As the body ages, individuals want to stay active and maintain a healthy pain free lifestyle. Can regenerative cells for arthritis and cartilage damage be the future of neuromusculoskeletal medicine and joint healing?
Regenerative Cells For Arthritis and Cartilage Damage
Individuals want to continue to do the physical activities they love, which require healthy joints. Scientists are learning how to harness the abilities of regenerative cells to repair and regrow damaged and deteriorated cartilage. Current stem cell treatment of cartilage problems has not been shown to reverse the effects of arthritis and while studies show clinical improvement, further research is necessary. (Bryan M. Saltzman, et al., 2016)
Cartilage and How It Gets Damaged
Cartilage is a type of connective tissue. In the joints, there are a few types of cartilage. The most commonly referred to is the smooth lining known as articular or hyaline cartilage. This type forms a smooth layer of cushion on the end of a bone at the joint. (Rocky S. Tuan, et al., 2013)
The tissue is very strong and has the ability to compress and absorb energy.
It is very smooth allowing a joint to glide effortlessly through a limb’s range of motion.
When joint cartilage is damaged, the cushioning can wear down.
In traumatic injuries, a sudden force can cause the cartilage to break off and/or suffer damage, that exposes the underlying bone.
In osteoarthritis – degenerative or wear-and-tear arthritis, the smooth layer can wear down thin and unevenly.
Eventually, the cushion wears away, the joints become inflamed and swollen and movements become stiff and painful.
There are treatments for arthritis and cartilage damage, but these treatments are usually focused on relieving symptoms by smoothing down the damaged cartilage or replacing the joint surface with an artificial implant, like knee replacement or hip replacement surgeries. (Robert F. LaPrade, et al., 2016)
Regenerative Cells
Regenerative stem cells are special cells that have the ability to multiply and develop into different types of tissue. In an orthopedic surgery setting for joint problems, stem cells are obtained from adult stem cell primary sources which are bone marrow and fatty tissue. These cells have the ability to develop into cartilage cells, called chondrocytes. (Rocky S. Tuan, et al., 2013)
They also help by stimulating the body to reduce inflammation, stimulate cell repair, and improve blood circulation.
This process is caused by cellular signals and growth factors to stimulate the body to activate the healing processes.
Once stem cells have been obtained, they need to be delivered to the area of cartilage damage.
Cartilage is a complex tissue that is described as a scaffold structure that is composed of collagen, proteoglycans, water, and cells. (Rocky S. Tuan, et al., 2013)
To regenerate cartilage, the complex tissues must also be reconstructed.
There are studies on types of tissue scaffolds engineered to recreate a similar type of cartilage structure.
The stem cells can then be injected into the scaffold, in hopes of restoring a normal type of cartilage.
Non-Surgical Arthritis Treatments
Standard treatments such as cortisone shots or physical therapies work as well and provide benefits that could be utilized in combination with regenerative cells for arthritis and cartilage damage in the near future. Data takes time and therefore how this impacts the long-term health of a joint needs continued research in terms of tissue engineering and cell delivery to determine the best approach to help individuals.
Arthritis
References
LaPrade, R. F., Dragoo, J. L., Koh, J. L., Murray, I. R., Geeslin, A. G., & Chu, C. R. (2016). AAOS Research Symposium Updates and Consensus: Biologic Treatment of Orthopaedic Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 24(7), e62–e78. https://doi.org/10.5435/JAAOS-D-16-00086
Saltzman, B. M., Kuhns, B. D., Weber, A. E., Yanke, A., & Nho, S. J. (2016). Stem Cells in Orthopedics: A Comprehensive Guide for the General Orthopedist. American journal of orthopedics (Belle Mead, N.J.), 45(5), 280–326.
Tuan, R. S., Chen, A. F., & Klatt, B. A. (2013). Cartilage regeneration. The Journal of the American Academy of Orthopaedic Surgeons, 21(5), 303–311. https://doi.org/10.5435/JAAOS-21-05-303
Are treatments more successful when patients know key terms that describe their back pain and associated conditions?
Nerve Pain Types
When individuals need to better understand their spine diagnosis, being able to distinguish between key terms can make a significant difference in understanding the development of a personalized treatment plan. Terms that describe back pain and various associated conditions can include:
Sciatica
Radiating and Referred pain
Radiculopathy
Radiculitis
Neuropathy
Neuritis
Causes of Back Pain
Back pain symptoms are most commonly caused by the continued practice of unhealthy/poor posture and overcompensated and weakened muscles. Even for individuals that exercise regularly, the movement choices that are made throughout the day can disrupt the way the muscles, tendons, ligaments, and fascia function to maintain proper body alignment.
Injuries to, and conditions of, the structures of the spinal column like the bones, discs, and nerves, are generally more serious than posture problems and soft tissue-related pain.
Depending on the diagnosis, structural problems can cause symptoms related to nerve compression, irritation, and/or inflammation. (Michigan Medicine, 2022)
Spine and Nervous System
The peripheral nerves extend out to the extremities with sensation and movement capabilities.
Nerve roots exit the spinal canal which is part of the peripheral nervous system.
The branching of nerves from the spinal cord and exit out of the foramina occurs at every level of the spine.
Terms
There are different medical terms when getting a spine diagnosis or going through the treatment process.
Radiculopathy
Radiculopathy is an umbrella term, describing any disease process that affects a spinal nerve root and is something that’s happening to the body.
When a healthcare provider informs you that your pain is due to radiculopathy, a number of more specific diagnoses, clinical signs, and symptoms may be included as part of the description.
Common causes of radiculopathy include herniated disc/s and spinal stenosis.
Less common causes can include a synovial cyst or tumor that presses on the nerve root. (Johns Hopkins Medicine, 2023)
Radiculopathy can occur in the neck, low back, or in the thoracic area.
Often, radiculopathy is brought on by some form of compression of the nerve root.
For example, extruded material from a herniated disc can land on a nerve root, causing pressure to build.
This can cause symptoms associated with radiculopathy, including numbness, weakness, pain, or electrical sensations. (Johns Hopkins Medicine, 2023)
Even though there’s a spinal nerve root on either side of the spinal column, injury, trauma, or issues stemming from degeneration affect the nerves in an asymmetric fashion. Degenerative changes, known as normal wear and tear, typically occur in this fashion. Using the previous herniated disc example, the material that leaks from the disc structure tends to travel in one direction. When this is the case, the symptoms tend to be experienced on the side where the nerve root makes contact with the disc material, but not the other side. (American Association of Neurological Surgeons, 2023)
Radiculitis
Radiculitis is a form of radiculopathy but it is about inflammation and not compression. (Johns Hopkins Medicine, 2023)
Radicu– refers to the spinal nerve root.
The suffix – itis refers to inflammation.
The word refers to a spinal nerve root that is inflamed and/or irritated rather than compressed.
In disc herniations, it is the gel substance that contains various chemicals that is inflammatory.
When the gel substance makes contact with nerve roots, an inflammatory response is triggered. (Rothman SM, Winkelstein BA 2007)
Radiating or Referred Pain
Radiating pain follows the path of one of the peripheral nerves that transmit sensory information like heat, cold, pins and needles, and pain.
Referred pain is experienced in a different area of the body that is away from the pain source which tends to be an organ. (Murray GM., 2009)
It can be brought on by myofascial trigger points or visceral activity.
An example of referred pain is symptoms in the jaw or arm when an individual is having a heart attack. (Murray GM., 2009)
Radicular
The terms radicular pain and radiculopathy tend to get confused.
Radicular pain is a symptom of radiculopathy.
Radicular pain radiates from the spinal nerve root to either part or all the way down the limb/extremity.
However, radicular pain does not represent the complete symptoms of radiculopathy.
Radiculopathy symptoms also include numbness, weakness, or electrical sensations like pins and needles, burning, or shock that travels down the extremity. (Johns Hopkins Medicine, 2023)
Neuropathy
Neuropathy is another umbrella term that refers to any dysfunction or disease that affects the nerves.
It’s usually classified according to the cause, like diabetic neuropathy, or the location.
Neuropathy can occur anywhere in the body – including the peripheral nerves, the autonomic nerves/organ nerves, or nerves that are located inside the skull and innervate the eyes, ears, nose, etc.
Peripheral nerves are the long, thin strands that supply sensation, feeling, and movement impulses to all areas of the body located outside the central nervous system.
Piriformis syndrome is where a tight buttock/piriformis muscle constricts the sciatic nerve, which runs underneath. (Cass SP. 2015)
Chiropractic
Chiropractic adjustments, non-surgical decompression, MET, and various massage therapies can relieve symptoms, release stuck or trapped nerves and restore function. Through the treatments, the chiropractor and therapists will explain what is happening and why they are using a specific technique. Knowing a little about how the neuromusculoskeletal system operates can help the healthcare provider and the patient in developing and adjusting effective treatment strategies.
Sciatica During Pregnancy
References
Michigan Medicine. Upper and Middle Back Pain.
American Academy of Neurological Surgeons. Anatomy of the Spine and Peripheral Nervous System.
Johns Hopkins Medicine. Health Conditions. Radiculopathy.
American Association of Neurological Surgeons. Herniated Disc.
American Academy of Orthopaedic Surgeons. OrthoInfo. Cervical Radiculopathy (Pinched Nerve).
Rothman, S. M., & Winkelstein, B. A. (2007). Chemical and mechanical nerve root insults induce differential behavioral sensitivity and glial activation that are enhanced in combination. Brain Research, 1181, 30–43. https://doi.org/10.1016/j.brainres.2007.08.064
Murray G. M. (2009). Guest Editorial: referred pain. Journal of applied oral science: Revista FOB, 17(6), i. https://doi.org/10.1590/s1678-77572009000600001
American Academy of Orthopaedic Surgeons. OrthoInfo. Carpal Tunnel Syndrome.
Bostelmann, R., Zella, S., Steiger, H. J., & Petridis, A. K. (2016). Could Spinal Canal Compression be a Cause of Polyneuropathy? Clinics and practice, 6(1), 816. https://doi.org/10.4081/cp.2016.816
Cleveland Clinic. Mononeuropathy.
American Association of Neurological Surgeons. Glossary of Neurosurgical Terminology.
National Institutes of Health. U.S. National Library of Medicine. Medline Plus. Peripheral Nerve Disorders.
Cleveland Clinic. Spinal Stenosis.
Cass S. P. (2015). Piriformis syndrome: a cause of non-discogenic sciatica. Current sports medicine reports 14(1), 41–44. https://doi.org/10.1249/JSR.0000000000000110
Individuals at work, school, etc, perform all kinds of repetitive physical tasks that put their bodies through a great deal of musculoskeletal stress, what are the effects and benefits of joint manipulation therapy for pain relief?
Joint Manipulation Health Benefits
Joint manipulation is a form of manual therapy that involves applying force to the spinal or peripheral joints to:
Relieve pain symptoms.
Realign the joints to their proper position.
Restore flexibility.
Improve mobility.
Increase range of motion.
Chiropractors, massage, and physical therapists use various manipulation techniques to help move and feel better after an injury or illness that causes loss of functional mobility. Here we explain joint manipulation, its applications, and if the technique is safe for you and your condition.
Joint Popping
The joints in the body are places where two or more bones come together to allow movement.
The cartilage allows the joint surfaces to glide/slide smoothly.
If the cartilage is injured or damaged, pain and limited motion can present.
When a joint doesn’t move properly, the muscles surrounding that joint don’t contract properly.
If a joint is dysfunctional for some time, significant muscle wasting and atrophy can occur around the joint, leading to difficulty with mobility like standing, walking, or reaching. (Hurley MV.1997)
The body is made up of cells that breathe by converting energy and releasing waste materials. One type of waste material from cell respiration is carbon dioxide. The gas is transported through the blood and delivered out of the body while breathing. Small pockets of gas can get trapped in the joints that expand and contract as pressure around the joint changes during movement, known as cavitation. When the gas is released through joint manipulation, there can be a popping or snapping sound as the joint is moved. Once the gas is released, joint pressure is decreased and mobility is increased. (Kawchuk, et al., 2015)
Causes
Non-medical
There are non-medical and medical causes of joint dysfunction and derangement that include:
Overuse and repetitive strain.
Unhealthy sitting and/or standing posture.
Lack of physical activity.
Over-stretching or stretching incorrectly.
In these situations, the joints can be temporarily placed in a dysfunctional/compromised position. When moving to the correct position, a popping sound can present as built-up pressure is released.
Medical
Joint problems can occur from medical conditions that can include:
Herniated cervical or lumbar discs.
Spinal arthritis.
Rheumatoid arthritis.
Osteoarthritis.
Joint contracture after being immobilized for some time.
In these cases, a medical problem can be causing a limitation in the joint’s position and movement. (Gessl, et al., 20220)
Benefits
If a chiropractic practitioner determines there is joint dysfunction then manipulation may be a treatment option. The benefits include:
Pain Relief
When a chiropractor or therapist gets an injured joint moving properly, the receptors in and around the area get reset allowing for pain relief.
Improved Muscle Activation
As a chiropractor manipulates a joint into its correct anatomical position, the surrounding muscles can flex and contract properly.
Improved Range of Motion
The joint is repositioned for proper movement.
This improves the range of motion and relieves tightness and stiffness.
Improved Functional Mobility
Once a joint is manipulated, the improved range of motion and muscle activation around the joint can lead to improved overall functional mobility. (Puentedura, et al., 2012)
Candidates
Joint manipulation is a safe manual therapy technique for certain individuals. (Puentedura, et al., 2016) This includes:
Individuals with acute neck, back, or peripheral joint pain.
Adults aged 25 to 65 with no serious medical conditions.
Athletes who have been injured from their sport.
Individuals who have been immobilized after injury or surgery.
Joint manipulation is not recommended for everyone and can be dangerous or lead to injury in individuals with certain conditions. (Puentedura, et al., 2016) These include individuals with:
Osteoporosis
Weakened bones may fracture if a high-velocity force is applied to a joint via manipulation
Joint fractures
Individuals with a joint fracture, should not have that specific joint manipulated.
Post Spinal Fusion Surgery
Individuals that have had spinal fusion in the neck or lower back should avoid spinal joint manipulations or adjustments for at least one year after the procedure.
The bones need time to heal thoroughly.
Manipulation can cause a failure of the fusion.
Individuals with Arterial Insufficiency In Their Neck
A rare but dangerous side effect of a neck adjustment is the risk of tearing an artery in the neck known as the vertebrobasilar artery. (Moser, et al., 2019)
If there is pain, loss of movement, or decreased mobility after an injury or surgery, a chiropractic adjustment with joint manipulation can be beneficial to help regain movement. Manual techniques can help improve joint mobility, alleviate pain, and increase strength and stability around the joints. Joint manipulation isn’t for everyone and is recommended to consult with a healthcare professional to see if it is safe for your specific condition.
Gessl, I., Popescu, M., Schimpl, V., Supp, G., Deimel, T., Durechova, M., Hucke, M., Loiskandl, M., Studenic, P., Zauner, M., Smolen, J. S., Aletaha, D., & Mandl, P. (2021). Role of joint damage, malalignment, and inflammation in articular tenderness in rheumatoid arthritis, psoriatic arthritis, and osteoarthritis. Annals of the rheumatic diseases, 80(7), 884–890. https://doi.org/10.1136/annrheumdis-2020-218744
Hurley M. V. (1997). The effects of joint damage on muscle function, proprioception, and rehabilitation. Manual therapy, 2(1), 11–17. https://doi.org/10.1054/math.1997.0281
Kawchuk, G. N., Fryer, J., Jaremko, J. L., Zeng, H., Rowe, L., & Thompson, R. (2015). Real-time visualization of joint cavitation. PloS one, 10(4), e0119470. https://doi.org/10.1371/journal.pone.0119470
Moser, N., Mior, S., Noseworthy, M., Côté, P., Wells, G., Behr, M., & Triano, J. (2019). Effect of cervical manipulation on the vertebral artery and cerebral hemodynamics in patients with chronic neck pain: a crossover randomized controlled trial. BMJ open, 9(5), e025219. https://doi.org/10.1136/bmjopen-2018-025219
Puentedura, E. J., Cleland, J. A., Landers, M. R., Mintken, P. E., Louw, A., & Fernández-de-Las-Peñas, C. (2012). Development of a clinical prediction rule to identify patients with neck pain likely to benefit from thrust joint manipulation to the cervical spine. The Journal of orthopedic and sports physical therapy, 42(7), 577–592. https://doi.org/10.2519/jospt.2012.4243
Puentedura, E. J., Slaughter, R., Reilly, S., Ventura, E., & Young, D. (2017). Thrust joint manipulation utilization by U.S. physical therapists. The Journal of manual & manipulative therapy, 25(2), 74–82. https://doi.org/10.1080/10669817.2016.1187902
Joints are the musculoskeletal areas where two bones connect. The joints have soft tissues around them, like cartilage, tendons, and ligaments. Cartilage is the flexible tissue that covers the ends of the bones at a joint. The tendons are bands between the muscles and bones that connect everything to initiate joint movement. And the ligaments are a kind of bridge that connects the bones of the joints to keep the body stable when in motion. After an injury, the joints need to be worked out, stretched, and massaged to return to proper function and support. A chiropractic personalized rehabilitation program will include exercises that target joint stability.
Joint Injury Rehabilitation
The shoulders, elbows, wrists, knuckles, hips, knees, and ankles are joints. The spine is also made up of joints. The first step for achieving joint stability after a lower-body injury is to assess the joints for:
A physician, chiropractor, or therapist will check the joint and test for weakness or deficits in soft tissues, tendons, ligaments, and cartilage.
Individuals can have conditions, diseases, or injuries that affect the joints, causing dysfunction.
Correcting deficits may require taping, bracing, exercises, or surgery.
Joint stability is attained through specific exercises that target balance, proprioception, range of motion, flexibility, strength, and endurance.
Individuals must participate in their rehabilitation program to fully recover from their injuries.
Proprioception and Neuromuscular Training
Neuromuscular training and proprioception are essential to joint stability.
Neuromuscular control is an unconscious response to joint motions without awareness.
It is how workers or athletes adjust to uneven pavement or shift their weight to stay balanced on an incline or stairs.
Proprioceptionis the ability to sense the body’s orientation in the environment.
It allows body movement and responds without consciously thinking about where the body is in space.
The information signals detect joint position, limb movement, direction, and speed.
A joint with a high level of neuromuscular control and a trained proprioceptive system can respond appropriately to various forces placed upon it during activity, decreasing the risk of injury.
Proprioceptive exercises train joint proprioceptors to adapt before initiating a potentially damaging/injurious movement.
Targeted Training
Specific to the individual’s injury, specific exercises are incorporated to regain/relearn skill sets and reset automatic movement patterns.
Skills training improves the ability to make adjustments quickly and decreases the potential for worsening or creating another injury.
Research has found that individuals who participate in neuromuscular retraining have improved muscular activation and reaction to changes compared to those who do not incorporate retraining exercises.
Trainers and therapists use neuromuscular exercises to prevent and rehabilitate ACL injuries.
The following example of an exercise rehabilitation program can be used to rehabilitate the lower extremities. The exercises should be done slowly over several weeks. Therapeutic exercises should be combined with an appropriate and gradual range of motion and strengthening program. Individuals should always work with a chiropractor and physical therapist to develop the most suitable program for specific injuries and limitations.
One-Leg Balance
Try to stand on one leg for 10 to 30 seconds.
One-Leg Balance with Eyes Closed
Stand on one leg for 10 to 30 seconds with your eyes closed.
Akbar, Saddam, et al. “Effects of neuromuscular training on athletes’ physical fitness in sports: A systematic review.” Frontiers in physiology vol. 13 939042. 23 Sep. 2022, doi:10.3389/fphys.2022.939042
Borrelli, Joseph Jr et al. “Understanding Articular Cartilage Injury and Potential Treatments.” Journal of orthopedic trauma vol. 33 Suppl 6 (2019): S6-S12. doi:10.1097/BOT.0000000000001472
Cote, Mark P, et al. “Rehabilitation of acromioclavicular joint separations: operative and nonoperative considerations.” Clinics in sports medicine vol. 29,2 (2010): 213-28, vii. doi:10.1016/j.csm.2009.12.002
Jeong, Jiyoung, et al. “Core Strength Training Can Alter Neuromuscular and Biomechanical Risk Factors for Anterior Cruciate Ligament Injury.” The American Journal of sports medicine vol. 49,1 (2021): 183-192. doi:10.1177/0363546520972990
Porschke, Felix, et al. “Return to work after acromioclavicular joint stabilization: a retrospective case-control study.” Journal of orthopedic surgery and Research vol. 14,1 45. 12 Feb. 2019, doi:10.1186/s13018-019-1071-7
Vařeka, I, and R Vařeková. “Kontinuální pasivní pohyb v rehabilitaci kloubů po úrazech a operacích” [Continuous passive motion in joint rehabilitation after injury and surgery]. Acta Chirurgie orthopaedicae et traumatologiae Cechoslovaca vol. 82,3 (2015): 186-91.
Individuals dealing with or managing chronic back pain should incorporate swimming exercises. Swimming is a low-impact aerobic conditioning exercise that’s easy on the back and healthy for the spine. When an individual struggles with back problems, they may be tempted to rest and avoid physical activity/exercise. Total rest is not recommended as it can cause the muscles that support the back to weaken or atrophy. When the muscles weaken, they cannot stabilize the spine or body correctly, which causes conditions to worsen or contribute to new injuries. Starting swimming exercises can expand the spine, relieve painful pressure or strain on the back and strengthen the muscles for spinal health.
Starting Swimming Exercises
Swimming does not impact the spine and other musculoskeletal structures because the water suspends the body.
Swimming is a full-body, low-impact exercise which is excellent for individuals of all ages and all body shapes and sizes.
Talk to a healthcare professional about any questions or concerns about how swimming may impact your body.
Swimming benefits include stress relief, a strengthened musculoskeletal system, and support in heart health.
Swimming for Back Problems
Relaxes The Nervous System
Tense muscles can cause or contribute to back problems and pain symptoms and aggravate spinal conditions.
Swimming exercises release endorphins to relax the nervous system and tense muscles.
Relieves Pressure on Joints
The water lightens the body relieving pressure on the joints and muscles.
Builds Muscle to Support the Spine
The resistance and movement strengthen the whole body with the joints and spine supported.
Swimming engages muscles not always used, specifically those needed to improve spinal stability.
Exercises for Back Relief
Checking with a physician before exercising is recommended, especially if starting a new exercise routine. When you meet with the Injury Medical Chiropractic and Functional Medicine Cline team, we can determine if starting swimming exercises would benefit you. Once cleared, here are some swimming exercises that could help bring relief:
Walking
Walking around the pool means movement that the body needs to heal and build muscle without aggravating symptoms.
Aerobics
Water aerobics is perfect for working on cardiovascular health needed to build strength.
Increase mobility and flexibility.
Swimming Laps
Start slow when swimming laps, maybe only twice a week at first.
The different types of strokes work various muscles in the hips, chest, and back.
Treading water is a great way to get the body used to the movements.
A swim coach can provide tips on the proper technique and form.
Swim Exercise Tools and Accessories
Proper swimming equipment can make the exercise sessions much more enjoyable.
Swim Cap
Swim caps protect the hair from the water’s elements and keep hair from blocking the view.
Goggles
Goggles protect the eyes and help to see better underwater.
Look for a comfortable pair that doesn’t leak.
Sun protection and clothing
A day in the sun and water increases the risk of exposure to UV rays.
Waterproof Headphones
For listening to music or podcasts while swimming.
Kickboard
Many pools can provide kickboards that swimmers can borrow during their time there.
Lean the upper body on the board and kick, focusing on lower body movements.
Pull Buoy
Pull buoys help focus on the upper body and arm work.
It is placed between the upper thighs to help the legs float as the individual pulls with their arms.
It is recommended to take some lessons to learn how the body moves through the water. Once a basic understanding of balance and buoyancy is met, individuals can propel through the water more efficiently.
Sciatica Secrets Revealed
References
Bartels, Else Marie, et al. “Aquatic exercise for the treatment of knee and hip osteoarthritis.” The Cochrane Database of systematic reviews vol. 3,3 CD005523. 23 Mar. 2016, doi:10.1002/14651858.CD005523.pub3
Cole, A J et al. “Spine pain: aquatic rehabilitation strategies.” Journal of Back and musculoskeletal rehabilitation vol. 4,4 (1994): 273-86. doi:10.3233/BMR-1994-4407
Ferrell, M C. “The spine in swimming.” Clinics in sports medicine vol. 18,2 (1999): 389-93, viii. doi:10.1016/s0278-5919(05)70153-8
Su, Yanlin, et al. “Swimming as Treatment for Osteoporosis: A Systematic Review and Meta-analysis.” BioMed research international vol. 2020 6210201. 15 May. 2020, doi:10.1155/2020/6210201
Wirth, Klaus, et al. “Strength Training in Swimming.” International Journal of environmental research and public health vol. 19,9 5369. 28 Apr. 2022, doi:10.3390/ijerph19095369
As one of the most load-bearing joints in the body, the hips nearly affect every movement. If the hip joint is involved in a vehicle crash, the space in the joint/hip capsule can fill with fluid, causing joint effusion or swelling, inflammation, dull-immobilizing pain, and stiffness. Hip pain is a common injury symptom reported after a vehicle crash. This pain can range from mild to severe and may be short-term or last for months. No matter the level of pain being experienced, action must be taken quickly to avoid long-term damage. Individuals need high-quality, patient-focused care from experienced specialists as soon as possible to get on the road to recovery.
Vehicle Crash Hip Injury
The hip joints must be healthy and work as effectively as possible to stay active. Arthritis, hip fractures, bursitis, tendonitis, injuries from falls, and automobile collisions are the most common causes of chronic hip pain. Depending upon the type of injury, individuals may experience pain symptoms in the thigh, groin, inside of the hip joint, or buttocks.
Associated Injuries
The most common injuries that cause pain in the hip after a collision include:
A hip ligament sprain or strain is caused by overstretched or torn ligaments.
These tissues attach bones to other bones and provide stability to the joints.
These injuries may only require rest and ice to heal, depending on the severity.
Chiropractic, decompression, and physical massage therapies may be necessary for realignment and to keep muscles flexible and relaxed.
Bursitis
Bursitis is an inflammation of the bursa, or the fluid-filled sac providing cushioning/material between bones and muscles.
It is one of the main causes of hip pain after an automobile collision and requires immediate medical attention.
Tendonitis
Tendonitis is a type of injury that affects soft tissues like tendons and ligaments, as opposed to bone and muscle.
Tendonitis can result in chronic pain and various discomfort symptoms in and around the hip area if left untreated.
Hip Labral Tear
A hip labral tear is a type of joint damage in which the soft tissue/labrum that covers the hip’s socket gets torn.
The tissue ensures that the thighbone head moves smoothly within the joint.
Damage to the labrum can lead to severe pain symptoms and affect mobility.
Hip Dislocation
A hip dislocation means the femur ball has popped out of the socket, causing the upper leg bone to slide out of place.
Hip dislocations can cause avascular necrosis, which is the death of bone tissue from a blockage in the blood supply.
Hip Fractures
The hip bones can be broken down into three parts:
Ilium
Pubis
Ischium
A hip fracture, or broken hip, occurs whenever a break, crack, or crush happens to any one of these parts of the hip.
Acetabular Fracture
An acetabular fracture is a break or a crack outside the hip socket that holds the hip and thigh bones together.
A fracture to this body part is not as common because of the location.
Significant force and impact are often necessary to cause this type of fracture.
Symptoms
If any of the following symptoms after a vehicle crash are experienced, it could be a hip injury and should be examined by a medical professional. These include:
Soreness or tenderness at the site of injury.
Bruising.
Swelling.
Difficulty moving the hip/s.
Intense pain when walking.
Limping.
Loss of muscle strength.
Abdominal pain.
Knee pain.
Groin pain.
Treatment and Rehabilitation
A doctor or specialist should always evaluate hip problems and pain symptoms. With the help of a physical examination and diagnostics like X-rays, CT Scans, or an MRI, a physician can diagnose and recommend treatment options. Treatment after a vehicle crash depends on the severity of the damage. For example, hip fractures often require immediate surgery, while other injuries may only necessitate medication, rest, and rehabilitation. Possible treatment plans include:
Rest
Pain, muscle relaxants, and anti-inflammatory medication.
Surgery – after surgery, a physical therapist can help stretch and work on muscles around the hip to gain mobility and flexibility for a complete recovery.
Total hip replacement
Our team collaborates with the necessary specialists to provide the complete care needed to experience full recovery and healing for long-term relief. The team will work together to form a comprehensive treatment plan to strengthen the hip muscles for better support and increased range of motion.
Movement as Medicine
References
Cooper, Joseph, et al. “Hip dislocations and concurrent injuries in motor vehicle collisions.” Injury vol. 49,7 (2018): 1297-1301. doi:10.1016/j.injury.2018.04.023
Fadl, Shaimaa A, and Claire K Sandstrom. “Pattern Recognition: A Mechanism-based Approach to Injury Detection after Motor Vehicle Collisions.” Radiographics: a review publication of the Radiological Society of North America, Inc vol. 39,3 (2019): 857-876. doi:10.1148/rg.2019180063
Frank, C J et al. “Acetabular fractures.” The Nebraska medical journal vol. 80,5 (1995): 118-23.
Masiewicz, Spencer, et al. “Posterior Hip Dislocation.” StatPearls, StatPearls Publishing, 22 April 2023.
Monma, H, and T Sugita. “Is the mechanism of traumatic posterior dislocation of the hip a brake pedal injury rather than a dashboard injury?.” Injury vol. 32,3 (2001): 221-2. doi:10.1016/s0020-1383(00)00183-2
Patel, Vijal, et al. “The association between knee airbag deployment and knee-thigh-hip fracture injury risk in motor vehicle collisions: A matched cohort study.” Accident; Analysis and Prevention vol. 50 (2013): 964-7. doi:10.1016/j.aap.2012.07.023
Range of motion – ROM measures the movement around a joint or body part. When stretching or moving certain body parts, like a muscle or joint, the range of motion is how far it can move. Individuals with a limited range of motion cannot move a specific body part or joint through its normal range. Measurements are different for everybody, but there are ranges that individuals should be able to achieve for proper function. The Injury Medical Chiropractic and Functional Medicine Team can address issues/problems with ROM through a personalized treatment plan to alleviate symptoms and restore mobility and flexibility.
Improve Range of Motion
Over 250 joints in the body move from extension to flexion and are responsible for all of the body’s movements. These include the ankles, hips, elbows, knees, and shoulders. Tightness in the hips and ankles can decrease ROM when lifting an object, limiting the muscles’ ability. Form and strength potential becomes limited and suffers from an inadequate ROM. When form and posture are compromised, pain and injuries can result. There are many reasons why this can occur, including:
Tight and stiff muscles.
Trying to use these muscles can worsen the condition, limiting ROM further.
A limited ROM in the back, neck, or shoulders may be due to the body being out of natural alignment.
Repetitive motions, injuries, and everyday wear and tear can shift proper alignment and limit movement.
Conditions like arthritis, brain, nerve, and/or muscle disorders.
A mild to moderate range reduction may be caused by a sedentary lifestyle or insufficient physical activity.
Daily Living
Decreased range of motion and poor mobility can hinder the body from lifting objects, job occupation performance, and household tasks. A healthy physical ability is what determines independent aging and optimal function.
Restoring a healthy range of motion can improve physical performance during work, home, and sports activities.
An improved range of motion allows the affected muscles to work at longer lengths, build strength and relieve tension.
A stronger muscle capable of contracting efficiently through larger ranges prevents and decreases the risk of injury.
Chiropractic Restoration
Chiropractic care can realign the body and improve range of motion to optimal levels.
Therapeutic and Percussive Massage
Massage therapy will release the tightness, keep the muscles loose, and increase circulation.
This prepares the body for chiropractic adjustments and spinal decompression.
Decompression and Adjustments
Non-surgical mechanical decompression realigns the body to a pliable state.
Chiropractic adjustments will reset any misalignments, restoring flexibility and mobility.
Exercises
A chiropractor will provide physical therapy-type exercises and stretches to mobilize the joints.
Targeted exercises and stretches will help to maintain the adjustments and strengthen the body to prevent ROM worsening and future injuries.
Secrets of Optimal Wellness
References
Behm, David G et al. “Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review.” Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme vol. 41,1 (2016): 1-11. doi:10.1139/apnm-2015-0235
Calixtre, L B et al. “Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomized controlled trials.” Journal of oral rehabilitation vol. 42,11 (2015): 847-61. doi:10.1111/joor.12321
Fishman, Loren M. “Yoga and Bone Health.” Orthopedic nursing vol. 40,3 (2021): 169-179. doi:10.1097/NOR.0000000000000757
Lea, R D, and J J Gerhardt. “Range-of-motion measurements.” The Journal of Bone and joint surgery. American Volume vol. 77,5 (1995): 784-98. doi:10.2106/00004623-199505000-00017
Thomas, Ewan, et al. “The Relation Between Stretching Typology and Stretching Duration: The Effects on Range of Motion.” International Journal of sports medicine vol. 39,4 (2018): 243-254. doi:10.1055/s-0044-101146
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