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Hip Sprain

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Hip Pain & Disorders

The hips are highly active joints. Hip sprains are rare but do occur. A hip sprain is caused by tearing or stretching the ligaments that surround the hip and join the bones to each other. This is different from a hip strain, which is an injury to the muscles and is generally caused by over-use of the hip flexor muscles and tendons, causing them to tear. Hip sprains usually happen after a fall or a sudden twisting motion, which can occur during sports or an accident.

Individuals involved in sports that require quick stops, body shifting, and sudden direction changes, like soccer, football, basketball, tennis, volleyball, etc., have an increased risk. Most hip sprains can be effectively treated with conservative treatments like self-massage, rest, ice, and nonsteroid anti-inflammatory medications. For more severe cases, physical therapy and chiropractic can treat the condition.

Hip Sprain Symptoms

Tenderness in the hip increases when lifting the thigh.
Cramping sensation/s in the muscles of the upper leg.
Swelling in the hip or thigh
Bruising in the hip or thigh.
Sudden pain in the hip or pelvis.
Sharp pain in the hip or pelvis.
Pain that worsens when walking, running, or stretching the hip muscles.
Loss of strength in the front of the groin.
Tugging or pulling sensation.
Limping.

Diagnosis

The doctor or chiropractor will:

Look into medical history.
Inquire about symptoms.
Inquire about activities that could cause symptoms.
Perform a physical examination.
Ask the individual to perform a variety of movements to determine what type of injury has been sustained.
Other conditions could cause radiating pain.
Pain in one or both hips might not have anything to do with the hips but a pinched nerve root in the lower back.
Sciatica can develop when certain nerve roots in the lower back are irritated or compressed, causing symptoms to travel down the sciatic nerve and radiate around the pelvis and leg.
X-rays can help rule out hip stress fractures, which can have similar symptoms.
MRI or CT scans are used to see if any soft tissue damage has occurred.

Hip Sprain Treatment

Treatment usually begins with over-the-counter pain medications and anti-inflammatories to reduce swelling and relieve pain.
Resting the hip will help prevent further damage.
Applying ice will help prevent tissue damage and reduce swelling.
It is recommended to use an ice pack several times a day for the first 48 hours after an injury.
Once the swelling goes down, a chiropractor and physical therapy team will create a personalized treatment plan that includes:
Adjustments.
Exercise therapy.
Posture training.
Stretching.
Massage.

Treatment/Rehabilitation Objectives

Reduce inflammation.
Relax muscle spasms.
Strengthen weakened muscles.
Improve joint mobility.

Individuals will be shown how to prevent the risk of sprains in the future. This includes:

Avoiding exercising when the body is tired
Wearing proper footwear and protective equipment
Warming up properly before exercise/physical activities.

Depending on the severity of the sprain, surgery could be the last resort to repair the ruptured or torn ligaments.

Body Composition

Realistic Goals

Not seeing results after putting in the work through exercise and diet can be frustrating. Setting realistic goals can help when results are not showing.

Realistic Fat Loss

Do not expect actual fat loss without being in a caloric deficit.
The body needs to use more energy than the amount of food/energy taken in; otherwise, excess energy/food gets stored, primarily as adipose tissue.
Total Daily Energy Expenditure or TDEE is necessary to set a realistic caloric deficit to achieve measurable fat loss.
There are caloric deficit variations, but most doctors, dieticians, trainers, and fitness experts agree that a caloric deficit of around 500 calories a day that equals to about 3,500 calories a week will result in a pound of fat loss per week.
One pound of fat a week lost might seem slow, but the one pound of fat is a real pound removed.
The long-term goal is not to fall back into unhealthy habits and develop and maintain new healthy ones.

References

Brantingham JW, Globe GA, Cassa TK, et al. A single-group pretest posttest design using full kinetic chain manipulative therapy with rehabilitation in the treatment of 18 patients with hip osteoarthritis. Journal of Manipulative and Physiological Therapy 2012; 33(6): 445-57.

Kamali, Fahimeh and Esmaeil Shokri. The effect of two manipulative therapy techniques and their outcome in patients with the sacroiliac joint syndrome. Journal of Bodywork and Movement Therapies. 2012; 16: 29-35.

McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. Manipulation or microdiscectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics. 2010; 33(8): 576-584.

Tibor, Lisa M, and Jon K Sekiya. “Differential diagnosis of pain around the hip joint.” Arthroscopy: the journal of arthroscopic & related surgery: official publication of the Arthroscopy Association of North America and the International Arthroscopy Association vol. 24,12 (2008): 1407-21. doi:10.1016/j.arthro.2008.06.019

Wedro, Benjamin. “Hip Pain: Causes, Symptoms, Treatment Information and Diagnosis-eMedicineHealth.” http://www.emedicinehealth.com/hip_pain/article_em.htm.

Infections of The Spine: Symptoms, Risks, Diagnosis

by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Spinal Hygiene

Anyone from young children, adults, and the elderly can get a spinal infection. Individuals can have an infection:

In vertebral bone tissue
An intervertebral disc
The spinal canal – space where the spinal cord runs through
The spinal cord’s protective lining

These types of infections can happen anywhere along the spine, from the atlas at the base of the neck to the coccyx all the way to the lowest part of the back. Individuals should expect unpredictability if dealing with a spinal infection. During testing, lab results could be misleading or inaccurate. What can happen is white blood cell counts are normal, X-rays might not show any abnormalities, and sensitive diagnostic tests like a CT or MRI scan might not show positivity of infection for a week or more. What to know about spinal infections.

Spinal Infection Types

They are classified according to the type of tissue they infect. The most common include:

Vertebral Osteomyelitis

This is a common infection type. Bacteria most often cause the cause. It can develop after trauma to the spine, post-surgery, or bacterial infections located in other body parts that travel via the blood to the vertebra. Symptoms include:

Persistent, chronic back pain that can become severe worsens at night and becomes aggravated from moving.
The pain radiates/spreads into the arms and legs
Tingling, numbness, and burning sensations
Inflammation
Fever
Weight loss
Vomiting
Post-surgery wound drainage, redness, and swelling near the surgical site

Treatment includes:

Intravenous antibiotics
Antibiotics
Over-the-counter analgesics like nonsteroidal anti-inflammatory meds for pain relief.
Prescription pain medications
Back brace
Surgery is recommended if antibiotic treatment fails, nerve damage develops, a spinal deformity develops, or to remove infected bone and/or soft tissues.

Discitis

This type of infection develops between the intervertebral discs. It is also rare, but it is more common in children and adolescents, but it can still happen in adults. Discitis can be potentially deadly, despite advanced treatment. The most common causes are bacterial and viral infections.

The Staphylococcus aureus bacterium, known as staph, is the most common microbe that can cause discitis.
Other forms of staph that cause discitis include:
E. coli
Salmonella
Strep
Fungi
Autoimmune disorders

Symptoms
Individuals with discitis can present with minimal symptoms when the infection initializes, but it does worsen and can cause:

Abdominal pain and discomfort
Posture changes
Mobility issues
Difficulty performing everyday tasks
Fever
Severe back pain that worsens at night or by moving

Treatment options include:

Antibiotics
Anti-inflammatory medications
Supportive devices
Rest
Steroids to alleviate inflammation in chronic and severe cases
Severe cases could require surgery to restructure areas of the affected spine to improve function and mobility

Epidural Abscess

This is an infection that can develop in the spaces between the bones of the spine, the skull, or soft tissues surrounding the brain and spinal cord. This is a medical emergency that needs to be addressed immediately. The infection is often caused by a bacterial or fungal infection in or around the affected area. This is commonly a Staphylococcus aureus bacteria. In some cases, an abscess can develop from an infection in another part of the body. This could be a urinary tract infection that spreads out to the spine. Symptoms include:

Inflammation and swelling
Mid to low back pain
Headache
Fever
Nausea and/or vomiting
Neurological weakness, numbness in the arms and legs, bowel or bladder incontinence
Walking problems

Treatment consists of intravenous antibiotics to combat the infection that caused the abscess. In some cases, if there is difficulty moving around or are experiencing numbness, then surgery is required to drain the abscess or completely remove it.

Risk Factors

Spine infections can affect anyone. However, there are individuals with certain chronic health problems that have an increased risk. They include those with:

Kidney disease
Liver disease
Auto-immune diseases
Immune systems compromised like cancer and HIV
Individuals that have undergone a spinal surgical procedure are at greater risk post-surgery

Risk factors include:

Individuals that have had a spinal infection could be more susceptible to developing another.
Age – older adults
Malnutrition
Diabetes mellitus
Obesity
Smoking
Intravenous drug use
Certain areas of the back are more prone to infection. This includes the cervical/back of the neck and the lumbar/low back.

Surgical risk factors:

Long surgical procedure
Massive loss of blood
Multiple surgeries of the same area