Can healthy noodle alternatives and heart-healthy ingredients help make cholesterol-friendly pasta dishes for individuals trying to lower and manage cholesterol levels?
Pasta and Cholesterol
Pasta, like other refined carbohydrates such as white bread and rice, can increase cholesterol levels. Although pasta does not contain cholesterol, it is high in carbohydrates, which can increase the amount of calories and fat in one’s diet and contribute to high cholesterol levels. Since some types of carbohydrates can affect cholesterol levels, the goal is to eat the right pasta and healthier sauces and sides. Even for those following a cholesterol-lowering diet, there’s no reason you can’t enjoy meals containing pasta occasionally.
The Pasta and Cholesterol Link
Pasta made from white flour is considered a refined carbohydrate because it is high in carbs and low in fiber. Research has shown that a diet high in refined carbohydrates is associated with increased levels of triglycerides and LDL (unhealthy) cholesterol in the blood. (Yu, D. et al., 2013) (Bhardwaj B., O’Keefe E. L., and O’Keefe J. H. 2016) High levels of blood fats increase the risk of developing heart disease. Examples of refined carbohydrates include:
White rice
Breakfast cereals
Potato Chips
White bread
Pastries
Pizza
One cup of dry pasta has 0 milligrams of cholesterol but is high in carbohydrates, with around 43 grams per serving (U.S. Department of Agriculture, 2018). Eating foods high in saturated fats and refined carbohydrates can raise cholesterol levels.
Choosing Healthy Alternatives
Choosing healthier options that are cholesterol-friendly can make pasta healthy. Pasta labeled whole wheat or whole grain is darker than white flour pasta, which contains more fiber and can lower cholesterol levels and reduce the risk of heart disease. (American Heart Association, 2024) The label will show the carbohydrate and fiber content per serving.
Alternatives
Alternatives that are lower in carbohydrates and/or higher in protein and fiber include:
Spaghetti squash
Spiralized vegetables like zucchini, carrots, and butternut squash.
Shirataki noodles are made from the konjac plant.
Chickpea pasta
Black bean pasta
Red lentil pasta
Edamame pasta
Vegetables
Vegetables are heart-healthy and are a great addition to pasta dishes. Vegetables that pair well with pasta include:
Peppers
Onion
Zucchini
Spinach
Broccoli
Asparagus
Add a few olives, which contain healthy monounsaturated fats. (Rocha J., Borges N., and Pinho O. 2020) Mix vegetables and pasta in equal amounts to create a lower-carb, fiber-dense dish that will keep cholesterol levels low and maintain a healthy heart.
Cheese and Low-Fat Cheese
It is common to incorporate cheese. While cheese contains calcium and adds flavor and texture, it also adds saturated fat. The American Heart Association recommends that saturated fats make up less than 6% of daily calories because of their role in heart health and high cholesterol risks. (American Heart Association, 2024) Instead, use a small amount of cheese, such as Romano or cheddar, and add a small amount of low-fat cheese that includes:
Parmesan cheese
Part-skim mozzarella cheese
Low-fat ricotta
Low-fat cottage cheese
Lean Meats
Sausage and ground beef are common additions but are also a source of saturated fat that could raise cholesterol levels. (American Heart Association, 2024) So, when possible, limit red meat and sausage or use a low-fat sausage alternative that is chicken or turkey-based, and add heart-healthy options, which include:
Beans
Shrimp
Turkey
Chicken
Salmon
Make It Herbaceous and Spicy
Spices can enhance the taste of a dish. Many herbs and spices commonly used in pasta dishes, such as parsley, oregano, garlic, and basil, contain healthy nutrients and don’t add any fat or calories. Spice up a pasta dish to taste with a little heart-healthy olive oil and spices to create a light coating on the noodles. (Rocha J., Borges N., and Pinho O. 2020) One tablespoon of olive oil contains nearly 120 calories and 14 grams of fat. (U.S. Department of Agriculture, 2019)
Healthy Sauces
Sauces are important, but an unhealthy one can introduce extra sugar and fat. Plenty of healthy sauces are at the store, but check the label as some contain extra salt, sugar, and fat, which are not heart-healthy. (U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015) Try to limit the use of creamy sauces, such as cheese and alfredo sauces, as they are a source of added fat and are high in saturated fat. An alternative is to dress the pasta with sautéd olive oil and sliced cherry tomatoes. Sauteing helps soften the tomatoes and release extra flavor into the oil.
Injury Medical Chiropractic and Functional Medicine Clinic
So, experiment with healthy pasta, various vegetables, lean meat, and healthy sauces to add flavor and make your next pasta dish delicious and cholesterol-friendly. Injury Medical Chiropractic and Functional Medicine Clinic focuses on and treats injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers use an integrated approach to create customized care plans for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and sports medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, nutritionists, and health coaches to provide the most effective clinical treatments.
Chiropractic, Fitness, and Nutrition
References
Yu, D., Shu, X. O., Li, H., Xiang, Y. B., Yang, G., Gao, Y. T., Zheng, W., & Zhang, X. (2013). Dietary carbohydrates, refined grains, glycemic load, and risk of coronary heart disease in Chinese adults. American journal of epidemiology, 178(10), 1542–1549. https://doi.org/10.1093/aje/kwt178
Bhardwaj, B., O’Keefe, E. L., & O’Keefe, J. H. (2016). Death by Carbs: Added Sugars and Refined Carbohydrates Cause Diabetes and Cardiovascular Disease in Asian Indians. Missouri medicine, 113(5), 395–400.
U.S. Department of Agriculture. FoodData Central. (2018). Pasta, dry, enriched. Retrieved from https://fdc.nal.usda.gov/fdc-app.html#/food-details/169736/nutrients
American Heart Association. (2024). Whole grains, refined grains, and dietary fiber. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/whole-grains-refined-grains-and-dietary-fiber
Rocha, J., Borges, N., & Pinho, O. (2020). Table olives and health: a review. Journal of nutritional science, 9, e57. https://doi.org/10.1017/jns.2020.50
American Heart Association. (2024). Saturated fat. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/saturated-fats
U.S. Department of Agriculture. FoodData Central. (2019). Oil, olive, extra virgin. Retrieved from https://fdc.nal.usda.gov/fdc-app.html#/food-details/748608/nutrients
U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015). Dietary Guidelines for Americans. 8th Edition. Retrieved from https://odphp.health.gov/our-work/nutrition-physical-activity/dietary-guidelines/previous-dietary-guidelines/2015
How is eucalyptus tea made, and what are its health benefits?
Eucalyptus Tea
Eucalyptus tea is an herbal tea made from the leaves of the Australian eucalyptus tree. It is drunk as a hot tea and is commonly used to treat cold and flu symptoms. It can also be combined with other teas as a tonic. Researchers have been studying its benefits.
Eucalyptus Tree
There are different varieties of eucalyptus trees. The blue gum or Australian fever tree is a fast-growing tree that produces long grey-greenish leaves whose glands contain essential oil to prepare eucalyptus tea and oil. Eucalyptus tea is made from crushed leaves of the tree, not from the oil. The hot drink is sometimes called eucalyptus leaves tea to avoid confusion. The tea has a pale green color and a strong scent that can be described as woody or piney and clean or fresh. The smell is familiar to many because many lip balms and skin creams are made with eucalyptus.
Making The Tea
Eucalyptus or loose-leaf tea bags can be purchased in grocery stores, health markets, and online. Follow the instructions provided on the box. Eucalyptus leaves can be prepared for tea at home, but it must be prepared with leaves and not with eucalyptus oil, as using the oil can produce harmful side effects.
Home Preparation
To make the tea, use one dried eucalyptus leaf (around a teaspoon).
Add the crushed leaf to the bottom of an eight-ounce teacup.
Heat water to 194-205 Fahrenheit if using a temperature-controlled teapot.
Or bring water to a boil and let it sit for a minute to reduce the temperature.
Pour six ounces of water over the tea leaves.
Let the leaves steep for as long as desired, up to 10 minutes.
Breathe in the vapors while the tea is steeping.
Strain loose leaves from the cup before drinking.
Adding honey to the tea will increase sugar, sweetness, and calories. However, if you drink the tea to soothe a sore throat, the honey can also help ease symptoms. (Allan G. M. and Arroll B. 2014) The tea can also be blended with peppermint and chamomile (manzanilla) to increase its soothing properties.
Caffeine
Eucalyptus tea is not a traditional tea and is not made from Camellia sinensis plant leaves, like black or green tea. It is brewed from just the leaves of the eucalyptus tree, which do not contain any caffeine, making the tea completely caffeine-free. However, the vapors can be described as bright and refreshing.
Health Benefits
Most scientific research on eucalyptus’s health benefits uses the oil rather than the tea. The oil is much more concentrated, so drinking the tea is unlikely to provide the same benefits. However, according to a study, the leaves contain flavonoids and tannins that provide antioxidant and anti-inflammatory properties. (Panche A. N., Diwan A. D., and Chandra S. R. 2016)
Eucalyptus tea is commonly used as an inhalant to relieve cold or flu symptoms. Its vapors are often described as healing because inhaling them helps open up congested airways. However, there isn’t enough evidence to recommend using eucalyptus for cold. (American Lung Association, 2024) In addition to treatment for the common cold, eucalyptus has gained a variety of other health benefits, including (Dhakad A. K. et al., 2018)
Headache relief
Asthma treatment
Bronchitis treatment
Diabetes treatment
Reduce dental plaque and bad breath
Help treat liver and gallbladder problems
Prevent insect bites
Eliminate head lice
Toothpaste, mouthwash, bath products, and body creams made with eucalyptus are commonly found in stores.
Side Effects
Eucalyptus leaves are generally safe when consumed in the small amounts found in foods. However, there isn’t enough information to determine whether supplements containing larger amounts of eucalyptus leaf are safe when taken by mouth. Consulting with a healthcare provider before using this or any other herbal treatment is always recommended.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic focuses on and treats injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers use an integrated approach to create customized care plans for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and sports medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, nutritionists, and health coaches to provide the most effective clinical treatments.
Assessing Patients in a Chiropractic Setting
References
Allan, G. M., & Arroll, B. (2014). Prevention and treatment of the common cold: making sense of the evidence. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 186(3), 190–199. https://doi.org/10.1503/cmaj.121442
Panche, A. N., Diwan, A. D., & Chandra, S. R. (2016). Flavonoids: an overview. Journal of nutritional science, 5, e47. https://doi.org/10.1017/jns.2016.41
American Lung Association. (2024). Facts About the Common Cold. https://www.lung.org/lung-health-diseases/lung-disease-lookup/facts-about-the-common-cold
Dhakad, A. K., Pandey, V. V., Beg, S., Rawat, J. M., & Singh, A. (2018). Biological, medicinal and toxicological significance of Eucalyptus leaf essential oil: a review. Journal of the science of food and agriculture, 98(3), 833–848. https://doi.org/10.1002/jsfa.8600
Yips are involuntary wrist muscle spasms that affect athletes. They are often associated with golf, baseball, and sports that involve swinging and throwing motions, such as bowling, darts, cricket, and others. Can understanding the information and causes help diagnose and find the right therapy or training?
Yips
Yips are involuntary wrist spasms that athletes experience. The term is also used to refer to performance anxiety without physical spasms. Researchers believe they are caused by muscle overuse that leads to dystonia (a condition that causes muscles to contract involuntarily), and combined with psychological factors like performance anxiety and overthinking, can make them worse. (Beacon Health Systems, 2024)
The most common symptom is muscle spasms, often in the hands and wrists. That’s why it is the most common among athletes who play sports that require precision hand and wrist movements. Yips affect fine motor skills. (Aoyama, T. et al., 2021) In addition to muscle spasms, symptoms can also include: (Beacon Health Systems, 2024)
Twitching
Tremors
Freezing up
Psychological distress
Causes
Healthcare providers, trainers, coaches, and researchers know that psychological and physical factors cause yips. Underlying physical causes include overusing wrist muscles, which leads to dystonia or involuntary muscle movements. Also known as task-specific dystonia, it can also affect individuals who engage in repetitive muscle movements, like factory and assembly line workers, store check-out clerks, musicians, etc. (Clarke P., Sheffield D., and Akehurst S. 2020). Performance anxiety and psychological stress can worsen dystonia. (Aoyama, T. et al., 2021) Athletes can become so focused on their movements that they overthink their actions and perform worse. Individuals who have anxiety, self-consciousness, or stress about a game or performance often find that their involuntary wrist spasms are worse. (Clarke P., Sheffield D. and Akehurst S. 2020)
Increased Risk
Yips are most common in athletes who use their hands and wrists for their sport and are likely to impact more experienced, competing, and older athletes. (Beacon Health Systems, 2024) They are more common in athletes focused on smaller movements or shorter distances. For example, golfers commonly experience involuntary wrist spasms when putting, and baseball players are likelier to experience them when throwing less than 20 meters. (Clarke P., Sheffield D. and Akehurst S. 2020)
Diagnosis
There is no official diagnosis for yips. However, a coach, athletic trainer, sports doctors, and others can observe the pattern of symptoms and behavior and provide an informed diagnosis.
Once trigger/s are identified, they can be addressed. Treatments that can help include: (Beacon Health Systems, 2024)
Alternate Hand Positions
This can provide relief from dystonia and overthinking.
Using Different Equipment or Stabilizers
This allows the immobilization of certain muscles and the activation of different muscles.
Mindfulness
Reducing anxiety and distress can help relax the body.
Practicing mindfulness before games or tournaments can help reduce psychological triggers.
Botox Injections
Botox injections can treat certain types of dystonia.
Sports Psychology
A sports psychologist is a healthcare provider who studies individual athletes’ sports performance and how it affects their minds and skills.
A sports psychologist can help individuals create a program that reduces stress or anxiety around games and performance.
Injury Medical Chiropractic and Functional Medicine Clinic
Yips are common among athletes. It is important to address the physical and psychological components to treat the condition. Talking with a coach or a sports psychologist, other athletes, and supporting staff like trainers can help you find a solution. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Sports Injuries
References
Beacon Health Systems. (2024). Yips. https://www.beaconhealthsystem.org/library/diseases-and-conditions/yips/
Clarke, P., Sheffield, D., & Akehurst, S. (2020). Personality Predictors of Yips and Choking Susceptibility. Frontiers in psychology, 10, 2784. https://doi.org/10.3389/fpsyg.2019.02784
Aoyama, T., Ae, K., Souma, H., Miyata, K., Kajita, K., Kawamura, T., & Iwai, K. (2021). Difference in Personality Traits and Symptom Intensity According to the Trigger-Based Classification of Throwing Yips in Baseball Players. Frontiers in sports and active living, 3, 652792. https://doi.org/10.3389/fspor.2021.652792
How is fat turned into energy to be used as fuel for individuals working to improve their health and physical abilities?
Fat Into Energy Conversion
Fat is an essential component of a diet that fuels physical activity, work, exercise, etc. Its calorie density is the highest of all nutrients, and fat’s unlimited storage capacity makes it the body’s largest energy reserve. Fat is essential for longer, slower, lower-intensity endurance physical activities and exercises like walking and cycling.
What Is Fat?
Everything eaten is made up of:
Macronutrients
Protein
Carbohydrates
Fat
Micronutrients
Vitamins
Minerals
These are converted to energy, helping to fuel all bodily functions.
Dietary fat has been blamed for various health problems, but it is an essential nutrient for optimal health. The adipose tissue/stored fat provides cushion and insulation to internal organs, protects nerves, circulates vitamins A, D, E, and K through the body, and is the largest stored energy reserve. Stored body fat is different from dietary fat. Body fat is only stored when more calories are consumed than used from all foods, not just from dietary fats. There is an optimal level of body fat for health and regular physical and athletic activity.
Types
Researchers and scientists are learning more and more about body fat/adipose tissue and its roles in the body. Two well-known types are white fat and brown fat.
White fat is responsible for energy storage and metabolic functions like insulin sensitivity.
White fat can transition to brown fat under certain cold temperatures. (Rabiee A. 2020)
Beige fat is another type that scientists are still learning about.
When Fat Is Burned
When fat is used as fuel, the fatty acids inside the fat cell are broken down and released into the system as water and carbon dioxide. (MacLean P. S. et al., 2015) The body uses the water for hydration, and the carbon dioxide is exhaled through the lungs. The remaining fat cell shrinks as it is depleted of its fatty acids. The fat into energy conversion also produces heat.
Fat for Fuel
Fat is the main fuel source for long-duration, low—to moderate-intensity physical activities and exercise like endurance sports. Even during high-intensity activities and training, where carbohydrates are the main fuel source, the body still needs fat to help access the stored carbohydrates or glycogen. Using fat to fuel activity includes three key components which include:
Digestion
Fat is slow to digest and convert into a usable form of energy.
The process can take up to six hours.
Transportation
After the body breaks down the fat, it needs time to transport it to the working muscles before it can be used as energy.
Conversion
Converting stored body fat into energy takes increased oxygen, requiring decreased physical activity and exercise intensity.
This is why timing when and how much fat is consumed is important for its full potential. Eating foods high in fat immediately before or during intense physical work activity or exercise is not recommended. First, the job, chore, or workout will be done before the fat can be used as energy. And second, it can cause uncomfortable gastrointestinal symptoms like nausea, vomiting, and diarrhea.
Fat Loss Optimization
For individuals trying to alter body fat composition, the most important thing is to adopt a safe and effective physical activity and exercise routine and to eat a balanced diet of nutrient-dense foods that provide adequate amounts of macronutrients, including dietary fat.
Macronutrient
Low-carbohydrate and high-fat diets, like the ketogenic and Paleo diets, all work on the same premise: Lower carbohydrate intake, high fat intake, and moderate to high protein intake lead to burning body fat as the primary fuel source while engaging in physical activity or exercising. There is some scientific evidence that long-term low-carb/high-fat diets are safe and may help improve metabolic risk factors for chronic disease. Some studies on these diets have shown them to be beneficial for performance in endurance sports, but several months of adaptation to a low-carb/high-fat diet are required for metabolic changes to occur. (Chang C. K., Borer K., and Lin P. J. 2017))
High-Intensity Interval Training
High-intensity interval training is an efficient way to convert fat to energy. In a study, overweight individuals were able to convert body fat to energy in half the time using HIIT vs. aerobic activity alone (Zhang H. et al., 2017). HIIT specifically converts visceral fat, typically white adipose tissue, often found in the midsection. (Mittal B. 2019) HIIT also helps increase muscle mass and resting metabolism. (Thyfault J. P. and Bergouignan A. 2020) However, any exercise regimen that helps increase muscle mass provides these beneficial effects.
Injury Medical Chiropractic and Functional Medicine Clinic
At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for you to relieve pain, restore function, prevent injury, and better the body. Through research methods and total wellness programs, individuals can condition themselves to excel in physical activity or sports through proper fitness and nutrition. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Integrative Medicine and Chiropractic Care
References
Richard, A. J., White, U., Elks, C. M., & Stephens, J. M. (2000). Adipose Tissue: Physiology to Metabolic Dysfunction. In K. R. Feingold, B. Anawalt, M. R. Blackman, A. Boyce, G. Chrousos, E. Corpas, W. W. de Herder, K. Dhatariya, K. Dungan, J. Hofland, S. Kalra, G. Kaltsas, N. Kapoor, C. Koch, P. Kopp, M. Korbonits, C. S. Kovacs, W. Kuohung, B. Laferrere, M. Levy, E. A. McGee, R. McLachlan, M. New, J. Purnell, R. Sahay, A. S. Shah, F. Singer, M. A. Sperling, C. A. Stratakis, D. L. Trence, & D. P. Wilson (Eds.), Endotext. https://www.ncbi.nlm.nih.gov/pubmed/32255578
Rabiee A. (2020). Beige Fat Maintenance; Toward a Sustained Metabolic Health. Frontiers in endocrinology, 11, 634. https://doi.org/10.3389/fendo.2020.00634
MacLean, P. S., Higgins, J. A., Giles, E. D., Sherk, V. D., & Jackman, M. R. (2015). The role for adipose tissue in weight regain after weight loss. Obesity reviews : an official journal of the International Association for the Study of Obesity, 16 Suppl 1(Suppl 1), 45–54. https://doi.org/10.1111/obr.12255
Chang, C. K., Borer, K., & Lin, P. J. (2017). Low-Carbohydrate-High-Fat Diet: Can it Help Exercise Performance?. Journal of human kinetics, 56, 81–92. https://doi.org/10.1515/hukin-2017-0025
Zhang, H., Tong, T. K., Qiu, W., Zhang, X., Zhou, S., Liu, Y., & He, Y. (2017). Comparable Effects of High-Intensity Interval Training and Prolonged Continuous Exercise Training on Abdominal Visceral Fat Reduction in Obese Young Women. Journal of diabetes research, 2017, 5071740. https://doi.org/10.1155/2017/5071740
Mittal B. (2019). Subcutaneous adipose tissue & visceral adipose tissue. The Indian journal of medical research, 149(5), 571–573. https://doi.org/10.4103/ijmr.IJMR_1910_18
Thyfault, J. P., & Bergouignan, A. (2020). Exercise and metabolic health: beyond skeletal muscle. Diabetologia, 63(8), 1464–1474. https://doi.org/10.1007/s00125-020-05177-6
An axillary nerve injury can cause pain, weakness, and shoulder mobility loss. Can physical therapy help restore and maintain shoulder joint flexibility?
Axillary Nerve
The axillary nerve, or the circumflex nerve, is a peripheral nerve that runs through the shoulder and supports movement and sensation in the upper limbs. It originates in the neck at the brachial plexus, a network of nerves that extends from the neck and upper torso to the shoulders and arms. Its primary purpose is to supply nerve function to the shoulder joint and three muscles in the arm and also innervates some skin in the region.
Anatomy
Except for the cranial nerves, all the body’s nerves branch off from the spinal cord, emerge from between vertebrae and continue to branch off as they travel to various muscles and other structures. The axillary nerve is named after the axilla, the medical name for the armpit. Individuals have two, one on each side. After leaving the spinal column, the axillary nerve runs behind the axillary artery and continues to the shoulder blade’s lower edge of the subscapularis muscle. It winds back and travels down the arm along the posterior humeral circumflex artery, which then passes through the quadrangular space (a small area of the shoulder blade just above the armpit where there is a gap in the muscles that allows nerves and blood vessels to pass through to the arm before it divides into terminal branches, which are:
Anterior Division
Supplies motor innervation to the deltoid’s anterior and middle heads, allowing the arm to abduct or move away from the body.
It winds around the neck of the humerus/funny bone, goes beneath the deltoid muscle, and then connects to the forward edge of the deltoid.
A few small cutaneous branches serve the skin in that area.
Posterior Division
Innervates the teres minor muscles and the lower part of the deltoid.
It enters the deep fascia and becomes the superior lateral cutaneous nerve.
It then wraps around the lower edge of the deltoid, connects to the skin over the lower two-thirds of the muscle, and covers the long head of the triceps brachii.
Articular Branch
Comes from the trunk of the axillary nerve and enters the glenohumeral joint, which is in the shoulder, below the subscapularis muscle.
Anatomical Variations
In a case report, healthcare providers noted an incidence of the nerve branching directly off the upper trunk of the brachial plexus rather than the posterior cord. (Subasinghe S. K. and Goonewardene S. 2016) In this case, it innervated the subscapularis muscle, latissimus dorsi, and the deltoid and teres minor muscles and also had a communicating branch to the posterior cord. Another case documented multiple abnormalities in the course of the axillary nerve in an individual with pain and severely limited shoulder mobility. (Pizzo R. A. et al., 2019) During reverse shoulder arthroplasty, the surgeon discovered that the axillary nerve ran beside the coracoid process instead of underneath and stayed close to the subscapularis muscle instead of traveling through the quadrangular space. The case noted earlier reports of axillary nerves not running through the quadrangular space. In those cases, the nerve pierced the subscapularis muscle or split into branches before reaching the quadrangular space.
Function
The axillary nerve functions as a motor nerve that controls movement and a sensory nerve that controls sensations like touch or temperature.
Motor
As a motor nerve, the axillary nerve innervates three muscles in the arm and includes:
Deltoid
Allows flexing of the shoulder joint and rotating the shoulder inward.
Long Head of the Triceps
It runs down the back of the outer arm, allowing straightening, pulling the upper arm toward the body, or extending it backward.
The radial nerve can also innervate this muscle.
Teres Minor
One of the rotator cuff muscles starts outside the shoulder and runs diagonally along the bottom edge of the shoulder blade.
It works with other muscles to allow for the external rotation of the shoulder joint.
Sensory
In its sensory role, the nerve carries information to the brain from the following:
Glenohumeral joint or the ball-and-socket joint in the shoulder.
The skin on the lower two-thirds of the deltoid muscle through the superior lateral cutaneous branch.
Injuries and Conditions
Problems with the axillary nerve can be caused by injuries anywhere along the arm and shoulder and by disease. Common injuries include:
Dislocations
Of the shoulder joint, which can cause axillary nerve palsy.
Fracture
Of the surgical neck of the humerus.
Compression
This stems from walking with crutches, also known as crutch palsy.
Direct Trauma
This can be from an impact sports, work, automobile accident, collision, or laceration.
Added Pressure
This can be from wearing a cast or splint.
Surgical Accidental Injury
An injury or damage can come from shoulder surgery, especially arthroscopic surgery on the inferior glenoid and capsule.
Quadrangular Space Syndrome
This is where the axillary nerve is compressed where it passes through that space, which is most common in athletes who perform frequent overhead motions)
Nerve Root Damage
Between the fifth and sixth cervical vertebrae, where the nerve emerges from the spinal cord, which can be caused by traction, compression, spinal disc prolapse, or a bulging disc.
Systemic Neurological Disorders
Example – multiple sclerosis
Erb’s Palsy
A condition often is the result of a birth injury called shoulder dystocia, in which a baby’s shoulder/s becomes stuck during childbirth.
Axillary Nerve Palsy
Damage can result in a type of peripheral neuropathy that can cause weakness in the deltoid and teres minor muscles.
This can result in losing the ability to lift the arm away from the body and weakness in various shoulder movements.
If the damage is severe enough, it can cause paralysis of the deltoid and other minor muscles, resulting in flat shoulder deformity, in which individuals cannot lay their shoulders flat when lying down.
Axillary nerve damage also can lead to a change, reduction, or loss of sensation in a small part of the arm just below the shoulder.
Nerve Injury Statistics
Three times more common in men than women.
It may be present in as many as 65% of shoulder injuries.
The risk of injury due to dislocation is significantly increased after age 50.
Tests
If a healthcare provider suspects a problem with axillary nerve function, they’ll test the shoulder’s range of motion and skin sensitivity. A difference in the range of motion between the shoulders can indicate a nerve injury. Individuals may be sent for electromyography and a nerve conduction study to verify nerve palsy. In some cases, an MRI and/or X-rays may be ordered, especially if the cause of possible nerve damage is unknown.
Rehabilitation
Depending on the severity and cause of the injury, non-surgical treatments may be recommended, with surgery as a last resort. Non-surgical treatment can include some combination of immobilization, rest, ice, physical therapy, and anti-inflammatory meds. Physical treatment typically lasts about six weeks and focuses on strengthening and stimulating the muscles to prevent joint stiffness, which can impair long-term function.
Surgery
If conservative treatments don’t work, surgery may be recommended, especially if several months have passed without improvement. Surgical outcomes are generally better if surgery is performed within six months of the injury, and regardless of the time frame, the prognosis is considered positive in about 90% of cases. Surgical procedures performed for axillary nerve dysfunction or injury include:
Neurolysis
This procedure involves targeted damage/degeneration of nerve fibers, interrupts the nerve signals, and eliminates pain while the damaged area heals.
Neurorrhaphy
This procedure stitches a severed nerve back together.
Nerve Grafting
Grafting involves transplanting a portion of another nerve, usually the sural nerve, to reconnect severed nerves.
This helps, especially when the damaged portion is too large to be repaired by neurorrhaphy.
It allows a pathway for signals and encourages the regrowth of nerve axons.
Neurotization or Nerve Transfer
Similar to grafting but used when the nerve is too damaged to heal.
This procedure involves transplanting a healthy but less important nerve, or a portion of a nerve, to replace the damaged one and restore function.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Shoulder Pain Chiropractic Treatment
References
Subasinghe, S. K., & Goonewardene, S. (2016). A Rare Variation of the Axillary Nerve Formed as Direct Branch of the Upper Trunk. Journal of clinical and diagnostic research : JCDR, 10(8), ND01–ND2. https://doi.org/10.7860/JCDR/2016/20048.8255
Pizzo, R. A., Lynch, J., Adams, D. M., Yoon, R. S., & Liporace, F. A. (2019). Unusual anatomic variant of the axillary nerve challenging the deltopectoral approach to the shoulder: a case report. Patient safety in surgery, 13, 9. https://doi.org/10.1186/s13037-019-0189-1
The vastus lateralis is a muscle on the outside part of the thigh. Injuries to the muscle include strains, tendinitis, femoral nerve compression, and others. Can rehabilitation like heat and ice, massage, and strength and mobility exercises help individuals return to normal activities and function?
Vastus Lateralis Muscle
The vastus lateralis is the largest of the four quadriceps muscles on the thigh’s outer portion. The vastus lateralis helps extend the knee joint and maintain the knee position when walking or running. The vastus lateralis functions to work with the other quad muscles to help extend the knee joint.
Anatomy
Most muscles are attached to bone points of attachment, called the origin and insertion points. The vastus lateralis origin and insertion points are as follows (Vieira, EPL. 2017)
Origin
The origin is on the upper inter-trochanteric line of the femur or thigh bone.
It also arises from the base of the greater trochanter and the linea aspera, the supracondylar ridge, and the lateral intermuscular septum.
Insertion
From its origin, the muscle courses down the lateral thigh and inserts as part of the lateral quadriceps tendon on the tibial tubercle, an elevated portion of the upper shin.
The muscle is a large, flat structure with different attachments and a flat aponeurosis or sheath of connective tissue on the outer thigh.
The femoral nerve from lower back levels two, three, and four controls or innervates the muscle.
Blood supply to the muscle goes through the lateral circumflex femoral artery of the upper thigh.
Function
The muscle works with the other quadriceps muscles to extend or straighten the knee. The quads are responsible for functional activities like walking, running, climbing stairs, and getting up from a seated position. The vastus lateralis and the iliotibial band, which courses down the lateral thigh next to this muscle, form the lateral wall of the thigh. The vastus lateralis is on the opposite side of the vastus medialis muscle on the inner portion of the thigh. These muscles work together to maintain the appropriate position of the patella/kneecap in the femoral groove of the thigh bone. Malfunctioning these muscles properly can lead to knee pain from patellofemoral stress syndrome. (American Academy of Orthopaedic Surgeons, 2024)
Conditions
Many different injuries and conditions can affect the vastus lateralis and quad muscles, especially in athletes or active individuals. These injuries can cause vastus lateralis pain and other problems. (Timothy J. Von Fange, 2024) Some of the injuries and conditions include:
Patellofemoral Stress Syndrome – PFSS
This occurs when the kneecap tracks improperly in the femoral groove of the knee joint.
This leads to pain and difficulty when walking and running.
Vastus Lateralis Strain
A sudden force on the thigh can cause the quad muscle to be strained.
If the vastus lateralis suffers a pull injury, individuals may have pain, muscle swelling, thigh bruising, and walking difficulties.
Patellar Tendinitis
Irritation of the quad tendon that courses over the kneecap can cause patellar tendinitis.
Femoral Nerve Compression Weakness
The femoral nerve may become pinched or irritated from a herniated disc, lumbar stenosis, or arthritis.
Pain, numbness, tingling, or weakness in the thigh may result.
Iliotibial Band Friction Syndrome
Tight or weak muscles can irritate the IT band, and the vastus lateralis muscle can be affected.
Injury Rehabilitation
Injury to the vastus lateralis or quad muscles can cause pain, swelling of the thigh, or limited walking ability. Various treatments are available to help expedite recovery. A primary healthcare provider may recommend working with a physical therapy team. Self-care techniques can include:
Heat and Ice
Ice may be applied to the lateral thigh the first few days after injury to control pain and decrease swelling and inflammation.
Ice should be applied for 10 to 15 minutes.
Individuals may switch to heat two to three days after to promote circulation and improve tissue mobility.
Heat should be applied for 10 to 15 minutes.
Massage
Massage can help decrease pain and promote circulation.
Massage techniques can improve tissue mobility before stretching to help improve quadriceps motion.
Exercises and Stretching
A physical therapy team will prescribe certain exercises and stretches to help regain strength and range of motion. After an injury, quad stretching can improve the mobility and function of the muscle group.
Prone Towel Quad Stretch
Lie on your stomach and place a towel or strap around the ankle.
Bend the knee up, and gently pull on the towel to bend the knee fully.
A pulling sensation should be felt in the front of the thigh.
Hold the stretch for 30 seconds and release.
Repeat three times.
Half-kneeling Quad and Hip Flexor Stretch
Kneel on one knee.
Slowly move forward until a stretch is felt in the front of the hip and thigh.
Hold this position for 30 seconds.
Relax back to the starting position.
Repeat three times.
Back Exercises
If femoral nerve irritation coming from the lower back is causing thigh pain or weakness, exercises to release the nerve may be helpful and can include:
Prone press-ups
Supine lumbar flexion
Lumbar side glides
The exercises are designed to relieve pressure on the lumbar nerve, and postural correction exercises may be performed to maintain decompression.
Strengthening
Weakness to the vastus laterals and quads may be causing injury, and strengthening exercises may be prescribed during rehabilitation and can include:
Hip-strengthening exercises
Straight leg raises
Leg extension exercises
Lunges
Squats
Strengthening exercises should be done two to four times weekly with appropriate rest between sessions.
Balance exercises and sport-specific plyometric training may be recommended to ensure the quad functions normally.
Most quadriceps and vastus lateralis muscle injuries heal within six to eight weeks.
Recovery may be shorter or longer depending on the nature of the injury.
Injury Medical Chiropractic and Functional Medicine Clinic
By understanding the anatomy and function of the vastus lateralis muscle, a healthcare provider can help individuals understand their specific injury and develop a treatment program to rehabilitate the muscle properly. At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for you and strive to develop fitness and better the body through research methods and total wellness programs. These natural programs use the body’s ability to achieve improvement goals, and athletes can condition themselves to excel in their sport through proper fitness and nutrition. Our providers use an integrated approach to create personalized programs, often including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.
Knee Injury Chiropractor
References
Vieira EPL. (2017). Anatomic study of the portions long and oblique of the vastus lateralis and vastus medialis muscles. J Morphol Sci., 28(4), 0-. http://www.jms.periodikos.com.br/article/587cb49f7f8c9d0d058b47a1/pdf/jms-28-4-587cb49f7f8c9d0d058b47a1.pdf
American Academy of Orthopaedic Surgeons. (2024). Patellofemoral pain syndrome. https://orthoinfo.aaos.org/en/diseases–conditions/patellofemoral-pain-syndrome/
Timothy J Von Fange. (2024). Quadriceps muscle and tendon injuries. UpToDate. https://www.uptodate.com/contents/quadriceps-muscle-and-tendon-injuries/print
Ramírez-delaCruz, M., Bravo-Sánchez, A., Esteban-García, P., Jiménez, F., & Abián-Vicén, J. (2022). Effects of Plyometric Training on Lower Body Muscle Architecture, Tendon Structure, Stiffness, and Physical Performance: A Systematic Review and Meta-analysis. Sports medicine – open, 8(1), 40. https://doi.org/10.1186/s40798-022-00431-0
Individuals experiencing persistent pain, weakness, numbness, and tingling in the back could be suffering from nerve root encroachment. Could surgery ease nerve compression and improve symptoms for persistent and severe cases?
Surgical Decompression
The pain, weakness, numbness, and tingling associated with nerve root encroachment are usually first treated with non-surgical therapies that include:
Anti-inflammatory medications
Physical therapy
This can be enough to address the irritation of the spinal nerve root. But when cases become severe, surgical decompression may be recommended and necessary. It can be done in a couple of different ways.
Causes and Symptoms
Vertebrae are bones in the spine. Small openings called foramina allow a spinal nerve root to pass through on each side of the vertebra. When nerve root encroachment is present, the spinal nerve root gets compressed, pinched, and trapped, which can cause peripheral symptoms such as numbness, tingling, pain, or weakness to develop. Nerve root encroachment is typically caused by normal aging degenerative wear and tear changes in the vertebrae. (Choi Y. K. 2019) These degenerative changes can include:
Facet joint hypertrophy
Ligament and bone hypertrophy
Disc disorders
Formation of bone spurs or osteophytes.
If these degenerative changes progress, they can encroach and compress a nerve root, leading to peripheral symptoms. (Choi Y. K. 2019)
When Surgery Is Recommended
When symptoms occur, initial treatment will involve:
Physical therapy
Chiropractic realignment
Massage therapies
Rest
Lifestyle adjustments
Nonsteroidal anti-inflammatories – NSAIDs
Corticosteroid injections into the spine
If conservative therapies don’t fully heal or improve symptoms or there are neurological problems like difficulty with balance or walking, then surgery may be recommended. Severe pain that limits normal function is an indication for surgery, and rapidly progressive weakness of the arms and/or legs or signs of cauda equina syndrome are indications for emergency surgery.
Surgery Options
Different types of spinal surgery may be performed. A neurosurgeon will decide the best procedure for each patient based on their case, age, medical conditions, and other factors. Specific spinal surgical decompression depends on what is causing the nerve compression. In most cases, it involves removing bone or tissue to relieve nerve pressure or provide support to stabilize the joint. The most common types of surgical decompression include: (Mayo Clinic Health System, 2022)
Maintain the stability and alignment of the spine.
Improve the stability and alignment of the spine.
Anterior Surgery
The anterior approach to surgery means that the spine is accessed through the anterior/front of the spine. In this surgery, one or more discs and bone spurs may be removed through an incision in the front of the neck. (American Association of Neurological Surgeons, 2024) For example, an anterior cervical discectomy may alleviate pressure on one or more nerve roots in the neck. With an anterior lumbar interbody fusion, a surgeon removes a degenerative disc in the lower spinal area by going through a patient’s lower abdomen. (American Association of Neurological Surgeons, 2024) After the disc is removed, a structural device, usually made of bone, fills the space where it once was. This device encourages bone healing and helps the vertebrae’s bodies fuse.
Posterior Surgery
Posterior surgery means the spine is accessed through the posterior/back of the spine. An example is removing a thickened ligament, bone spur, or disc material in the neck. To do this, a small incision in the back of the neck may be made to remove part of the back of the vertebrae called the lamina. This is called a posterior cervical laminectomy. (American Association of Neurological Surgeons, 2024) A posterior lumbar interbody fusion removes a degenerative disc by going through the back. (American Association of Neurological Surgeons, 2024) Like the anterior approach, a structural device often contains bone to fill the space where the disc once was to fuse the bones.
Potential Risks
As with any surgery, it’s important that the individual and their healthcare provider carefully discuss the benefits and risks. Spinal surgical decompression includes: (Proietti L. et al., 2013)
Bleeding
Blood clots
Surgical site infection
Urinary tract infection
Lung infection
Intestinal blockage
There are also specific risks to the area of the spine being operated on and how it is surgically approached. For example, a cervical anterior procedure may injure the esophagus, trachea, or carotid artery. Likewise, damage to the C5 nerve root/C5 palsy can occur from cervical spinal decompressive surgery. This complication causes weakness, numbness, and pain in the shoulders. (Thompson S. E. et al., 2017) The spinal cord may also be injured during surgery and result in paralysis, although this is rare. (American Association of Neurological Surgeons, 2024)
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
The Non-Surgical Solution
References
Choi Y. K. (2019). Lumbar foraminal neuropathy: an update on non-surgical management. The Korean journal of pain, 32(3), 147–159. https://doi.org/10.3344/kjp.2019.32.3.147
Mayo Clinic Health System. (2022). Decompress and stabilize: understanding types of back surgery. Speaking of Health. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/understanding-types-of-back-surgery
American Association of Neurological Surgeons. (2024). Cervical spine. https://www.aans.org/patients/conditions-treatments/cervical-spine/
American Association of Neurological Surgeons. (2024). Lumbar spinal stenosis. https://www.aans.org/patients/conditions-treatments/lumbar-spinal-stenosis/
Proietti, L., Scaramuzzo, L., Schiro’, G. R., Sessa, S., & Logroscino, C. A. (2013). Complications in lumbar spine surgery: A retrospective analysis. Indian journal of orthopaedics, 47(4), 340–345. https://doi.org/10.4103/0019-5413.114909
Thompson, S. E., Smith, Z. A., Hsu, W. K., Nassr, A., Mroz, T. E., Fish, D. E., Wang, J. C., Fehlings, M. G., Tannoury, C. A., Tannoury, T., Tortolani, P. J., Traynelis, V. C., Gokaslan, Z., Hilibrand, A. S., Isaacs, R. E., Mummaneni, P. V., Chou, D., Qureshi, S. A., Cho, S. K., Baird, E. O., … Riew, K. D. (2017). C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases. Global spine journal, 7(1 Suppl), 64S–70S. https://doi.org/10.1177/2192568216688189
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