion, adduction and external rotation and stretches in flexion, adduction and internal rotation.
Pigeon Stretch for left piriformis muscle: hip flexion, neutral adduction and maximal hip external rotation.
Stretch for left piriformis muscle: hip is in flexion, neutral adduction and maximal external rotation.
Short leg posterior chain stretch for right piriformis muscle: hip is in 90 degree flexion, adduction and neutral rotation.
Trigger Points and Massage
The most appropriate suggestion to palpate the piriformis muscle trigger points is in the following recommended position. In this posture, the healthcare professional can feel for the deep piriformis muscle trigger points and apply a constant pressure to relieve the trigger points as well as apply a flush massage to the muscle in this position. In this position, the large gluteus maximus is relaxed and it is easier to feel the deeper piriformis muscle.
The piriformis muscle is a deep posterior hip muscle that is anatomically similar to both the sacroiliac joint and the sciatic nerve. It is a muscle that functions as a dominant hip rotator and stabilizer, with a propensity to shorten and become hypertonic. For that reason, stretching and massage techniques are best utilized and often recommended to reduce the tone through the muscle. In conclusion, it has also been implied in compression and irritation of the sciatic nerve, most frequently referred to as piriformis syndrome.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
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By Dr. Alex Jimenez
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic, Scoop.it
If you�ve never been to a chiropractor, you may have some questions about how it works. Basically, chiropractors believe that the body is a connected system. If your bones, ligaments, muscles, joints and tendons aren�t functioning properly then they can lead to an improperly functioning system. When your skeletal structure is strong, your body is strong. Chiropractors help restore the balance in your skeletal structure through adjustments, manipulations and stretches to eliminate the pain associated with fibromyalgia.
Patients with this syndrome have been turning to chiropractic care in increasing numbers over the years to treat the neck pain, back pain and leg cramps that often accompany fibromyalgia. Many have found that a few adjustments to the neck and spine can greatly relieve the chronic pain that they live with.
A lot of people who suffer from fibromyalgia are also afflicted with upper cervical spinal stenosis. This condition leads to the compression of meninges (the coverings of the upper spine) to become compressed. In turn, the patient is left with pain across their entire body. A chiropractor who is familiar with this syndrome can adjust the head and neck so that the spine isn�t compressed, which can help alleviate some of the chronic pain that is associated with fibromyalgia.
So, just how effective is chiropractic care at managing the pain associated with fibromyalgia? There have been several studies done to answer that question and the answer appears to be �Quite effective.� One study in particular, examined the effectiveness of the spinal manipulation done by chiropractors on relieving symptoms related to fibromyalgia. After only 15 treatments, patients reported a decrease in pain and fatigue, and an increase in the quality of their sleep.
If you suffer from fibromyalgia, talk to your primary care physician about the risks and benefits of chiropractic care. Then, take your time and search out a Doctor of Chiropractic who understands the unique symptoms that your body presents. While there is currently no cure for fibromyalgia, there is definitely treatment available that can make your life more manageable.
Sourced through Scoop.it from: www.thejoint.com
If you�ve been diagnosed with fibromyalgia you may feel as if there will never be an end to the tingling, pain and exhaustion that accompany this syndrome. However, help may be as close as your chiropractor�s office. Chiropractic care has demonstrated to be an effective treatment for individuals with fibromyalgia.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900�.
![Causes of Piriformis Syndrome and Sciatica]()
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Complex Injuries, Scoop.it, Sports Injuries
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Medial tibial stress syndrome, commonly referred to as shin splints, is not considered to be a medically serious condition, however, it can challenge an athlete�s performance. Approximately 5 percent of all sports injuries are diagnosed as medial tibial stress syndrome, or MTSS for short.
MTSS, or shin splints, occurs most commonly in specific groups of athletes, accounting for 13-20 percent of injuries in runners and up to 35 percent in military service members. Medial tibial stress syndrome is identified as pain along the posterior-medial border of the lower half of the tibia, which is active during exercise and typically inactive during rest. Athletes report feeling discomfort along the lower front half of the leg or shin. Palpation along the medial tibia can usually recreate the pain.
Causes of Medial Tibial Stress Syndrome
There are two main suspected causes for medial tibial stress syndrome. The first is that contracting leg muscles place a repeated strain upon the medial portion of the tibia, producing inflammation of the periosteal outer layer of bone, commonly known as periostitis. While the pain of a shin splint is felt along the anterior leg, the muscles located around this region are the posterior calf muscles. The tibialis posterior, flexor digitorum longus, and the soleus all emerge from the posterior-medial section of the proximal half of the tibia. As a result, the traction force from these muscles on the tibia probably aren�t the cause of the pain generally experienced on the distal portion of the leg.
Another theory of this tension is that the deep crural fascia, or the DCF, the tough, connective tissue which surrounds the deep posterior muscles of the leg, may pull excessively on the tibia, causing trauma to the bone. Researchers at the University of Honolulu examined a single leg from 5 male and 11 female adult cadavers. Through the study, they concluded that in these specimens, the muscles of the posterior section of muscles were introduced above the portion of the leg that is usually painful in medial tibial stress syndrome and the deep crural fascia did indeed attach on the entire length of the medial tibia. Doctors at the Swedish Medical Centre in Seattle, Washington hypothesized that, given the anatomy, the tension from the posterior calf muscles could produce a similar strain on the tibia at the insertion of the DCF, causing injury. In a laboratory study conducted using three fresh cadaver specimens, researchers determined that strain at the insertion site of the DCF along the medial tibia advanced linearly as tension increased in the posterior leg muscles. The study confirmed that an injury caused by tension at the medial tibia was possible. However, studies of bone periosteum on individuals with MTSS have yet to find inflammatory indicators to confirm the periostitis theory. The second theory believed to cause medial tibial stress syndrome is that repetitive or excessive loading may cause a bone-stress reaction in the tibia. When the tibia cannot properly bear the load being applied against it, it will bend during weight bearing. The overload results in micro damage within the bone, not just along the outer layer. If the repetitive loading exceeds the bone�s ability to repair, localized osteopenia can occur. Because of this, some researchers consider a tibial stress fracture to be the result of a continuum of bone stress reactions that include MTSS. Utilizing magnetic resonance imaging, or MRI, on the affected leg can often show bone marrow edema, periosteal lifting, and areas of increased bony resorption in athletes with medial tibial stress syndrome. This supports the bone-stress reaction theory. An MRI of an athlete with a diagnosis of MTSS can also help rule out other causes of lower leg pain, such as a tibial stress fracture, deep posterior compartment syndrome, and popliteal artery entrapment syndrome.
Risk factors for MTSS
While the cause, set of causes or manner of causation of MTSS is still only a hypothesis, the risk factors for athletes developing it are well identified. As determined by the navicular drop test, or NDT, a large navicular drop considerably corresponds with a diagnosis of medial tibial stress syndrome. The NDT measures the difference in height position of the navicular bone, from a neutral subtalar joint position in supported non-weight bearing, to full weight bearing. The NDT explains the degree of arch collapse during weight bearing. Results of more than 10 mm is considered excessive and can be a considerable risk factor for the development of MTSS.
Research studies have suggested that athletes with MTSS are most frequently female, have a higher BMI, less running experience, and a previous history of MTSS. Running kinematics for females can be different from that of males and has often been demonstrated to leave individuals vulnerable to experience anterior cruciate ligament tears and patellofemoral pain syndrome. This same biomechanical pattern may also incline females to develop medial tibial stress syndrome. Hormonal considerations and low bone density are believed to be contributing factors, increasing the risk of MTSS in the female athlete as well.
A higher BMI in an athlete demonstrates that they have more muscle mass rather than being overweight. The end result, however, is the same in that the legs bear a considerably heavy load. It�s been hypothesized that in these cases, the bone growth accelerated by the tibial bowing may not advance quickly enough and injury to the bone may occur. Therefore, those with a higher BMI may need to continue their training programs gradually in order to allow the body to adapt accordingly. Athletes with less running experience are more likely to make training errors, which may be a common cause for medial tibial stress syndrome. These include but are not limited to: increasing distance too quickly, changing terrain, overtraining, poor equipment or footwear, etc. Inexperience may also lead the athlete to return to activity before the recommended time, accounting for the higher prevalence of MTSS in those who had previously experienced MTSS. A complete recovery from MTSS can take from six months up to ten months, and if the original injury does not properly heal or the athlete returns to training too soon, chances are, their pain and symptoms may return promptly.
Biomechanical Analysis
The NDT is used as a measurable indication of foot pronation. Pronation is described as a tri-planar movement consisting of eversion at the hindfoot, abduction of the forefoot and dorsiflexion of the ankle. Pronation is a normal movement of the body and it is absolutely essential in walking and running. When the foot impacts the ground at the initial contact phase of running, the foot begins to pronate and the joints of the foot acquire a loose-packed position. This flexibility helps the foot absorb ground reaction forces.
During the loading response phase, the foot further pronates, reaching peak pronation by approximately 40 percent during stance phase. In mid stance, the foot moves out of pronation and back to a neutral position. During terminal stance, the foot supinates, moving the joints into a fastened position, creating a rigid lever arm from which to generate the forces for toe off. Starting with the loading response phase and throughout the rest of the single leg stance phase of running, the hip is stabilized and supported as it is extended, abducted and externally rotated by the concentric contraction of the hip muscles of the stance leg, including the gluteals, piriformis, obturator internus, superior gemellus and inferior gemellus. Weakness or fatigue in any of these muscles can develop an internal rotation of the femur, adduction of the knee, internal rotation of the tibia, and over-pronation. Overpronation therefore, can be a result of muscle weakness or fatigue. If this is the case, the athlete may have a completely normal NDT and yet, when the hip muscles don�t function as needed, these can overpronate.
In a runner who has considerable overpronation, the foot may continue to pronate into mid stance, resulting in a delayed supination response, causing for there to be less power generation at toe off. The athlete can make the effort to apply two biomechanical fixes here that could contribute to the development of MTSS. First of all, the tibialis posterior will strain to prevent the overpronation. This can add tension to the DCF and strain the medial tibia. Second, the gastroc-soleus complex will contract more forcefully at toe off to improve the generation of power. However, it�s hypothesized that the increased force within these muscle groups can add further tension to the medial tibia through the DCF and possibly irritate the periosteum.
Evaluating Injury in Athletes
Once understood that overpronation is one of the leading risk factors for medial tibial stress syndrome, the athlete should begin their evaluation slowly and gradually progress through the procedure. Foremost, the NDT must be performed, making sure if the difference is more than 10mm. Then, it�s essential to analyze the athlete�s running gait on a treadmill, preferably when the muscles are fatigued, such as at the end of a training run. Even with a normal NDT, there may be evidence of overpronation in running. � 
Next, the athlete�s knee should be diagnosed accordingly. The specialist performing an evaluation should note whether the knee is adducted, whether the hip is leveled or if either hip is more than 5 degrees from level. These can be clear indications that there is probably weakness at the hip. Traditional muscle testing may not reveal the weakness; therefore, functional muscle testing may be required. Additionally, it should be observed whether the athlete can perform a one-legged squat with arms in and arms overhead. The specialist must also note if the hip drops, the knee adducts and the foot pronates. Furthermore, the strength of the hip abductors should be tested in side lying, with the hip in a neutral, extended, and flexed position, making sure the knee is straight. All three positions with the hip rotated in a neutral position and at end ranges of external and internal rotation should also be tested. Hip extensions in prone with the knee straight and bent, in all three positions of hip rotation: external, neutral and internal can also be analyzed and observed to determine the presence of medial tibial stress syndrome, or MTSS. The position where a medical specialist finds weakness after the evaluation is where the athlete should begin strengthening activities. 
Treating the Kinetic Chain
In the presence of hip weakness, the athlete should begin the strengthening process by performing isometric exercises in the position of weakness. For example, if there is weakness during hip abduction with extension, then the athlete should begin isolated isometrics in this position. Until the muscles consistently activate isometrically in this position for 3 to 5 sets of 10 to 20 seconds should the individual progress to adding movement. Once the athlete achieves this level, begin concentric contractions, in that same position, against gravity. Some instances are unilateral bridging and side lying abduction. Eccentric contractions should follow, and then sport specific drills. In the case that other biomechanical compensations occur, these must also be addressed accordingly. If the tibialis posterior is also displaying weakness, the athlete should begin strengthening exercises in that area. If the calf muscles are tight, a stretching program must be initiated. Utilizing any modalities possible might be helpful towards the rehabilitation process. Last but not least, if the ligaments in the foot are over stretches, the athlete should consider stabilizing footwear. Using a supported shoe for a temporary period of time during rehabilitation can be helpful to notify the athlete to embrace new movement patterns.
MTSS and Sciatica
Medial tibial stress syndrome, best referred to as as shin splints, is a painful condition that can tremendously restrict an athlete�s ability to walk or run. As mentioned above, several studies can be performed by a healthcare professional to determine the presence of MTSS in an athlete, however, other conditions aside from shin splints may be causing the individuals leg pain and hip weakness. That is why it�s important to also seek the expertise of additional specialists to ensure the athlete has received the correct diagnosis for their injuries or conditions. Sciatica is described as a set of symptoms that begin from the lower back, generally caused by an irritation of the sciatic nerve. The sciatic nerve is the single, largest nerve in the human body, communicating with many different areas of the upper and lower leg. Because leg pain can occur without the presence of low back pain, an athlete�s medial tibial stress syndrome could really be sciatica originating from the back. Most commonly, MTSS can be identified by pain that is generally worse when walking or running while sciatica is generally worse when sitting with an improper posture. Regardless of the symptoms, it�s essential for an athlete to seek proper diagnosis to determine the cause of their pain and discomfort. Chiropractic care is a popular form of alternative treatment which focuses on musculoskeletal injuries and conditions as well as nervous system dysfunctions. A chiropractor can help diagnose an athlete�s MTSS as well as conclude the presence of sciatica as a cause of the symptoms. Additionally, chiropractic care can help restore and improve an athlete�s performance. By utilizing careful spinal adjustments and manual manipulations, a chiropractor can help strengthen the structures of the body and increase the individual�s mobility and flexibility. After suffering an injury, an athlete should receive the proper care and treatment they need and require to return to their specific sport activity as soon as possible.
Chiropractic and Athletic Performance
In conclusion, the best way to prevent pain from MTSS is to decrease the athlete�s risk factors. An athlete should have a basic running gait analysis and proper shoe fitting as well as include hip strengthening in functional positions as part of the strengthening program. Furthermore, one must ensure the athletes fully rehabilitate before returning to play because the chances of recurrence of medial tibial stress syndrome can be high.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
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By Dr. Alex Jimenez
