Corticosteroid injections are widely used to aid injury rehabilitation but we still understand very little about their mechanism. Chiropractor, Dr. Alexander Jimenez examines the current thinking and discusses how this potentially impacts treatment options…
Corticosteroids are used for their anti- inflammatory and pain reducing effects. They can also reduce muscle spasms and influence local tissue metabolism for faster healing. Injection therapy is now widely available from specially trained general practitioners, physiotherapists and consultants, and can be offered for a wide range of clinical conditions. Because of this wide availability and the growing desire for injury �quick fixes�, it is important that they are used correctly and the full consequences are understood prior to injection.
The main indications for corticosteroid injection use are(1):
Acute and chronic bursitis
Acute capsulitis (tight joint capsule)
Chronic tendinopathy
Inflammatory arthritis
Chronic ligament sprains
Steroid injections of hydrocortisone are a synthetic form of a naturally produced hormone within the body called cortisol. Cortisol is important for regulating carbohydrate, protein and fat metabolism. It is also involved in metabolic responses in times of stress such as emotional problems, trauma, and infection, where levels of inflammation are elevated. Steroid injections work on the immune system by blocking the production of chemicals that activate the inflammatory reactions, therefore reducing inflammation and pain within injury locations.
Steroid injections can be directed into a joint, muscle, tendon, bursa, or a space around these structures. Figure one shows an injection aiming for the bursa within the shoulder joint. This is often a source of irritation and causes impingement when the shoulder moves. The location will depend on what tissue is causing the symptoms. When injected locally to the specific structure, the effects are primarily only produced there and widespread detrimental effects are minimal(2).
When To Use
Identifying the correct time to issue a steroid injection following injury requires careful consideration. The mechanical status of the tissue is important because this will vary depending on the stage of healing and therefore the effectiveness of the injection will also vary.
Figure 2 shows the different stages that a tendon can progress through following trauma. This is equally applicable to muscles, fascia, and other tissues too. A reactive tendinopathy (tendon degeneration/damage) will present shortly after injury/trauma/stress/ excessive loading, and will display acute swelling and inflammation. The initial care should be 2-3 weeks of rest, analgesia, ice application and gentle physiotherapy. If symptoms have not significantly improved after this period, then the introduction of a corticosteroid injection is appropriate for providing symptomatic relief by reducing inflammation and eliminating the occurrence of further damage because mechanical normality will be quickly restored(3).
If the tendon continues to be placed under excessive load, swelling and inflammation will remain or escalate, and continuous loading will eventually cause micro trauma and further tendon degeneration. If this is prolonged for long enough then the tendon will fail structurally(4).
The use of corticosteroids here is questionable because there is unlikely to be inflammation present to combat, and the injection alone will not repair this physical damage. Injection treatment at this stage may only be indicated if the athlete is in too much pain to participate in any significant rehabilitation. The symptomatic relief the injection may bring at this point could allow exercises to be performed, which can help accelerate the repair of physical damage. Ultimately, physical exercise is a key component in recovery following corticosteroid injections.
Impact On Treatment & Performance
For the best outcome, post-injection care � particularly with respect to timing � is important. Relative rest is recommended for the first two weeks post-injection. During this first two weeks the tissues are weakened and their failing strengths are reduced by up to 35%; this means the strength at which they would fail (tear) is much lower and more susceptible to rupturing(8).
By six weeks the bio-mechanical integrity is reestablished and the tissues are deemed �normal� again, with increased strength and function(8). Benefits are optimal within this 6-week period and often short-lived; therefore the athlete must comply strictly to a rehabilitation program to gradually load the tissues and ensure the correct load is applied during this period(9). Research has also shown that at twelve weeks post-injection�there is little significance in the difference between those who received a steroid injection and those who focused on exercise therapy alone, suggesting this early symptom relief should be used to enhance rehabilitation(10). If loading is accelerated in the early stages the athlete risks re-aggravation of the injury, delayed healing, further weakening and thus rupture.
If this rehabilitation protocol is followed, the athlete will likely maximise their outcome. They can return to training, and with the severity of their symptoms reduced, this can allow progression to the next stage of training. If the injury is severe enough that surgery may be considered within three months, a steroid injection should not be performed as this can affect the success of the surgery.
Evidence For Sports Injuries
Here we will consider some of the more common sports injuries and summarize what the current evidence regarding steroid injection suggests.
Shoulders
Injection therapy is indicated in subacromial impingement or bursitis (as in Figure 3 below) to allow the inflammation reduction and restoration of normal movement. It is also indicated in rotator cuff pathology where the tendons are again inflamed, but also damaged and unable to undergo exercise therapy. Shoulder injections are shown to produce early improvements in pain and function with a high level of patient satisfaction(10). Symptoms are similar to those without injection at 12 weeks however, suggesting physical therapy is also important(10). Injection is not appropriate for shoulder instability as it can make the joint more unstable. Exercise therapy alone is recommended for this condition.
Hip Pain
Two soft tissue conditions that benefit the most from injection are piriformis syndrome (muscle tightness running deep to the buttock muscles), and greater trochanter pain syndrome (affecting the bursa surrounding the hip joint, or the gluteal tendons that are all in close proximity to the lateral hip)(11). Injection success is reported to be approximately 60-100% if the diagnosis is accurate and the correct protocols are adhered to(12). Other regions such as the adductor and hamstring tendons can also be treated for tendinitis or groin pains. However, injections into these�regions are deep and painful, and require extensive rest afterwards.
Knee Pain
Knee joint injections for arthritic conditions are most commonly used, with injection to the soft tissues much less common due to the complex diagnosis, and risk of detrimental side effects. The various bursa around the knee, the iliotibial band, and quadriceps and patellar tendons have all been shown to significantly benefit in the short-term; however accurate location is essential to ensure the tendon itself is not penetrated � only the surrounding regions(13).
Plantar Fasciitis
This is a painful injection to receive, and pain can last for well over one week post- injection (see figure 4). There is an approximate 2-4% risk that the fascia can rupture. In addition, there�s a risk of local nerve damage and wasting of the fat pad within the heel. Studies have demonstrated that at 4 weeks post-injection pain and thickness of the injured plantar fascia are reduced and these benefits remain three months later, suggesting a good outcome if the risks are avoided(14).
Many people have back pain so often that it starts to become a daily struggle. You don�t have to put up with pain every day.
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TIP! One interesting fact is that good chiropractic care can actually strengthen your immune system. Spine issues can cause problems with the nervous system, which is linked to the immune system.
Many doctors work with alternative therapy. This makes it important that your insurance policy and see what back care therapies are covered. This can improve your health even more effective.
Pay attention to your sleep in order to fix back-related problems.Put a pillow underneath your head and shoulders. Place rolled-up towels underneath your neck and knees to help support the body�s curves. You should also have a mattress that is comfy.
TIP! Don�t think you�re going to get all the care you need from just a single visit to a�chiropractor. While it may make you feel better right away, it will take many sessions to see great improvements.
You should not expect one treatment at the chiropractor to solve all your pain problem. You will probably see some immediate relief; however, but regular visits are required for lasting relief. Stick with whatever regiment your chiropractor�recommends. If you fail to do this, you will end up disappointed with the results.
There are lots of solid reasons as to why a person ought to visit a chiropractor. If your back or neck hurt, you should find a reputable chiropractor right away. Your body will not run correctly if your skeletal structure.
TIP! Don�t be afraid to ask your chiropractor�about discounts; they may offer one the more frequently you visit. Chiropractic treatment usually involves multiple visits.
Ask your chiropractor if there are frequency discounts in their office. Chiropractic treatment usually requires a series of office visits. You may need to visit several times weekly for months to come. It can quickly become quite costly. The doctor�s office may have some sort of discount if you visit a lot so things don�t cost you so much more affordable.
Ask you doctor to recommend a chiropractor. Even if you don�t need a referral, your doctor can suggest a good chiropractor.
TIP! Ask your regular physician if they can refer you to a quality�chiropractor. A referral may not be required, but it helps you find the most qualified, trusted professionals in your local area.
Make a wise decision when searching for a chiropractor. Most chiropractors are honest, but others cannot be trusted. There are actually some of people going to a chiropractor and feeling much worse afterwards. Make sure you�re doing research prior to choosing a chiropractor.
Check out the references of a chiropractor before scheduling an appointment with them. While lots of chiropractors are interested in their patients� health, there are some that attempt to extend treatments beyond what is actually needed. Look at reviews online and get recommendations from your regular doctor.
TIP! Before ever contacting a�chiropractor, ask for references from your doctor or physician. The majority of professional chiropractors are experts in their field who actually care about your health, but there are a few bad eggs in the bunch.
A cervical pillow or roll up a towel and position it beneath your neck when you sleep can really help. They let your head drop down while a regular pillow has your head being pushed forward.
Blood Pressure
TIP! Is high blood pressure something you have? Studies show that vertebrae manipulation is more effective than blood pressure medications. Certain manipulations of the vertebrae can help get your blood pressure regular.
Is your blood pressure something you have? Studies show that vertebrae is as good as using two hypertension medications together. When the vertebrae are manipulated, the blood pressure can be regulated.
Chiropractic care can also help your immune system as well. Your nervous system can malfunction when the bones in your spine are misaligned. Because your nervous system controls tissue, cell and organ function, if it gets impacted it can make your health go wrong. Fixing the issue can get your immune system back to optimal performance.
TIP! Chiropractic care is not just for back and necks, it boosts your immune system as well. Bones that are out of alignment in the spine often interfere with your nervous system�s functioning.
Stay away from chiropractors that want to give you dietary supplements and other products. They are likely charlatans if they offer and cannot be trusted. Nutritionists and doctors are reliable sources for such advice.
It is easy to find a qualified chiropractor in the United States. Chiropractic care makes up the second largest health care profession. It is also happens to be the fastest. On top of that number, as many as 10,000 students or more are learning the practice themselves.
TIP! Do not carry a wallet inside your back pocket. Many men�carry a wallet in their back pocket and don�t understand how it affects their back.
Meet with the chiropractor before scheduling an appointment. A chiropractor can really improve your quality of living. A poorly qualified chiropractor can make matters so much worse. Find a chiropractor you feel comfortable. Be sure you talk with a chiropractor before scheduling treatment.
Avoid slumping when you are sitting or standing in a hunched position for long periods. This strains your back and will give you lower back pain and that�s going to hurt you stand straight. If sitting or standing hunched over is unavoidable, make sure you stretch well and periodically get up from your position.
TIP! Don�t work with a�chiropractor that�s going to try to place you on supplements or homeopathic products that can help to treat disease. If they are selling these items from their offices, they are not entirely trustworthy.
If you do a lot of sit-ups and crunches to build up your core strength, it�s time to find other core exercises, since these are two that often make things worse. The Yoga plank position is a good alternative and can help your back and core.
The thoracic spinal area of your spine is responsible for communication regarding digestion and other stomach functions. You can have problems with things like acid reflux or other irritations when the thoracic area is irritated. Chiropractic care can fix any alignment issues and prevent misalignment of this area to help heal the stomach.
TIP! When you carry around a wallet, don�t put it in the pocket on the back of your pants. You may not believe it, but doing that can strain your lower back.
Don�t be afraid to ask for assistance lifting heavy item. Ask someone else to help or use proper equipment. A dolly that�s good and secure can assist you in moving something. A dolly is a great investment if you are moving heavy things often.
To keep headache pain at bay, you may want to go to your chiropractor or a therapist that can massage the pain out of your body.Tightness in the pain. The temperomandibular joint (TMJ) can suffer from teeth in your sleep. A guard might keep this case.
TIP! Now you can confidently find the�chiropractor who is perfect for you. Many people in the United States and around the world seek chiropractic care today.
It is important to take your time when searching for a good chiropractor. There are tons of chiropractors out there. Once you find the ideal one, shop around for a good price. Call each one and ask for a quote. Make sure that their quote includes all of their services and they are quoting you doesn�t neglect to mention any hidden fees.
You may believe that your use of a smartphone is making your life better. It may actually be hurting your neck though. When you look at the screen, your neck is pulled down, which puts too much weight on the muscles. Use your phone at eye level to avoid this.
TIP! You can get back strain from standing for long periods of time. If you need to stand, do this with one foot on something low every so often to relieve the strain on your lower back.
Clearly, there really is no reason to endure ongoing back pain. You can help yourself through the situation. Try some of the advice here, and you can get relief quickly.
Mr. and Mrs. Dominguez share their wonderful story of health and recovery. After being injured in a car accident, Manuel Dominguez and his wife needed help healing their injuries. That’s when they found Push-as-Rx � and their path to recovery began. With the help of Dr. Jimenez, Mr. and Mrs. Dominguez started the therapies that changed their lives completely and together with the exercises given to them by the trainers at Push as Rx, little by little, they regained back their health. With great gratitude, Mr. and Mrs. Dominguez give their thanks for the magnificent service they received at Push-as-Rx �.
El Sr. y la Sra. Dominguez nos dieron a conocer su maravillosa historia de salud y recuperacion. Despues de salir lastimados en una accidente de auto, Manuel Dominguez y su esposa necesitaban ayuda para curar sus lesiones. Ahi fue cuando encontraron la clinica de Push-as-Rx � y empezaron su camino a la recuperacion. Con la ayuda del Dr. Jimenez, el Sr. y la Sra. Dominguez comenzaron a recibir terapias que cambiaron sus vidas por completo y junto con los ejercicios de los entrenadores de Push as Rx, poco a poco fueron recuperando su salud. Con mucho agradecimiento, el Sr. y la Sra. Dominguez dan las gracias por el magnifico servicio que recibieron en la clinica Push-as-Rx �.
PUSH-as-Rx � is leading the field with laser focus supporting our youth sport programs. The PUSH-as-Rx � System is a sport specific athletic program designed by a strength-agility coach and physiology doctor with a combined 40 years of experience working with extreme athletes. At its core, the program is the multidisciplinary study of reactive agility, body mechanics and extreme motion dynamics. Through continuous and detailed assessments of the athletes in motion and while under direct supervised stress loads, a clear quantitative picture of body dynamics emerges. Exposure to the biomechanical vulnerabilities are presented to our team. Immediately, we adjust our methods for our athletes in order to optimize performance. This highly adaptive system with continual dynamic adjustments has helped many of our athletes come back faster, stronger, and ready post injury while safely minimizing recovery times. Results demonstrate clear improved agility, speed, decreased reaction time with greatly improved postural-torque mechanics. PUSH-as-Rx � offers specialized extreme performance enhancements to our athletes no matter the age.
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Chiropractor, Dr. Alexander Jimenez gives insights into the most common questions about whiplash.
What Is Whiplash?
Whiplash, although not technically a medical term, can be quite painful and is quite serious. We call it whiplash because, within an accident, your neck actually can whip back and forth�first backward (hyperextension) and then forwards (hyperflexion). Doctors call whiplash a neck sprain or strain. Whiplash is an injury to the soft tissues of your neck and upper back that occurs when ligaments and your muscles get overstretched in the strength of an accident.
What Causes Whiplash?
The most common source of whiplash is car accidents. Nonetheless, you can even get whiplash from a sports injury or a fall. It’s also possible to get whiplash when you are hit or shaken.
What Are Some Non-Surgical Ways To Take Care Of Whiplash?
Time is just one of the greatest non surgical treatment options for whiplash. Most instances of whiplash recover by themselves to some months in several weeks. Your doctor may also indicate: wearing a cervical collar, cervical traction, chiropractic adjustment, physical therapy, and pain drugs as you heal.
Will I Need Surgery?
Patients with whiplash quite, very rarely need surgery. If, nevertheless, you’ve been through wide-ranging non-operative treatments and also you have pain, surgery may be considered by you. There are several kinds of surgery useful for whiplash
Corpectomy:
Sometimes whiplash induces the spinal canal to narrow because of how a soft tissues (muscles, ligaments, and tendons) and bones moved throughout the first injury. By removing area of the vertebra and the intervertebral disc using a corpectomy, the surgeon is wanting to make more room in your spinal canal.
Discectomy:
The surgeon will remove section of the intervertebral disc, which may be pressing on your own spinal cord or alternative nerves and causing pain. Sometimes, the surgeon will have to do a spinal fusion at the same time as the discectomy. The fusion plans to permanently stabilize that region of your spine, although not everyone who has a discectomy will need a fusion.
Foraminotomy:
As with a corpectomy, a surgeon uses a foraminotomy to make more room for your nerves that could have gotten pinched and compressed throughout the harm. In this process, the foramina (the place where the nerve roots leave the spinal canal) is removed to boost the size of the nerve pathway.
Doctor of Chiropractic, Dr. Alex Jimenez examines Tiger Woods’ and his latest back surgery.
We have a look at Tiger Woods’ extensive history of injuries during his career. USA TODAY Sports
Tiger Woods Won�t Be Back For Some Time
Woods, that has made just three starts in a couple of years, likely won�t play again this year after he’d his back surgery that is fourth in Texas. The latest procedure alleviated pain in his back and leg, Woods announced on his web site Thursday.
That I’m confident this will relieve my back spasms and pain, and The operation went well,� Woods said in a statement. When fixed, �, I anticipate playing with my kids getting back to a normal life, competing in professional golf and living without the pain I’ve been fighting so long.�
Woods, who also has had four surgeries on his left knee, first had surgery on his back and then had two procedures in the autumn of 2015.
According to his statement, a disc in Woods back seriously narrowed because of causing sciatica, the three surgeries and severe back and leg pain. During the recent operation, the damaged disc was removed and the collapsed disc space was elevated to levels that were regular. The goal is to relieve the pressure on the nerve, the statement said. The procedure was performed by Dr. Richard Guyer of the Centre for Disc Replacement at the Texas Back Institute.
A Look At Tiger Woods’ Injury History
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About playing on Champions Tour, Tiger Woods jokes around
Woods, 41, last played in February, where he shot a birdie-free 77 in the very first round before removing. Where he missed the cut his only other start was in the Farmers Insurance Open the week prior.
His only appearance on the golf course in 2016 arrived at the Hero World Challenge in December. While he finished 15th in the 17-man field, he tied for the tournament lead in birdies (24), seemed healthy and upbeat.
Before beginning therapy, he will be resting for several weeks. The recovery interval is usually about half a year. That would mean Woods, a winner of 14 major tournaments and 79 PGA Tour titles, won�t play in any of the four majors for a second straight year. He is now rated No. 788 in the world.
Woods is in good spirits after the surgery, said his agent, Mark Steinberg.
USA TODAY Sports, he believes somewhat that the large weight was lifted off his shoulders,� Steinberg told. �The three previous operations were somewhat temporary repairs. But it got to the point where the pain was more common and this latest surgery was something he had to do.�
Steinberg said Woods decided to take a conservative approach along with his back previously three years with his difficulties. That alternative wasn�t accessible this time.
�This just isn’t a temporary repair,� Steinberg said. � his physicians proposed him that this is the top path to a healthy, energetic lifestyle. He and his children were playing but he was in so much pain.
�Now he �ll possess a healthy life without pain.�
One, Steinberg said, that can include playing golf.
�Entirely,� Steinberg said. �He desires to get out (on the PGA Tour) again.�
Woods� last public appearance ahead of the operation was Tuesday in Hollister, Missouri, where he pronounced he�s designing his first public golf course. The course will probably be called Payne’s Valley in honor of Missouri native Payne Stewart. Woods is a partner on the project with CEO Johnny Morris and Bass Pro Shops founder.
El Paso, TX. Chiropractor Dr. Alex Jimenez looks at exercise as treatment for back injuries.
Since 1992 Opioid Prescriptions Rose From 112 Million To More Than 249 Million As Of 2015
In 2004, there were enough written opioid prescriptions to ensure every American could have their own bottle. According to studies, a written prescription of a pain-killer should not be used for a back related injury; but rather, exercise is the most effective tool for recovery.
The First &�Foremost Way To Heal & Prevent Further Injury To The Back Is By Simply Moving Around
Vidan Family Chiropractic explains that �what made the body-heals the body.” They suggest exercise such as walking, stretching and yoga instead of requesting an opioid prescription.
Dr. Alex Vidan from Vidan Family Chiropractic joins us more information on the excessive use and prescription of opioids for injuries.
El Paso, TX. Chiropractor Dr. Alex Jimenez discusses student-athletes and injuries.
Most injuries to student-athletes occur during routine practices, but only about a third of public high schools have a full-time trainer, according to the U.S.-based National Athletic Trainers’ Association (NATA).
“It’s important to have the right sports safety protocols in place to ensure the health and welfare of student athletes,” said Larry Cooper, chairman of NATA’s secondary school committee. “By properly preparing for practices and competitions, young athletes can excel on the field and stay off the sidelines with potential injuries.”
As Spring Season Approaches NATA Recommends Parents & Students Review Their Schools Policies On Sports Injuries
Here’s what to consider:
Who handles sports-related injuries? Know who will care for athletes who are hurt during practice. Consider that person’s experience and credentials, including first aid and medical training. Determine who makes medical decisions. Coaches and athletes may not make objective decisions about injuries and safety if they are concerned about winning.
What’s the emergency action plan? Every team should have a written plan detailing what to do if a serious injury occurs. An athletic trainer or first responder should review this plan.
Is all equipment in good working condition? Sports equipment such as field goals, turf, basketball flooring and gymnastics apparatus should be examined to make sure it’s safe. Medical equipment such as splints and spine boards should be checked routinely. Schools should have an automated external defibrillator (AED) and staff trained in its use.
Are high school coaches qualified? All coaches, assistant coaches and team volunteers should undergo a background check. They should have knowledge in the sport they are coaching and all credentials required by the state and athletic conference or league. Coaches should be trained to administer CPR, use an AED and provide first aid.
Are locker rooms and gyms sanitary? These areas should be cleaned routinely to prevent the spread of bacterial, viral and fungal skin infections. Athletes should never share towels, athletic gear, water bottles, razors and hair clippers.
NATA says parents should also help ensure their teens are both mentally and physically prepared to play sports. This includes a preseason physical to identify any health conditions that could limit their participation. Young athletes shouldn’t be pushed or forced to participate. Parents should make sure their child’s school, coaches and other staff have a copy of his or her medical history as well as a completed emergency medical authorization form.
NATA recommends parents, student-athletes and coaches keep these safety tips in mind when spring training begins:
Acclimate gradually. Athletes playing in hot weather should build up their endurance over one to two weeks. During this time, they should stay well hydrated and adjust their exercises according to weather. Athletes who must wear heavy protective equipment should gradually get used to playing in their gear. For example: wear only helmets on days one and two; then helmets and shoulder pads on days three and four, then full gear by day five.
Be aware of concussions. Student-athletes, coaches and school medical staff must be well educated on concussion prevention and management. Students with head injuries should speak up if they experience symptoms such as dizziness, loss of memory, lightheadedness, fatigue or trouble with balance.
Screen for sickle cell. All newborns are tested for this inherited trait that can lead to blockage of blood vessels during intense exertion. Athletes with sickle cell trait should take precautions. Warning signs include fatigue or shortness of breath.
Allow for recovery time. The body needs to rest between seasons. Incorporating recovery time into the year can help prevent injuries. Repetitive motions can put excessive stress on joints, muscles or ligaments, resulting in injuries from overuse.
“It’s critical that all members of a school’s sports medicine team (athletic trainers, physicians and school nurses) work together to help prevent, manage and treat injuries or illnesses should one occur,” Cooper said in a NATA news release. “With a team approach we can reduce acute, chronic or catastrophic injury and ensure a successful season all around.”
News stories are written and provided by HealthDay and do not reflect federal policy, the views of MedlinePlus, the National Library of Medicine, the National Institutes of Health, or the U.S. Department of Health and Human Services.
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Hip Pain
What Causes Whiplash?
