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Regenerative Medicine: Exploring the Benefits & Risks

Regenerative Medicine: Exploring the Benefits & Risks

Nowadays, individuals trying to avoid surgery have more therapy options. Can regenerative medicine help treat neuromusculoskeletal injuries?

Regenerative Medicine: Exploring the Benefits & Risks

Regenerative Medicine

Regenerative medicine utilizes the body’s raw cells and is used in cancer treatment and to reduce the risk of infections. (American Cancer Society. 2020) Researchers are looking for other ways to use these cells in medical therapies.

What are These Cells

Therapy

Regenerative cell therapy uses these cells as a treatment for a disease or condition.

  • Regenerative cells are given to individuals to replace cells that have been destroyed or have died.
  • In the case of cancer, they may be used to help the body regain the ability to produce regenerative cells after treatment. (American Cancer Society. 2020)
  • For individuals with multiple myeloma and certain types of leukemia, regenerative cell therapy is used to eliminate cancer cells.
  • The therapy is called graft-versus-tumor effect/GvT, where a donor’s white blood cells/WBCs are used to eliminate the cancerous tumor. (American Cancer Society. 2020)

What They Can Treat

This is a new treatment that is still going through research. The Food and Drug Administration has only approved it for certain cancers and conditions that affect the blood and immune system. (Centers for Disease Control and Prevention. 2019) Regenerative cell therapy is FDA-approved to treat: (National Cancer Institute. 2015)

  • Leukemia
  • Lymphoma
  • Multiple myeloma
  • Neuroblastoma
  • It is also used to decrease the risk of infection after regenerative cell transplantation in individuals with blood cancers. (U.S. Food & Drug Administration. 2023)

Researchers are studying how these cells can treat other conditions. Clinical trials are analyzing how to use the therapy for neurodegenerative diseases like:

  • Parkinson’s
  • Alzheimer’s
  • Multiple sclerosis – MS
  • Amyotrophic lateral sclerosis – ALS. (Riham Mohamed Aly. 2020)

Cell Types

During regenerative cell therapy, the cells are given through an intravenous line. The three places where blood-forming cells can be obtained are bone marrow, the umbilical cord, and blood. Transplants can include: (American Cancer Society. 2020)

Autologous

  • The cells are taken from the individual who will be receiving the therapy.

Allogeneic

  • The cells are donated by another individual.

Syngeneic

  • The cells come from an identical twin, if there is one.

Safety

The therapy has shown to provide benefits but there are risks.

  • One risk is known as graft-versus-host disease – GVHD.
  • It occurs in one-third to half of allogeneic recipients.
  • This is where the body does not recognize the donor’s white blood cells and attacks them causing problems and symptoms throughout the body.
  • To treat GVHD medications are given to suppress the immune system to stop attacking the donor cells. (American Cancer Society. 2020)

Other potential risks can include: (American Cancer Society. 2020)

  • Cancer relapse
  • New cancer
  • Hepatic veno-occlusive disease
  • Post-transplant lymphoproliferative disorder – PTLD

Future Possibilities

The future of regenerative cell therapy is promising. Research is ongoing to find out how these cells can treat conditions and find new ways to treat and cure diseases.
Regenerative medicine has been researched for over twenty years for conditions like macular degeneration, glaucoma, stroke, and Alzheimer’s disease. (National Institutes of Health. 2022) This therapy is a new medical treatment that could be used in future therapies as part of a multidisciplinary approach to neuromusculoskeletal injuries and conditions.


Quick Patient Initiation Process


References

American Cancer Society. (2020). How stem cell and bone marrow transplants are used to treat cancer.

National Institutes of Health. (2016). Stem cell basics.

Centers for Disease Control and Prevention. (2019). Stem cell and exosome products.

National Cancer Institute. (2015). Stem cell transplants in cancer treatment.

U.S. Food & Drug Administration. (2023). FDA approves cell therapy for patients with blood cancers to reduce risk of infection following stem cell transplantation.

Aly R. M. (2020). Current state of stem cell-based therapies: an overview. Stem cell investigation, 7, 8. doi.org/10.21037/sci-2020-001

American Cancer Society. (2020). Stem cell or bone marrow transplant side effects.

National Institutes of Health. (2022). Putting stem cell-based therapies in context.

Q/Quadriceps Angle Knee Injuries In Women Athletes

Q/Quadriceps Angle Knee Injuries In Women Athletes

The Q or quadriceps angle is a measurement of pelvic width that is believed to contribute to the risk of sports injuries in women athletes. Can non-surgical therapies and exercises help rehabilitate injuries?

Q/Quadriceps Angle Knee Injuries In Women Athletes

Quadriceps Q – Angle Injuries

The Q angle is the angle where the femur/upper leg bone meets the tibia/lower leg bone. It is measured by two intersecting lines:

  • One from the center of the patella/kneecap to the anterior superior iliac spine of the pelvis.
  • The other is from the patella to the tibial tubercle.
  • On average the angle is three degrees higher in women than men.
  • Average 17 degrees for women and 14 degrees for men. (Ramada R Khasawneh, et al., 2019)
  • Sports medicine experts have linked a wider pelvis to a larger Q-angle. (Ramada R Khasawneh, et al., 2019)

Women have biomechanical differences that include a wider pelvis, making it easier to give birth. However, this difference can contribute to knee injuries when playing sports, as an increased Q angle generates more stress on the knee joint, as well as leading to increased foot pronation.

Injuries

Various factors can increase the risk of injury, but a wider Q angle has been linked to the following conditions.

Patellofemoral Pain Syndrome

  • An increased Q angle can cause the quadriceps to pull on the kneecap, shifting it out of place and causing dysfunctional patellar tracking.
  • With time, this can cause knee pain (under and around the kneecap), and muscle imbalance.
  • Foot orthotics and arch supports could be recommended.
  • Some researchers have found a link, while others have not found the same association. (Wolf Petersen, et al., 2014)

Chondromalacia of the Knee

  • This is the wearing down of the cartilage on the underside of the kneecap.
  • This leads to degeneration of the articular surfaces of the knee. (Enrico Vaienti, et al., 2017)
  • The common symptom is pain under and around the kneecap.

ACL Injuries

  • Women have higher rates of ACL injuries than men. (Yasuhiro Mitani. 2017)
  • An increased Q angle can be a factor that increases stress and causes the knee to lose its stability.
  • However, this remains controversial, as some studies have found no association between the Q angle and knee injuries.

Chiropractic Treatment

Strengthening Exercises

  • ACL injury prevention programs designed for women have resulted in reduced injuries. (Trent Nessler, et al., 2017)
  • The vastus medialis obliquus or VMO is a teardrop-shaped muscle that helps move the knee joint and stabilize the kneecap.
  • Strengthening the muscle can increase the stability of the knee joint.
  • Strengthening may require a specific focus on muscle contraction timing.
  • Closed-chain exercises like wall squats are recommended.
  • Glute strengthening will improve stability.

Stretching Exercises

  • Stretching tight muscles will help relax the injured area, increase circulation, and restore range of motion and function.
  • Muscles commonly found to be tight include the quadriceps, hamstrings, iliotibial band, and gastrocnemius.

Foot Orthotics

  • Custom-made, flexible orthotics decrease the Q angle and reduce pronation, relieving the added stress on the knee.
  • A custom orthotic ensures that the foot and leg dynamics are accounted for and corrected.
  • Motion-control shoes can also help correct overpronation.

Knee Rehabilitation


References

Khasawneh, R. R., Allouh, M. Z., & Abu-El-Rub, E. (2019). Measurement of the quadriceps (Q) angle with respect to various body parameters in young Arab population. PloS one, 14(6), e0218387. doi.org/10.1371/journal.pone.0218387

Petersen, W., Ellermann, A., Gösele-Koppenburg, A., Best, R., Rembitzki, I. V., Brüggemann, G. P., & Liebau, C. (2014). Patellofemoral pain syndrome. Knee surgery, sports traumatology, arthroscopy: Official journal of the ESSKA, 22(10), 2264–2274. doi.org/10.1007/s00167-013-2759-6

Vaienti, E., Scita, G., Ceccarelli, F., & Pogliacomi, F. (2017). Understanding the human knee and its relationship to total knee replacement. Acta bio-medica : Atenei Parmensis, 88(2S), 6–16. doi.org/10.23750/abm.v88i2-S.6507

Mitani Y. (2017). Gender-related differences in lower limb alignment, range of joint motion, and the incidence of sports injuries in Japanese university athletes. Journal of Physical Therapy Science, 29(1), 12–15. doi.org/10.1589/jpts.29.12

Nessler, T., Denney, L., & Sampley, J. (2017). ACL Injury Prevention: What Does Research Tell Us? Current reviews in musculoskeletal medicine, 10(3), 281–288. doi.org/10.1007/s12178-017-9416-5

Golfing Wrist Injuries

Golfing Wrist Injuries

Golfing wrist injuries are common with treatment requiring 1-3 months of rest and immobilization and if tears are present surgery. Can chiropractic treatment help avoid surgery, expedite recovery, and rehabilitation?

Golfing Wrist Injuries

Golfing Wrist Injuries

Golfing Wrist Injuries: According to a study, there are over 30,000 golf-related injuries treated in American emergency rooms every year. (Walsh, B. A. et al, 2017) Nearly a third are related to a strain, sprain, or stress fracture.

  • One of the most common causes of wrist pain is overuse. (Moon, H. W. et al, 2023)
  • Repeated swinging generates added stress on the tendons and muscles, leading to inflammation and pain.
  • Improper swing techniques can cause the wrists to twist uncomfortably, resulting in inflammation, soreness, and injuries.
  • Golfers who grip the club too tightly can add unnecessary strain on their wrists, leading to pain and weakened grip.

Wrist Tendonitis

  • The most common wrist injury is an inflammation of the tendons. (Ray, G. et al, 2023)
  • This condition is often caused by overuse or repetitive motion.
  • It usually develops in the leading hand from bending the wrist forward on the backswing and then extends backward at the finish.

Wrist Sprains

  • These can occur when the golf club hits an object, like a tree root, and makes the wrist bend and/or twist awkwardly. (Zouzias et al., 2018)

Hamate Bone Fractures

  • When the club hits the ground abnormally it can compress the handle against the bony hooks at the end of the smaller hamate/carpal bones.

Ulnar Tunnel Syndrome

  • This can cause inflammation, and numbness, and is usually caused by an improper or loose grip.
  • It causes nerve damage to the wrist from repeated bumping of the golf club handle against the palm.

de Quervain’s Tenosynovitis

  • This is a repetitive motion injury below the thumb at the wrist. (Tan, H. K. et al, 2014)
  • This causes pain and inflammation and is usually accompanied by a grinding sensation when moving the thumb and wrist.

Chiropractic Treatment

Given the nature of these injuries, medical attention should be sought out for image scans to look at any damage and properly immobilize the wrist. Once a fracture has been ruled out or healed, golfing wrist injuries can benefit from chiropractic and physical therapy(Hulbert, J. R. et al, 2005) A typical treatment may involve a multifaceted approach involving various therapies including:

  • Active release therapy, myofascial release, athletic taping, corrective exercise, and stretching. 
  • A chiropractor will examine the wrist and its functioning to determine the nature of the injury.
  • A chiropractor may recommend using a splint to immobilize the wrist, particularly in cases of overuse.
  • They will relieve pain and swelling first, then focus on strengthening the joint.
  • They may recommend a regimen of icing the hand.
  • Adjustments and manipulations will relieve pressure on the nerves to reduce swelling and restore mobility.

Peripheral Neuropathy Successful Recovery


References

Walsh, B. A., Chounthirath, T., Friedenberg, L., & Smith, G. A. (2017). Golf-related injuries treated in United States emergency departments. The American journal of emergency medicine, 35(11), 1666–1671. doi.org/10.1016/j.ajem.2017.05.035

Moon, H. W., & Kim, J. S. (2023). Golf-related sports injuries of the musculoskeletal system. Journal of exercise rehabilitation, 19(2), 134–138. doi.org/10.12965/jer.2346128.064

Ray, G., Sandean, D. P., & Tall, M. A. (2023). Tenosynovitis. In StatPearls. StatPearls Publishing.

Zouzias, I. C., Hendra, J., Stodelle, J., & Limpisvasti, O. (2018). Golf Injuries: Epidemiology, Pathophysiology, and Treatment. The Journal of the American Academy of Orthopaedic Surgeons, 26(4), 116–123. doi.org/10.5435/JAAOS-D-15-00433

Tan, H. K., Chew, N., Chew, K. T., & Peh, W. C. (2014). Clinics in diagnostic imaging (156). Golf-induced hamate hook fracture. Singapore medical journal, 55(10), 517–521. doi.org/10.11622/smedj.2014133

Hulbert, J. R., Printon, R., Osterbauer, P., Davis, P. T., & Lamaack, R. (2005). Chiropractic treatment of hand and wrist pain in older people: systematic protocol development. Part 1: informant interviews. Journal of chiropractic medicine, 4(3), 144–151. doi.org/10.1016/S0899-3467(07)60123-2

Radial Nerve: Peripheral Upper Extremity

Radial Nerve: Peripheral Upper Extremity

The brachial plexus is a network of nerves that begin in the cervical/neck spinal cord and travel down the cervicoaxillary canal into the armpit. Forming in the area of the shoulder joint at the branch junction of the brachial plexus, the radial nerve extends down the arm, through the elbow joint, into the forearm, across the wrist, and tips of the fingers. The nerves are susceptible to injury that can cause abnormal function leading to unusual sensations and impaired muscle function.

Radial Nerve: Peripheral Upper Extremity

Radial Nerve

One of the major nerves of the upper extremity.

  • There is one brachial plexus on each side of the body that carries the nerves to each arm.
  • The radial nerve has two major functions.
  • One is to provide sensations in the hands, forearms, arms, and fingers.
  • The other is to deliver messages to muscles about when to contract.

Motor Function

  • The radial nerve transmits signals to the muscles of the back of the arm and forearm on when to contract.
  • Individuals who have abnormal radial nerve function can experience weakness of the muscles and symptoms like wrist drop.
  • A wrist drop occurs when the back forearm muscles cannot support the wrist, causing the individual to hold the wrist in a flexed posture.
  • Abnormal radial nerve function can cause symptoms of numbness or tingling in the back of the hand.

Conditions

Associated conditions to the radial nerve include lacerations, contusions, fractures, and palsies.

Nerve Contusion

  • A contusion typically occurs through blunt force trauma that can crush and smash the nerve area.
  • This causes abnormal or no function.
  • A nerve contusion can occur from a personal, work, or sports injury or other conditions that generate intense pressure on the nerve/s.

Nerve Lacerations

  • A laceration occurs when there is a penetrating injury that cuts and/or severs the nerve.
  • This injury can occur from stab wounds or sliced by broken glass, metal, etc.

Fractures

  • Broken bones of the upper extremity can lead to extended damage to the nerves near the damaged bone.
  • The most common type of fracture associated with radial nerve malfunction is fractures to the humerus bone.
  • The nerve wraps tightly around the humerus and can be injured with a fracture.
  • Most fracture-related radial nerve injuries heal on their own and do not require surgery.
  • However, the way the injury heals can be the difference between normal function and chronic pain.

Crutch Palsy

  • Crutch palsy is pressure on the radial nerve in the armpit resulting from using crutches incorrectly.
  • To use crutches properly, the individual needs to support their body weight through the hands.
  • However, many tend to place pressure around the armpit at the top of the crutch, causing irritation to the nerve in that area.
  • Padding the top of crutches and using the proper form can prevent the condition.

Saturday Night Palsy

  • Saturday night palsy is the abnormal function of the radial nerve after sleeping in a position that causes direct pressure against the nerve.
  • This often occurs when an individual falls asleep with their arm draped over an armrest on a chair.
  • The name comes from when individuals are intoxicated and fall asleep in a location other than the bed and in awkward positions.

Treatment

Nerve injuries often cause symptoms at different locations other than where the nerve damage is, complicating diagnosis. Determining the specific location of nerve damage is the first step in developing an appropriate treatment plan. Once the location has been identified, steps can be taken to prevent worsening damage to the nerve.

  • The objective is to relieve the pressure from the irritation or compression.
  • Chiropractic treatment can relieve symptoms and restore function through:
  • Massage to relax the area and increase blood circulation.
  • Decompression to physically restore alignment.
  • Adjustments to restore body balance.
  • Exercises and stretches to maintain treatment, strengthen the muscles, and prevent injuries.
  • In cases where there is structural damage, surgery may be necessary to remove pressure or repair damage.

Avoid Surgery


References

Ansari FH, Juergens AL. Saturday Night Palsy. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK557520/

Barton, N J. “Radial nerve lesions.” The Hand vol. 5,3 (1973): 200-8. doi:10.1016/0072-968x(73)90029-6

Daly, Michael, and Chris Langhammer. “Radial Nerve Injury in Humeral Shaft Fracture.” The Orthopedic Clinics of North America vol. 53,2 (2022): 145-154. doi:10.1016/j.ocl.2022.01.001

DeCastro A, Keefe P. Wrist Drop. [Updated 2022 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK532993/

Eaton, C J, and G D Lister. “Radial nerve compression.” Hand Clinics vol. 8,2 (1992): 345-57.

Glover NM, Murphy PB. Anatomy, Shoulder and Upper Limb, Radial Nerve. [Updated 2022 Aug 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK534840/

Ljungquist, Karin L et al. “Radial nerve injuries.” The Journal of hand surgery vol. 40,1 (2015): 166-72. doi:10.1016/j.jhsa.2014.05.010

Węgiel, Andrzej, et al. “Radial nerve compression: anatomical perspective and clinical consequences.” Neurosurgical review vol. 46,1 53. 13 Feb. 2023, doi:10.1007/s10143-023-01944-2

Hamstring Injuries Could Be Implementing Other Issues

Hamstring Injuries Could Be Implementing Other Issues

Introduction

How do non-surgical treatments compare with traditional surgical treatments to improve mobility for individuals with hamstring injuries? The hamstrings are muscles in the lower extremities that provide mobility to the legs and stabilize the pelvis. Many athletes rely on their hamstrings to perform strenuous actions such as sprinting, jumping, squatting, and kicking during sporting events. However, the hamstrings are also very susceptible to injury. Athletes who repeatedly overstretch their hamstrings can experience muscle strain until microscopic tears form, which is common. Similarly, individuals who sit for long periods can also experience hamstring issues. When individuals are not physically active, their hamstrings can become weak and shortened, leading to symptoms such as muscle pain, trigger points, and strain on the accessory muscles. Hamstring injuries can also cause other issues that affect the lower body extremities. This article will explore how hamstring injuries affect mobility and how non-surgical treatments help people regain mobility. We work with certified medical providers who use our patients’ valuable information to treat individuals suffering from hamstring injuries and inform them about non-surgical treatments to regain mobility. We encourage patients to ask essential questions and seek education from our associated medical providers about their condition. Dr. Jimenez, D.C., provides this information as an educational service. Disclaimer

 

Hamstring Injuries Implementing Other Issues

 

Do you experience stiffness in the back of your thighs when warming up before exercising? Are you feeling radiating pain from the side of your hips and glutes due to prolonged sitting? Or do you tend to limp, affecting your gait and walking? Many people are unaware they are overexerting their hamstrings, which can cause pain. Those who engage in sports or work sedentary jobs may over or underuse their hamstrings, affecting their flexibility and mobility to the lower extremities. According to research studies, hamstring injuries are the most common non-contact muscle injuries caused by two mechanisms of injuries: stretch-type and sprint-type. Sprint-type injuries associated with hamstrings occur when the muscles are overexerted due to maximal or near-maximal action, causing muscle fatigue. To that point, hamstring injuries can also affect a person’s walking mobility. 

 

Running without properly warming up the hamstring muscle can cause muscle fatigue. Stretch-type injuries associated with the hamstring muscles involve combination movements that include extreme hip flexion and knee extension. These injuries can also mimic sciatica, leading people to believe their sciatic nerve is acting up. However, treatments available can help reduce the pain associated with hamstring injuries and lengthen the shortened muscle to reduce pain.

 


Best Lower Body Stretches To Increase Flexibility-Video

If you want to reduce the pain associated with hamstring injuries, incorporating RICE can help prevent it from becoming chronic. This involves gently stretching the affected muscle to avoid cramps and pain while increasing flexibility. Hamstring injuries can also be linked to other chronic issues, which can cause inflammation in the surrounding muscles. Studies show that conditions like piriformis syndrome can cause nerve entrapment in the hamstrings, resulting in radiating pain down the leg that mimics low back pain and sciatica. As previously mentioned, hamstring injuries can limit mobility and be linked to chronic conditions. Thankfully, non-surgical treatments can help reduce pain and provide relief. Check out the video above to learn different stretches that can help reduce pain in the lower body and increase flexibility.


Treatments To Restore Mobility

 

If rest, ice, compression, and gentle stretching do not provide relief, incorporating treatments for hamstring injuries to restore mobility can benefit many individuals. Seeking the help of a pain specialist, such as a massage therapist or chiropractor, to create a customized plan/program is recommended. There are various approaches that pain specialists can use to regain mobility and treat hamstring injuries.

 

MET Therapy

Many chiropractors and massage therapists incorporate MET (muscle energy techniques) therapy to gently stretch out the shortened hamstring muscle and help restore joint mobility in the lower extremities. In “Clinical Applications of Neuromuscular Techniques,” written by Leon Chaitow, N.D., D.O., and Judith Walker DeLany, L.M.T., stated that MET is crucial in stretching and strengthening the hamstring muscles through isometric contraction. At the same time, additional research studies reveal that the MET technique allows the hamstrings to have a greater increase in hip flexion ranges. MET therapy also helps strengthen the accessory muscles surrounding the hamstrings to restore mobility.

 

Spinal Decompression

If hamstring injuries are caused by nerve entrapment, then trying out spinal decompression can help restore mobility to the hips and lower extremities. According to “The Ultimate Spinal Decompression,” written by Dr. Eric Kaplan, D.C., FIAMA, and Dr. Perry Bard, D.C., stated that spinal decompression is safe and gentle on the spine as it provides gentle traction on the spinal disc to reduce pain and increase disc height. When hamstring injuries are associated with nerve entrapment, it could result from a herniated disc that aggravates the nerve root and causes referred pain to the hamstrings. Using gentle traction on the spine can help alleviate the pain caused by the aggravating nerve and reduce pain in the hamstrings. Many individuals can incorporate these treatments to reduce hamstring injuries and regain their mobility back to their legs.

 


References

Chaitow, L., & Delany, J. (2002). Clinical application of neuromuscular techniques. Vol. 2, The lower body. Churchill Livingstone.

Gunn, L. J., Stewart, J. C., Morgan, B., Metts, S. T., Magnuson, J. M., Iglowski, N. J., Fritz, S. L., & Arnot, C. (2018). Instrument-assisted soft tissue mobilization and proprioceptive neuromuscular facilitation techniques improve hamstring flexibility better than static stretching alone: a randomized clinical trial. Journal of Manual & Manipulative Therapy, 27(1), 15–23. doi.org/10.1080/10669817.2018.1475693

Huygaerts, S., Cos, F., Cohen, D. D., Calleja-González, J., Guitart, M., Blazevich, A. J., & Alcaraz, P. E. (2020). Mechanisms of Hamstring Strain Injury: Interactions between Fatigue, Muscle Activation and Function. Sports (Basel, Switzerland)8(5), 65. doi.org/10.3390/sports8050065

Kaplan, E., & Bard, P. (2023). The Ulitimate Spinal Decompression. JETLAUNCH.

Vij, N., Kiernan, H., Bisht, R., Singleton, I., Cornett, E. M., Kaye, A. D., Imani, F., Varrassi, G., Pourbahri, M., Viswanath, O., & Urits, I. (2021). Surgical and Non-surgical Treatment Options for Piriformis Syndrome: A Literature Review. Anesthesiology and Pain Medicine, 11(1). doi.org/10.5812/aapm.112825

Disclaimer

Compressed Nerve In The Knee

Compressed Nerve In The Knee

A nerve becomes pinched/compressed when added pressure is placed on it by surrounding structures that can include muscles, bones, ligaments, tendons, or a combination. This injures and damages the nerve causing function problems and symptoms and sensations in that area or other parts of the body that are supplied by that nerve. Medical practitioners refer to this as nerve compression or entrapment. Although compressed nerves are more commonly associated with the neck, arms, hands, elbows, and lower back, any nerve in the body can experience irritation, spasms, inflammation, and compression. The causes and treatment of a compressed nerve in the knee.

Compressed Nerve In The Knee

Compressed Nerve In The Knee

There’s only one nerve that goes through the knee that has an increased risk of getting compressed. It’s a branch of the sciatic nerve called the peroneal nerve. The nerve goes around the outside of the knee before traveling down the outside of the lower leg. At the bottom of the knee, it lies between the bone and skin, making it vulnerable to irritation or compression by anything that can put pressure on the outside of the knee.

Causes

Traumatic injuries over time can lead to pressure on the nerve from inside the knee. Common causes of a compressed nerve in the knee include:

Frequently Crossing Legs

  • Compression by the opposite knee, while the legs are crossed is the most common cause.

Knee Brace

  • A too-tight or strong brace can compress the leg and nerve.

Thigh-High Compression Stockings

  • Designed to maintain pressure on the legs, if too tight these stockings can compress the nerve.

Squatting Posture For Long Periods

  • This position places pressure on the side of the knee.

Fractures

  • A fracture of the large lower leg bone/tibia or sometimes the small bone/fibula near the knee can entrap the nerve.

Lower Leg Cast

  • The portion of the cast around the knee can be tight and compress the nerve.
  • Tell the doctor if a cast or brace feels tight or is causing numbness or pain in the leg.

Knee-High Boots

  • The top of a boot can land right below the knee and be too tight pinching the nerve.

Knee Ligament Injury

  • The nerve can become compressed due to bleeding or inflammation from an injured ligament.

Knee Surgery Complications

  • This is rare, but the nerve can inadvertently get pinched during knee replacement surgery or an arthroscopic procedure.

Prolonged Bed Rest

  • When lying down the legs tend to rotate outward and the knees flex.
  • In this position, the mattress can place pressure on the nerve.

Tumors or Cysts

  • Tumors or cysts can develop right on top or next to a nerve irritating and compressing the area.

Abdominal or Gynecologic Surgery

  • The equipment used to keep the legs rotated outward and the knees flexed for gynecologic and abdominal surgeries can compress the nerve.

Symptoms

The peroneal nerve supplies sensation and movement to the outside of the lower leg and the top of the foot. When compressed, it becomes inflamed, which causes the symptoms of a compressed nerve. Usually, only the lining/myelin sheath around the nerve is what gets injured. However, when the nerve gets damaged, the symptoms are similar but more severe. Common symptoms include:

  • Weakness that limits the ability to lift the foot toward the leg aka dorsiflexion.
  • This causes dragging the foot when walking.
  • The ability to turn the foot outward and extend the big toe is also affected.
  • Symptoms can be felt on the outside of the lower leg and on the top of the foot and include:
  • Tingling or pins and needles sensations.
  • Numbness.
  • Loss of sensation.
  • Pain.
  • Burning.
  • For individuals that have had a pinched nerve for two or more weeks, the muscles supplied by the nerve can begin to waste away or atrophy.
  • Symptoms can be intermittent or continuous depending on the cause.
  • The other common cause is a pinched nerve in the lumbar/lower spine.
  • When this is the cause, sensations, and pain will present in the lower back or the back and outside of the thigh.

Diagnosis

A doctor will look at medical history and perform an examination to make a diagnosis, determine the cause, and lay out a personalized treatment plan. The nerve in the knee can be felt as it travels around the top of the tibia, so a doctor may tap on it. If there is shooting pain down the leg, a pinched nerve may be present. Tests a doctor may order can include:

Knee X-ray

  • Shows any bone fractures or abnormal masses.

Knee MRI

  • Can confirm the diagnosis
  • Shows masses within the nerve.
  • Shows details of fractures or other problems in the bones.

Electromyogram – EMG

  • Tests electrical activity in the muscles.

Nerve Conduction Test

  • Tests the signal speed of the nerve.

Treatment

Treatment is aimed at reducing pain and improving mobility.

Over-the-Counter Pain Medication

  • OTC medication can reduce inflammation and improve symptoms short term.

Ice and Heat

  • Applying either heat or ice for 15 to 20 minutes at a time can provide relief from the symptoms.
  • An ice pack can make symptoms worse if it adds more pressure on the nerve.

Chiropractic and Physical Therapy

  • Chiropractic and physical therapy can release the compressed nerve, realign the structures, strengthen the muscles, and provide gait training.

Orthotic Boot

  • If walking gait is affected because the foot cannot bend, an orthotic boot can help.
  • This is a support that maintains the foot in a neutral position to walk normally.

Corticosteroid Injection

  • A corticosteroid injection can reduce inflammation and relieve pressure on the nerve.

Surgery

  • The nerve can suffer permanent damage if it has been pinched for a long time.
  • If that happens, surgery cannot repair the damage.
  • A doctor can perform surgery to correct a fracture, tumor, or other invasive problem causing a compressed nerve.
  • If conservative treatment doesn’t work, a peroneal nerve decompression procedure can be done to remove the pressure.
  • If surgery is needed, symptoms can disappear immediately, but it takes around four months to recover and rehabilitate.

Injury Rehabilitation


References

Krych, Aaron J et al. “Is peroneal nerve injury associated with worse function after knee dislocation?.” Clinical orthopedics and related research vol. 472,9 (2014): 2630-6. doi:10.1007/s11999-014-3542-9

Lezak B, Massel DH, Varacallo M. Peroneal Nerve Injury. [Updated 2022 Nov 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK549859/

Soltani Mohammadi, Sussan, et al. “Comparing the squatting position and traditional sitting position for ease of spinal needle placement: a randomized clinical trial.” Anesthesiology and pain medicine vol. 4,2 e13969. 5 Apr. 2014, doi:10.5812/aapm.13969

Stanitski, C L. “Rehabilitation following knee injury.” Clinics in sports medicine vol. 4,3 (1985): 495-511.

Xu, Lin, et al. Zhongguo gu Shang = China Journal of Orthopedics and Traumatology vol. 33,11 (2020): 1071-5. doi:10.12200/j.issn.1003-0034.2020.11.017

Yacub, Jennifer N et al. “Nerve injury in patients after hip and knee arthroplasties and knee arthroscopy.” American Journal of physical medicine & Rehabilitation vol. 88,8 (2009): 635-41; quiz 642-4, 691. doi:10.1097/PHM.0b013e3181ae0c9d

Overexertion, Repetitive Stress Injuries: EP Back Clinic

Overexertion, Repetitive Stress Injuries: EP Back Clinic

Overexertion and repetitive stress injuries make up a fourth of all work injuries. Repetitive pulling, lifting, punching in numbers, typing, pushing, holding, carrying, and scanning are the most common causes of job-related injuries. These types of injuries are the most common that cause missed days at work.  Overexertion can lead to lasting physical chronic conditions, ranging from chronic back pain to chronic joint pain caused by the advanced wearing and tearing of the various musculoskeletal tissues. Chiropractic medicine takes a comprehensive and whole-body approach to treating neuromusculoskeletal injuries. Chiropractic relieves tight or damaged muscles, increases nerve energy flow, and properly aligns the joints through adjustments, spinal traction, decompression, and various forms of manual manipulation.

Overexertion, Repetitive Stress Injuries: EP Chiropractic Specialists

Overexertion and Repetitive Stress Injuries

Overexertion and repetitive stress injuries typically occur over time/years of engaging in the same strenuous activity regularly. However, an overexertion injury can occur with one sudden or extreme movement. A worker can injure muscles, tendons, joints, and ligaments. Overexertion can lead to musculoskeletal disorders with symptoms including:

  • Inflammation
  • Swelling
  • Numbness
  • Stiffness
  • Chronic pain
  • Limited or total loss of mobility in the muscles, tendons, ligaments, and joints.

Types

A few of the most common examples of overexertion injuries include:

Soft-Tissue

  • Injuries to muscles, ligaments, tendons, and joints.

Back

  • Pulled, strained back muscles.
  • Herniated discs.
  • Compressed nerve roots.
  • Fractured vertebrae.

Dehydration and Heat Stroke

  • Most common among workers doing outdoor manual labor.

Repetitive and Overuse

  • Injuries range from carpal tunnel syndrome to stress fractures.
  • Often the result of weeks, months, or years of repeated movements
  • In many cases, two or more injuries can happen simultaneously.
  • For example, a worker is more likely to sustain an injury if they are dehydrated or they are performing dual tasks.

Causes

Certain movements and activities are more likely to cause overexertion injuries. Some of the most common include:

  • Daily lifting of objects, light and heavy.
  • Performing awkward movements that cause the body to be in unhealthy positions.
  • Standing and/or sitting or for long periods.
  • Using excessive force to perform tasks.
  • Operating heavy machinery.
  • Working in hot and/or humid conditions.

High-Rate Injury Industries

Industries in which overexertion injuries are most common include:

  • Education.
  • Health services.
  • Manufacturing.
  • Construction.
  • Warehouse work.
  • Transportation.
  • Wholesale trade.
  • Retail stores.

Chiropractic Treatment

These injuries can lead to missed work, debilitating pain, and medical bills. Depending on the severity of the injury, chiropractic care will use massage techniques, spinal manipulation, traction, and decompression therapies, to increase flexibility and mobility to reduce the chances of a recurring injury. The benefits of chiropractic include:

  • Prevents the risk of worsening or future injuries.
  • Expedites recovery to help individuals rehabilitate and get back to work sooner.
  • Improves physical and mental well-being.
  • Provide recommendations on how to properly stretch and strengthen muscles.
  • Nutritional anti-inflammatory recommendations.

By learning how to avoid overexertion injuries, workers can be more productive, enjoy work, and improve their quality of life.


From Injury To Recovery


References

Anderson, Vern Putz, et al. “Occupational fatalities, injuries, illnesses, and related economic loss in the wholesale and retail trade sector.” American Journal of industrial medicine vol. 53,7 (2010): 673-85. doi:10.1002/ajim.20813

Choi, Hyun-Woo, et al. “Characteristics of occupational musculoskeletal disorders of five sectors in the service industry between 2004 and 2013.” Annals of Occupational and environmental medicine vol. 29 41. 19 Sep. 2017, doi:10.1186/s40557-017-0198-4

Friedenberg, Rivi, et al. “Work-related musculoskeletal disorders and injuries among emergency medical technicians and paramedics: A comprehensive narrative review.” Archives of Environmental & occupational health vol. 77,1 (2022): 9-17. doi:10.1080/19338244.2020.1832038

Galinsky, T et al. “Overexertion injuries in home health care workers and the need for ergonomics.” Home health care services quarterly vol. 20,3 (2001): 57-73. doi:10.1300/J027v20n03_04

González Fuentes, Aroa, et al. “Work-related overexertion injuries in cleaning occupations: An exploration of the factors to predict the days of absence by means of machine learning methodologies.” Applied ergonomics, vol. 105 103847. 30 Jul. 2022, doi:10.1016/j.apergo.2022.103847

Schoenfisch, Ashley L et al. “Declining rates of work-related overexertion back injuries among union drywall installers in Washington State, 1989-2008: Improved work safety or shifting of care?.” American Journal of industrial medicine vol. 57,2 (2014): 184-94. doi:10.1002/ajim.22240

Williams, J M et al. “Work-related injuries in a rural emergency department population.” Academic emergency medicine: official journal of the Society for Academic Emergency Medicine vol. 4,4 (1997): 277-81. doi:10.1111/j.1553-2712.1997.tb03548.x