Optimal Joint Movement: Enhancing Mobility and Stability at El Paso Back Clinic
A chiropractor or Nurse Practitioner works with a patient in a rehabilitation center to improve joint mobility.
Optimal joint movement is essential for an active, pain-free life. At El Paso Back Clinic in El Paso, TX, we specialize in helping people achieve this through personalized chiropractic care. This article explains what optimal joint movement means, why it’s important, and how our clinic’s integrative approaches can restore it. Whether you’re dealing with back pain, sports injuries, or daily stiffness, our team, led by Dr. Alex Jimenez, DC, APRN, FNP-BC, uses spinal adjustments, rehabilitation, and functional medicine to get you moving better. Discover how we support joint health to improve function in everyday tasks and athletic pursuits.
Understanding Optimal Joint Movement
Optimal joint movement is the ability to move your joints through their full natural range of motion (ROM) smoothly, without pain, and with good control. It’s often referred to as high-quality mobility, blending flexibility with strength for daily activities and sports (University of Colorado Anschutz Medical Campus, n.d.).
At El Paso Back Clinic, we define it as moving joints efficiently while maintaining balance between mobility (active movement) and stability (joint control). This ensures muscles, ligaments, and tendons work together properly (National Academy of Sports Medicine, n.d.; Mainstay Medical, n.d.). For instance, a healthy shoulder should lift overhead to 180 degrees without strain, allowing you to reach shelves or throw a ball (Verywell Health, 2023a).
When injury or prolonged sitting disrupts this, mobility declines, leading to awkward movements elsewhere in the body (University of Colorado Anschutz Medical Campus, n.d.). Our clinic addresses this through holistic care, combining adjustments, soft-tissue therapy, and exercises to reduce inflammation and improve coordination.
Key Elements of Optimal Movement:
Full ROM: Joints reach their natural limits, like knee flexion to 140 degrees for squatting (The GO KNEE, n.d.).
Smooth Control: No jerking or pain, thanks to strong muscles and clear nerve signals.
Balance: Mobility for range, stability to prevent wobbles or injuries (ACE Fitness, n.d.a).
The Importance of Mobility and Stability Balance
At El Paso Back Clinic, we emphasize the balance between mobility and stability for peak performance. Mobility allows free movement, while stability keeps joints secure during activities (ACE Fitness, n.d.b). This synergy is key in our treatments.
Think of the body as a chain: Ankles and hips need mobility for steps, while knees and lower back provide stability (Motus Physiotherapy, n.d.; NASM, n.d.). If an ankle stiffens due to injury, the knee compensates, increasing the risk of pain (Physical Therapy at MJC, n.d.). Our chiropractic adjustments and rehab programs restore this chain, enhancing joint function.
Integrative care at our clinic—including spinal decompression and strength training—supports this balance, reducing the risk of injury and improving mobility (Peninsula Wellness Partners, n.d.).
Common Disruptions to Joint Mobility
Life factors can hinder optimal joint movement. Injuries cause swelling and tightness, limiting ROM (Frozen Shoulder Clinic, n.d.; Musculoskeletal Key, n.d.). A sedentary lifestyle, common in desk jobs, tightens muscles and stiffens joints (Dr. Ong Kee Leong, n.d.).
At El Paso Back Clinic, we see this in patients with back pain or sciatica, where poor posture leads to compensation and strain in other areas (OMassageT, n.d.). Aging, arthritis, or repetitive motions worsen it (Arthritis Foundation, n.d.; Chesapeake Regional, n.d.).
Typical Causes:
Trauma: Sprains create hard end-feels, stopping movement early (Physiopedia, n.d.c).
Inactivity: Shortens tissues, reducing flexibility (Dr Ong Kee Leong, n.d.).
Health Conditions: Arthritis limits ROM, causing bony sensations (Physiopedia, n.d.c).
Habits: Bad ergonomics unbalance the kinetic chain (OMassageT, n.d.).
Without correction, this increases fall risk and reduces quality of life. Our clinic’s diagnostic tools, such as digital X-rays, identify issues early.
Why Prioritize Optimal Joint Movement?
Good joint movement enhances everything from walking to sports. It prevents pain and boosts efficiency (OneStep, n.d.). At El Paso Back Clinic, we help athletes improve power and reduce injuries through better ROM (Activ Therapy, n.d.).
For daily life, it means easier tasks without fatigue (Baliston, n.d.). In walking, ankle flexion aids balance; poor ROM shortens strides (Baliston, n.d.). Our programs keep joints lubricated and muscles strong (Arthritis Foundation, n.d.).
At El Paso Back Clinic, maintenance starts with assessment. We measure ROM against norms using tools like goniometers (Physical Therapy at MJC, n.d.; Trainerize, n.d.). Then, we recommend exercises.
Regular activity, such as stretching, helps keep joints flexible (Arthritis Foundation, n.d.; Royal City Physiotherapy, n.d.). Our mobility drills focus on control for real-world use (Royal City Physiotherapy, n.d.).
Practical Tips:
Warm-Ups: Shoulder circles or ankle rolls (Chesapeake Regional, n.d.).
Stretching: Hold for 30 seconds on tight spots (Verywell Health, 2023a).
Strength Work: Squats for knee stability (ACE Fitness, n.d.b).
Activity: Low-impact, like swimming (Arthritis Foundation, n.d.).
Tools: Foam rollers for self-care (Muscle and Motion, n.d.).
Visit our East Side location for personalized plans.
Integrative Chiropractic Care at El Paso Back Clinic
Our clinic offers holistic chiropractic care to restore joint movement. Led by Dr. Alex Jimenez, we combine adjustments, therapy, and guidance (Peninsula Wellness Partners, n.d.; Evolved Health Chiropractic, n.d.).
Adjustments realign joints, easing inflammation and nerves (Rodgers Stein Chiropractic, n.d.a; Rodgers Stein Chiropractic, n.d.b). Soft tissue work and rehab build muscle support (Evolved Health Chiropractic, n.d.).
This approach enhances mobility, strengthens areas, and reduces risks (Core Integrative Health, n.d.; Duca Chiropractic, n.d.). Joint mobilization gently increases ROM (Smart Sports Medicine, n.d.).
Our Services:
Spinal Adjustments: Restore alignment for better ROM (Chiropractic Omaha, n.d.).
Functional Medicine: Addresses root causes, such as nutrition (TXMAC, n.d.).
Rehab: Exercises for long-term health (Duca Chiropractic, n.d.).
Clinical Insights from Dr. Alex Jimenez at El Paso Back Clinic
Dr. Alex Jimenez, DC, APRN, FNP-BC, heads El Paso Back Clinic, with over 30 years of experience in integrative care. At our facilities, he blends chiropractic, functional medicine, and rehab for joint issues (Jimenez, n.d.a; Jimenez, n.d.b).
His observations: Adjustments alleviate nerve-related issues, restoring ROM in cases of back pain or sciatica (Jimenez, n.d.a). Patients from accidents or sports regain mobility through tailored plans (Jimenez, n.d.a).
Dr. Jimenez focuses on root causes with nutrition and exercises, preventing surgery (Jimenez, n.d.b). For hips or knees, agility programs balance mobility and stability (Jimenez, n.d.a). Our holistic model empowers patients and aligns with evidence supporting better function (Jimenez, n.d.b).
At El Paso Back Clinic, optimal joint movement is achievable with our expert care. Balance mobility and stability to overcome disruptions. Visit elpasobackclinic.com or our El Paso locations for help from Dr. Jimenez’s team.
When You Don’t Stretch: Why Muscles Get Stiff, Movement Gets Harder, and Injuries Become More Likely
A patient with chronic back pain does targeted stretches.
If you rarely stretch, your body can start to feel “tight,” which can change how you move. Many people notice they can’t bend, twist, squat, reach overhead, or turn their head as easily as they used to. Over time, this can affect your flexibility, your range of motion (how far a joint can move), and how smooth and efficient your daily movements feel.
At El Paso Back Clinic, Dr. Alexander Jimenez, DC, APRN, FNP-BC, often explains this: when mobility decreases, the body starts to “compensate.” That means you move around a stiff area instead of through it, and those workarounds can build up stress in nearby joints and muscles (Jimenez, n.d.-a). This is one reason people can develop recurring back pain, neck stiffness, hip tightness, or shoulder irritation even without a single big injury.
What “Muscle Stiffness” Really Means
Muscle stiffness usually feels like tightness, soreness, or difficulty moving. It can happen after overuse, after you’ve been still for a long time, or when your muscles stay “stuck” in a more contracted state (Tarantino, 2025). Osmosis
Osmosis notes that stiffness can appear after a long period of minimal motion (such as bed rest or inactivity) or after new exercise that causes temporary muscle cell damage (Tarantino, 2025). Osmosis
Key idea: When your body doesn’t move a joint through its normal range often enough, the muscles and tissues around it can start to feel restricted. That restriction can make normal tasks think harder than they should.
Do Muscles Actually “Shorten” If You Don’t Stretch?
You’ll hear people say, “If you don’t stretch, your muscles will shorten.” That statement is partly true, but it needs context.
Adidas explains that the word “shorten” can be misleading: for most people, it feels like shortening because mobility and flexibility decrease when stretching is skipped, even if the muscle is not literally shrinking in everyday life (Adidas, 2025). adidas
Harvard Health adds an important clarification: without regular stretching, muscles can become tight, and when you need them for activity, they may not extend fully, increasing the risk of joint pain, strains, and muscle damage (Harvard Health Publishing, 2024). Harvard Health
So the practical takeaway is simple:
Skipping stretching often leads to less mobility and flexibility
Tight muscles can reduce how far joints can move
Tight muscles can make injuries more likely when you suddenly “ask more” of your body
How Tight Muscles Reduce Range of Motion
Range of motion (ROM) is the movement around a joint or body part. When ROM is limited, you can’t move that body part through its usual, healthy motion (Jimenez, n.d.-b). El Paso Back Clinic® • 915-850-0900
El Paso Back Clinic explains how tightness—especially in areas like the hips and ankles—can reduce ROM and limit potential for form and strength. When posture and form are compromised, pain and injury risk can rise (Jimenez, n.d.-b). El Paso Back Clinic® • 915-850-0900
What limited ROM can look like in real life
You might notice:
You can’t turn your head fully when driving
You bend from your lower back instead of your hips
You can’t squat without your heels lifting
Your shoulders feel “pinched” when reaching into a cabinet
Your hamstrings feel tight when you try to walk fast
And here’s the tricky part: your body still gets the job done—just with more strain.
Why Stiffness Can Raise Injury Risk
Harvard Health explains that tight muscles may be more easily damaged when they are suddenly stretched during strenuous activity (Harvard Health Publishing, 2024). Harvard Health
That’s why injuries often show up in moments like:
A weekend game after sitting all week
A sudden sprint to catch something
Lifting a heavy box with “cold” hips and hamstrings
A long drive followed by quick unloading or bending
Mayo Clinic also notes that better flexibility can help joints move through full ROM and may decrease injury risk, while emphasizing that stretching must be done correctly (Mayo Clinic Staff, n.d.). Mayo Clinic
Common Reasons People Stop Stretching (And How to Fix Them)
Most people don’t skip stretching because they don’t care. They skip it because it feels confusing, time-consuming, or uncomfortable.
Common barriers
“I don’t have time.”
“Stretching hurts.”
“I’m not flexible, so it doesn’t work for me.”
“I only need stretching if I work out.”
Better, more realistic reframes
You only need 5–10 minutes a few times a week to start seeing benefits (Mayo Clinic Staff, n.d.). Mayo Clinic
Stretching should create tension, not pain (Mayo Clinic Staff, n.d.). Mayo Clinic
Flexibility improves over weeks to months, not days (Harvard Health Publishing, 2024). Harvard Health
Stretching supports everyday movement, not just workouts (Harvard Health Publishing, 2024). Harvard Health
Safe Stretching Basics (So You Don’t Make Things Worse)
This matters: stretching done poorly can backfire.
Mayo Clinic recommends:
Don’t stretch cold muscles—warm up 5–10 minutes first
Don’t bounce
Hold stretches about 30 seconds (longer for problem areas)
Don’t stretch into pain (Mayo Clinic Staff, n.d.). Mayo Clinic
The American Heart Association adds:
Stretch when muscles are warm
Hold 10–30 seconds and repeat 3–5 times
Stretch slowly and smoothly (American Heart Association, 2024). www.heart.org
Quick safety checklist
Warm up first (easy walk, gentle movement)
Move slowly
Breathe
No bouncing
Stop if you feel sharp pain, numbness, or joint pain
A Simple 10-Minute Daily Stretch Routine for Real Life
This is designed for normal adults: busy schedules, stiff hips, tight neck, and lots of sitting.
Step 1: Warm up (1–2 minutes)
Walk around the house
March in place
Gentle arm circles
Step 2: Do these 6 stretches (about 8 minutes total)
1) Hip flexor stretch (1 minute each side) Helps if you sit a lot and feel tight in the front of your hips.
2) Hamstring stretch (1 minute each side) Harvard points out that tight hamstrings from sitting can limit how well you extend your leg and support walking mechanics (Harvard Health Publishing, 2024). Harvard Health
3) Calf stretch (45 seconds each side) Helpful for ankle mobility, walking, and squatting mechanics.
4) Chest opener (45 seconds) Stand in a doorway and gently open the chest to reduce rounded-shoulder posture.
5) Upper back reach (45 seconds) Hug yourself and gently pull your shoulder blades apart.
6) Neck side stretch (30 seconds each side) Gentle only—never crank your neck.
Step 3: Add “micro-mobility” during your day (optional but powerful)
Stand up every hour for 30–60 seconds
Do 5 bodyweight squats to a chair
Do 10 shoulder rolls
Take a 3-minute walk after meals
These small habits often matter as much as one long stretch session.
Stretching After Workouts: What You Should Know
Adidas explains the difference clearly:
Dynamic movement is best before workouts (prepares your body)
Static stretching is typically better after workouts, when you’re warm (Adidas, 2025). adidas
Mayo Clinic also cautions that stretching cold muscles can increase injury risk and notes that some intense activities may not benefit from heavy stretching right before performance (Mayo Clinic Staff, n.d.). Mayo Clinic
A balanced approach
Before exercise: warm up + dynamic mobility
After exercise: gentle static stretching + breathing
On rest days: short, consistent flexibility routine
When Stiffness Is a Sign You Need More Than Stretching
Sometimes the problem is not just “tight muscles.” You may have:
Joint restrictions that block movement
Spine or pelvis alignment issues affecting mechanics
Inflammation around a joint
Pain patterns that keep muscles “guarded”
A nerve-related problem (numbness, tingling, weakness)
El Paso Back Clinic notes that limited ROM in areas like the back, neck, or shoulders can be linked to the body being out of natural alignment, repetitive motions, or wear and tear (Jimenez, n.d.-b). El Paso Back Clinic® • 915-850-0900
If stretching doesn’t help—or makes symptoms worse—it’s smart to get assessed.
The El Paso Back Clinic Approach: Integrative Chiropractic + Nurse Practitioner Support
This is where integrative care can be a game-changer: you’re not only “stretching more,” you’re also finding out why you’re tight and building a plan that fits your body.
What chiropractic care can add
El Paso Back Clinic describes a “restoration” approach that may include:
Soft tissue work (to reduce tightness and improve circulation)
Adjustments (to address misalignments and support mobility)
Nurse practitioners are advanced practice clinicians who assess, diagnose, and treat illnesses and injuries and support chronic condition management (American Nurses Association, n.d.). ANA Healthgrades also describes NPs performing screenings and physical exams, ordering lab work, documenting care, and diagnosing certain conditions (Prosser, 2025). Healthgrades Resources
Why the combo helps stiffness and pain
Together, a chiropractor + NP team can:
Screen for red flags (nerve symptoms, systemic issues)
Decide when imaging or labs are appropriate
Build a movement plan that matches your pain level
Address sleep, stress, inflammation, and recovery habits
Track progress using measurable goals (like ROM improvements)
Dr. Jimenez’s Mobility & Flexibility materials emphasize that “great mobility” supports functional movement without ROM restrictions and that people who don’t stretch often may experience stiffened muscles that reduce effective movement (Jimenez, n.d.-a). El Paso Back Clinic® • 915-850-0900
Red Flags: When to Stop Stretching and Get Checked
Call a clinician promptly if you have:
Numbness, tingling, or weakness in an arm/leg
Loss of balance, clumsiness, or trouble walking
Severe pain that doesn’t improve
Pain after trauma (car accident, fall, sports collision)
Fever, unexplained swelling, or sudden intense stiffness
Muscle stiffness can sometimes be related to underlying medical issues, and diagnosis may require an exam and follow-up testing, depending on the cause (Tarantino, 2025). Osmosis
The Bottom Line
If you don’t stretch regularly, it’s common to feel tighter and less mobile over time. That stiffness can reduce range of motion, make daily tasks harder, and increase your risk of injury when you suddenly push your body. The good news is that you don’t need extreme flexibility. You need consistent, safe mobility work—and when required, professional support to restore movement and reduce pain.
A practical plan usually includes:
Small daily stretching habits
Better warm-ups and recovery routines
Strength + mobility (not stretching alone)
Integrative evaluation when pain, ROM loss, or repeated flare-ups keep returning
For individuals looking to improve their fitness health, can a fitness assessment test identify potential areas and help evaluate overall health and physical status?
Fitness Assessment
A fitness test, also known as a fitness assessment, helps evaluate an individual’s overall and physical health. It comprises a series of exercises to design an appropriate exercise program for general health and fitness. (National Strength and Conditioning Association. 2017) Fitness assessment testing benefits include:
Identifying areas that need improvement.
Assisting professionals in understanding what types of exercise are safest and most effective.
Helping measure fitness progress over time.
Allowing for an individualized plan that can help prevent injuries and maintain the body’s overall health.
An assessment can comprise a wide range of tests, including:
Body composition tests.
Cardiovascular stress tests.
Endurance tests.
Range of motion tests.
They are meant to ensure the individual won’t be at risk of injury and provide the trainer with the insights needed to establish clear and effective fitness goals. Individuals who wonder whether fitness testing would benefit them should consult their healthcare provider.
General Health
Before starting a fitness program, it is important to inform the trainer of individual medical history and get the necessary approval from a primary healthcare provider. (Harvard Health Publishing. Harvard Medical School. 2012) Fitness specialists usually use one or more screening tools to help determine individual baseline health.
This may include obtaining vital sign measurements like height and weight, resting heart rate/RHR, and resting blood pressure/RBP. Many trainers will also use a physical activity readiness questionnaire/PAR-Q comprising questions about general health. (National Academy of Sports Medicine. 2020) Among the questions, individuals may be asked about the medications being taken, any problems with dizziness or pain, or medical conditions that may impair their ability to exercise.
Body Composition
Body composition describes total body weight components, including muscles, bones, and fat. The most common methods for estimating body composition include:
Bioelectrical Impedance Analysis – BIA
During BIA, electrical signals are sent from electrodes through the soles of the feet to the abdomen to estimate body composition. (Doylestown Health. 2024)
These measurements use calipers to estimate the amount of body fat in a fold of skin.
Cardiovascular Endurance
Cardiovascular endurance testing, also known as stress testing, measures how efficiently the heart and lungs work to supply oxygen and energy to the body during physical activity. (UC Davis Health, 2024) The three most common tests used include:
12-minute Run Tests
Twelve-minute run tests are performed on a treadmill, and an individual’s pre-exercise heart and respiration rates are compared with post-exercise heart and respiration rates.
Exercise Stress
Exercise stress testing is performed on a treadmill or stationary bike.
It involves using a heart monitor and blood pressure cuff to measure vital signs during exercise.
VO2 Max Testing
Performed on a treadmill or stationary bike.
V02 max testing uses a breathing device to measure the maximum rate of oxygen consumption during physical activity (UC Davis Health, 2024)
Some trainers will incorporate exercises like sit-ups or push-ups to measure response to specific exercises.
These baseline results can be used later to see if health and fitness levels have improved.
Strength and Endurance
Muscle endurance testing measures the length of time a muscle group can contract and release before it fatigues. Strength testing measures the maximal amount of force a muscle group can exert. (American Council on Exercise, Jiminez C., 2018) The exercises used include:
The push-up test.
Core strength and stability test.
Sometimes, a trainer will use a metronome to measure how long the individual can keep up with the rhythm. The results are then compared to individuals of the same age group and sex to establish a baseline level. Strength and endurance tests are valuable as they help the trainer spot which muscle groups are stronger, vulnerable, and need focused attention. (Heyward, V. H., Gibson, A. L. 2014).
Flexibility
Measuring the flexibility of joints is vital in determining whether individuals have postural imbalances, foot instability, or limitations in range of motion. (Pate R, Oria M, Pillsbury L, 2012)
Shoulder Flexibility
Shoulder flexibility testing evaluates the flexibility and mobility of the shoulder joint.
It is performed by using one hand to reach behind the neck, between the shoulders, and the other hand to reach behind the back, toward the shoulders, to measure how far apart the hands are. (Baumgartner TA, PhD, Jackson AS, PhD et al., 2015)
Fitness assessment testing has various benefits. It can help trainers design a personalized workout program, help individuals identify fitness areas that need improvement, measure progress, and add intensity and endurance to their routine, which can help prevent injuries and help maintain overall health. We focus on what works for you and strive to better the body through researched methods and total wellness programs. These natural programs use the body’s ability to achieve improvement goals. Ask a healthcare professional or fitness professional for guidance if you need advice.
PUSH Fitness
References
National Strength and Conditioning Association. (2017). Purposes of assessment. https://www.nsca.com/education/articles/kinetic-select/purposes-of-assessment/
Harvard Health Publishing. Harvard Medical School. (2012). Do you need to see a doctor before starting your exercise program? HealthBeat. https://www.health.harvard.edu/healthbeat/do-you-need-to-see-a-doctor-before-starting-your-exercise-program
National Academy of Sports Medicine. (2020). PAR-Q-+ The Physical Activity Readiness Questionnaire for Everyone. https://www.nasm.org/docs/pdf/parqplus-2020.pdf?sfvrsn=401bf1af_24
Doylestown Health. (2024). Bio-Electrical Impedance Analysis (BIA)-Body Mass Analysis. https://www.doylestownhealth.org/service-lines/nutrition#maintabbed-content-tab-2BDAD9F8-F379-403C-8C9C-75D7BFA6E596-1-1
National Heart, Lung, and Blood Institute. U.S. Department of Health and Human Services. (N.D.). Calculate your body mass index. Retrieved from https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
UC Davis Health. (2024). VO2max and Aerobic Fitness. https://health.ucdavis.edu/sports-medicine/resources/vo2description
American Council on Exercise. Jiminez C. (2018). Understanding 1-RM and Predicted 1-RM Assessments. ACE Fitness. https://www.acefitness.org/fitness-certifications/ace-answers/exam-preparation-blog/2894/understanding-1-rm-and-predicted-1-rm-assessments/
Heyward, V. H., Gibson, A. L. (2014). Advanced Fitness Assessment and Exercise Prescription. United Kingdom: Human Kinetics. https://www.google.com/books/edition/Advanced_Fitness_Assessment_and_Exercise/PkdoAwAAQBAJhl=en&gbpv=1&dq=Strength+and+endurance+tests+muscle+groups+are+stronger+and+weaker&pg=PA173&printsec=frontcover#v=onepage&q=Strength%20and%20endurance%20tests%20muscle%20groups%20are%20stronger%20and%20weaker&f=false
Pate R, Oria M, Pillsbury L, (Eds). (2012). Health-related fitness measures for youth: Flexibility. In R. Pate, M. Oria, & L. Pillsbury (Eds.), Fitness Measures and Health Outcomes in Youth. https://doi.org/10.17226/13483
Baumgartner, T. A., Jackson, A. S., Mahar, M. T., Rowe, D. A. (2015). Measurement for Evaluation in Kinesiology. United States: Jones & Bartlett Learning. https://www.google.com/books/edition/Measurement_for_Evaluation_in_Kinesiolog/_oCHCgAAQBAJ?hl=en&gbpv=1&dq=Measurement+for+Evaluation+in+Kinesiology+(9th+Edition).&printsec=frontcover#v=onepage&q&f=false
American Council of Exercise. Metcalf A. (2014). How to improve flexibility and maintain it. ACE Fitness. https://www.acefitness.org/resources/everyone/blog/3761/how-to-improve-flexibility-and-maintain-it/
Individuals in post-surgery recovery or dealing with illness or an injury can experience weakened muscles and endurance that can cause temporary loss of sleeping mobility and not being able to move around normally because of weakness, decreased range of motion, or pain. Can they benefit from physical therapy to help get back to normal functional mobility?
Sleeping Mobility
For individuals who are hospitalized or homebound from injury, illness, or surgical recovery, a physical therapist will assess various areas of functional mobility. These include transfers – from sitting to standing positions, walking, and sleeping mobility. Sleeping mobility is the ability to perform specific motions while in bed. A therapist can assess sleeping or bed mobility and recommend strategies and exercises to improve movements. (O’Sullivan, S. B., Schmitz, T. J. 2016) A therapist may have the individual use specific devices, like an over-the-bed trapeze or a sliding board, to help move around.
All of these movements require strength in different muscle groups. By checking out individual motions in sleeping mobility, a therapist can work out specific muscle groups that may be weak and require targeted exercises and stretches to restore mobility to normal. (O’Sullivan, S. B., Schmitz, T. J. 2016) Individuals visiting a therapist in an outpatient clinic or rehabilitation area may have the individual work on sleeping mobility on a treatment table. The same motions on the treatment table can be done in the bed.
Importance
The body is meant to move.
For individuals who cannot move comfortably on their bed, the body may suffer disuse atrophy or the wasting away of muscular strength, which can lead to increased difficulties. Not being able to move can also lead to pressure ulcers, especially for individuals who are severely deconditioned and/or remain in one position for a long period. Skin health may start to break down, leading to painful wounds that require specialized care. Being able to move around in bed can help prevent pressure ulcers. (Surajit Bhattacharya, R. K. Mishra. 2015)
Improvement
A physical therapist can prescribe specific exercises to strengthen muscle groups and improve sleeping mobility. The muscles include:
Shoulder and rotator cuff muscles.
Triceps and biceps in the arms.
Gluteus muscles of the hips.
Hamstrings
Quadriceps
Calf muscles
The shoulders, arms, hips, and legs work together when moving the body around the bed.
Various Exercises
To improve bed movement, physical therapy exercises can include:
Physical therapists are trained to assess these motions and functions and prescribe treatments to improve body movement. (O’Sullivan, S. B., Schmitz, T. J. 2016) Maintaining appropriate physical fitness can help the body stay active and mobile. Performing mobility exercises prescribed by a physical therapist can keep the right muscle groups working properly, and working with a physical therapist can ensure the exercises are correct for the condition and are performed properly.
Bhattacharya, S., & Mishra, R. K. (2015). Pressure ulcers: Current understanding and newer modalities of treatment. Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India, 48(1), 4–16. https://doi.org/10.4103/0970-0358.155260
When a groin strain injury happens, can knowing the symptoms help in the diagnosis, treatment, and recovery times?
Groin Strain Injury
A groin strain is an injury to an inner thigh muscle. A groin pull is a type of muscle strain affecting the adductor muscle group (the muscles help pull the legs apart). (Parisa Sedaghati, et al., 2013) The injury is caused when the muscle is stretched beyond its normal range of motion, creating superficial tears. Severe strains can tear the muscle in two. (Parisa Sedaghati, et al., 2013)
A groin muscle pull causes pain and tenderness that worsens when squeezing the legs together.
There may also be swelling or bruising in the groin or inner thigh.
An uncomplicated groin pull takes four to six weeks to heal with proper treatment. (Andreas Serner, et al., 2020)
Symptoms
A groin pull can be painful, interfering with walking, navigating stairs, and/or driving a car. In addition to pain, other symptoms around the injured area include: (Parisa Sedaghati et al., 2013)
A popping sound or snapping sensation when the injury occurs.
Increased pain when pulling the legs together.
Redness
Swelling
Bruising of the groin or inner thigh.
Groin pulls are graded by severity and how much they impact mobility:
Grade 1
Mild discomfort but not enough to limit activities.
Grade 2
Moderate discomfort with swelling or bruising that limits running and/or jumping.
Grade 3
Severe injury with significant swelling and bruising can cause pain while walking and muscle spasms.
Signs of a severe groin strain
Difficulty walking
Groin pain while sitting or resting
Groin pain at night
A healthcare provider should see severe groin pulls because the muscle may have ruptured or be on the verge of rupturing.
In severe cases, surgery is necessary to reattach the torn ends.
Groin pulls are sometimes accompanied by a stress fracture of the pubis/forward-facing pelvic bones, which can significantly extend healing and recovery time. (Parisa Sedaghati et al., 2013)
Causes
Groin pulls are often experienced by athletes and individuals who play sports where they must stop and change directions quickly, placing excessive strain on the adductor muscles. (Parisa Sedaghati et al., 2013) The risk is increased in individuals who: (T. Sean Lynch et al., 2017)
Have weak hip abductor muscles.
Are not in adequate physical condition.
Have a previous groin or hip injury.
Pulls can also occur from falls or extreme activities without the proper conditioning.
Diagnosis
A healthcare provider will perform a thorough investigation to confirm the diagnosis and characterize the severity. This involves: (Juan C. Suarez et al., 2013)
Medical History Review
This includes any previous injuries and specifics about where and when the symptoms started.
Physical Examination
This involves palpating – lightly touching and pressing the groin region and manipulating the leg to understand better where and how extensive the injury is.
Imaging Studies
Ultrasound or X-rays.
If a muscle rupture or fracture is suspected, an MRI scan may be ordered to visualize soft tissue injuries and stress fractures better.
Differential Diagnosis
Certain conditions can mimic a groin pull and require different treatments. These include: (Juan C. Suarez, et al., 2013)
Sports Hernia
This type of inguinal hernia occurs with sports and work injuries.
It causes a portion of the intestine to pop through a weakened muscle in the groin.
Hip Labral Tear
This is a tear in the cartilage ring of the labrum outside the rim of the hip joint socket.
Hip Osteoarthritis
This is the wear-and-tear form of arthritis that can present with groin pain symptoms.
Osteitis Pubis
This is inflammation of the pubic joint and surrounding structures, usually caused by the overuse of the hip and leg muscles.
Referred Groin Pain
This nerve pain originates in the lower back, often due to a pinched nerve, but is felt in the groin.
Treatment
Beginning treatment is conservative and includes rest, ice application, physical therapy, and prescribed gentle stretching and exercises.
Individuals may need crutches or a walking device to reduce pain and prevent further injury if the pain is significant. (Andreas Serner, et al., 2020)
Physical therapy will be a part of the treatment plan.
Over-the-counter pain medications like Tylenol/acetaminophen or Advil/ibuprofen can help with pain relief short term.
If there is severe pain from a grade 3 injury, prescription medications may be used for a short period to help minimize pain. (Andreas Serner, et al., 2020)
Sedaghati, P., Alizadeh, M. H., Shirzad, E., & Ardjmand, A. (2013). Review of sport-induced groin injuries. Trauma monthly, 18(3), 107–112. https://doi.org/10.5812/traumamon.12666
Serner, A., Weir, A., Tol, J. L., Thorborg, K., Lanzinger, S., Otten, R., & Hölmich, P. (2020). Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthopaedic journal of sports medicine, 8(1), 2325967119897247. https://doi.org/10.1177/2325967119897247
Lynch, T. S., Bedi, A., & Larson, C. M. (2017). Athletic Hip Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 25(4), 269–279. https://doi.org/10.5435/JAAOS-D-16-00171
Suarez, J. C., Ely, E. E., Mutnal, A. B., Figueroa, N. M., Klika, A. K., Patel, P. D., & Barsoum, W. K. (2013). Comprehensive approach to the evaluation of groin pain. The Journal of the American Academy of Orthopaedic Surgeons, 21(9), 558–570. https://doi.org/10.5435/JAAOS-21-09-558
Individuals who have gone through recent low back surgery, like a lumbar laminectomy and discectomy, could they benefit from physical therapy for full recovery? (Johns Hopkins Medicine. 2008)
Rehabilitation Exercise Program
A lumbar laminectomy and discectomy is a surgical procedure performed by an orthopedic or neurologic surgeon to help decrease pain, relieve associated symptoms and sensations, and improve flexibility and mobility. The procedure involves cutting away disc and bone material that presses against, irritates, and damages the spinal nerves. (Johns Hopkins Medicine. 2023)
Post-Surgery
The therapist will work with the individual to develop a rehabilitation exercise program. The objective of a rehabilitation exercise program is to help the individual:
Relax their muscles to prevent muscle tensing and becoming over-cautious
Regain full range of motion
Strengthen their spine
Prevent injuries
A guide on what to expect in physical therapy.
Postural Retraining
After back surgery, individuals have to work to maintain proper posture when sitting and standing. (Johns Hopkins Medicine. 2008)
Postural control is important to learn as it maintains the lower back in the optimal position to protect and expedite the healing of lumbar discs and muscles.
A physical therapist will teach the individual how to sit with proper posture and use lumbar support.
Attaining and maintaining proper posture is one of the most important things to help protect the back and prevent future back problems.
Walking helps to improve cardiovascular health and blood circulation throughout the body.
This helps to provide added oxygen and nutrients to the spinal muscles and tissues as they heal.
It is an upright exercise that puts the spine in a natural position, which helps to protect the discs.
The therapist will help set up a program tailored to the individual’s condition.
Prone Press Up
One of the exercises to protect the back and lumbar discs is prone press-ups. (Johns Hopkins Medicine. 2008) This exercise helps keep the spinal discs situated in the proper position. It also helps to improve the ability to bend back into lumbar extension.
To perform the exercise:
Lie facing down on a yoga/exercise mat and place both hands flat on the floor under the shoulders.
Keep the back and hips relaxed.
Use the arms to press the upper part of the body up while allowing the lower back to remain against the floor.
There should be a slight pressure in the lower back while pressing up.
Hold the press-up position for 2 seconds.
Slowly lower back down to the starting position.
Repeat for 10 to 15 repetitions.
Sciatic Nerve Gliding
Individuals who had leg pain coming from the back prior to surgery may have been diagnosed with sciatica or an irritation of the sciatic nerve. Post-surgery, individuals may notice their leg feels tight whenever straightening it out all the way. This could be a sign of an adhered/trapped sciatic nerve root, a common problem with sciatica.
After lumbar laminectomy and discectomy surgery, a physical therapist will prescribe targeted exercises called sciatic nerve glides to stretch and improve how the nerve moves. (Richard F. Ellis, Wayne A. Hing, Peter J. McNair. 2012)
Nerve glides can help free the stuck nerve root and allow for normal motion.
To perform the exercise:
Lie on the back and bend one knee up.
Grab underneath the knee with the hands.
Straighten the knee while supporting it with the hands.
Once the knee is fully straightened, flex and extend the ankle about 5 times.
Return to the starting position.
Repeat the sciatic nerve glide 10 times.
The exercise can be performed several times to help improve how the nerve moves and glides in the lower back and leg.
Supine Lumbar Flexion
After surgery, gentle back flexion exercises can help safely stretch the low-back muscles and gently stretch the scar tissue from the surgical incision. Supine lumbar flexion is one of the simplest exercises to improve lumbar flexion range of motion.
To perform the exercise:
Lie on the back with the knees bent.
Slowly lift the bent knees towards the chest and grasp the knees with both hands.
Gently pull the knees toward the chest.
Hold the position for 1 or 2 seconds.
Slowly lower the knees back to the starting position.
Perform for 10 repetitions.
Stop the exercise if experiencing an increase in pain in the lower back, buttocks, or legs.
Hip and Core Strengthening
Once cleared, individuals can progress to an abdominal and core strengthening program. This involves performing specific motions for the hips and legs while maintaining a pelvic neutral position. Advanced hip strengthening exercises help generate strength and stability in the muscles that surround the pelvic area and lower back. A physical therapist can help decide which exercises are recommended for the specific condition.
Return-to-Work and Physical Activities
Once individuals have gained an improved lumbar range of motion, hip, and core strength, their doctor and therapist may recommend working on specific activities to help them return to their previous level of work and recreation. Depending on job occupation, individuals may need to:
Work on proper lifting techniques.
Require an ergonomic evaluation if they spend time sitting at a desk or workstation.
Some surgeons may have restrictions on how much an individual can bend, lift, and twist from two to six weeks after surgery.
Low-back surgery can be difficult to rehab properly. Working with a healthcare provider and physical therapist, individuals can be sure to improve their range of motion, strength, and functional mobility to return to their previous level of function quickly and safely.
Ellis, R. F., Hing, W. A., & McNair, P. J. (2012). Comparison of longitudinal sciatic nerve movement with different mobilization exercises: an in vivo study utilizing ultrasound imaging. The Journal of orthopaedic and sports physical therapy, 42(8), 667–675. https://doi.org/10.2519/jospt.2012.3854
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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