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Skateboarding Injuries Chiropractor: Back Clinic

Skateboarding Injuries Chiropractor: Back Clinic

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 Chiropractor

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.
  • The inexperience of knowing how to fall to prevent injuries.

Chiropractic Therapy

A chiropractor can work with other doctors and specialists to:

  • Assess and treat the skateboarding injury/s.
  • Reset the spine, hips, arms, hands, and feet.
  • Rehabilitate and strengthen the body.
  • Recommend safety and prevention education.
  • 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

Leg Injuries Car Accidents and Crashes

Leg Injuries Car Accidents and Crashes

Individuals drive to jobs, to school, run errands, take road trips, spending a lot of time on the road. Accidents and crashes happen more frequently with all kinds of injuries. The National Highway Traffic Safety Commission has found that 37% of car accidents and crashes involve leg injuries and damage. Chiropractic physical rehabilitation and functional medicine can help heal injuries getting the individual back to everyday life.

Leg Injuries Car Accidents and Crashes

Leg Injuries

Common leg injuries include:

Bruising and Cuts

Bruising and cuts are typical from the impact and the body getting slammed around. Lacerations can be noticed right away, but bruising comes from blood pooling underneath the skin and can take time to present, possibly 24 to 48 hours. Most bruises and cuts heal independently from home first aid care. A standard recovery used to take care of bruising is R.I.C.E or rest, ice, compression, and elevation. This helps the healing process; however, if the injury/s are more severe, chiropractic can help with therapeutic massage to relieve pain and strengthen the injured muscles, tendons, and ligaments.

ACL Injuries

The femur or thigh bone has several bands of tissue connecting it to the patella or kneecap and tibia or shin bone. One of the bands is the anterior cruciate ligament or ACL. Injuries to this band of tissue are common in sports. Car accidents and crashes are another common cause, specifically tearing the ligament. Individuals experiencing a tear may notice some or all of the following symptoms:

  • A cracking or popping sound when the accident or crash took place.
  • Swelling in and around the knee.
  • Severe pain in and around the knee.
  • Unstable and unsteady when walking or standing.
  • Reduced range of motion that makes walking or moving difficult.

A chiropractor can help treat the injury and help correct any muscular imbalances.

Meniscus Tears

Tears to the meniscus are also common in car accidents and crashes. The meniscus is a part of the knee. Two wedge-shaped pieces of cartilage provide a cushion where the femur and tibia meet to absorb shock. The wedges are called menisci.

  • When the meniscus tears, individuals might feel or hear a pop and could feel the leg suddenly give out.
  • Swelling in the knee.
  • Some pain but still be able to walk.
  • The knee will be stiff for the next few days.
  • More difficulty bearing weight or walking.

The RICE method is a recommended method of self-care. Many meniscus tears do not require surgery to improve knee function. Mild to moderate meniscus tears can be successfully treated with chiropractic techniques like soft tissue work, corrective stretches, and exercises. Surgery could eventually be necessary for severe cases to repair the meniscus to prevent long-term complications.

Broken Crushed Bones

From the hips to the toes, the bottom half of the body bones are vulnerable to fractures. Physical trauma from prolonged pressure on the body can cause bones to get shattered from a crush injury. Crush injuries affect the bones, soft tissues, and other leg areas. Different forms of fractures range in severity. There are partial fractures that do not cause the bone to separate and complete fractures that break apart and open fractures that pierce the skin. Some fractures are hard to detect for up to several days.

Chiropractic care can help the body heal and recover from a bone fracture. A patient’s bone density is evaluated and tested with an individualized treatment plan to help regain and maintain optimal bone strength. The treatments strengthen the muscles, reduce stiffness, improve nutrition, and relieve pain. Manipulation adjustments, rehabilitation, relaxation techniques, and dietary health coaching help individuals heal faster and strengthen their bones. The objective is to help regain increased mobility and range of motion.

Sciatica

Car accidents and crashes are one instance where the spine can be damaged enough to bring on sciatic pain where no back problems were present before. The impact from a car accident can cause the discs to be knocked out of place, damaged, and/or rupture around the surrounding tissue. Any of these results can pinch the sciatic nerve, leading to pain and other sciatica symptoms. Chiropractic can realign the spine and relieve pressure from the nerve/s.


DOC Spinal Decompression Table


References

Atkinson, T, and P Atkinson. “Knee injuries in motor vehicle collisions: a study of the National Accident Sampling System database for the years 1979-1995.” Accident; analysis and prevention vol. 32,6 (2000): 779-86. doi:10.1016/s0001-4575(99)00131-1

Foulk, David M, and Brian H Mullis. “Hip dislocation: evaluation and management.” The Journal of the American Academy of Orthopaedic Surgeons vol. 18,4 (2010): 199-209. doi:10.5435/00124635-201004000-00003

Reynolds, April. “The fractured femur.” Radiologic technology vol. 84,3 (2013): 273-91; quiz p.292-4.

Wilson, L S Jr et al. “Foot and ankle injuries in motor vehicle accidents.” Foot & ankle international vol. 22,8 (2001): 649-52. doi:10.1177/107110070102200806

Compression Fracture

Compression Fracture

Sometimes the bones or vertebrae of the spine can crack and collapse under their weight. This is known as a compression fracture, vertebral compression fracture, or VCF. There are almost 1 million compression fractures every year, usually because the bones become weakened and crack under the weight of the vertebrae above them. These fractures can cause spinal weakness affect posture and the ability to stand up straight. They are often the cause for individuals to hunch over, also called kyphosis.

Compression Fracture

Compression Fracture

Compression fractures are small breaks or cracks in the vertebrae. The breaks occur in the vertebral body, the thick rounded part on the front of each vertebra. These fractures cause the spine to weaken and collapse. With time, these fractures affect posture as the spine curves forward. The fractures are often found in the middle/thoracic spine in the lower area. They often result from osteoporosis but can also happen after a trauma like an automobile accident, work, sports injury, or a tumor on the spine.

Symptoms

Compression fracture symptoms range from mild to severe or no symptoms. Many individuals can stand or walk without pain. They are often discovered when X-rays are taken for another condition. Symptoms include:

  • Back pain can come on suddenly and last for a significant time, often diagnosed as chronic back pain.
  • It usually develops between the shoulders and the lower back.
  • The pain and discomfort decrease when lying down and worsen when standing or walking.
  • Decreased mobility or flexibility in the spine. Individuals are unable to twist or bend.
  • Hunched over appearance, known as dowager’s hump or hunchback.
  • Loss of height from the vertebrae compression and the spine curving.
  • Pinched nerves
  • Nerve damage can cause tingling, numbness, and difficulty walking.
  • Loss of bladder or bowel control with severe, untreated fractures.

Individuals At Risk

  • Individuals who have had a compression fracture are more likely to have another one.
  • Women over 50 have a higher risk due to osteoporosis.
  • With age, the risk increases for men and women.

Diagnosis

A doctor will perform an examination and ask about symptoms. The exam will include:

  • Checking spinal alignment.
  • Posture analysis.
  • Gently palpates different areas of the back to identify the source of pain.
  • Examine for signs of nerve damage that include numbness, tingling, or muscle weakness.

A doctor will order imaging studies to examine the backbones, muscles, and soft tissues. Imaging studies include:

  • CT scan, X-ray, or MRI of the spine.
  • DEXA scan is a type of X-ray that measures bone loss bone density.
  • A myelogram is a procedure used along with imaging studies. A contrast dye is injected into the spine before the scan making the images easier to see.
  • A triple-phase bone scan is an imaging study that takes three sets of pictures.

Treatment

Compression fracture treatment focuses on relieving pain, stabilizing the vertebrae, and ongoing fracture prevention. Treatment depends on the severity of the fracture and the individual’s overall health. Treatment can include:

Pain Medication

  • A doctor can recommend over-the-counter non-steroidal anti-inflammatory medication.
  • A doctor may prescribe muscle relaxers or prescription medication.
  • Follow instructions carefully when taking medications.

Back Brace

  • A special type of back brace helps to support the vertebrae.
  • The brace can also relieve pain by reducing how much the spine moves.

Strengthening Meds

Vertebroplasty or Kyphoplasty

  • This minimally invasive procedure relieves pain, stabilizes the bones, and improves mobility.
  • During vertebroplasty, the doctor inserts a needle in the vertebra and injects bone cement.
  • During kyphoplasty, the doctor inserts an inflatable device that they fill with cement.
  • Both are outpatient procedures allowing the individual to go home the same day.

Individuals over 65 or that have osteoporosis or a history of cancer are recommended to see their doctor. Individuals who present with sudden back pain that doesn’t get better after a day or two are advised to see a doctor and evaluate for back pain so the doctor can determine the cause and develop a treatment plan.


Body Composition


Vitamin D To Build Muscle

Skeletal Muscle Mass decreases as the body ages, primarily due to decreased physical activity. Vitamin D has been reported to influence muscle quality. This could be helpful for adults as they age. Muscle loss diminishes functional performance on activities that require strength and coordination. When this loss of muscle mass becomes significant, it becomes a condition known as sarcopenia. Treatments include:

  • Healthy diet
  • Exercise
  • Vitamin D supplementation
  • All were found to slow down muscle loss and help regain muscle mass and strength.
  • Vitamin D supplementation is effective, especially in older adults whose blood levels are low.
References

American Academy of Orthopaedic Surgeons. Osteoporosis and Spinal Fractures. (orthoinfo.aaos.org/en/diseases–conditions/osteoporosis-and-spinal-fractures/) Accessed 10/25/2021.

American Association of Neurological Surgeons. Vertebral Compression Fractures. (www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Vertebral-Compression-Fractures) Accessed 10/25/2021.

Bischoff-Ferrari, H A et al. “Vitamin D receptor expression in human muscle tissue decreases with age.” Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research vol. 19,2 (2004): 265-9. doi:10.1359/jbmr.2004.19.2.265

Donnally III CJ, DiPompeo CM, Varacallo M. Vertebral Compression Fractures. [Updated 2021 Nov 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK448171/

Hassan-Smith, Zaki K et al. “25-hydroxyvitamin D3, and 1,25-dihydroxyvitamin D3 exert distinct effects on human skeletal muscle function and gene expression.” PloS one vol. 12,2 e0170665. 15 Feb. 2017, doi:10.1371/journal.pone.0170665

McCarthy, Jason, and Amy Davis. “Diagnosis and Management of Vertebral Compression Fractures.” American family physician vol. 94,1 (2016): 44-50.

Slip and Fall Injuries

Slip and Fall Injuries

Individuals involved in slip and fall accidents lead to around 9 million emergency room visits a year. Recovering from a severe injury suffered in a slip and fall accident requires extensive medical care and physical rehabilitation. Older adults are susceptible to slip and fall injuries. According to the CDC, falls are the leading cause of nonfatal injuries of older adults and are a common hazard in nursing homes, where between half of the residents fall each year. The most common injuries sustained include:

Slip and Fall Accidents and Injuries

Cuts and Abrasions

Cuts and abrasions can be minor to severe. Leg and arm abrasions are the most common, followed by wounds to the head and hips. These injuries require superficial treatment and possibly stitches. However, if the impact of the fall is severe, cuts and abrasions can overlap more severe injuries like concussions and broken bones.

Soft Tissue Injuries

Soft tissue injuries often do not get noticed, so individuals don’t realize they have a mild tissue injury until days or weeks after the fall. Soft tissue injuries can range from minor ankle and/or wrist sprains to severe tears in tendons and ligaments. Left untreated, these injuries can lead to chronic pain conditions making the body more vulnerable to further injuries. Even when individuals feel fine after a slip and fall accident, they are recommended to seek medical care or consult an injury specialist as soft tissue injuries don’t often produce immediate symptoms.

Sprains and Strains

A slip and fall accidents often happen as a result of taking an uneven or awkward step. Individuals also often react with their hands in front to try to cushion the fall. Both the awkward step and pushing the hands out can cause the wrist or ankle to tear, causing a sprain or a strain. The ligaments do not circulate a lot of blood, meaning that healing and recovery can take a significant amount of time.

Broken Bones

A fall can result in stressful forces on the bones of the body. In slip and fall accidents, hip, wrist, and ankle fractures are the most common bones that get broken. The older an individual is, the more likely they will break a bone from a slip and fall accident.

Hip Fractures

More than 95% of broken hips are caused by falls, according to the CDC. Hip fractures often require surgery that can include implantation of an artificial hip and hospitalization for about a week, followed by extensive physical therapy and rehabilitation.

Knee Injuries

Knee injuries can result from a slip and fall, especially if the knee gets rotated the wrong way or twisted. Knees are made up of bone and ligaments, meaning it could take a long to heal and recover. Dislocation of the patella is also a possibility that could require knee reconstruction.

Neck and Shoulder Injuries

Shoulder and neck injuries can be the result of landing on the shoulder or neck. They can also occur from overexertion when trying to right oneself during a fall. Neck injuries can range from:

  • Muscle sprains
  • Spinal injuries
  • Paralysis

Shoulder injuries can result in:

  • Shoulder dislocation
  • Torn nerves
  • Collarbone breaks

Even the most minor neck and shoulder injuries can require surgery and rehabilitation.

Back and Spinal Cord Injuries

Severe impact on the body in a slip and fall accident can cause slipped or herniated discs and fractured vertebrae, causing significant pain and limiting mobility. An injury to the spinal cord can lead to temporary paralysis, permanent paralysis, neurologic and sensory impairments. According to the Mayo Clinic, falls cause more than a quarter of spinal cord injuries and the majority of spinal injuries among adults 65 and older.

Traumatic Brain Injuries

Traumatic brain injuries occur when an individual hits their head on a hard surface during a fall. Traumatic brain injuries can range from:

  • Minor injuries like:
  • Minor concussions
  • Bumps
  • Bruises
  • To major injuries like:
  • Skull fractures
  • Hematomas
  • Subarachnoid hemorrhage
  • Severe traumatic brain injuries like:
  • Brain function issues
  • Seizures
  • Loss of bodily control

Chiropractic Care

A chiropractor will review imaging scans, medical history, and current symptoms to determine the best form of treatment. Inflammation is common and is the body’s defense to protect the injured area by slowing down the blood flow in that area to allow the body’s internal defenses to repair the injury. Sometimes the body overreacts to the problem and produces far more inflammation than is needed. Depending on the severity of the injury, various massage, manipulation techniques, and tools will be utilized to help the body heal itself.


Body Composition


Recovery and Swelling

Recovery is an essential part of individuals involved in physical training programs and after injury. A significant sign that the body has undergone intense physical exertion and requires recovery is swelling. Swelling occurs for several reasons and is the body’s response to tiny, microscopic muscle tears that arise from intense use. It is possible to see this swelling in body composition results. Recovery is about giving the body a chance to:

  • Relax
  • Recuperate
  • Recover from the swelling to resume normal physical activities.
References

Courtney, T K et al. “Occupational slip, trip, and fall-related injuries–can the contribution of slipperiness be isolated?.” Ergonomics vol. 44,13 (2001): 1118-37. doi:10.1080/00140130110085538

Kannus, Pekka et al. “Prevention of falls and consequent injuries in elderly people.” Lancet (London, England) vol. 366,9500 (2005): 1885-93. doi:10.1016/S0140-6736(05)67604-0

Reuben, David B et al. “The Strategies to Reduce Injuries and Develop Confidence in Elders Intervention: Falls Risk Factor Assessment and Management, Patient Engagement, and Nurse Co-management.” Journal of the American Geriatrics Society vol. 65,12 (2017): 2733-2739. doi:10.1111/jgs.15121

Rosen, Tony et al. “Slipping and tripping: fall injuries in adults associated with rugs and carpets.” Journal of injury & violence research vol. 5,1 (2013): 61-9. doi:10.5249/jivr.v5i1.177

Vitamin B12 and Shoulder Injuries

Vitamin B12 and Shoulder Injuries

Vitamin B12 and Shoulder Injuries. Most shoulder injuries involve the muscles, ligaments, and tendons. Individuals that perform repetitive arm motions/movements, constantly lift objects as part of their job, and athletes that use their arms repetitively have an increase in developing/experiencing shoulder injuries and problems. Shoulder injuries are commonly caused by physical activities that involve:

  • Excessive motions
  • Repetitive motions
  • Overhead motions
  • Sports like swimming, tennis, pitching, and weightlifting involve these repetitive arm/shoulder motions that contribute to shoulder injuries.
  • Injuries can also be brought on from everyday activities like washing/painting walls, hanging curtains/plants, and gardening.

Vitamin B12 and Shoulder Injuries

 

Shoulder Injury Symptoms

If there is discomfort and/or pain in and around the shoulder here are a few ways to analyze the situation.

  1. Is there stiffness in or around the shoulder?
  2. Can you rotate the arm through the normal range of active movement?
  3. Does the shoulder feel like it could pop out or slide out of its socket?
  4. Is there a lack of strength in the shoulder for normal daily activities?

If yes was an answer to any of these questions, individuals should consult an orthopedic surgeon and/or chiropractor for assistance in determining the problem and its severity.

Injury Categories

Individuals often underestimate the extent of an injury and usually just push/play through the discomfort and pain. This is how powerful the brain is as it ignores steady pain, weakness, or limitation of joint motion. Shoulder injuries and problems are grouped in the following categories.

Instability

This is when a shoulder joint moves/shifts or is forced out of its normal position. This is called instability and can result in dislocation of the joints in the shoulder. Individuals will experience pain when raising their arms. It can feel as if the shoulder is slipping out.

Impingement

Impingement is caused by excessive rubbing/friction of the muscles against the top part of the shoulder blade, known as the acromion. Impingement can happen during physical activities that require excessive overhead arm motion. Medical examination and care are recommended for inflammation, as it could eventually lead to a more serious injury.

Injuries

Bursitis

The bursa is the fluid-filled sacs that cushions the joints. These can become swollen and irritated from repetitive motions, falls, or other injuries. Individuals will notice the pain most when moving/rotating the shoulder.

Cartilage tear

The cartilage – the rubbery padding that goes around the rim of the shoulder joint can get damaged from repetitive motions, overextending, falls, or from intense force to the shoulder. With this type of injury individuals feel pain when reaching overhead, weakness, and/or catching, locking, and grinding feelings.

Rotator cuff tear

The rotator cuff consists of a group of muscles and tendons that hold the arm in place and allow for lifting the arm up and overhead. It can get damaged through overuse, falls, and regular wear and tear with age. Pain often presents at night, when lifting objects, and there could be a cracking sound when trying to move or rotate.

Frozen shoulder

This condition limits the joint’s movement. What happens is abnormal bands of tissue called adhesions build up in the joint and restrict movement. The shoulder can freeze up from not using it. This could be because pain or surgery causes an individual to use it less. This is when adhesions begin to build up.

Separation

This injury affects the joint where the collarbone and shoulder blade join. It is known as the acromioclavicular or AC joint. A fall or hard impact can tear the ligaments that hold it together. If the collarbone gets pushed out of place a bump forms/develops on top of the shoulder.

Fracture

A bone can break or crack from a vehicle accident, fall, or takes a hard hit. The most common fractures are to the clavicle – collarbone and the humerus – arm bone closest to the shoulder. This type of injury causes a great deal of pain and bruising. If the collarbone is broken, the shoulder can sag with the inability to lift the arm.

Vitamin B12

Rotator cuff injuries involve dysfunctional and/or damaged connective tissue. This could be from impaired collagen synthesis Vitamin B12 helps combat inflammation and plays a significant role in collagen formation. Low vitamin B12 status can be directly linked to pro-inflammatory cytokines. This means that a lack of vitamin B12 increases inflammation.

Researchers followed a group of individuals to determine if their individual vitamin B12 levels correlated with an increased risk of a rotator cuff tear. To begin the study, levels of vitamin B12 were measured along with other nutrients that included:

  • Vitamin D
  • Zinc
  • Calcium
  • Magnesium
  • Folate

Homocysteine and blood sugar biomarkers, which are both associated with B12 metabolism were also measured. Homocysteine is a metabolite that builds up in the blood when specific nutrients, like B12, folate, or B6 become deficient. Elevated levels of homocysteine can be harmful and cause damage to blood vessels and brain tissue when not detoxified properly. In the study, the homocysteine levels did not differ between the groups, but vitamin B12 levels were significantly different.

  • The patients that were included were a healthy group that did not have any rotator cuff injury during the study.
  • The second group all experienced a rotator cuff tear that required surgery during the study.
  • With the various nutrients measured, only vitamin B12 and vitamin D showed differences. With the B12 and D being lower in the group that had the shoulder injury.
  • Specifically, the B12 levels in the healthy group were 627 pg/mL compared to 528 pg/mL in the injured group. This was a 16% decrease.

These subclinical deficiencies are usually missed with traditional serum testing which is why functional nutritional testing is clinically recommended.


Body Compositional Testing


Disclaimer

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico

References

American Society for Surgery of the Hand: Shoulder Pain.

American Academy of Family Physicians: Shoulder Pain.

BMC Musculoskeletal Disorders, April 2021

Cleveland Clinic: Rotator Cuff Tendonitis Shoulder Tendinitis.

Monica, James et al. Acute Shoulder Injuries in Adults. American family physician vol. 94,2 (2016): 119-27.

OrthoInfo: Shoulder Pain and Common Shoulder Problems, Rotator Cuff and Shoulder Conditioning Program.

Knee Injuries, Surgeries, and Vitamin D Status

Knee Injuries, Surgeries, and Vitamin D Status

Knee Injuries, Surgeries, and Vitamin D Status. The knee joint is one of the largest and complex joints. It connects the thigh bone to the shinbone, which has a very important role in:

  • Supporting the body’s weight
  • Facilitating movement
  • Allowing the ability to bend the knee

Because of the complexity of the knee joint, it is highly susceptible to injuries. The most common injuries include tears in the:

  • Ligaments
  • Tendons
  • Cartilage
  • The kneecap itself can be fractured and/or dislocated.

Knee Injuries, Surgeries, and Vitamin D Status

Tears

Meniscal Tears

The meniscus is the cartilage between the knee joint that absorbs the impact/shock when running, playing sports, yard work, hiking, bicycling, etc. It cushions the joint and maintains stability.

Meniscus tears are common in sports that have a lot of jumping, starting/stopping quickly, changing direction suddenly, like volleyball, basketball, tennis, soccer, football. This is when the meniscus tears. Surgery can be required, depending on the severity/extent of the injury and tear.

Tendon Tears

The patellar tendon works with the knee muscles in the front of the thigh to straighten the leg. Tears in the patellar tendon are common among middle-aged individuals and those that participate in running or jumping sports.

  • A complete tear is considered a disabling injury that requires surgery for full functional recovery.
  • Fortunately, most tears are partial and require rest and chiropractic/physical therapy to heal.

Dislocation

Knee dislocations happen when the knee bones shift out of position. This can happen after a fall, car crash, or high-speed impact. It can also be caused by twisting the knee while the foot stays planted. Dislocations require relocation. However, sometimes a dislocated kneecap corrects itself and returns to the proper position. Other cases can require a mild sedative to allow a doctor to relocate the knee. Dislocations generally take around six weeks to fully heal.

Anterior Cruciate Ligament – ACL Injury

The anterior cruciate ligament or ACL is knee tissue that joins the upper and lower leg bones and maintains the knees’ stability. The ACL can be torn if the lower leg over-extends forward or if the leg gets twisted. ACL injuries are common knee injuries and account for around 40% of sports-related injuries. These injuries can range from a small tear in the ligament to a severe injury where the ligament tears completely or gets separated from the bone. Treatment depends on the severity of the injury. Depending on various factors including the severity of the tear, surgery could be required.

Knee Surgery

For most cases, surgery is done using arthroscopy technology. This procedure uses small incisions to insert a camera and surgical instruments into the joint. Usually, two or three incisions are needed with recovery time being quicker than large incision surgery where the whole knee is opened. Minimally invasive arthroscopic surgery is preferred by sports medicine experts. With this procedure:

  • There is no need to cut the tendons or muscles
  • Bleeding is reduced
  • Small incisions decrease scarring
  • Recovery time is shorter

However, sometimes a large incision is required for complex surgical techniques. Common knee surgery procedures include:

Arthroscopy Surgery

This method allows the ability to see inside the knee joint. The procedure is often recommended for:

  • Diagnosis
  • Minor repairs to ligaments and/or tendons
  • Cartilage or bone that needs to be removed

Total Knee Replacement

A full knee replacement is known as arthroplasty. When the joint is damaged beyond repair from injury or disease, an implant is placed in the knee joint restoring function. A small amount of cartilage and bone from the shinbone and thigh bone gets removed for perfect placement of the new knee joint.

Revision Knee Replacement

Most knee replacements last around 15 – 20 years. For individuals that have knee replacement early, then a new operation for new implants could be required. Here, the surgeon removes the original prosthesis and replaces it with a new one.

Partial Knee Replacement

Some knee injuries do not require complete replacement. Here, only the worn-out portion of the joint is replaced. As an example, the cartilage that has been lost in an area of the knee can be repaired with a partial replacement.

Vitamin D Status

A study on athletes that underwent ACL surgery looked at their vitamin d status and how it affected their recovery.

  • The research concluded that vitamin D status had no effect on surgery outcomes.
  • However, those with the lowest vitamin D status had three times the failure rate than those with higher vitamin D
  • The average age of the individuals was around twenty-four and were healthy athletes.

Each of the patients in this study had their vitamin levels measured  before the operation and were grouped based on their vitamin D status:

  • Group 1 vitamin D below 20 ng/mL – considered deficient
  • Group 2 vitamin D between 20-30 ng/mL – considered low but in a technical range
  • Group 3 vitamin D above 30 ng/mL – considered sufficient, but not optimal

All were followed for two years with their surgery recovery being measured with two systems.

The Lysholm score, which is a 100 point scoring system that looks at an individual’s knee functions that include:

  • Mechanical locking
  • Instability
  • Pain
  • Swelling
  • Stair climbing
  • Squatting

The WOMAC score is a scoring system that measures:

  • Physical function
  • Pain
  • Stiffness
  • This can be for knee and hip replacement

After 2 years, the Lysholm score and the WOMAC scores were similar.

However, there was a difference in the graft failure rate which was about 6% in group 1 with the lowest vitamin D and around 2% in groups 2 and 3. This shows that the lowest vitamin D status has three times the failure rate compared with those that had increased vitamin D levels. Vitamin D is a known anti-inflammatory with metabolic functions that are documented. Therefore, vitamin D does improve surgical success and recovery in healthy athletes.


Body Composition


Disclaimer

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico

References

Brambilla, Lorenzo, et al. “Outcome of total hip and total knee arthroplasty and vitamin D homeostasis.” British medical bulletin vol. 135,1 (2020): 50-61. doi:10.1093/bmb/ldaa018

European Journal of Orthopedic Surgery and Traumatology, January 2021

Zhang, Hao et al. “Vitamin D Status and Patient Outcomes after Knee or Hip Surgery: A Meta-Analysis.” Annals of nutrition & metabolism vol. 73,2 (2018): 121-130. doi:10.1159/000490670

Avoiding and Preventing Spinal Compression Fractures

Avoiding and Preventing Spinal Compression Fractures

Spinal vertebral compression fractures are a common injury in older individuals brought on from a lowered bone density. Hip and wrist fractures get most of the attention when it comes to osteoporosis. However, spinal fractures happen almost twice as often and affect around 700,000 individuals yearly. This is according to the American Academy of Orthopaedic Surgeons or the AAOS. These types of fractures are also known as:

  • Fragility fractures
  • Vertebral compression fractures
  • Osteoporotic compression fractures. These usually happen as a result of thinning and weakening bones caused by osteoporosis.

The Academy of Orthopedic Surgeons notes that changes in the body’s musculoskeletal bone structure can go unnoticed for years. This leads to the vertebrae narrowing and flattening, rounding the spine as a result, creating compression. Because of the weakened bone, the pressure, even from everyday low-impact movements like reaching, bending or twisting. There are strategies that can help prevent osteoporosis and osteoporotic compression fractures.

11860 Vista Del Sol, Ste. 128 Avoiding and Preventing Spinal Compression Fractures

More Movement and Physical Activity

One prevention strategy that is highly recommended is more movement and physical activity. This does not include occasional gentle movements like taking a break from sitting. Improving the spine’s health means using the full range of motion and loading the bones so they can get build strength. This could be walking more, which creates spinal resistance. Also using light weights with high repetitions with five to ten pounds of a load is enough to challenge the spine without generating muscle stress.

Individuals think they need to rest more as they get older, but to build and maintain bone density to prevent osteoporotic compression fractures more physical activity is needed. Moving around for 10 to 15 minutes every hour is a good way to start. Incorporating more activity, and focusing on healthy diet changes will help shed excess weight. This will decrease pressure on the spine, reducing the risk of fractures. For individuals with osteoporosis of the spine, it is important to review any exercise plans with a physician or doctor of chiropractic to ensure that they are safe. The wrong types of movement or too much stress on a fragile spine can definitely cause a fracture.

Medications and Other Conditions

There are medications that can help build bone density, but there are also medications for conditions that can actually cause faster bone density loss. Individuals could be taking a medication that’s good for one issue/condition, but not realize it may be associated with a reduction in bone density. This is why it is important to review prescriptions with a doctor with bone density loss side effects in mind. Medications that can cause bone loss include:

  • Glucocorticoids
  • Aromatase inhibitors for breast cancer
  • Androgen deprivation therapy for prostate cancer
  • Proton pump inhibitors
  • Depo-Provera for contraception
  • Anti-seizure drugs like carbamazepine and phenytoin
  • Diuretics like furosemide

Also, review any underlying conditions that could affect osteoporosis. As an example, the National Institutes of Health or NIH note that individuals with diabetes, specifically type 1, can have poor bone quality increasing their risk of fractures.

11860 Vista Del Sol, Ste. 128 Avoiding and Preventing Spinal Compression Fractures

Adding Calcium To The Diet

An adequate intake of calcium is essential for osteoporosis prevention and helps lower the risk of fragility fractures. A low calcium intake contributes significantly to lower bone density and faster bone loss with age. Vitamin D also helps in bone injury prevention.

Treatment

Compression fracture/s diagnosis are confirmed through imaging tests like:

  • X-rays
  • Magnetic resonance imaging MRI scan
  • Bone scan
  • Computed tomography CT scan

Bone density testing with dual-energy x-ray absorptiometry DEXA will determine bone mineral density. If a scan reveals there is a vertebral compression fracture, the most common approach is no treatment. According to the Academy of Orthopedic Surgeons, most individuals with this type of injury improve within three months with a combined rest period and limited pain medication use.

11860 Vista Del Sol, Ste. 128 Avoiding and Preventing Spinal Compression Fractures

Some individuals are recommended to wear braces to restrict movement so the fracture can heal without any added compression or stress. For those that do not respond to non-surgical treatment, minimally invasive surgery could become an option. In both cases, a doctor will suggest similar aforementioned strategies to help strengthen the bones and prevent worsening or creating new issues.

Body Composition

Changes in an individual’s 30’s

As an individual enters their 30’s and up, new challenges begin to emerge with greater demands at work and home. A few things that can begin to present:

  • More flab on the middle that gets harder to burn off
  • Performance at work, the gym, or on the road slows down or begins to reverse
  • Workouts, sporting events, physical activity that the body was able to bounce back from quite easily now take twice as long to recover from

Things start to change when the body enters its 30’s. Whether light exercise, playing weekend games, local sports, etc, the key is to just stay active. By paying close attention to nutrition and making minor adjustments, individuals can maintain and improve body composition, stay strong and healthy in their 30s and be ready for the future.

Disclaimer

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP, CIFM, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico

References

OrthoInfo/spine fracture prevalence: orthoinfo.aaos.org/en/diseases–conditions/osteoporosis-and-spinal-fractures

Medications that affect bone density: osteoporosis.ca/about-the-disease/what-is-osteoporosis/secondary-osteoporosis/medications-that-can-cause-bone-loss-falls-andor-fractures/#:~:text=The%20anti%2Dseizure%20drugs%20carbamazepine,decreased%20intestinal%20absorption%20of%20calcium.

NIH: osteoarthritis and diabetes: www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/diabetes

Certain Medications Increase Risk for Osteoporosis and Spinal Fractures

Certain Medications Increase Risk for Osteoporosis and Spinal Fractures

Medications can be lifesavers when it comes to the treatment of various conditions. But they can also open the door to other serious conditions. Medications fall into pharmacological drug classes. Certain medications can interfere with bone health, and induce bone density loss. Users of these medications could put them at risk for osteoporosis and possible spinal fracture/s. Medications that can potentially weaken bones and how to protect yourself is the focus. Not all of the medications listed are for treating spinal disorders or neck and back pain.  
11860 Vista Del Sol, Ste. 128 Certain Medications Increase Risk for Osteoporosis and Spinal Fractures
 

Steroids

Steroids taken by mouth are commonly prescribed for spinal conditions. This includes:
  • Low back pain
  • Neck pain
  • Spinal inflammatory arthritis
These medications carry anti-inflammatory compounds that are pretty powerful. These help the pain but can cause bone loss with long-term use. These types of steroids put the bones at risk because of how they slow down the osteoblasts, which are bone-building cells. As the osteoblasts are slowed, the work of the osteoclasts, which are bone-absorbing cells gets increased straining the system and ultimately leading to bone loss.

Examples of steroids:

  • Dexamethasone
  • Methylprednisolone
  • Prednisone
Daily doses of more than 5 mg pose the biggest threat to the skeletal system. Ask a doctor about a short-term low-dose regimen, especially, if there is a heightened risk for osteoporosis or spinal fracture.

Selective Serotonin Receptor Uptake Inhibitor

Selective serotonin receptor uptake inhibitors help those with neck and low back pain in a variety of ways. These include reducing the mental and emotional effects of chronic pain. But, selective serotonin receptor uptake inhibitors can boost the fracture risk. This type of medication can cause bone loss in older women and reduced bone density in men and children.

Examples of selective serotonin receptor uptake inhibitors:

Ask a doctor for another type of selective serotonin receptor uptake inhibitor. Possibilities include serotonin and norepinephrine reuptake inhibitors, that can achieve the same results without bone loss and fracture risks.

Certain Anticonvulsants

Anticonvulsants are used to control seizures. However, they have been found to help individuals with spinal nerve pain. But there are some types of anticonvulsants that can increase the liver�s vitamin D metabolism. This lowers the blood�s vitamin D levels. Vitamin D is essential to the body�s ability to absorb calcium. That means that lower vitamin D levels can cause bone loss.

Examples of anticonvulsants:

Talk to a doctor, chiropractor, or health coach about taking a vitamin D supplement/s to boost vitamin D levels.

Certain Diabetic Medications

There are two types of diabetic medications that can increase the risk of fracture. Thiazolidinediones known as TZD’s and sodium-glucose cotransporter 2 inhibitors. The TZD’s increase the fat cells in the bone marrow, and lower the bone-building cells. The sodium-glucose cotransporter 2 inhibitors can reduce bone density.

Examples of TZD’s:

If there is a high risk of fracture, ask a doctor if an alternative medication to a TZD can be taken.

Examples of sodium-glucose cotransporter 2 inhibitors:

  • Canagliflozin
  • Dapagliflozin
  • Empagliflozin
If there is a greater risk of falls, ask a doctor if an alternative to taking a sodium-glucose cotransporter 2 inhibitor can be taken.

Hormone Medications

Medications that reduce estrogen or androgen levels in the body also increase the bone’s absorbing cell activity. And this can lead to bone density loss.

Examples of hormone medications:

  • Anastrozole
  • Exemestane
  • Leuprolide
  • Goserelin
  • Medroxyprogesterone acetate
If there is an increased risk for osteoporosis or fracture, talk to a doctor about ways to protect the bones while taking these medications.

Antacids

Antacids both over-the-counter and prescription that contain aluminum help to neutralize stomach acid. There are other medications called H2-blockers also known as proton-pump inhibitors. These reduce how much acid the stomach produces. While these aid in reducing heartburn, stomach pain, etc, long-term use can reduce the body�s ability to absorb calcium and thus increase the risk for fracture.

Examples of these types of antacids:

Examples of Proton-Pump Inhibitors:

  • Omeprazole
  • Esomeprazole
  • Lansoprazole
Ask a doctor if a different H2-blocker can achieve the same results. Additionally, a doctor, nutritionist, or health coach could recommend dietary changes/adjustments to help reduce stomach acid.

Blood Thinners and Anticoagulants

These medications help reduce the risk of stroke, can interfere with the body�s ability to absorb calcium. They reduce the activity of the bone-building cells. This causes bone loss and increases the risk of fracture.

Examples of anticoagulants or blood thinners:

  • Enoxaparin sodium
  • Warfarin
Talk to a doctor about a possible alternative anticoagulant. A change in medication has been shown to put the bones at less risk.

Diuretics

Loop diuretics work by reducing inflammation/swelling along with water retention by increasing the kidneys urine production. These medications can cause the kidneys to remove key nutrients like calcium, potassium, and magnesium to help increase bone production. Reduction in all of these increases the risk of bone loss and a spinal fracture.

Examples of loop diuretics:

  • Furosemide
  • Ethacrynic acid
  • Bumetanide
Talk to a doctor about an alternative known as a thiazide diuretic. These encourage the kidneys to retain calcium, thus increasing bone density.

Reduce The Risk

Protecting bone health is the objective. A bone mineral density test could help along with taking bone-boosting supplements. Learning about the risks of taking these medications can help prevent osteoporosis and spinal fractures. Keep track of all medications over-the-counter, prescription, holistic, all-natural, etc, and make sure all doctors, specialists understand what is being taken. A spine specialist or endocrinologist might not what the other doctor has prescribed, so keep everyone informed.
 

Rehabilitation for Cerebral Palsy

 
 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Osteoporosis and Rising Bone Fractures El Paso, TX.

Osteoporosis and Rising Bone Fractures El Paso, TX.

Bone fracture rates have been on the rise in the last few years and a study predicts that they are going to increase in the coming decades.

These predictions are based on:

  • Rising osteoporosis among the aging population
  • Increase in sports-related fractures among young and active people

Any type of bone fracture, especially when the spine is involved, comes with the most common and debilitating symptom is severe pain.

Managing pain correctly is vital to the proper healing of a fractured bone.

Unfortunately, the common treatments prescribed to manage fracture pain can cause significant side effects, especially when used beyond the short-term or acute phase of pain.

Bone fractures cannot be always be avoided, but when it comes to osteoporosis, everyone can take steps to help minimize the risk of developing the condition.

 

11860 Vista Del Sol, Ste. 128 Osteoporosis and Increasing Bone Fractures El Paso, TX.

 

How to Prevent Osteoporosis and Bone Fracture

First, understand that osteoporosis is not a normal part of the aging process.

It is an irreversible and degenerative disease that causes bones to become porous over time.

 

11860 Vista Del Sol, Ste. 128 Osteoporosis and Increasing Bone Fractures El Paso, TX.

 

Prevention should begin as early as possible, as this will benefit an individual later in life.

It’s never too late to begin taking steps!

Protecting the bones begins with the most important thing and that is diet.

Most individuals’ diet does not fill the recommended daily values of calcium and Vitamin D.

Both are essential for strong bone health and density.

Diet must be well-balanced with an abundance of:

  • Green leafy vegetables
  • Fruit

Dairy sources high in calcium:

  • Milk
  • Yogurt
  • Cheese

However, vitamin D is typically highest in sources of wild-caught fatty fish like salmon and tuna.

Regular exercise is the next important step to help reduce the risk and keep bones strong.

Do exercises that are both:

  • Weight-bearing (high/low-impact aerobics or walking/jogging)
  • Muscle-strengthening (weightlifting and exercise bands)

Yoga and Pilates can also help to improve:

  • Strength
  • Balance
  • Flexibility

These are essential in the prevention of bone fractures from falls.

Engage in exercise that you enjoy, this way you will stick with it on a regular basis.

Try for two to three sessions a week if you�re beginning and try to work up to five.

While diet and exercise are extremely important to prevent osteoporosis, there are some areas that should be removed from the lifestyle or limited.

  • Smoking
  • Alcohol

These chemicals in both cigarettes and heavy alcohol consumption are known to be significant contributors to bone loss.

Injury Medical & Chiropractic Clinic offers not only chiropractic treatment, but exercise, and diet programs set up by professional life/health coaches that are customized to each patient. Set up an appointment today, we can help!


 

Chronic Body Pain Treatment El Paso, TX Chiropractor

 

 

Aracely Norte suffered a slip-and-fall accident which tremendously limited her ability to work, affecting her quality of life. Due to the chronic pain she experienced, Aracely had difficulty engaging in her regular, everyday responsibilities. After her lawyer recommended Dr. Alex Jimenez, chiropractor, Aracely found the relief she was looking for.

Chronic pain is a common issue that can occur due to a variety of reasons, including injuries and underlying conditions, however, chiropractic care can help eliminate chronic pain symptoms from the source.


 

NCBI Resources

As with most conditions, prevention is the most�effective treatment. If you have a family history or fall under any of the risk factors, there are things you can do to minimize the effects or prevent the conditions completely.

Your chiropractor can talk to you about lifestyle changes, exercise, and�diet�as well as supplements that you can take. Chiropractic adjustments can also be effective for many patients with osteopenia and osteoporosis as long as the chosen technique is a low force technique like Activator.

 

Bisphosphonate-Related Proximal Femoral Fractures

Bisphosphonate-Related Proximal Femoral Fractures

With the increase of osteoporosis in older adults, the diagnosis and treatment�of abnormal hip fractures, such as�bisphosphonate-related proximal femoral fractures,�has become more important. According to Dr. Edward J. Fox, MD, obesity is often managed through the long-term�use of bisphosphonate treatment, which can inhibit�osteoclast-mediated bone regeneration. Over the prolonged utilization of bisphosphonate, patients� may develop atypical proximal femoral fractures.

Understanding Atypical Femur Fractures

Atypical femur fractures are characterized as stress fractures which commonly occur in the proximal one-third of the diaphyseal bone, although they might also occur more distally, developing in the lateral cortex and slowly progressing medially. “With irregular fractures, a small ‘beak’ of bone can form on the lateral surface of the femur and that is where the fracture generally begins,” explains Dr. Fox. This contrasts with stress fractures which occur laterally in the medial portion of the bone.

As a result, when a patient with osteoporosis reports feeling hip and knee pain without previous damage or injury, healthcare professionals will ask about bisphosphonate treatment. It is essential for the�doctor to request x-rays of the hip and femur shaft for proper diagnosis.�It is also important to request x-rays of the opposite femur, as atypical bisphosphonate-related proximal femoral fractures frequently occur bilaterally. Dr. Edward J. Fox urges patients to discontinue bisphosphonate use in the case of hip fractures,�followed by the subsequent use of crutches or a walker. Patients will eventually be able to resume regular physical activities.

 

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Approximately more than 250,000 hip fractures occur in the United States, causing significant patient disability. The variety of hip fractures in older adults, including bisphosphonate-related proximal femoral fractures, often need several treatment approaches which depend on different considerations, such as the mechanism of injury, location and degree of the fracture, as well as the patient’s age and overall health and wellness.

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

 

 

The precise mechanism of injury by which bisphosphonates cause atypical femur fractures is unknown. Research studies have demonstrated that the suppression of osteoclast activity prevents the clearance of bone fragments which build up on the bone surface during regular daily tasks; decreasing the strength of the bones which lead to fracture. “We all know that the threat of those fractures increases with the extended duration of bisphosphonate exposure, particularly after five decades. Bisphosphonates are stored with a half-life of at least eight decades in bone matrix. To reduce over-exposure and risk of atypical fracture, passing medication discontinuance has been speculated to be beneficial,” explained Dr. Fox

Dr. Edward J. Fox, MD, stated that until research studies find the exact mechanism of injury and treatment for bisphosphonate-related proximal femoral fractures, healthcare professionals should continue to determine the best treatment option for each patient, carefully weighing the benefits and risks of individual patients. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.

Curated by Dr. Alex Jimenez

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Additional Topics: Acute Back Pain

Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain is the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.

 

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EXTRA IMPORTANT TOPIC: Chiropractic Hip Pain Treatment

Surgical Interventions for Cervical Spinous Process Fractures

Surgical Interventions for Cervical Spinous Process Fractures

Fractures of the process of the lower spine or upper thoracic spine are often referred to as clay-shoveler’s fractures.

Initially reported in 1940, these fractures were described among employees in Australia who dug drains in clay soil and also threw the clay overhead with shovels. The mud wouldn’t discharge from the spade, causing excess power to be transmitted into the supraspinous ligaments and leading to an avulsion fracture of one or more spinous processes.

 

The following frequently describes the mechanism of injury for clay shoveler’s fractures. The contraction of the paraspinal and trapezius muscles on the ligaments along with the attachment to the spinous processes make this a common injury during athletics with a flexed position of the shoulders and neck. The consequent fracture or apophyseal avulsion is painful and frequently requires a visit to the doctor, together with plain films, computed tomography (CT) scans, or magnetic resonance imaging (MRI) confirming the identification.

 

Often a period of rest will allow a return to activity, although treatment of these fractures hasn’t been clarified. We present a collection of adolescent athletes who underwent surgical interventions to treat the fracture of the spinous process, after rest and physical therapy with persistent symptoms.

 

Surgical Intervention Study

 

Dr. Hedequist operated on 3 patients using a spinous process nonunion within the study time period. The patients’ average age was 14 years; the location of the spinous process fracture was the T1 vertebra in all patients. Two patients sustained the injury while playing hockey and one while wrestling. The average duration of symptoms before surgery was 10 months; all patients had seen physicians without a diagnosis before test in institution. All patients had a trial of physical therapy and all had been unable to return after trauma to pain.

 

Examination of patients showed pain directly over the fracture site and accentuated by forward flexion of the neck and neck. Evaluation of harm plain films revealed a fracture fragment in two patients (Figure 1). All 3 patients underwent CT and MRI scans confirming the identification. MRI confirmed areas of increased signal at the tip of the T1 spinous process, with inflammation in the supraspinous ligament directly at that area (Figure 2). The CT scans confirmed the presence of a bony fragment correlating with the suggestion of the T1 spinous process (Figure 3).

 

Figure 1

 

Figure 2

 

Figure 3

 

Surgery was performed under general endotracheal anesthesia using a midline incision over the affected region down to the spinous procedure. The supraspinous ligament was opened showing an identified and ununited ossicle, which has been removed without taking down the ligament. All 3 nonunions have been noted to be atrophic with no evidence of surrounding inflammatory tissue or bursa. The residual end of the spinous process was smoothed down with a rongeur. Standard closure was performed. There were no surgical complications.

 

All patients had complete relief of pain at followup; 1 individual returned to full sports activity at 6 months and the other 2 returned to full sports activity at 3 months. There was no loss of peripheral movement or trapezial strength at follow-up. All patients expressed satisfaction together with the decision.

 

Discussion

 

Clinical practice suggests that most patients with spinous process fractures will become pain-free; however, that is not universal. This series demonstrates that a tiny subset of patients with this trauma will continue to have significant symptoms despite a period of rest. In those patients who want a yield to sports, we recommend consideration of surgical excision after confirmation of nonunion with studies. The inherent risks of surgical treatment are minimal with this procedure, and the advantages include return for athletes, with the physical and psychosocial benefits to pain-free sports activity.

 

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�Green-Call-Now-Button-24H-150x150-2.png

 

By Dr. Alex Jimenez

 

Additional Topics: Automobile Accident Injuries

 

Whiplash, among other automobile accident injuries, are frequently reported by victims of an auto collision, regardless of the severity and grade of the accident. The sheer force of an impact can cause damage or injury to the cervical spine, as well as to the rest of the spine. Whiplash is generally the result of an abrupt, back-and-forth jolt of the head and neck in any direction. Fortunately, a variety of treatments are available to treat automobile accident injuries.

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Sports Injuries: Stress Fractures to the Ribs

Sports Injuries: Stress Fractures to the Ribs

Stress fractures to the ribs occur in rowers, golfer, canoeists, lacrosse players and baseball pitchers. They are more common in sports involving an element of trunk rotation with scapula movement across the rib cage.

A stress fracture is described as an overload to the bone caused by repetitive loading due to a particular movement. Any load on the bone will create a stress in the bone. However, given enough recovery time the bone heals and ends up stronger. This is known as Wolfe�s law. But, if the bone load is too high or too frequent, then the bone does not repair quickly enough, a stress response occurs and a fracture follows.

In rowing, the repetitive loading is created by a number of factors. Muscles such as the serratus anterior and abdominals that directly attach to the ribs can lead to loading on the ribcage due to contraction. Bad rowing technique, perhaps caused by poor hip flexibility, which then requires an excessive compensatory thoracic rotation, may then lead to rib breakdown.

Other causes include equipment issues such as the oar type (lighter carbon oars increase rib loading), bigger boats with more drag and position in the boat (bow rowers have less incidence due to lower stroke rate and force). Rib cross section and density also influence the chance of stress fractures, and women have a higher chance due to greater likelihood of bone density issues. Finally, training variables such as volume, intensity, type of loading and off water training can also be factors in stress fracture development.

The signs and symptoms are usually straight forward. These include generalised rib pain with a focused spot of tenderness, pain rolling onto the ribs whilst sleeping and pain with deep breathing. They can be confirmed with bone scan (black spot) and/or MRI (white spot).

Unfortunately for the rower, the immediate management of the injury involves rest. Usually 4-6 weeks away from rowing will be enough to allow some bone healing and this is followed by a progressive increase in rowing load over another 4 weeks before the athlete is back to full training.

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900

Additional Topics: Chiropractic and Athletic Performance

Chiropractic care is a popular, alternative treatment option which focuses on the diagnosis, treatment and prevention of injuries and/or conditions associated to the musculoskeletal and nervous system, primarily the spine. Many athletes, and civilians alike, seek chiropractic care to restore their natural health and wellness, however, chiropractic has been demonstrated to benefit athletes by increasing their athletic performance.

 

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