ACL injuries are some of the most common sports-related injuries that doctors and chiropractors see. It occurs when one of the ligaments in the knee, the ACL, is torn. If left untreated, it can cause the person to have difficulty moving their knee or controlling its movements because of the breakdown of knee support. When this happens, the bones of the joint often rub against each other. Over time this can cause a condition called chronic ACL deficiency. Osteoarthritis can also occur due to the bones rubbing against each other, eroding the cartilage and meniscus. A chiropractor can help reduce the pain of an ACL injury and help prevent further damage.
What is an ACL Injury?
The anterior cruciate ligament, or ACL, is a major ligament in the knee that connects the femur (thighbone) to the tibia (shinbone) in the knee joint and provides stability for the knee. An ACL injury does not occur gradually, but instead usually happens suddenly. Most often they happen when a person is playing sports and jumps, stops suddenly, or makes a sudden change in direction. Soccer, basketball, tennis, volleyball, downhill skiing, gymnastics, and football.
What causes an ACL injury?
Sports and fitness activities, typically ones that place stress on the knee, are the most common causes of ACL injury. Specific actions that can lead to the tears include:
Pivoting when the foot is planted firmly
Sudden stops
Cutting or slowing and changing direction suddenly
Landing incorrectly from a jump
Being involved in a collision where the knee is hit or it causes any of the other listed actions
Receiving a direct, sudden, hard hit to the knee
The resulting tear can be minor and small or it can be severe, including a complete tear. In very mild cases, the ligament may be overextended but still intact.
What are the symptoms of an ACL injury?
People who experience an ACL injury will often hear a loud POP when it occurs. Other symptoms of an ACL injury include:
Severe or intense pain
Swelling (begins in the first few hours after the injury)
A feeling that the knee is unstable
A popping sensation in the knee
The knee feels like it �gives away� when bearing weight
Unable to continue the activity they were doing when the injury occurred
Loss of or decreased range of motion
Who is most at risk of having an ACL injury?
Statistically, when both men and women are participating in the same sports, women are more likely to sustain an ACL injury. Research shows that, generally speaking, women have a tendency to have an imbalance of strength in their thighs. Specifically, the quadriceps, the muscles in the front are typically stronger that the hamstrings, the muscles in the back. It�s the hamstrings that work to keep the shinbone from extending too far forward � the type of movement that overextends the ACL. Additionally, men and women athlete jump differently with women more likely to land in a manner that places extra stress on the knees.
How is an ACL injury treated?
There are several treatments for an ACL injury. Immediate treatment can help reduce swelling and pain that the injury causes. The R.I.C.E. model is the recommended self-care that the patient can do at home:
Rice
Ice
Compression
Elevation
In some cases, surgery may be recommended, but usually the best course of treatment includes physical therapy and chiropractic care. The knee may be braced and the patient may have to rest for a while before beginning physical therapy. A chiropractor can help not only treat the ACL injury, but also help correct any muscular imbalances that the patient may have.
Assembly lines have long been the standard for factory workers. Henry Ford got the ball rolling on December 1, 1913, when he created the very first assembly line to mass produce a car. Workers stood for hours, doing the same tasks over and over. Although Ford took steps to reduce at least some of the damage, many factory workers still went home with aching backs and feet, migraines, fallen arches, and repetitive motion injuries.
Now, more than a hundred year later, some things have changed. According to the United States Department of Labor Bureau of Labor Statistics, there were 1,834,000 assembly line and fabrication jobs in 2014. Technology is better, and some tasks can be automated making some people�s jobs more manageable � and, unfortunately, eliminating some as well.
Despite the great strides in technology, there are still some things that haven�t changed all that much. The working conditions in many factories are often still not as healthy as they could be. Many workers are still required to stand for long periods of time and perform repetitive motions for hours without a break. This can lead to injuries, pain, and certain conditions that can cause immobility, inflexibility, and even disability. The good news is, chiropractic can help.
Working in a Standing Position Can Be Bad For Your Health
Many assembly line jobs require that the worker stand for long periods of time. While standing is a natural posture for humans and, by itself does not pose any real harm or health problem, working in a standing position every day isn�t good for you. It can lead to muscle fatigue, stiff shoulders and neck, swelling of the legs and feet, low back pain, varicose veins, fallen arches, and sore feet � to name a few.
Another problem with standing for extended or frequent periods of time without any breaks (such as walking or stretching) can cause the joints in the feet, knees, hips, and spine to become locked or immobilized temporarily. If the behavior continues, it can cause degenerative damage, leading to rheumatic diseases because the ligaments and tendons become damaged.
Other Assembly Line Related Health Problems
Barring traumatic injury due to an accident, working in a factory environment can cause problems with mobility, pain, and flexibility. The nature of the job places specific demands on the human body that can lead to certain types of injuries and health conditions, which include:
Repetitive motion injury � When a worker performs the same task that involves the same movements over and over, it can lead to certain types of injuries. Carpal tunnel is common repetitive motion injury.
Overexertion � Lifting, pulling, even standing can take a toll on the body, especially when it is done without adequate breaks. The person can get muscle fatigue, pulled muscles, and pulled tendons.
Body movement injuries � When the worker is continuously reaching, twisting, crawling, and bending, it can cause problems with the muscles and joints.
Chiropractic can Help Assembly Line Workers
Chiropractic care can help keep bodies flexible and help with range of motion. It is a very effective, non-invasive treatment for pain and can help with joint and muscular problems as well. Regular chiropractic treatments can help you better manage your body�s response to your work environment. It can also undo many of the ill effects that that type of work can cause.
You can enjoy more pain-free days without invasive surgeries or medications that leave you groggy, nauseous, or worse. When you sit down with your chiropractor, he or she will talk to you about your medical history as well as your current lifestyle. After a complete evaluation, you will be given a plan of action that may include lifestyle changes, dietary changes, and recommended supplements in addition to spinal manipulation. Chiropractic is all about whole body wellness, and that is what will help you perform better on your job and recover faster.
Vincent Garcia trains in martial arts as a part of his activities. However, after he developed turf toe and he started to undergo knee pain, Vincent’s performance was affected. Dr. Alex Jimenez, a doctor of chiropractic, helped treat Vincent Garcia’s knee pain along with turf toe, gradually restoring his overall health and well-being. Dr. Alex Jimenez has also helped treat a variety of other sport-related injuries. Chiropractic care utilized corrections and manipulations that were manual to carefully restore the original integrity of the backbone, allowing the human body to heal itself. Vincent Garcia highly recommends Dr. Alex Jimenez as the non-invasive pick for many different accidents and/or conditions, including several sports accidents, among other problems.
Chiro Treatment
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused on treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and educated on how to maintain this way of life. I have made a life of taking care of every one of my patients.
I assure you, I will only accept the best for you�
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Being involved in strenuous physical activities and exercises as an athlete can often result in a variety of sports injuries. For several of Dr. Alex Jimenez’s patients, their painful symptoms tremendously affected their overall athletic performance. Chiropractic care is a safe and effective, alternative treatment option which focuses on the diagnosis, treatment, and prevention of a variety of injuries and/or conditions associated with the musculoskeletal and nervous system. Several patients describe how Dr. Alex Jimenez’s sports injuries rehabilitation has helped them find pain relief from their symptoms and allowed them to return-to-play faster than with other treatments. Dr. Alex Jimenez is highly recommended as the non-surgical choice for sports injuries, among other common health issues.
Chiro Rehab
�
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused on treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and educated on how to maintain this way of life. I have made a life of taking care of every one of my patients.
I assure you, I will only accept the best for you�
If you have enjoyed this video and we have helped you in any way, please feel free to subscribe and recommend�us. Recommend: Dr. Alex Jimenez � Chiropractor
Every year an estimated 3.8 million people in the United States sustain mild traumatic brain injuries (MTBI) or concussions. Many of these injuries are due to sports-related activities, work related injuries, motor vehicle accidents, and military operations. It is also estimated that as many as 50% of MTBIs are never reported because the patient does not seek medical attention. This makes it difficult to get a substantial number on how many there are, but it is a prevalent condition.
The Brain and Skull
A patient does not have to hit their head to sustain an MTBI. It can be caused by whiplash even though the person never hit their head. The reason for this lies in the construction of the brain and skull.
The brain is very soft; some experts compare the texture to that of soft butter. The skull is designed to protect the brain, and it is tough. If you run your hand over your head, you may feel some lumps and bumps, it may not feel entirely even, but the surface will be smooth.
The same cannot be said for the inside of the skull. There are boney ridges on the inside that are quite sharp. The design is intended to keep the brain in place.
When the head is hit or is jolted hard enough it caused the brain to shift inside of the skull, coming into contact with those boney ridges � sometimes forcefully. This can cause damage and the result in a brain injury. The harder the jolt, the more serious the injury may be.
Symptoms of Mild Traumatic Brain Injury
Part of the problem with MTBI is that the symptoms may not show up immediately. They could emerge weeks or even months after the incident making it unlikely that the symptoms will be tracked back and connected to it.
Often, MTBI is called a �silent epidemic� because the symptoms that it causes are usually not visible and may not be immediately connected to the injury. Depression, anxiety, angry outbursts, and impaired memory are more likely to be considered a psychiatric issue instead of a neurological one. The symptoms can be debilitating just the same.
Evaluation and diagnosis of an MTBI
Chiropractors routinely treat patients with Mild Traumatic Brain Injuries. When they are presented with a patient that they know has sustained a head injury, or if they suspect a brain injury based on specific symptoms, they use the Sports Concussion Assessment Tool 2 (SCAT2) to determine the severity. The SCAT2 helps the chiropractor create evaluate the physical signs, symptoms, sideline assessment using Maddocks score, Glasgow Coma Scale, coordination, balance, and cognitive.
As they evaluate the patient, they look for specific markers that indicate the patient is experiencing worsening neurological symptoms. These include:
Loss of consciousness
Vomiting
Headaches get�worse
Increased confusion
Weakness on one side or in one leg or arm
Blurred vision
Dilated pupils
Balance or coordination problems
Chiropractic Treatment for MTBI
A head injury usually involves a neck injury as well. The chiropractor may use a variety of techniques to treat the patient, including spinal manipulation, massage, and bracing. The patient will also be advised to avoid anti-inflammatory medication, aspirin, alcohol, and sleep aids, using acetaminophen for pain as needed. If the patient needs to see another doctor or specialist, the chiropractor will refer them.
In adults: Radial head Fx is the m/c (33%) and accounts for 1.5-4% of all fractures. Etiology: FOOSH with forearm pronated. Associated injuries: elbow collateral ligaments tears. EssexLoprestiFx with interosseous membrane tearing and dislocation of the Distal Radio-Ulnar Joint(DRUJ)
Terrible triad: of the Radial head Fx, elbow dislocation and Coronoid process Fx (typically avulsed by the Brachialis M)
Imaging: 1st step is x-radiography with elbow series, CT scanning may help in complex cases, MRIif ligamentous injury.
In children: Supracondylar Fx of the distal humerus accounts for 90% of acute trauma. It is always d/t accidental trauma with FOOSH and elbow extended, rarely <5% with flexed elbow. MostSupracondylar Fx occur in children <10 y.o. Males>Females. Complications: malunion in cubitus varus aka Gunstock deformity, vascular injury and acute ischemic compartment syndrome with Volkmann contracture
Imaging: 1st step x-radiography can be sufficient. CT occasionally used in complex cases.
Radial head (RH) Fx: Mason classification helps to determine the degree of complexity and mode of treatment
Type 1- undisplaced is the m/c and stable contained by ligaments. On radiographs can be very subtle and evaluation of abnormal elbow fat pads is critical and often the only diagnostic clue
Type 2- displaced by 2-mm or > with rotational block
Type 3- comminuted >2-3 fragments and
Type4 is presented with RH fx, posterior elbow dislocation and sometimes Coronoid process fracture often d/t Brachialis M avulsion
Rx: Type 1 managed non-operatively by immobilization and movement rehab. Type 2- ORIF if rotational block. Type 3 and 4, ORIF and RH resection or RH arthroplasty
Note abnormally displaced anterior fat pad (orange arrow) and the emergence of the posterior fat pad (green arrow) that is usually deep in the olecranon fossa and not seen unless acute hemarthrosis or other effusiondevelopsFat pad signs are most reliable indicators of intra-articular elbow Fx
Mason type 1 RH Fx can be v. subtle and missed. Radiographic search should involve a�close evaluation of positive fat pad signs. Note anterior fat pad displacement aka Sail sign and the presence of the post fat pad d/t acute bleed
Monteggia fracture-dislocations: prox 1/3ulnar shaft Fx. with concomitant dislocation of PRUJ (radial head). FOOSH injury. Children4-12 y.o. Infrequent in adults.
X-rays readily reveal ulnar Fx, but radial head dislocation may be subtle and occasionally missed. This is a serious injury leading to elbow disability if Dx delayed 2-3 weeks or left untreated. X-rays are typically sufficient:Rx: casting vs. operative.
Supracondylar Fx: this is the M/C elbow Fx in children.
Especially, the un-displaced types 1(top right) is difficult to Dx. Abnormality of “fat pads” and anterior humeral line and radiocapitella line disturbance are often most reliable
Type 3 carries a particularly high risk for Volkmann contracture (vascular ischemic-necrosis of the anterior forearm muscle compartment
Elbow complaints in a young athlete
Epicondyle Fx: common pediatric injury, about 10%.Essentially an avulsion Fx and a MUCL tear. Medial epicondyle is m/c Fx. FOOSH is the m/c mechanism.M>F. If minimally displaced or undisplaced can be treated with casting esp. in non-dominant arm. If displaced as in this case, require ORIF.
Medial epicondyle avulsive Fx in a young baseball pitcher was coined a �little league elbow� in the 60sand now should be avoided to avoid confusion
OCD of the Capitellum is a common athletic injury induced by repeated compression/flexion. OCD must be DDx from Panner�s disease or osteochondritis typically presented in younger patients
Difficulty in diagnosis may stem�from multipleapophysis about the elbow (see CRITOE)
Imaging: 1st step: x-rays followed by MRI and MRarthrogramme if indicated.
CT may help with complex injury evaluation. MRI and MSKUS may help with a�ligament injury.
Elbow Arthritis
DJD of the elbow is uncommon and typically 2nd to trauma, occupation, CPPD, OCD of theCapitellum or other pathology. Clinically: pain, reduced ROM esp. in dominant arm, deterioration of ADL. Loss of terminal flexion and extension. 50% develop Ulnarcompressive neuropathy. Rx: conservative,arthroscopic debridement/osteophytes removal, capsular release. In older patients and not active patients Total Elbow Arthroplasty (TEA) can be used
Imaging: x-radiography is sufficient, CT helps with pre-operative planning
Inflammatory Arthritis: RA of the elbow is frequent (20-50%) and destructive d/t synovitis, pannus, bone/cartilage,�and ligamentous destruction/laxity. Clinically: begins after the onset of hands symptoms with, symmetrical swelling, pain, reduced ROM, flexion contracture. Presence of rheumatoid nodules can be noted along the olecranon and posterior forearm. Rx: DMARD, operative tendons repair.
Imaging: x-radiography with early non-specific effusion (fat pads),later: erosions, symmetric JSL, osteopenia. MSK US helps early Dx. MRI reveals synovitis; bone edema correlates with pre-erosive x-ray findings, synovial enhancement on FS T1+C.
Gouty Arthritis: may affect the elbow but less than in the lower extremity. Olecranon bursitis causing a �rising sun sign� on x-rays with or w/o bone erosions. Aspiration and polarised microscopy revealing needle-shaped negatively birefringent monosodium urate crystals. Rx: colchicine, other meds.
Septic Arthritis: consider in people with diabetes, IV drug users, concurrent RA, patients with active TB, gonococcal in young adults. Clinically presents as monoarthritis with or w/o constitutional signs. X-ray: poor detection in early stages. US may show effusion and high Doppler.MRI: effusion, osseous edema. Bone scintigraphy can help as well. Labs: CBC, ESR, CRP. Diagnostic arthrocentesis with gram staining and culture are crucial. Rx: Prompt IV antibiotics
Juvenile Idiopathic Arthritis (JIA) considered M/C chronic disease of childhood and preceded IBD infrequency. Dx is clinical and imaging: Criteria: Joint pain and swelling in a child 0-16-years for 6-weeks or longer. Many forms exist�M/C pauciarticular(oligoarticular) 40%, F>M, associated with ocular involvement (iridocyclitis) and potential blindness. Polyarticular and Systemic forms.
Elbow is frequently affected along with the knee, wrists,�and hands,�especially in polyarticular dz.
Labs: ESR/CRP RF-VE in most cases
Imaging: early x-ray features are non-specific. Later: osseous erosion, destruction of joint cartilage, overgrowth of articular epiphyses, early closure of physis. Delayed features: 2nd DJD, joint ankyloses.DDx: hemophilic arthropathy. Cervical radiographs are crucial.
Rx: DMARD, conservative care
Miscellaneous pathologies
Supracondylar process: 2% of the population. Described by Sir JohnStruthers in 1854. Fibrous band(Ligament of Struthers) may lead to compression of the Median N. DDx fromOsteochondroma that typically points away from the joint
Primary synovial chondrometaplasia�(Reichel Syndrome): abnormalmetaplasia of synovial cells shedding cartilage into joint potentially causing DJD, extrinsic bone erosion, synovitis, nerve compressions etc. Removedoperatively. Imaging: multiple osseocartilaginous loose bodies of relatively equal sizes in the joint cavityDDx with DJD and 2ndosteochondromatosis. MRI-low signal onT1 and T2 with potential joint effusion. Ina tight joint like the elbow may present with large joint distention.�
Panner�s Disease: osteochondrosis of theCapitellum typically in 5-10 y.o. young athlete DDX from OCD of Capitellum(discussed) that occurs in teenagers.Clinically: pain on activity. Recovery occurs in most cases by spontaneous healing. Imaging: x-rays reveal sclerosis and slight fragmentation of theCapitellum w/o loose body. MRI: low T1and high T2 signal in the entireCapitellum.
Myositis Ossificance:
Soft Tissue & Bone Neoplasms about the Elbow
Lipoma: intramuscular, subcutaneous. Most common soft tissue neoplasms. Composed of fat but a substantial number may undergo fat necrosis-calcification-fibrosis. Typically remains benign. Occasionally difficult to DDx from a well-differentiated liposarcoma. Imaging: x radiography: radiolucent lesion well-circumscribed with or w/o calcification. US and MRI are important. On MRIT1high, T2 low SI.
Hemangioma: benign vascular lesion, often composed of multiple vascular channels. Capillary vs. cavernous. More common in children, but found in any age. May often form phleboliths (calcification). Imaging: x-rays reveal soft tissue mass containing phleboliths. MRI: T1-high or variable signal. T2-high signal in areas of slow flow. �bag of worms� sign. Biopsy best avoided. Rx: difficult: local excision vs. embolization vs. observation. High recurrence.
Peripheral Nerve sheath tumor (PNST): benign vs.malignant. Greater incidence in NF1 with a higher risk of malignant PNST. Benign PNST: Schwannoma vs.Neurofibroma. Spinal vs. peripheral nerves. Histology: Schwann cells interspersed with fibroblast and vessels.Clinically: pts in 20s and 30s, palpable mass with or w/o local pressure. Imaging: MRI: T1: split-fat sign, T2: target sign. T1+C enhancement
Soft Tissue Sarcomas: MFH, Synovial sarcoma,(discussed), Liposarcoma (more frequent in the retroperitoneum) Dx: MRI. Clinically: Dx is delayed d/t painless enlarging mass often ignored. Clinically palpable mass deserves MRI examination, US may be helpful. Biopsy confirms Dx.
Malignant bone Neoplasms: Children: OSA, Ewing�s sarcoma (discussed) Adults: Mets, Myeloma (discussed)
Automobile accidents are a common cause of injuries and aggravated conditions, such as neck pain and back pain which can affect the victim’s daily physical activities. Patients describe how their symptoms ultimately changed their quality of life. Dr. Alex Jimenez is a chiropractor who focuses on a variety of injuries and underlying conditions, including automobile accident injuries. Satisfied with the treatment and services they’ve received for their health issues, many patients highly recommend Dr. Alex Jimenez as the non-surgical choice for automobile accident injuries, among other health issues. Chiropractic care is a safe and effective alternative treatment option.
Chiropractor for Auto injuries
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused on treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and we have helped you in any way, please feel free to subscribe and recommend�us.
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