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Temporomandibular Joint, Jaw Pain, Chiropractic Lasting Relief

Temporomandibular Joint, Jaw Pain, Chiropractic Lasting Relief

Jaw pain can make chewing, yawning, and talking a painful experience. This is a syndrome known as Temporomandibular Joint syndrome or disorder or TMJ and TMD. What happens is the temporomandibular joint that connects the jaw to the skull becomes inflamed. It is part of the musculoskeletal system, which means that chiropractors can treat the syndrome with various chiropractic techniques that include soft tissue work and temporomandibular joint adjustments. Chiropractic can bring lasting relief from Temporomandibular Joint Syndrome/Disorder.
11860 Vista Del Sol, Ste. 128 Temporomandibular Joint, Jaw Pain, Chiropractic Lasting Relief

How to Tell if TMJ Is Present

Jaw pain is the most common symptom but there are other factors that can cause pain. To help determine if it is TMJ, here is a list of additional symptoms:
  • Difficulty or pain moving the mouth such as when chewing
  • Popping sensation sound when opening/closing the jaw
  • Cracking sensation sound when opening or closing the jaw
  • Headaches that radiate to the facial muscles
  • Tooth pain
  • Pain in the neck and shoulders
  • Tightness in the jaw
  • Facial muscles become fatigued
  • Dizziness or ringing in the ears

Chiropractic and Dental

If it is TMJ should an individual see a dentist or a chiropractor? This depends on the situation and individual.
  • If TMJ is caused by teeth grinding while sleeping, or there is pain/problems with the teeth then seeing a dentist is recommended.
  • If TMJ pain is accompanied by joint or muscle pain, or there is neck and/or back pain, then chiropractic is recommended.
  • Certain cases could require dental treatment and a chiropractor for the joint issues.

Chiropractic TMJ Treatment

Jaw Adjustment

One way chiropractic treats TMJ is through jaw adjustment/s. This varies from patient to patient. An example assessment and adjustment for TMJ.
  • The chiropractor will utilize the most beneficial technique/s for each individual.
  • The chiropractor will have the individual open and close their jaw while feeling each side.
  • They will determine which side opens first and widest, and which opens last and not as wide.
  • Then they will perform a jaw adjustment through gentle pressure applied to both sides of the jaw.

Soft Tissue Treatment

A contributor to jaw pain can be attributed to the muscles that are used to open and close. In this case, the chiropractor will perform soft tissue manipulation to loosen them up. This releases the jaw so it evens out. This also helps with headaches associated with TMJ. The focus is on three muscles:
  • Masseter
  • Pterygoid
  • Temporalis
11860 Vista Del Sol, Ste. 128 Temporomandibular Joint, Jaw Pain, Chiropractic Lasting Relief
A chiropractor will mobilize these muscles applying pressure repeatedly as the individual opens and closes their mouth.

Jaw Exercise Therapy

The chiropractor will recommend exercises to help quicken the healing process and strengthen the muscles. These are simple exercises that can be done at home or work to help relieve any discomfort or pain and for prevention.

Mouth Opening

  • Place one thumb under the chin
  • Open the mouth and gently push against it with the thumb
  • Hold for 5 to 8 seconds then close mouth
  • Repeat a few times every day

Mouth Closing

  • Open the mouth holding the chin with the index finger and thumb from both hands
  • Close jaw with gentle resistance with the fingers
  • Hold for 5 to 8 seconds
  • Repeat a few times every day
A chiropractor may collaborate with a dentist to provide the best treatment plan.

Body Composition


 

Body Dehydration

Dehydration happens when the body loses more water than it can replace. This can come from frequent:
  • Diarrhea episodes
  • Vomiting episodes
  • Too much alcohol the night before
  • Excessive sweating
  • Excessive urination
When dehydration sets in a wide range of symptoms can present. Early signs/symptoms include:
  • Dizziness
  • Headaches
  • Dry mouth
  • Cool skin
If dehydration is not addressed in the early stages, it can lead to not having the urge/need to urinate. There is potential for long-term health issues like high blood pressure. High blood pressure is common for individuals that are chronically dehydrated. When the body’s cells lack water, the brain sends a signal to secrete vasopressin, which is a chemical that constricts the blood vessels. This causes blood pressure to rise. This could eventually lead to heart failure. If the blood vessels continue to progressively narrow, oxygen, and blood circulation to the brain decreases. This results in migraine headaches and decreased ability to concentrate.  

Disclaimer

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP, CIFM, CTG* email: coach@elpasofunctionalmedicine.com phone: 915-850-0900 Licensed in Texas & New Mexico
References
Ibi, Miho. “Inflammation and Temporomandibular Joint Derangement.” Biological & pharmaceutical bulletin vol. 42,4 (2019): 538-542. doi:10.1248/bpb.b18-00442 Blum, Charles L. “Chiropractic and dentistry in the 21st Century.” Cranio: the journal of craniomandibular practice vol. 22,1 (2004): 1-3. doi:10.1179/crn.2004.001 Brantingham, James W et al. “Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review.” Journal of manipulative and physiological therapeutics vol. 36,3 (2013): 143-201. doi:10.1016/j.jmpt.2013.04.001 https://www.nidcr.nih.gov/health-info/tmj
Chiropractic Relief From Pinched Nerves

Chiropractic Relief From Pinched Nerves

Pinched nerves occur when added pressure is applied to a nerve or set of nerves from surrounding tissues like bones, cartilage, muscles, or tendons. The pressure affects the nerve’s ability to function properly and usually causes pain, tingling, numbness, or weakness. A pinched nerve can occur at various sites in the body. Whether located in the neck, shoulder, arm, hand, back, or knees, they can lead to other debilitating conditions/injuries and permanent nerve damage if left untreated.  

11860 Vista Del Sol, Ste. 128 Chiropractic Relief From Pinched Nerves
 

Pinched Nerves

The nerves are not actually being pinched but are being compressed. The added pressure on or around the nerve causes painful sensations that can also include:

Pinched nerves are nothing to dismiss. Individuals experiencing any of the above symptoms should get a proper diagnosis from a chiropractor.  

 

Compression Goes Away By Itself

A compressed nerve can go away on its own if the pain has recently started or is not severe. In addition, home remedies like rest, heat, ice, and stretching can be utilized to help the compression subside on its own.  

Length of Time It Takes for a Pinched Nerve to Heal

The length of time depends on the reason why the nerve is compressed and irritated. For example, some pinched nerves are brought on from poor posture and tight muscles. These can usually heal within 4 weeks. However, if the pain has been going on for some time, like more than 3 months, it will take longer, especially to identify the root cause/s and address them according to their severity.  

11860 Vista Del Sol, Ste. 128 Chiropractic Relief From Pinched Nerves
 

Treatment Options

 

Chiropractic Adjustments and Massage

These two types of treatment/therapy highly complement each other. A chiropractor understands the importance of massage when it comes to healing and stress relief. Some cases of pinched nerves come from tight muscles and muscle spasms. Along with chiropractic adjustments, massage therapy is perfect for releasing and stretching the nerves back to their natural form.

Studies show that chiropractic massage therapy offers pain relief and also helps reduce any depression and anxiety that the pain symptoms can generate. In addition, comprehensive chiropractic treatment has been proven to be the best and fastest way to deal with pinched nerves.  

11860 Vista Del Sol, Ste. 128 Chiropractic Relief From Pinched Nerves
 

Get More Sleep

Whenever the body is going through stress and needs repair, more sleep gives the body the time to heal itself. An extra hour of sleep also ensures that the injured area moves less. However, try to avoid sleeping on the stomach and make sure that the pillows being used provide plenty of support.  

Warm/Hot Soothing Bath

Ice can really help lower swelling and inflammation, but if icing the area has not relieved the pain after 72 hours, it is time for a warm/hot bath. Warm water increases blood circulation, which delivers oxygen and nutrients to help heal and restore. In addition, heat relaxes the muscles of the body, which relieves pressure on the affected area.  

Collagen Nerve Joint Repair

Collagen adds cushion to the spaces between the joints and bones while damaged tissues are being repaired. Collagen is the most plentiful natural protein in the human body. Supplements with glucosamine, chondroitin and hyaluronic acid can help and consume bone broth, a healthy collagen source. An anti-inflammatory diet can also help. Inflammation contributes to pain symptoms. Lowering inflammation lowers pain as well.  

 

Proper Posture

Slouching and poor posture, whether sitting or standing, place added pressure/stress on the joints. When this goes on for long periods or when something traumatic occurs, a pinched nerve can result. A chiropractor will restore the body’s natural curvature. In addition, a chiropractor will discuss and show what proper posture should be and how to strengthen the core to maintain proper posture.  

 

Other Treatment Options

Conventional treatments usually include:

  • Over the counter pain relievers
  • Prescription pain relievers for severe cases
  • Corticosteroids
  • Microdiscectomy spinal surgery
  • Regular surgery

Most individuals want to avoid any of the above treatment options. The body has a tremendous ability to heal itself. Chiropractic will reduce the amount of time that is required to heal a pinched nerve. It’s about treating the entire body, not just the symptoms. A customized treatment/recovery diet plan will be developed according to each individual’s needs. At Injury Medical Chiropractic and Functional Medicine Clinic, we encourage anyone experiencing any pain to call us right away.


Composition of the Body

 


 

What happens to the body when you stop eating

Not eating for a few hours causes glucose levels in the blood to drop, and insulin release stops. Alpha cells in the pancreas produce a hormone called glucagon that helps the liver break down the body’s stored glycogen, converting it back into glucose. The liver can also produce glucose by utilizing fats, amino acids, and waste.

If the body’s blood sugar levels drop, too low a condition called hypoglycemia happens. It occurs a few hours after eating when there is too much insulin in the blood or certain medications. This is why an individual might feel dizzy, shaky, anxious, or irritable when they have not eaten for several hours. Eating at least 15 to 20 grams of carbohydrates will reverse the symptoms.  

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that directly or indirectly support our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

References
  • Dubinsky RM, Miyasaki J.Assessment: Efficacy of transcutaneous electric nerve stimulation in treating pain in neurologic disorders (an evidence-based review). Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.Neurology. 2010;74:173-176.
  • Shrier I. Does stretching help prevent injuries? Evidence-based Sports Medicine. Williston, VT: BMJ Books; 2002.
Weakness, Pain, Numbness, Radiculopathy, and Chiropractic

Weakness, Pain, Numbness, Radiculopathy, and Chiropractic

Weakness, pain, and numbness can find their root in the spine. It is known as radiculopathy. If left untreated, health problems will only continue to get worse, with the potential to become a chronic condition. When it comes to degenerative pain conditions they usually start small. There is occasional discomfort that gradually develops into pain, then weakness and numbness.  
11860 Vista Del Sol, Ste. 128 Weakness, Pain, Numbness, Radiculopathy, and Chiropractic
 
Usually, by the time an individual seeks help, the original condition has devolved into radiating pain. This is why it is important to address the issue right away. Chiropractic works with individuals to help them understand the degenerative nature of pain and how to address and prevent it. Early intervention will prevent minor discomfort from turning into debilitating, chronic pain.

Radiculopathy

Radiating pain root cause is a compressed or inflamed nerve. It happens at the site of compression and spreads outward growing larger with time. It can be a catalyst for different pain conditions and syndromes like sciatica or complex regional pain syndrome. There are a variety of terms for nerve pain, they are typically a form of radiculopathy.  
 

Stages

The pain can spiral as fast as the underlying condition/s that is causing it. A compressed nerve that generates pain but does not become worse in severity is usually because the compression stays the same. Conversely, minimal discomfort brought on from shifted vertebrae can rapidly progress into weakness, numbness, and reduced mobility as a nerve is continually and severely getting compressed. Radiculopathy pain usually follows a pattern. Understanding the signs and symptoms will help determine to what extent the condition has progressed, and how it can develop into a worsening nerve injury:
  • Discomfort is the first stage. Subluxation, rotation, or a spinal shift is what is occurring, with the nerve not yet affected.
  • The pain signals that come from nerve compression along with the severity can help determine the cause of the condition.
  • Weakness usually follows pain. The nerve that is affected begins to take on permanent damage and cannot function properly.
  • Numbness follows the weakness reaching the most severe level. Mobility is limited along with a high increase for permanent nerve pain.
Being aware of these radiculopathy symptoms will help an individual stay ahead of nerve injury. Acting on discomfort can prevent progression into pain, addressing pain can stave off weakness, and acting upon weakness may prevent permanent nerve damage. The sooner an individual seeks help for any type of pain, the better chance they have to prevent degeneration.  
11860 Vista Del Sol, Ste. 128 Weakness, Pain, Numbness, Radiculopathy, and Chiropractic
 

Long-Term Prevention

It is crucial to consult with a chiropractor at the first sign of discomfort in the spine or if there is radiating/spreading back pain. A chiropractor will be able to provide decisive treatment that will bring relief and prevent the pain from worsening. The pain, weakness, and numbness can be avoided, along with long-term damage to the nerves.

Sciatica Pain Therapy


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Stochkendahl, Mette Jensen et al. �National Clinical Guidelines for non-surgical treatment of patients with recent-onset low back pain or lumbar radiculopathy.� The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society�vol. 27,1 (2018): 60-75. doi:10.1007/s00586-017-5099-2
Gastric Distress, Spinal Nerve Compression, and Chiropractic Release

Gastric Distress, Spinal Nerve Compression, and Chiropractic Release

Stomach ache, acid reflux, gas, and other symptoms of gastric distress can be linked to spinal issues and misalignment. The spinal cord sends nerve signals to all parts of the body, specifically those affecting digestion functions. The lumbar spine/lower back includes the sacrum which is vital in terms of nerve function.
11860 Vista Del Sol, Ste. 128 Gastric Distress, Spinal Nerve Compression, and Chiropractic Release
 
Various spinal cord issues could cause problems with the rest of the body. These include:
  • Disc compression
  • Herniated discs
  • Strained ligaments
Misalignments/problems in the lower back can result in gastric symptoms like:
  • Constipation
  • Diarrhea
  • Bloating
  • Gas
  • Bladder malfunction
 
This is because this area of the spine includes sympathetic and parasympathetic nerves that are connected to the digestive system. Any problem with these systems can result in miscommunicated signals to the rest of the body. The wide-range effects that compressed nerves can have on the body, as well as, how the spine is affected by the obstruction of these nerves, can be detrimental. Chiropractic adjustments can help alleviate and release the gastric distress are able to correlate their spine�s role in gut health. This along with an education on the central nervous system. A chiropractic approach can help as a long-term solution to gastric distress.  
 

The Nerves

Every organ in the body functions by sending and receiving electrical impulses, transmitted through the nerves. These impulses direct the function of organs. If blocked or the signals are improperly/partially sent/received, various health issues can begin to present. For the gut, proper nerve signal transmission at full capacity is crucial. The stomach needs to be able to properly digest food while absorbing nutrients and preparing for waste removal. This is where gastric distress conditions begin like:
  • Irritable bowel syndrome – IBS
  • Gastroesophageal reflux disease – GERD
  • Abdominal pain syndrome – APS
Nerve conditions worsen with time if the health and function of the affected nerves are not restored. This could mean severe chronic symptoms and the possibility of permanent nerve damage.  

Nerve Blockage

Messed up nerve signals are usually pinched, blocked, or displaced. Most nerve bundles exit through the spine and are usually where a chiropractic exam will start. Through palpitation of the spine along with diagnostic imaging, a chiropractor can track down exactly where the nerve blockage/s are taking place. The lower back and upper back are common areas to examine. This is because a majority of abdominal organ nerves branch out from these spinal segments. If spinal subluxations are present, more than likely they are affecting the function of these organs. Chiropractic will adjust the spine and reset/realign the spine to its proper form, allowing for proper blood circulation. Compressed nerves can also cause inflammation that could require more complex treatment.  
11860 Vista Del Sol, Ste. 128 Gastric Distress, Spinal Nerve Compression, and Chiropractic Release
 

Listening to the Body

If the gut is presenting with aches, and bloating after every meal, it could be indicating that something is wrong or off. Individuals cannot feel blocked nerve signals, but the gut can. Listen to it when it is alerting an issue or problem. We want to educate our patients on gut and spinal health. Chronic gastric distress can be corrected with chiropractic.

Chiropractic Pain Relief

 
 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Spiegel, Brennan M R et al. �Understanding gastrointestinal distress: a framework for clinical practice.��The American journal of gastroenterology�vol. 106,3 (2011): 380-5. doi:10.1038/ajg.2010.383 Kehl, Amy S et al. �Relationship between the gut and the spine: a pilot study of first-degree relatives of patients with ankylosing spondylitis.��RMD open�vol. 3,2 e000437. 16 Aug. 2017, doi:10.1136/rmdopen-2017-000437
Chiari Malformation Brain Tissue and The Spinal Canal

Chiari Malformation Brain Tissue and The Spinal Canal

Chiari malformation is a condition that causes brain tissue to extend out and settle into the spinal canal. It protrudes out where the skull and neck meet. It occurs because part of the skull is too small or shaped in a unique way that allows part of the brain to settle into the foramen magnum. The foramen magnum is a large opening at the bottom of the skull. The brain’s nerves go through into the spinal canal and join the spinal cord. However, only the nerves should be present. The brain should not be able to push/press/leak through. When it does this is Chiari malformation.  
11860 Vista Del Sol, Ste. 128 Chiari Malformation Brain Tissue and The Spinal Canal
 

Causes

Chiari malformation can be caused by structural problem/s with the:
  • Brain
  • Skull
  • Spinal canal
Structural conditions/issues can be present at birth, which are congenital defects. This is also called primary Chiari malformation and is not caused by any other condition. Secondary Chiari malformations are caused by something else, most often through surgery. This is extremely rare, but it is possible to develop after having surgery to remove a tumor in the skull or neck region. A surgeon could have removed too much bone while removing the tumor. This allowed the brain to settle into the open space.

Types

There are 4 types and are categorized by how much brain tissue protrudes into the spinal canal.

Type I

This is the adult version and is also the most common. It is usually first noticed and discovered from an examination for something else. Most individuals don’t realize that they have Chiari malformation unless the symptoms are severe. With Type I a part of the brain, specifically the cerebellar tonsils settle into the foramen magnum.

Type II

Type II is also known as Arnold-Chiari malformation. This is the pediatric version. Symptoms are more severe with Type II because more brain tissue comes through. With this type, the cerebellar tonsils and some of the brainstem protrude. With Type II myelomeningocele, which is a form of spina bifida is a concern. What happens is the vertebrae and spinal canal do not close correctly before birth, so the spinal cord has no protection.

Type III

This type also affects children and is more severe than types 1 or 2. Here a significant portion of the brain, including the cerebellum and the brainstem protrude all the way through the foramen into the spinal canal.

Type IV

Type IV is the most severe form. With this type, the brain does not develop properly.

Symptoms

The symptoms vary based on the type and severity. The most common symptom is a headache. Individuals with a Chiari malformation usually have headaches in the occipital region of the brain. This is the back of the head, right where the skull joins the cervical spine/neck. The headaches can be aggravated being in certain positions and actions, tilting the head back, and coughing. Typical symptoms include:
  • Balance problems
  • Dizziness
  • Difficulty with fine motor skills
  • Trouble swallowing
  • Vision problems
  • Weakness
However, Chiari malformation can interrupt the flow of cerebrospinal fluid. Cerebrospinal fluid is necessary to protect the brain and spinal cord. If the normal flow is disrupted it becomes more difficult for the brain and spinal cord to send/receive nerve messages. The pressure built up can also cause nerve issues/problems. For some individuals, symptoms can come and go. This depends on how much cerebrospinal fluid has built up. Individuals with Type I sometimes don’t have any symptoms. It all depends on the severity.  
11860 Vista Del Sol, Ste. 128 Chiari Malformation Brain Tissue and The Spinal Canal
 

Diagnosis

Diagnosis is done with a magnetic resonance imaging test or MRI. The MRI will show the various parts of the brain, skull, spinal cord, and spinal canal. They will be able to see abnormalities that could point to Chiari malformation.

Treatment

The recommended treatment depends on the severity. If pain is presenting a doctor could recommend pain medications to help manage the pain. Non-steroidal anti-inflammatory meds could also be recommended to reduce inflammation. Analgesics or pain killers can be recommended. Often both non-steroidal anti-inflammatories and analgesics are available in over-the-counter and prescription. The doctor will figure out the best medication treatment plan. Surgery can be used to relieve symptoms and is the only way to relieve the pressure on the spinal cord and nerves. The goal is to stop the malformation from worsening. Surgeons use a posterior fossa decompression procedure. The surgeon removes part of the skull to make more room for the brain to sit in. This takes the pressure off the brain and spinal cord, and should reduce the neurological symptoms and problems. The surgeon may increase the size of the dura or the sac around the brain. Laminectomies at C1 and C2, which are the first and second levels of the neck and are utilized to make more room for the brain. The surgeon will place a patch that is made from animal or synthetic tissue that will grow into the dura. The patch makes the dura bigger, which allows more room for the brain. Not all surgeries involve the dural patch.
 

Neck Pain Chiropractic Care


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Causes of Chronic Pain

Causes of Chronic Pain

Several conditions and factors can cause chronic pain. Usually, these are conditions that accompany normal aging, which affect bones and joints. The top three are osteoarthritis, rheumatoid arthritis, and fibromyalgia. Other common causes are nerve damage and injuries that fail to heal properly.

Spinal Cord and the Nerves of the Corresponding Organs

 

11860 Vista Del Sol, Ste. 128 Causes of Chronic Pain

Fibromyalgia

Individuals with fibromyalgia experience unexplained pain in almost every part of their bodies. Doctors and scientists are still trying to figure out what causes fibromyalgia. Currently, scientists think a part of the condition comes from an imbalance of certain chemicals in the brain. They believe the imbalances play a critical role. Fibromyalgia can create:

  • Tender areas
  • Muscle pain
  • Headaches
  • Long-term back pain
  • Long-term neck pain

Osteoarthritis

Osteoarthritis causes severe sporadic or non-stop aches and pain in the knees, hips, spine, and feet. Associated symptoms include joint stiffness, swelling, and limited joint mobility. Individuals with osteoarthritis could have some pain throughout their lives. According to the CDC, around fifteen million adults with arthritis have severe pain in their joints.

facetogenic neuropathic, osteoarthritis and headaches pain el paso tx.

Rheumatoid Arthritis

Rheumatoid arthritis causes continual aching that affects multiple joints. The hands, wrists, and knees are the most affected joints. Individuals with rheumatoid arthritis can present alternate symptoms, like joint stiffness, swelling, and fever.

Multiple Sclerosis

Multiple sclerosis is a disease of the brain and the spinal cord. What happens is the immune system targets and damages the protective covering of the nerves themselves. The brain can’t properly and effectively communicate with the body. Multiple sclerosis causes pain in the legs, feet, arms, and hands. Associated symptoms include burning, prickling, or stabbing pain just about every day. �

11860 Vista Del Sol, Ste. 128 Causes of Chronic Pain

Sciatica

Sciatica can cause mild to sharp, electrical burning pain that travels from the lower back through the buttocks to the back of the leg and even into the foot. Chronic sciatica lasts for three months or more. The condition is more common in adults age 40 and older.

Carpal Tunnel Syndrome

Carpal tunnel syndrome causes pain and numbness in the:

  • Hand
  • Wrist
  • Forearm
  • Thumb
  • Index finger
  • Middle finger
  • Ring finger

Common causes include:

Injury Trauma

Around half of the cases involving chronic pain are linked to physical trauma and injury. Individuals hospitalized after a serious injury often report chronic pain symptoms within the first year. Scientists are still unsure of how injuries lead to chronic pain. They believe several factors increase the risk. These include:

  • Pre-injury depression
  • Anxiety
  • Alcohol use
  • Family history of chronic pain

Individuals that have sustained multiple injuries are at higher risk for chronic pain. �

Spinal Injuries

One of the most common causes of chronic back pain. The lower back is the area likely to be affected. Certain types of chronic pain can have more than one cause. For example, general back pain could be caused by a single factor or a combination of factors like:

  • Poor posture
  • Improper lifting of heavy objects
  • Improper carrying of heavy objects
  • Being overweight places added strain on the back and knees
  • Abnormal curvature of the spine
  • Wearing high heels too often
  • Sleeping on a worn-out mattress
  • Degenerative disc changes

Combat Injuries

More than half of combat-related injuries are the result of explosions, from landmines, and shrapnel. Nearly all injured soldiers have to deal with some type of pain and many have a traumatic brain injury. A traumatic brain injury can cause chronic headaches. Delayed treatment and repeated injuries in injured soldiers make up for most chronic pain cases. �

11860 Vista Del Sol, Ste. 128 Causes of Chronic Pain

Sports Injuries

Sports injuries and chronic pain is nothing new. Studies found that 1 in 2 football players deal with chronic pain in their retirement. This along with sleep problems and mild-severe depression. Both can contribute to chronic pain. Athletes are continuously exposed to high-risk injury situations. Having the pressure of performing optimally and winning can take a toll on an athlete’s health. �

Weight

Obesity does not directly cause chronic pain, but it does raise the risk. Around 40% of individuals that are obese also experience mild to severe chronic pain. Plus, individuals that are severely overweight are more likely to develop a condition that can cause chronic pain like diabetes, arthritis, and fibromyalgia. �

The source of chronic pain can be very complex. It can start with an injury or illness and develop slowly without the individual realizing it until it has become a full-blown chronic condition. This fact alone makes recommending a single course of treatment risky and is why health care providers recommend a number of different types of treatment options.


Chiropractic Care on Personal Injury

 


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

Sensory Nerves and Deep Tendon Reflexes

Sensory Nerves and Deep Tendon Reflexes

Burning, numbness, tingling, and pain can be felt in the back, lower back,� legs, and into the feet. A lot of times these symptoms spread out/radiate from one part of the body into another area.�Sciatica is an example of pain that radiates into an extremity, in this case, the back of the leg. Nerves originate from the spine and are divided/separated into sensory and motor nerves. The sensory nerve/s give the sensation to the skin known as dermatomes. Dermatomal patterns act as a map on the body.

 

11860 Vista Del Sol, Ste. 128 Sensory Nerves and Deep Tendon Reflexes El Paso, Texas

 

Example: Dermatomes on the torso of the body react to the thoracic spinal nerve roots, the arms react to the cervical spine nerve roots, and the legs react to the lumbar spinal nerve roots.

Dermatome Location – Corresponding Spine Level

  • Shoulders – C4, C5
  • Inner/Outer Forearms – C6, and T1
  • Thumbs and Little Fingers – C6, C7, C8
  • Front of Thighs – L2
  • Middle, Sides of Both Calves – L4, L5
  • Little Toes – S1

A physician might use a piece of cotton, a swab, pin, or paperclip to test the symmetrical feelings in the arms and legs. Abnormal responses could be a sign of a nerve root problem.

 

TendonInjuryDiagram ElPasoChiropractor

Tendon Reflexes

Most individuals have experienced a physician tapping the knees with a rubber hammer. The normal response is a kick. This is a reflex, which is an involuntary muscular response generated by the hammer tapping the tendon. When the reflex responses do not present, this could mean that the spinal cord, nerve root, peripheral nerve, or muscle has been injured/damaged in some way. Absent reflexes are also clues to other conditions/injuries. An abnormal reflex response could also be caused by a disruption of the sensory (feeling) or motor (movement) nerves and sometimes both. Determining where the neural problem might be, a physician will test reflexes in various parts of the body.

Reflex Tested Areas – Corresponding Spine Level

  • Upper Arm Biceps� – C5-C6 Cervical Spine
  • Forearm Distal Radius – C6-C7
  • Elbow Triceps – C7
  • Abdominal – T8, T9, T10, T11, T12, Thoracic
  • Knees/Thighs Patellar, Quadriceps -� L3, L4 Lumbar
  • Ankles – S1 Sacral

 

Neurological Exams for Neck/Back Pain

 

11860 Vista Del Sol, Ste. 128 Sensory Nerves and Deep Tendon Reflexes El Paso, Texas

 

Muscle Strength/Tone

Muscle strength and tone measurements are another way to diagnose nerve deficits. Depending on the symptoms/condition/injury/s there are different ways to evaluate muscle strength:

  • Stepping on a stool
  • Standing on the heels
  • Standing on the toes
  • Hopping in place
  • Performing knee bends
  • Gripping an item in each hand

Muscle strength is graded and recorded in the patient�s chart.

 

 

A physician will test the body’s muscle tone by passively flexing and extending the arms and legs. Normal muscle tone will respond with a slight resistance to passive motion. Other movements test for proximal (trunk/torso) and distal (distant) weakness. Muscle symmetry is also taken into account.

Neurological Tests

If necessary a spine specialist might order neurological studies like a Nerve Conduction Study (NCS) or Electromyogram (EMG), to measure nerve performance.

Imaging Studies

MRI and/or CT scans of the spine can be ordered to help the spine specialist/chiropractor make a correct diagnosis, as well as help in creating a plan of treatment.

Conclusion

A neurological exam, along with a mechanical examination consisting of movement of the arms, legs, and torso, can significantly help doctors in making the correct diagnosis. Examination results are then correlated with the patient�s history, illness, and diagnostic studies. Once the diagnosis is made an appropriate treatment plan is discussed. This will begin with non-surgical strategies but if those fail, then surgical intervention could be considered.


 

Peripheral Neuropathy Relief & Treatment

 


NCBI Resources

 

Chronic Back Vertebrogenic Pain and Vertebral Endplates

Chronic Back Vertebrogenic Pain and Vertebral Endplates

Research has found that vertebrogenic chronic low back pain could be caused by a lumbar vertebral endplate change that involves the basivertebral nerve and is not disc-related. The underlying cause of chronic low back pain can be very difficult to diagnose. The intervertebral discs are a common suspect, but when disc-related treatments don�t ease the pain, the root problem could be something else. Researchers are exploring an overlooked area with the vertebral endplates being the cause of vertebrogenic low back pain.

 

11860 Vista Del Sol, Ste. 128 Chronic Low Back Vertebrogenic Pain and Spinal Vertebral Endplates

 

Research has found that there are more nerves in the vertebral endplates than in the spinal discs. More nerves can mean higher potential/increase in pain. And like the other areas of the spine such as the discs and joints, vertebral endplates can also degenerate, also increasing the risk for pain.

 

Vertebral Endplates and Basivertebral Nerve

The vertebral endplates line the top and bottom of each vertebral body. These are the round, thick, weight-bearing bones in the spine. The vertebral endplates are made of cancellous or spongy bone and function as the barrier between each disc and the vertebrae.

The low back/lumbar spine takes the most weight. That can be a significant amount of pressure on the structures in the low back. The endplates are situated between a cushioned disc/s and the hard, bony vertebral body making them vulnerable to degeneration and nerve damage contributing to chronic low back pain. The endplates and vertebral bodies consist of a network of intraosseous nerves.

 

Intraosseous nerves live within the bone.

The basivertebral nerve� BVN is an intraosseous nerve that winds through the vertebral bodies. This nerve feeds into each spinal bone through the back of the vertebral body and then branches out with nerves going towards the top and bottom vertebral endplates. Research has shown that although these nerves are inside the bone they can send pain signals from a damaged vertebral endplate that could result in vertebrogenic low back pain. This is why it has been�recently linked it as a possible cause of chronic low back pain.

Nerve pain in the spine has been linked with discs that have degenerated. A doctor, chiropractor/spine specialist refers to this as discogenic pain. But with new research, an understanding of the function the vertebral endplates and BVN play in the sensation of pain has been realized and this is where the term vertebrogenic pain comes from. If a doctor discovers that the endplates could be the source of your chronic low back pain, they might use this term.

 

Vertebral Endplate Pain Diagnosis

Like most back pain conditions diagnosing vertebral endplate pain can be just as challenging. This is because diagnostic imaging scans typically don�t pick up mild to moderate endplate damage. A classification scale known as Modic changes helps doctors identify vertebrogenic pain.

Modic changes or MC are areas that show up on an MRI showing bone marrow damage that has been linked to low back pain. The name comes from the doctor that classified them in 1988, Dr. Michael Modic. Modic changes help doctors and spine specialists see and understand the connection between endplate damage and chronic low back pain.

2 types were identified that show a connection between vertebral endplate damage and chronic low back pain:

Type 1

This type shows a�development� in the vessels of the vertebral body, that includes:

  • Inflammation
  • Edema, which is a collection of excess fluid
  • Endplate changes like a split or crack/s in the endplate

Type 2

This type reveals changes in the bone marrow like fatty deposits that have taken the place of bone marrow.

If the lumbar MRI shows Type 1 or Type 2 MC, a doctor could recommend a conservative treatment plan that could include:

  • Physical therapy
  • Chiropractic
  • Medication
  • Massage
  • Acupuncture

These could be utilized in conjunction with spine specialist care in addressing symptoms and pain. However, if the pain does not ease or reduce with conservative treatment, a doctor could suggest an outpatient procedure.

11860 Vista Del Sol, Ste. 128 Osteoporosis and Increasing Bone Fractures El Paso, TX.

 

Treating Vertebral Endplate Pain

This treatment option is known as the Intracept� Intraosseous Nerve Ablation System which addresses BVN nerve pain and is a minimal procedure.

Candidates for this procedure usually qualify meeting the following:

  • The individual has struggled with chronic low back pain for at least 6 months
  • The pain has not reduced/eased up with at least 6 months of conservative care
  • MRI shows Type 1 or Type 2 Modic changes�that correlate symptoms of vertebrogenic low back pain

The procedure uses fluoroscopy or an x-ray video. A thin tube called a cannula is inserted into a vertebral pedicle. A pedicle is a structure that sticks out from the back of the vertebra. The cannula tunnels its way to the basivertebral nerve. The doctor then runs the Intracept Radiofrequency generator into the path of the nerve and ablates destroys/removes any obstructions in the nerve with the help of the frequency generator. Since it�s a minimally invasive procedure, it can be performed in an outpatient clinic, allowing the patient to go home the same day.

The device/tool used in the procedure is not implanted in the spine. It is removed once the procedure is done.

Expectations as to how long the pain relief will last depends on:

  • The severity of the condition
  • Post-physical therapy
  • Type of work
  • Diet
  • Exercise

One study showed the benefits to last up to two years.

If�nonsurgical treatment has not worked for at least six months talk to your doctor about basivertebral nerve ablation for vertebrogenic chronic low back pain. There are risks and benefits both of which should be discussed in depth.

Endplate or Disc and the Root Cause

The intervertebral discs are often the more common cause of low back pain. But they might not be the root cause of spine pain. More research is going on with the role the vertebral endplates play in spine health. As more patients are being diagnosed earlier then better long-term outcomes will follow.


 

What Chiropractors Do & Why They Do It

 


 

NCBI Resources

 

Dermatomes and Myotomes: What Are They And How Do They Work?

Dermatomes and Myotomes: What Are They And How Do They Work?

The spinal cord and brain make up the central nervous system while the spinal nerves that branch to the spinal cord and cranial nerves that branch to the brain makes up the peripheral nervous system.

There are thirty-one sets of nerves that extend out of the spinal cord and are connected to it by the nerve root. Each nerve branches out about a half inch from the spinal cord before dividing into smaller branches. The dorsal rami are on the posterior side of the branch while the larger ventral rami are on the anterior side.

dermatomes myotomes injury medical chiropractic clinic el paso, tx.

The dorsal rami provide nerve function for the skin of the trunk and posterior muscles. The ventral rami from T1 to T12 provide nerve function to the skin of the trunk as well as the lateral and anterior muscles. The anterior divisions that remain for plexuses, networks that provide nerve function to the body. Each plexus has specific areas on the body for skin sensitivity as well as certain muscles. Their point where they exit the spine determines how they are numbered. The four primary plexuses are:

  • Cervical plexus, C1 � C4, innervates the diaphragm, shoulder, and neck
  • Brachial plexus, C5 � T1, innervates the upper limbs
  • Lumbar plexus, T12/L1 � L4, innervates the thigh
  • Sacral plexus, L4 � S4, innervates the leg and foot.

These spinal nerves have two sets of fibers: motor and sensory. Motor fibers facilitate movement and provide nerve function to the muscles. Sensory fibers facilitate sensitivities to touch, temperature and other stimuli. They provide nerve function to the skin.

dermatomes myotomes injury medical chiropractic clinic el paso, tx.

What are Myotomes and Dermatomes?

A group of muscles that are innervated by the motor fibers that stem from a specific nerve root is called a myotome. An area of the skin that is innervated by the sensory fibers that stem from a specific nerve root is called a dermatome. These patterns of myotome and dermatome are almost always identical from person to person. There are occasionally variances, but that is rare.

This consistency allows doctors to treat nerve pain in patients. If a specific area is hurting, they know that it is attributed to a certain myotome or dermatome, whichever the case may be, and its corresponding nerve root. Problems with nerve damage are often the result of stretching the nerve or compressing it.

When the nerves are injured in specific areas like the lumbosacral or brachial plexus, it presents as sensory and motor deficits in the limbs that correspond to them. Myotomes and dermatomes are used to assess the extent of the damage.

How are Myotomes and Dermatomes used to Assess Nerve Damage?

dermatomes myotomes injury medical chiropractic clinic el paso, tx.

When a doctor tests for nerve root damage in a patient, he or she will often test the myotomes or dermatomes for the nerves assigned to that location. A dermatome is examined for abnormal sensation, such as hypersensitivity or lack of sensitivity.

This is done by using stimulus inducing tools such as a pen, paper clip, pinwheel, fingernails, cotton ball, or pads of the fingers. The patient is instructed to provide feedback regarding their response. Some of the abnormal sensation responses include:

  • Hypoesthesia (decreased sensation).
  • Hyperesthesia (excessive sensation).
  • Anesthesia (loss of sensation).
  • Paresthesia (numbness, tingling, burning sensation).

A myotome is tested for nerve damage in the muscles which presents as muscle weakness. This grading scale, which assigns a rating to the degree of muscle weakness, is often used:

  • 5 � Normal � Complete range of motion against gravity with full resistance
  • 4 � Good � Complete range of motion against gravity with some resistance
  • 3 � Fair � Complete range of motion against gravity with no resistance, active ROM
  • 2 � Poor � Complete range of motion with some assistance and gravity eliminated
  • 1 � Trace � Evidence of slight muscular contraction, no joint motion evident
  • 0 � Zero � No evidence of muscle contraction
thoracic spine chiropractic treatment el paso tx.

During a typical chiropractic exam, your chiropractor will assess both dermatomes and myotomes for potential neurological problems. This gives them additional insight on how to treat your condition, whether it’s related to a subluxation of vertebral bodies or other, other disease processes.

Back Pain Chiropractic Treatment | El Paso, Tx

Occipital Neuralgia

Occipital Neuralgia

Many headaches that people classify as migraines are actually not migraines at all. Two of the most common headaches confused with migraines are sinus headaches and occipital neuralgia.

The condition can be debilitating but there are treatments, including chiropractic, that are very effective. Understanding occipital neuralgia can help patients better manage it so they can minimize the pain and symptoms of the condition.

What Is Occipital Neuralgia?

Occipital neuralgia is a neurological condition that affects the occipital nerves which run from the top portion of the spinal cord, through the scalp, transmitting messages to and from the brain. There are two greater occipital nerves, one on each side of the head, from between the vertebrae located in the upper neck through the muscles that are located at the base of the skull and back of the head.

While they do not cover the areas on or near the ears or over the face, they can extend over the scalp as far as the forehead. When those nerves are injured or become inflamed, occipital neuralgia is the result. A person with this condition may experience pain at the base of their skull or the back of their head.

What Are The Symptoms Of Occipital Neuralgia?

Pain is the prevalent symptom of occipital neuralgia. It often mimics the pain of migraine headaches or cluster headaches and is described as throbbing, burning, and aching.

There may also be intermittent shooting or shocking pain. Typically, the pain begins at the base of the skull but may radiate along the side of the scalp or in the back of the head. Other symptoms include:

  • Pain is experienced on one side (but sometimes both sides)
  • Pain behind the eye of the side that is affected
  • Tenderness in the scalp
  • Sensitivity to light
  • Pain triggered by neck movement

occipital neuralgia el paso tx.

What Causes Occipital Neuralgia?

Irritation or pressure to the occipital nerves are what actually cause the pain. This may be due to tight muscles in the neck that squeeze or trap the nerves, injury, or inflammation.

However, much of the time doctors are unable to determine the cause. There are several medical conditions linked to occipital neuralgia:

  • Tight neck muscles
  • Diabetes
  • Trauma or injury to the back of the head
  • Gout
  • Tension in the neck muscles
  • Whiplash
  • Inflammation of the blood vessels in and around the neck
  • Infection
  • Neck tumors
  • Cervical disc disease
  • Osteoarthritis

What Are The Treatments For Occipital Neuralgia?

Occipital neuralgia treatment focuses on pain relief. It often begins with conservative treatments that include:

  • Rest
  • Heat
  • Physical therapy
  • Anti-inflammatory over the counter medication
  • Massage
  • Chiropractic

In more severe cases the patient may be prescribed a stronger anti-inflammatory medication, muscle relaxants or in some cases an anticonvulsant medication.

If these therapies are not effective or do not bring about the desired level of pain relief, then doctors may recommend percutaneous nerve blocks and steroids. Sometimes surgery is recommended in cases where the pain is severe, chronic, and is unresponsive to more conservative treatments.

Chiropractic For Occipital Neuralgia

Chiropractic was once considered an �alternative� treatment for occipital neuralgia, but now it is often a regular part of recommended patient care. The advantage of chiropractic over medication or surgery is that chiropractic does not come with the side effects of drugs or the risks of surgery.

Another advantage is that chiropractic seeks to correct the root of the problem, not just manage the pain like other treatments.

Chiropractic treatment for occipital neuralgia may include lift adjustments, heat, massage, and traction. This will bring the body back into proper alignment and take the pressure off of the nerves as it loosens the neck muscles.

The patient stands a better chance of staying pain free when taking this treatment route.

Injury Medical Clinic: Doctor Of Chiropractic Near Me

Cranial Nerves: Introduction | El Paso, TX.

Cranial Nerves: Introduction | El Paso, TX.

Human Cranial nerves are a set of 12 paired nerves that come directly from the brain. The first two (olfactory and optic) come from the cerebrum, with the remaining ten come from the brain stem. The names of the these nerves relate to what function they perform and are also numerically identified in roman numerals (I-XII).�The�nerves serve in functions of smell, sight, eye movement, and feeling in the face. These�nerves also control balance, hearing, and swallowing.

Cranial Nerves: Review

  • CN I � Olfactory
  • CN II � Optic
  • CN III � Oculomotor
  • CN IV � Trochlear
  • CN V � Trigeminal
  • CN VI � Abducens
  • CN VII � Facial
  • CN VIII � Vestibulocochlear
  • CN IX � Glossopharyngeal
  • CN X � Vagus
  • CN XI � Accessory
  • CN XII – Hypoglossal

Location Of Nerves

cranial el paso tx.

http://www.strokeeducation.info/images/cranial%20nerves%20chart.jpg

 

cranial el paso tx.

https://upload.wikimedia.org/wikipedia/commons/thumb/8/84/Brain_human_normal_inferior_view_ with_labels_en.svg/424px-Brain_human_normal_inferior_view_with_labels_en.svg.png

cranial el paso tx.

https://diagramchartspedia.com/cranial-nerve-face-diagram/cranial-nerve-face-diagram-a- synopsis-of-cranial-nerves-of-the-brainstem-clinical-gate/

CN I � Olfactory

cranial el paso tx.CN I Clinically

  • Lesions resulting in anosmia (loss of the sense of smell) can be caused by:
  • Trauma to the head, especially patient�s hitting the back of their head
  • Frontal lobe masses/tumors/SOL
  • Remember that loss of the sense of smell is one of the first symptoms seen in Alzheimer’s and early dementia patients

Testing CN I

  • Have the patient close their eyes and cover one nostril at a time
  • Have them breathe out through their nose, THEN place the scent under the nostril while they breathe in.
  • Ask them �do you smell anything?�
  • This tests if the nerve is functioning
  • If they say yes, ask them to identify it
  • This tests if the processing pathway (temporal lobe) is functional

Cranial Nerve II � Optic

cranial el paso tx.Cranial Nerve II Clinically

Lesions to this nerve can be the result of:

  • CNS disease (such as MS)
  • CNS tumors and SOL
  • Most problems with the visual system arise from direct trauma, metabolic or vascular diseases
  • FOV lost in the periphery can mean SOL affecting the optic chiasm such as a pituitary tumor

Testing Cranial Nerve CN II

  • cranial el paso tx.

    https://upload.wikimedia.org/wikipedia/commons/9/9f/Snellen_chart.svg

    Can the patient see?

  • If patient has vision in each eye, nerve is functional
  • Visual acuity testing
  • Snellen chart (one eye at a time, then two eyes together)
  • Distance vision
  • Rosenbaum chart (one eye at a time, then two eyes together)
  • Near vision

 

 

 

 

 

Associated Testing For Visual System

  • Ophthalmoscopic/Funduscopic exam
  • Assessment of A/V ratio and vein/artery health
  • Assessment of cup to disc ratio
  • Field of vision testing
  • Intraoccular pressure testing
  • Iris shadow test

Cranial Nerve III � Oculomotor

cranial el paso tx.Cranial Nerve III Clinically

  • Diplopia
  • Lateral strabismus (unopposed lateral rectus m.)
  • Head rotation (yaw) away from the side of the lesion
  • Dilated Pupil (unopposed dilator pupillae m.)
  • Ptosis of the eyelid (loss of function of levator palpebrae superioris m.)
  • Lesions to this nerve can be the result of:
  • Inflammatory diseases
  • Syphilitic and tuberculous meningitis
  • Aneurysms of the posterior cerebral or superior cerebellar aa.
  • SOL in the cavernous sinus or displacing the cerebral peduncle to the opposite side

Testing Cranial Nerve CN II & III

  • Pupillary reflex testing
  • Move the light in front of the pupil from the lateral side and hold 6 seconds
  • Watch for direct (ispilateral eye) and consensual (contralateral eye) pupillary constriction

cranial el paso tx.Testing Cranial Nerve CN II & III

cranial el paso tx.

https://commons.wikimedia.org/wiki/File:1509_Pupillary_Reflex_Pathways.jpg

Cranial Nerve IV � Trochlear

cranial el paso tx.Cranial Nerve IV Clinically

  • Patient has diplopia & difficulty in downward gaze
  • Often complain of difficulty walking down stairs, tripping,falling
  • Extortion of the affected eye (unopposed inferior oblique m.)
  • Head tilt (roll) to the unaffected side
  • Lesions to this nerve can be the result of:
  • Inflammatory diseases
  • Aneurysms of the posterior cerebral or superior cerebellar aa.
  • SOL in the cavernous sinus or superior orbital fissure
  • Surgical damage during mesencephalon procedures

Head Tilt In Superior Oblique Palsy (CN IV Failure)

cranial el paso tx.

Pauwels, Linda Wilson, et al. Cranial Nerves: Anatomy and Clinical Comments. Decker, 1988.

Cranial Nerve VI � Abducens

cranial el paso tx.Cranial Nerve VI Clinically

cranial el paso tx.

  • Diplopia
  • Medial strabismus (unopposed medial rectus m.)
  • Head rotation (yaw) toward the side of the lesion
  • Lesions to this nerve can be the result of:
  • Aneurysms of the posterior inferior cerebellar or basilar aa.
  • SOL in the cavernous sinus or 4th ventricle (such as a cerebellar tumor)
  • Fractures of the posterior cranial fossa
  • Increased intracranial pressure

Testing Cranial Nerve CN III, IV & VI

  • H-Pattern testing
  • Have the patient follow an object no larger than 2 inches
  • Patient�s can have focus difficulty if the item is too large
  • It�s also important not to hold the object too close to the patient.
  • Convergence and accommodation
  • Bring object close to the bridge of the patient�s nose and back out. Perform at least 2 times.
  • Look for pupillary constriction response as well as convergence of the eyes

Cranial Nerve V � Trigeminal

cranial el paso tx.Cranial Nerve V Clinically

  • Decreased bite strength on the ipsilateral side of lesion
  • Loss of sensation in V1, V2 and/or V3 distribution
  • Loss of corneal reflex
  • Lesions to this nerve can be the result of:
  • Aneurysms or SOL affecting the pons
  • Specifically tumors at the cerebellopontine angle
  • Skull fractures
  • Facial bones
  • Damage to foramen ovale
  • Tic doloureux (Trigeminal neuralgia)
  • Sharp pain in V1-V3 distributions
  • Tx with analgesic, anti-inflammatory, contralateral stimulation

Testing Cranial Nerve CN V

  • V1 � V3 pain & light touch testing
  • Testing is best done toward the more medial or proximal areas of the face, where V1, V2 &V3 are better delineated
  • Blink/Corneal reflex testing
  • Puff of air or small tissue tap from the lateral side of the eye on the cornea, if normal, the patient blinks
  • CN V provides the sensory (afferent) arc of this reflex
  • Bite strength
  • Have patient bite down on tongue depressor & try to remove
  • Jaw jerk/Masseter Reflex
  • With patient�s mouth slightly open place thumb on patient�s chin and tap your own thumb with a reflex hammer
  • Strong closure of the mouth indicates UMN lesion
  • CN V provides both the motor and sensory of this reflex

cranial el paso tx.

https://upload.wikimedia.org/wikipedia/commons/a/ab/Trigeminal_Nerve.png

Cranial Nerve VII � Facial

cranial el paso tx.Cranial Nerve VII Clinically

  • As with all nerves, symptoms describe the location of the lesion
  • Lesion in the lingual nerve will result in loss of taste, general sensation in tongue & salivary secretion
  • Lesion proximal to the branching of the chorda tympani such as in the facial canal will result in the same symptoms without the loss of general sensation of the tongue (because V3 has not yet joined the CN VII)
  • Corticobulbar innervation is asymmetric to the upper and lower parts of the Facial Motor Nucleus
  • If there is an UMN lesion (lesion to the corticobulbar fibers) the patient will have paralysis of the muscles of facial expression in the contralateral lower quadrant
  • If there is a LMN lesion (lesion to the facial nerve itself) the patient will have paralysis of the muscles of facial expression in the ipsilateral half of the face
  • Bell�s Palsy

Testing Cranial Nerve CN VII

  • Ask the patient to mimic you or follow instructions to make certain facial expressions
  • Be sure to assess all four quadrants of the face
  • Raise eyebrows
  • Puff cheeks
  • Smile
  • Close eyes tightly
  • Check for strength of the buccinator muscle against resistance
  • Ask patient to hold air in their cheeks as you press gently from the outside
  • Patient should be able to hold air in against resistance

Cranial Nerve VIII – Vestibulocochlear

cranial el paso tx.Cranial Nerve VIII Clinically

  • Changes in hearing alone are most often due to
  • Infections (otitis media)
  • Skull fracture
  • The most common lesion to this nerve is caused by an acoustic neuroma
  • This affects CN VII and CNVIII (cochlear AND vestibular divisions) due to proximity in the internal auditory meatus
  • Symptoms include nausea, vomiting, dizziness, hearing loss, tinnitus, and bell�s palsy etc.

Testing Cranial Nerve CN VIII

  • Otoscopic Exam
  • Scratch Test
  • Can the patient hear equally on both sides?
  • Weber Test
  • Tests for lateralization
  • 256 Hz tuning fork placed on top of the patient�s head in the center, is it louder on one side than the other?
  • Rinne Test
  • Compares air conduction to bone conduction
  • Normally, air conduction should last 1.5-2 as long as bone conduction

Testing Cranial Nerve CN VIII

https://informatics.med.nyu.edu/modules/pub/neurosurgery/cranials.html

Cranial Nerve IX � Glossopharyngeal

cranial el paso tx.Cranial Nerve IX Clinically

  • This nerve is rarely damaged alone, due to it�s proximity to CN X & XI
  • Look for signs of CN X & XI damage as well if CN IX involvement is suspected

Cranial Nerve X � Vagus

cranial el paso tx.Cranial Nerve X Clinically

  • Patient may have dysarthria (difficulty speaking clearly) and dysphagia (difficulty swallowing)
  • May present as food/liquid coming out their nose or frequent choking or coughing
  • Hyperactivity of the visceral motor component can cause hypersecretion of gastric acid leading to ulcers
  • Hyper-stimulation of the general sensory component can cause coughing, fainting, vomiting and reflex visceral motor activity
  • The visceral sensory component of this nerve only provides general feelings of un-wellness, but visceral pain is carried on the sympathetic nerves

Testing Cranial Nerve IX & X

cranial el paso tx.

https://d1yboe6750e2cu.cloudfront.net/i/172ce0f0215312cee9dec6211a2441606df26c97

  • Gag reflex
  • CN IX provides the afferent (sensory) arc
  • CN X provides the efferent (motor) arc
  • ~20% of patients have a minimal or absent gag reflex
  • Swallowing, gargling, etc.
  • Requires CN X function
  • Palatal elevation
  • Requires CN X function
  • Is it symmetrical?
  • Palate elevates and uvula deviates contralateral to damaged side
  • Auscultation of the heart
  • R CN X innervates SA node (more rate regulation) and L CN X the AV node (more rhythm regulation)

 

Cranial Nerve XI � Accessory

cranial el paso tx.Cranial Nerve XI Clinically

  • Lesions may result from radical surgeries in the neck region, such as removal of laryngeal carcinomas

Testing Cranial Nerve XI

  • Strength test SCM m.
  • Patient will have difficulty turning head against resistance toward the side opposite of the lesion
  • Strength test trapezius m.
  • Patient will have difficulty with shoulder elevation on the side of the lesion

Cranial Nerve XII � Hypoglossal

cranial el paso tx.Cranial Nerve XII Clinically

cranial el paso tx.

https://openi.nlm.nih.gov/imgs/512/71/4221398/PMC4221398_arm-38-689-g001.png

  • On tongue protrusion, the tongue deviates toward the side of the inactive genioglossus m.
  • This could be contralateral to a corticobulbar (UMN) lesion OR ipsilateral to a hypoglossal n. (LMN) lesion

 

 

 

 

 

 

Testing Cranial Nerve XII

  • Ask patient to stick out their tongue Look for deviation as in above slide
  • Have patient place tongue inside cheek and apply light resistance, one side at a time
  • Patient should be able to resist moving the tongue with pressure

Clinical Examination – CN’s I – VI (Lower CN’s)

Clinical Examination – CN’s VII – XII

Sources

Blumenfeld, Hal. Neuroanatomy through Clinical Cases. Sinauer, 2002.
Pauwels, Linda Wilson, et al. Cranial Nerves: Anatomy and Clinical Comments. Decker, 1988.

Introduction To The Cerebellum | El Paso, TX. | Part II

Introduction To The Cerebellum | El Paso, TX. | Part II

El Paso, TX. Chiropractor, Dr. Alexander Jimenez continues with the cerebellum overview. The cerebellum is one of the most identifiable parts of the brain based on its unique shape and location. It is an extremely important part of the brain. It is responsible for being able to perform everyday voluntary tasks likes walking and writing. And it’s essential for being able to keep balance and remain upright. People who have suffered from a damaged cerebellum struggle with balance and maintaining proper muscle coordination.

EVERYTHING PERIPHERAL HAS A CENTRAL CONSEQUENCE!

CASE STUDY

Cerebellar Ataxia

54-YEAR-OLD FEMALE PRESENTED TO OUR CLINIC FOR FEELINGS OF �UNSTEADINESS�

cerebellum el paso tx.

  • Patient woke up one morning over one year ago with vertigo.cerebellum el paso tx.
  • Patient has difficulty with balance and walking. She sometimes resorts to using a cane. Extreme difficulty walking downstairs
  • Patient has been proactive in her weight loss, however, this has served as a speed bump in her plan of getting back to health.
  • She has not been able to exercise like she had in the past.
  • Patient has been to several vestibular rehabilitation clinics to no avail.

 

 

 

 

 

PHYSICAL EXAMINATION HIGHLIGHTS

  • cerebellum el paso tx.Cranial nerves I-XII WNL
  • Wide-based gait
  • Right cerebellar findings
  • Provocative Romberg testing produced significant sway in the right posterior and left anterior canal position.

 

 

 

 

 

 

 

 

THERAPEUTIC INTERVENTIONS

 

 

 

 

 

 

 

 

AFTER 1ST DAY

  • cerebellum el paso tx.Marked improvement in balance.
  • Comfortable walking and standing with more narrow- based gait.
  • Ability to walk down stairs without holding handrail.

 

 

 

 

CASE STUDY

Meet Aaron & McKayla

cerebellum el paso tx.

**Permission given to use names, images and whatever else needed to spread the word

A 39-year-old retired Explosives Ordinance Disposal Technician who in 2011…

cerebellum el paso tx.

And in 2015…

cerebellum el paso tx.

WHAT CAN FUNCTIONAL NEUROLOGY DO FOR AARON?

HOW CAN WE HELP HIS BALANCE?

 

IF YOU DON�T USE IT….

cerebellum el paso tx.WHAT DO YOU SEE?

cerebellum el paso tx.WHAT DO YOU SEE?

cerebellum el paso tx.

WHAT DO YOU SEE?

cerebellum el paso tx.

WHAT DO YOU SEE?

WHAT DOES IT MEAN?

cerebellum el paso tx.

cerebellum el paso tx.AFFERENTATION WITH METABOLIC CONSIDERATIONS

A-BETA – MECHANORECEPTORS
  • Merkel�s disc � slow adapting to pressure and texture. Sharpest resolution for spatial patterning. �steady light pressure�
  • Meissner�s Corupuscle � superfiicial motion detection. Two point discretion.
  • Ruffini�s Corpuscle � located in dermis. Steady skin stretch and joint pressure.
  • Pacinian Corpuscle � rapid adapter, Associated with vibration.
GOLGI TENDON ORGAN IB FIBERS
  • Responds to muscle tension changes.

cerebellum el paso tx.

1A IIA SOMATOSENSORY
  • Muscle spindle fiber is the largest fiber in the human body.
  • Respond to the rate of change in muscle length, as well to change in velocity, rapidly adapting.
  • This will require the most demands on metabolic capacity.

BACK TO THE CASE

  • cerebellum el paso tx.In 2011, Aaron had lost both of his eyes in an IED explosion.
  • Due to the blast, Aaron also lost his sense of smell and taste.
  • After several months of rehab, Aaron learned how to �be really good at being blind.�
  • Although he could not see, balance was no major issue. �I was climbing mountains, running marathons, kayaking…you name it.�

 

 

 

 

 

  • In 2015, a few months after running the Boston Marathon, Aaron was on the phone with Mckayla.
  • �He said he was not feeling well and was going to go lie down. I was concerned but did not think much of it.�
  • After a day and a half of waiting for his call, McKayla found out Aaron contracted meningitis and was intubated in the ICU.

cerebellum el paso tx.

  • Finding out Aaron is completely deaf after meningitis…

cerebellum el paso tx.

  • The meningitis obliterated his hearing and left him completely deaf for 5 months.
  • Not only that, the meningitis wreaked havoc on Aaron�s balance centers (his vestibulocerebellum) and he suffered from severe vertigo and difficulty standing and walking.
cerebellum el paso tx.After recovering from meningitis:
  • �You can see how he’s walking on the treadmill in the very beginning. It took so much out of him to be able to do that.� � Mckayla
  • Remember �metabolic capacity?�

cerebellum el paso tx.

  • Aaron was actually able to get himself back into running shape and ran one of his best times in Ohio, but not without struggle.
  • �Every little change in pace and every little movement was a huge calibration for me and it took a lot out of me.�
  • �I still have a lot of work to do…�

cerebellum el paso tx.

cerebellum el paso tx.CHALLENGE ACCEPTED

  • Sooooo….back to the basics!

cerebellum el paso tx.

  • We utilized different surfaces to challenge his balance system (foam pads, wobble boards, etc….
  • We also had him do most of his therapies barefoot to increase afferentation to the somatosensory cortex

cerebellum el paso tx.Updates from McKayla:

  • �Pace is a 7:30 and he’s doing 6 miles. Completed core work too.�

cerebellum el paso tx.

  • Typically in the OVARD we would spin Aaron in specific directions and he would tell us which direction he was spinning in.
  • At first this was very difficult and he could not perceive the movement, however it was not long until he was sensing each direction of his spin.
  • We let him have a little fun in this particular video….

cerebellum el paso tx.

  • I asked Aaron and McKayla how they felt therapy was going.
  • They responded �great, but we won�t really know until he goes for a run outside…�
  • So we went on a seven mile run at an 8 minute pace.
  • Here we are working on turns.

cerebellum el paso tx.

  • Cured!
  • Aaron is back home in Florida continuing his training for Boston in two weeks.
  • He is continuing at-home exercises and vestibular rehab with specialists
  • He and I are running a half marathon together in the not-so-distant future

cerebellum el paso tx.SOME SIMPLE CEREBELLAR THERAPIES

GENERAL CEREBELLAR EXERCISES

  • Spinning in desk chair will stimulate ipsilateral cerebellum
  • Passive muscle stretch will stimulate ipsilateral cerebellum
  • Squeezing tennis ball will stimulate ipsilateral cerebellum
  • Passive or active non-linear complex movements will stimulate ipsilateral cerebellum
  • Finger to nose pointing will stimulate ipsilateral cerebellum

Vermal & Paravermal Exercises

  • Passive and active gaze stabilization exercises with central fixation
  • Wobble board/unsteady surface exercises
  • Balance beam exercises and tandem walking
  • Bouncing a ball against the ground or throwing it against the wall
  • Core exercises such as planks, sit-ups and yoga
  • Learning how to balance on a bicycle
  • Supine cross crawl activity

Lateral Cerebellum Exercises

  • Cognitive processes
  • Learning a musical instrument
  • Tracing a maze
  • Playing �catch�
  • Tapping fingers/hand or toes/feet to the beat of a metronome
  • Trying to write with eyes closed
  • Strategic board games

THE LANGUAGE OF THE BRAIN IS REPETITION!

By RYAN CEDERMARK, RN BSN MSN DC DACNB

Introduction To The Cerebellum | El Paso, TX. | Part I

Introduction To The Cerebellum | El Paso, TX. | Part I

El Paso, TX. Chiropractor Dr. Alexander Jimenez presents an introduction to the cerebellum. The brain is a complex structure that has billions of nerve cells. The basic anatomy is easily understandable. But there is one part of the brain, the cerebellum, which is involved in virtually all movement. This is the part of the brain that helps a person drive, throw a ball, or walk across the street.

Problems with the cerebellum are uncommon and mostly involve movement and coordination difficulties. This article will give an overview of the anatomy, purpose, and disorders of the cerebellum, as well as, how to keep the brain healthy.

FAGIOLINI ET AL. EPIGENETIC INFLUENCES ON BRAIN DEVELOPMENT AND PLASTICITY CURR OPIN NEUROBIOL, 2009

cerebellum el paso tx.

  • �Enhancing plasticity in the adult brain is an exciting prospect and there is certainly evidence emerging that suggest the possible use of epigenetic factors to induce a �younger� brain.�
  • �Recent findings support a key role of epigenetic factors in mediating the effects of sensory experience on site-specific gene expression, synaptic transmission, and behavioral phenotypes.�

 

 

 

 

 

TAYLOR ET AL. CUTTING YOUR NERVE CHANGES YOUR BRAIN BRAIN, 2009

  • �Animal studies have established that plasticity within the somatosensory cortex begins immediately following peripheral nerve transection, and that 1 year after complete nerve transection and surgical repair, cortical maps contain patchy, noncontinuous representations of the transected and adjacent nerves.�
  • �Here, we have demonstrated for the first time that there is functional plasticity and both grey and white matter structural abnormalities in several cortical areas following upper limb peripheral nerve transection and surgical repair.�

cerebellum el paso tx.

THE CEREBELLUM

cerebellum el paso tx.

cerebellum el paso tx.

cerebellum el paso tx.

IMPORTANT FUNCTIONAL AREAS OF THE CEREBELLUM

  • Spinocerebellum
  • Vestibulocerebellum
  • Cerebrocerebellum

cerebellum el paso tx.

SPINOCEREBELLUM

  • cerebellum el paso tx.Responsibilities:

  • Regulation of muscle tone for posture and locomotion
  • Balance
  • Patient Complaints:

  • Difficulty with balance
  • Difficulty walking in the dark
  • Difficulty going down stairs
  • Sway to one side while walking
  • Examination Findings:

  • Wide based gait
  • Sway in Romberg�s position

 

 

cerebellum el paso tx.http://www.neuroexam.com/neuroexam/content.php?p=37

cerebellum el paso tx.http://www.neuroexam.com/neuroexam/content.php?p=37

WHAT DO YOU SEE?

cerebellum el paso tx.

cerebellum el paso tx.WHAT CAN YOU DO?

  • cerebellum el paso tx.Have the patient perform balance exercises:

  • Practice Romberg�s
  • Practice one leg standing
  • Bosu Ball exercises
  • Foam Pad exerscises
  • Balance Board exercises
  • Increase core stability:

  • Plank�s
  • Yoga
  • Increase proprioception:

  • Adjust!
  • But which side?

VESTIBULOCEREBELLUM

  • cerebellum el paso tx.

    Responsibilities:

  • Regulation of vestibular system
  • Regulation of balance
  • Assistance with eye movements (encoding retinal slip)
  • Patient Complaints:

  • Postural muscle fatigue
  • Dizziness
  • Disorientation
  • Difficulty riding in a car
  • Nausea
  • Examination Findings:

  • Wide based gait
    Sway in Romberg�s position
  • Nystagmus
  • Impaired VOR
  • Impaired smooth pursuits
  • Hypermetric Saccades

cerebellum el paso tx.http://www.neuroexam.com/neuroexam/content.php?p=37

cerebellum el paso tx.

cerebellum el paso tx.

cerebellum el paso tx.http://www.neuroexam.com/neuroexam/content.php?p=37

VOR

cerebellum el paso tx.

cerebellum el paso tx.

WHAT DO YOU SEE?

cerebellum el paso tx.EYE MOVEMENT REVIEW

cerebellum el paso tx.

cerebellum el paso tx.WHAT CAN YOU DO?

  • cerebellum el paso tx.Have the patient perform gaze stability exercises:

  • Sit arms length away
  • Fixate on dot
  • Rotate head in different directions
  • Rotation exercises:

  • Activate VOR
  • Activate side less active
  • Provide OPK stimulation:

  • Which side do you stimulate?

CEREBROCEREBELLUM

cerebellum el paso tx.Responsibilities:

  • Coordination of fine movements
  • Coordination of speech
  • Coordination of thought
  • Patient Complaints:

  • Clumsiness with hands
  • Clumsiness with feet
  • Tripping over feet
  • Hand shaking with intention
  • Examination Findings:

  • Intention tremor
  • Termination tremor
  • Dysmetria
  • Dysdiadochokinesia

cerebellum el paso tx.http://www.neuroexam.com/neuroexam/content.php?p=37

cerebellum el paso tx.http://www.neuroexam.com/neuroexam/content.php?p=37

cerebellum el paso tx.http://www.neuroexam.com/neuroexam/content.php?p=37

cerebellum el paso tx.http://www.neuroexam.com/neuroexam/content.php?p=37

WHAT DO YOU SEE?

cerebellum el paso tx.WHAT CAN YOU DO?

  • cerebellum el paso tx.Have the patient perform coordinated movements!
  • Example: piano playing, finger taping, finger to nose, etc.

 

 

 

 

 

 

 

TAYLOR ET AL. CUTTING YOUR NERVE CHANGES YOUR BRAIN BRAIN, 2009

  • �Animal studies have established that plasticity within the somatosensory cortex begins immediately following peripheral nerve transection, and that 1 year after complete nerve transection and surgical repair, cortical maps contain patchy, noncontinuous representations of the transected and adjacent nerves.�
  • �Here, we have demonstrated for the first time that there is functional plasticity and both grey and white matter structural abnormalities in several cortical areas following upper limb peripheral nerve transection and surgical repair.�

cerebellum el paso tx.

By�RYAN CEDERMARK, RN BSN MSN DC DACNB