Shoulder Pain Caused by Serratus Anterior Injuries

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic

Muscular imbalances around the complex structures of the shoulder can develop abnormal activation patterns and inherent myofascial restrictions, both which can cause a significant decrease in the athlete�s scapular control and dyskinesis, leading to glenohumeral joint injuries resulting from instability and impingement.

The serratus anterior, or SA, is one of the muscles of the scapula that functions by providing a connection between the shoulder girdle and the trunk, however, it�s often believed to be a dysfunctional muscle among shoulder pathologies. The serratus anterior is a primarily offers movement to the scapula, contributing to the maintenance of normal scapulo-humeral rhythm and motion. Due to its insertion on the inferior and medial border of the scapula, it can produce upward rotation and posterior tilting. Poor activation of the serratus anterior muscle may result in limited scapular rotation and protraction, causing a relative anterior-superior translation of the humeral head in relation to its glenoid articulation, leading to sub-acromial impingement and rotator cuff tears.

The serratus anterior is characterized as a flat sheet of muscle beginning from the lateral surface of the first nine ribs. Then, it passes behind and around the thoracic wall before inserting into the anterior surface of the medial border of the scapula. The most important function of the serratus anterior, or SA, is to protract and rotate the scapula, helping to maintain it close yet away from the thoracic wall, allowing for the proper positioning of the glenoid fossa to increase the efficiency of upper extremity motion to its maximum state. The anatomy of the SA can be broken down into three anatomical components as follows: Read more.

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Stretches and Exercises for SLAP Lesions

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic

Many variations of SLAP lesions can primarily be treated conservatively with methods to initially improve the patho-mechanical factors that affect SLAP lesions, such as glenohumeral internal rotation deficit (GHIRD) and scapular dyskinesis. With a majority of type 1 lesions, this can be significantly effective in eliminating the symptoms of the lesion without the need for surgery. However, once an athlete has surgically treated their SLAP lesions, they can follow a similar rehabilitation process to achieve overall wellness.

Minor type-1 SLAP lesions may only require a simple debridement without disrupting the biceps anchor, whereas type-2 SLAP lesions are the most commonly seen type by many healthcare providers, involving a detachment of the biceps anchor from the labrum. Type-2 lesions can be treated with arthroscopic fixation of the superior labrum to develop biceps anchor stability.

Type 3 SLAP lesions are identified by bucket-handle tears along the superior labrum with intact biceps anchor. This bucket handle fragment can easily be debrided by an arthroscopic shaver, and further treatment may often not be needed. The other types of SLAP lesions are not as common as the type 2 lesions, although if they do occur, these will almost certainly require surgical intervention.

A large database study found that the highest incidence of repair is among the 20-29 years and 40-49 years of age groups. This is believed to occur due to the younger population�s higher participation in sports activities. In the 40-49-year-old group however, the high incidence most likely occurs due to the degeneration of the labrum, which may primarily develop around this age. Also men have a three times higher incidence of repair. This is believed to occur due to how males are more likely to participate in a sport which may cause SLAP lesions. �

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Rehabilitating Acute Hamstring Injuries

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic

The semitendinosus, or ST, the semimembranosus, or SM, and the biceps femoris long and short heads (BFLH and BFSH) are part of the hamstring muscle group. They primarily function with the extension of the hip and flexion of the knee as well as providing multi-directional stability of the tibia and pelvis. These three muscles which make up the hamstring muscle group, cross the posterior aspect of both the hip and the knee joints, making them bi-articular. As a result, they are consistently responding to large mechanical forces created by upper limb, trunk and lower limb locomotion as a means of concentric and eccentric mobilization. During sporting activities, these forces will tend to increase, augmenting the frequency of injury.

In a study conducted at the University of Melbourne, biomechanical analysts measured the musculotendinous strain, velocity, force, power, work and other biomechanical loads experienced by the hamstrings throughout the course of over-ground sprinting and compared the biomechanical load across each individual hamstring muscle.

Basically, the hamstrings are subjected to a stretch-shortening cycle when sprinting, with the lengthening phase occurring during the terminal swing and the shortening phase commencing just before each foot strike, continuing throughout the stance. Then, the biomechanical load on the bi-articular hamstring muscles were determined to be stronger during the terminal swing.

BFLH had the greatest musculotendinous strain, ST displayed considerable musculotendinous lengthening velocity, and SM produced the highest musculotendinous force and both absorbed and generated the most musculotendinous power. Similar research also distinguished peak musculotendinous strain as a large contributor to eccentric muscle damage or injury, most commonly acute hamstring injuries, instead of peak muscle strength. This is why eccentric strengthening is often a rehabilitation recommendation for acute hamstring injuries.

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The Difference Between a Disc Herniation and a Disc Bulge

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic

The spine is a complex structure consisting of many vertebrae which are stacked upon one another and each of these bones are separated by spinal discs. The vertebral disc in the spine primarily function as a shock absorber between the adjacent vertebrae. Spinal discs also act as ligaments to hold the vertebrae of the spine together and as cartilaginous joints which allow for slight mobility in the spine.

Each disc is composed of two parts: the annulus fibrosus, a tough, circular outer portion which surrounds the inner core, and the nucleus pulposus, the soft, inner core consisting of a loose network of fibers. The structure of a healthy, vertebral disc is compared to that of a jelly doughnut. The complex composition of each disc evenly distributes the force and pressure which is applied on the spine. At birth, approximately 80 percent of the discs are composed of water and these must be well hydrated to function properly. However, as people age, the structures of the spine, including the discs, go through a natural process of degeneration which is generally the leading cause for disc complications.

As individual�s age, the spinal discs begin to dehydrate and become stiffer and fragile, causing the disc to be less able to adjust to compression and stress. While this is a normal process, the stage may be painful for some individuals and can ultimately cause a disc herniation, disc bulge and other issues within the discs of the spine.

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Hip Injury: Acetabular Labral Tears

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic

The labrum increases the surface area of the acetabulum by 22 percent while it increases the volume by 33 percent, functioning accordingly to fasten the head of the femur while allowing it to rotate. From a cross-sectional view, the labrum is triangular in shape with an extra articular area of thick connective tissue which contains a rich supply of blood while the intra articular area majorly has no blood supply.

When the hip�s normal range of mobility extends beyond its limit, the labrum is stressed by a strong, compressive force and a tear at his point can ultimately affect the stability of the joint and distribution of weight or load. Furthermore, the labrum is considered a pain generating structure as numerous pain receptors are located in its superior and anterior regions. It is at the anterior surface where an ALT is most vulnerable to pressure along the end point of hip flexion. On another note, abnormal alterations within the structure, such as retroverted acetabulum and coxa valga, have been simultaneously recorded in up to 87 percent of individuals with labral tears. �

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The Cause of Shoulder Injuries During Car Accidents

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic

Car accidents can occur in high levels of traffic and anyone involved may suffer an injury. Various forms and degrees of injury can result from these types of incidents, however, one of the most difficult to detect includes shoulder injuries. Automobile accidents can damage an individual�s body to the point where it may not be immediately noticeable. Collisions are fast-paced actions that leave the involved individuals in shock and denial until they receive the medical attention they need and require at the time of the incident. Often times, the people who�ve experienced an auto accident may not feel any symptoms until the adrenaline begins to wear off and the pain and discomfort develops into lingering pain suggesting the presence of an underlying injury.

Whether the victim of an automobile accident find their bodies sore and aching for days after or whether they simply do not feel any pain and symptoms until several days, even weeks after, delaying a visit to a healthcare professional to receive a diagnosis of any possible injuries to follow through with treatment can be detrimental to both the overall health of the body and to a legal case. After all, lingering pain is usually a symptom of an injury which may require immediate medical treatment.

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Subscapularis Shoulder Pain

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic

The subscapularis begins on the anterior scapular, or subscapular fossa, and introduces onto the minor tuberosity of the humerus. It is the largest of the rotator cuff muscles and its cross-sectional area is larger than the other three rotator cuff muscles combined; the infraspinatus, the teres minor and the supraspinatus. The most essential functions of the glenohumeral joint are: depressor of the humeral head; anterior stabilizer of the humeral head, which means it glides the humeral head posteriorly relative to the glenoid fossa; and internal rotator of the shoulder together with the powerful pectoralis major and latissimus dorsi.

The tendon fibres combine with the anterior capsule of the shoulder, which serve to reinforce the anterior shoulder capsule. The muscle is considered to be less substantial as a shoulder internal rotator, as the pectoralis major and latissimus dorsi are powerful internal rotators, and it�s therefore more essential as a dynamic anterior stabilizer of the glenohumeral joint due to its action in preventing an anterior shear of the humeral head.

The subscapularis has a deep connection with the long head of the biceps. This is known as a capsuloligamentous complex that functions to stabilize the long head of the biceps tendon in the bicipital groove. The pulley complex is made up of the superior glenohumeral ligament, the coracohumeral ligament, and the distal attachment of the subscapularis tendon, where it is located within the rotator interval between the anterior edge of the supraspinatus tendon and the superior edge of the subscapularis tendon. Subscapularis tendon injuries may weaken the stability of the bicep. In order to maintain the biceps tendon stabilized and in place, support of the most superior insertion point of the subscapularis from behind the ligament and tension in the superior glenohumeral ligament is needed. Issues with a biceps sling is a common cause and effect of disease in many athletes, requiring the constant and effective rotation of the shoulder, just like the cocking position during baseball pitching.

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A Treatment Approach to Ankle Sprains

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic

Due to the nature of lateral ankle sprains, once an individual has experienced an injury, there�s a high probability that another injury can occur. This is because damage or injury to the ligaments and joint capsules within the ankle can impair the structures ability to function appropriately. Along with any deficits in proprioception, this can often result in a high re-injury rate. Indeed, research has demonstrated that 73 percent of individuals who sprain their ankles are most likely to experience recurrent ankle injuries in the future.

The most frequent factor behind a majority of ankle sprains is when a single extremity lands on an uneven surface. During this case, a quick and joined ankle plantar flexion and inversion motion can often result in an extreme lateral movement which can lead to ankle sprains. Another factor that can influence the chance of lateral ankle sprains is proprioception, or an individual�s own neuromuscular control. With the necessary proprioception, an athlete may be able to accurately determine the speed and force of a disturbance of motion in order to be able to subsequently react with an appropriate joint and muscle motion to avoid injury. However, because there�s always a chance the athlete may be surrounded by uneven terrain, even an individual with excellent proprioceptive skills can suffer harm. Moreover, the evidence for the role of proprioceptive factors in preventing ankle sprains is still unclear.

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The Benefits of Chiropractic Care after an Auto Accident

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chiropractic

The most common type of car accident that many people face is where both involved parties seem to be either not injured at all or only have minor injuries. There may not be any visible wounds, cuts or bleeding but there may indeed be an underlying injury from inside and that can be quite serious. Individuals who believe they do not have to visit a doctor because there is no injury or the injury is minor, could be making a big mistake. Injuries that are caused internally can get worse over time if left untreated. And thus, immediate treatment is ultimately essential.�

Many people experience car accidents where there are no visible cuts or wounds and they ignore the need to visit a doctor. Generally, an individual may not feel any pain just after the accident due to a heavy rush of adrenaline. After 24 hours, people can begin to feel the symptoms of the incident, from neck pain, back pain, shoulder pain, dizziness etc. Therefore, seeking immediate medical care and treatment after the car accident is important in order to diagnose the cause of the individual�s symptoms.

If a person wants to file a personal injury lawsuit, they will need medical documents from a health expert to prove the fact of an injury. Without a strong backing of medical documents to prove this, no lawyer will be ready to take your case.

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