ClickCease
+1-915-850-0900 [email protected]
Select Page
Q/Quadriceps Angle Knee Injuries In Women Athletes

Q/Quadriceps Angle Knee Injuries In Women Athletes

The Q or quadriceps angle is a measurement of pelvic width that is believed to contribute to the risk of sports injuries in women athletes. Can non-surgical therapies and exercises help rehabilitate injuries?

Q/Quadriceps Angle Knee Injuries In Women Athletes

Quadriceps Q – Angle Injuries

The Q angle is the angle where the femur/upper leg bone meets the tibia/lower leg bone. It is measured by two intersecting lines:

  • One from the center of the patella/kneecap to the anterior superior iliac spine of the pelvis.
  • The other is from the patella to the tibial tubercle.
  • On average the angle is three degrees higher in women than men.
  • Average 17 degrees for women and 14 degrees for men. (Ramada R Khasawneh, et al., 2019)
  • Sports medicine experts have linked a wider pelvis to a larger Q-angle. (Ramada R Khasawneh, et al., 2019)

Women have biomechanical differences that include a wider pelvis, making it easier to give birth. However, this difference can contribute to knee injuries when playing sports, as an increased Q angle generates more stress on the knee joint, as well as leading to increased foot pronation.

Injuries

Various factors can increase the risk of injury, but a wider Q angle has been linked to the following conditions.

Patellofemoral Pain Syndrome

  • An increased Q angle can cause the quadriceps to pull on the kneecap, shifting it out of place and causing dysfunctional patellar tracking.
  • With time, this can cause knee pain (under and around the kneecap), and muscle imbalance.
  • Foot orthotics and arch supports could be recommended.
  • Some researchers have found a link, while others have not found the same association. (Wolf Petersen, et al., 2014)

Chondromalacia of the Knee

  • This is the wearing down of the cartilage on the underside of the kneecap.
  • This leads to degeneration of the articular surfaces of the knee. (Enrico Vaienti, et al., 2017)
  • The common symptom is pain under and around the kneecap.

ACL Injuries

  • Women have higher rates of ACL injuries than men. (Yasuhiro Mitani. 2017)
  • An increased Q angle can be a factor that increases stress and causes the knee to lose its stability.
  • However, this remains controversial, as some studies have found no association between the Q angle and knee injuries.

Chiropractic Treatment

Strengthening Exercises

  • ACL injury prevention programs designed for women have resulted in reduced injuries. (Trent Nessler, et al., 2017)
  • The vastus medialis obliquus or VMO is a teardrop-shaped muscle that helps move the knee joint and stabilize the kneecap.
  • Strengthening the muscle can increase the stability of the knee joint.
  • Strengthening may require a specific focus on muscle contraction timing.
  • Closed-chain exercises like wall squats are recommended.
  • Glute strengthening will improve stability.

Stretching Exercises

  • Stretching tight muscles will help relax the injured area, increase circulation, and restore range of motion and function.
  • Muscles commonly found to be tight include the quadriceps, hamstrings, iliotibial band, and gastrocnemius.

Foot Orthotics

  • Custom-made, flexible orthotics decrease the Q angle and reduce pronation, relieving the added stress on the knee.
  • A custom orthotic ensures that the foot and leg dynamics are accounted for and corrected.
  • Motion-control shoes can also help correct overpronation.

Knee Rehabilitation


References

Khasawneh, R. R., Allouh, M. Z., & Abu-El-Rub, E. (2019). Measurement of the quadriceps (Q) angle with respect to various body parameters in young Arab population. PloS one, 14(6), e0218387. https://doi.org/10.1371/journal.pone.0218387

Petersen, W., Ellermann, A., Gösele-Koppenburg, A., Best, R., Rembitzki, I. V., Brüggemann, G. P., & Liebau, C. (2014). Patellofemoral pain syndrome. Knee surgery, sports traumatology, arthroscopy: Official journal of the ESSKA, 22(10), 2264–2274. https://doi.org/10.1007/s00167-013-2759-6

Vaienti, E., Scita, G., Ceccarelli, F., & Pogliacomi, F. (2017). Understanding the human knee and its relationship to total knee replacement. Acta bio-medica : Atenei Parmensis, 88(2S), 6–16. https://doi.org/10.23750/abm.v88i2-S.6507

Mitani Y. (2017). Gender-related differences in lower limb alignment, range of joint motion, and the incidence of sports injuries in Japanese university athletes. Journal of Physical Therapy Science, 29(1), 12–15. https://doi.org/10.1589/jpts.29.12

Nessler, T., Denney, L., & Sampley, J. (2017). ACL Injury Prevention: What Does Research Tell Us? Current reviews in musculoskeletal medicine, 10(3), 281–288. https://doi.org/10.1007/s12178-017-9416-5

What Not To Do With Temporomandibular Joint Disorder

What Not To Do With Temporomandibular Joint Disorder

Temporomandibular joint disorder causes pain and jaw locking that can be worsened with certain activities. How individuals can manage and prevent flare-ups by learning what not to do to worsen the condition?

What Not To Do With Temporomandibular Joint Disorder

What Not To Do Temporomandibular Joint Disorder

Tenderness, aching, pain, and jaw locking are symptoms of temporomandibular joint disorder or TMJ. The temporomandibular joint connects the jaw to the skull. It is used daily for eating, drinking, and talking. It is a small disc in the joint that allows the jaw bones to slip and slide correctly. With TMJ, the disc shifts out of place, leading to clicking, snapping, and limited jaw movement. It can also cause pain in the jaw and face, neck pain, and headaches, and the muscles around the jaw and neck can become sore and/or go into spasm. Any type of activity that stresses or overworks the joint can trigger a flare-up and worsen TMJ symptoms. (Schiffman E, et al. 2014) This article looks at avoiding activities that make TMJ worse and what not to do to help keep TMJ symptoms in check.

Chewing Gum

  • Gum chewing is not recommended for individuals with TMJ.
  • The jaw is one of the most used joints in the body.
  • Limiting excessive use alleviates pressure allowing the joints and muscles to rest.
  • Resting sore muscles and joints is the first step in injury recovery.

Eating Chewy and Hard Foods

  • Chewy and hard foods make the jaw have to work overtime.
  • Avoid eating hard foods like chewy candies, hard and chewy breads, vegetables like corn on the cob, and fruits like apples.
  • These foods can place excessive stress on the jaw,  and prevent the joint from properly resting and healing.

Chewing Only On One Side

  • Many individuals chew their food on only one side of the mouth.
  • This can stress out one side of the temporomandibular joint and surrounding muscles, leading to pain and dysfunction. (Urbano Santana-Mora, et al., 2013)
  • Stay aware of chewing habits and make sure to utilize both sides of the mouth.
  • Individuals with dental issues or tooth pain are recommended to see a dentist.

Non-Functional Jaw Activities

  • Going through each day, individuals tend to do things unconsciously or out of habit.
  • For example, individuals:
  • Reading or writing might chew on a pen or pencil.
  • Bite their nails or chew on the inside of their mouth while watching TV or internet browsing.
  • These activities can place stress on the joint, worsen the condition, and extend the healing process.

Resting on The Chin

  • Individuals will rest their jaw in their hands while studying, on social media, or watching TV.
  • This position can be comfortable, but it can affect the jaw.
  • This position can build pressure against the side of the jaw and push against the joint, causing the disc to shift out of place affecting how the jaw opens and closes.
  • Breaking the chin resting habit can allow the joint to relax and heal correctly.

Teeth Clenching

  • Bruxism is the medical term for clenching the teeth.
  • This can occur during the day or during sleep.
  • Teeth clenching is often brought on by stress and can place incredible pressure on the jaw’s muscles and worsen TMJ.
  • A dentist can prescribe a mouth guard to be worn while sleeping to protect the teeth from excessive clenching. (Miriam Garrigós-Pedrón, et al., 2019)

Slouching

  • The function of the jaw is closely related to body posture.
  • The jaw operates optimally when the head is above the cervical spine and the posture is upright.
  • Slouching can change how the jaw muscles work and the way the jaw opens and closes.
  • Part of physical therapy for TMJ is working on posture adjustments and training.
  • This can involve strengthening the back and shoulder muscles and setting up posture reminders.
  • Sitting and standing correctly can keep the jaw operating properly.

Postponing Treatment

  • Many with musculoskeletal issues and symptoms wait for the pain to go away.
  • Individuals having problems with their jaw should not wait to get treatment.
  • TMJ has a positive rate of recovery with conservative treatment, which is all the more reason to seek treatment. (G Dimitroulis. 2018)
  • A dentist or healthcare provider can provide an accurate diagnosis if TMJ is suspected.
  • Individuals can benefit from visiting a physical therapist to learn exercises and strategies to self-treat the condition. (Yasser Khaled, et al., 2017)

Treatment

Treatment can involve:

  • Initial treatment focuses on pain relief and jaw function opens and closes improvement.
  • Exercises to get the jaw moving normally.
  • Joint mobilizations.
  • Treatments to maintain proper muscle function. (Amira Mokhtar Abouelhuda, et al., 2018)
  • A guard can help with night teeth grinding/bruxism.
  • Anti-inflammatory treatments.
  • In severe cases, surgery may be recommended to correct the problem, as a last resort. (Meghan K Murphy, et al., 2013)
  • Follow recommendations on what not to do and avoid certain activities.

Quick Patient Initiation


References

Schiffman, E., Ohrbach, R., Truelove, E., Look, J., Anderson, G., Goulet, J. P., List, T., Svensson, P., Gonzalez, Y., Lobbezoo, F., Michelotti, A., Brooks, S. L., Ceusters, W., Drangsholt, M., Ettlin, D., Gaul, C., Goldberg, L. J., Haythornthwaite, J. A., Hollender, L., Jensen, R., … Orofacial Pain Special Interest Group, International Association for the Study of Pain (2014). Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. Journal of oral & facial pain and headache, 28(1), 6–27. https://doi.org/10.11607/jop.1151

Santana-Mora, U., López-Cedrún, J., Mora, M. J., Otero, X. L., & Santana-Penín, U. (2013). Temporomandibular disorders: the habitual chewing side syndrome. PloS one, 8(4), e59980. https://doi.org/10.1371/journal.pone.0059980

Garrigós-Pedrón, M., Elizagaray-García, I., Domínguez-Gordillo, A. A., Del-Castillo-Pardo-de-Vera, J. L., & Gil-Martínez, A. (2019). Temporomandibular disorders: improving outcomes using a multidisciplinary approach. Journal of multidisciplinary healthcare, 12, 733–747. https://doi.org/10.2147/JMDH.S178507

Dimitroulis G. (2018). Management of temporomandibular joint disorders: A surgeon’s perspective. Australian Dental Journal, 63 Suppl 1, S79–S90. https://doi.org/10.1111/adj.12593

Khaled Y, Quach JK, Brennan MT, NapeÑas JJ. Outcomes after physical therapy for the treatment of temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol, 2017;124(3: e190. doi:10.1016/j.oooo.2017.05.477

Abouelhuda, A. M., Khalifa, A. K., Kim, Y. K., & Hegazy, S. A. (2018). Non-invasive different modalities of treatment for temporomandibular disorders: a review of the literature. Journal of the Korean Association of Oral and Maxillofacial Surgeons, 44(2), 43–51. https://doi.org/10.5125/jkaoms.2018.44.2.43

Murphy, M. K., MacBarb, R. F., Wong, M. E., & Athanasiou, K. A. (2013). Temporomandibular disorders: a review of etiology, clinical management, and tissue engineering strategies. The International journal of oral & maxillofacial implants, 28(6), e393–e414. https://doi.org/10.11607/jomi.te20

Bananas and Stomach Pain

Bananas and Stomach Pain

Should individuals with existing gastrointestinal problems eat bananas?

Bananas and Stomach Pain

Bananas

  • Bananas can be easy to digest and are often recommended for nausea and diarrhea, however, not everyone can tolerate them. (MedlinePlus. 2021)
  • Bananas are high in fructose, sorbitol, and soluble fiber, which makes them a common trigger for gastrointestinal problems.
  • Additionally, individuals not used to eating a high-fiber diet may find it helpful to gradually increase fiber and drink more water to alleviate unpleasant symptoms.
  • If there is a suspicion of intolerance, IBS, or malabsorption, it is recommended to speak with a healthcare provider for an evaluation.
  • Bananas can make the stomach hurt due to:
  • Irritable bowel syndrome (IBS)
  • Cramping
  • Gas
  • Bloating
  • Other gastrointestinal (GI) problems.
  • Individuals can experience stomach discomfort if there is a fructose intolerance or a rare banana allergy.

Stomach Pain

  • Bananas are used to replenish potassium and other essential nutrients lost from vomiting or diarrhea.
  • Some individuals can experience bloating and gas after eating them.
  • One reason is because of their soluble fiber content.
  • Soluble fiber dissolves in water and is more readily fermented in the colon than insoluble fiber.
  • This can lead to gas and bloating. (Jackson Siegelbaum Gastroenterology. 2018)
  • Bananas also contain sorbitol – a naturally occurring sugar that acts as a laxative and can cause gas, bloating, and diarrhea when consumed in large amounts. (U.S. Food and Drug Administration. 2023)

Irritable Bowel Syndrome – IBS

  • Bananas can be a common trigger food for individuals with IBS.
  • This is because as bananas break down in the stomach, they can generate excess gas. (Bernadette Capili, et al., 2016)
  • Bananas are also high in fructose/simple sugar especially when they have overripened.
  • Individuals who have IBS are advised to avoid bananas because they can trigger many of the same side effects as undigested lactose/sugar in milk. (Johns Hopkins Medicine. 2023)
  • Ripe bananas are considered to be high in FODMAPS – fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.
  • Individuals following a low FODMAP diet to manage IBS may want to avoid or limit consumption.
  • Unripe bananas are considered to be low-FODMAP food. (Monash University. 2019)

Allergy

  • Banana allergies are rare and affect less than 1.2% of the global population.
  • Many individuals with a banana allergy are also allergic to pollen or latex because of similar protein structures. (Dayıoğlu A, et al., 2020)
  • An individual with a banana allergy may experience wheezing, narrowing of the throat, or hives within minutes of eating.
  • They can also experience nausea, abdominal pain, vomiting, and diarrhea. (Family Medicine Austin. 2021)

Fructose Intolerance

  • An individual with fructose intolerance has difficulty digesting fructose.
  • Individuals with this intolerance should restrict or limit fructose. (UW School of Medicine and Public Health. 2019)
  • Fructose malabsorption is when the body cannot digest or absorb fructose correctly. This causes bloating gas and abdominal discomfort.
  • Hereditary fructose intolerance is very rare. It happens when the liver cannot assist in the breakdown of fructose.
  • This condition often causes more severe symptoms and requires additional treatment besides removing fructose from an individual’s diet. (UW School of Medicine and Public Health. 2019)
  • Most can tolerate small amounts of fructose found in fruits like bananas.
  • There is often more difficulty tolerating large fructose amounts found in honey and high fructose corn syrup. (UW School of Medicine and Public Health. 2019)

Prevent GI Symptoms

  • If experiencing gas, bloating, or abdominal discomfort after eating bananas, consider limiting the portion size.
  • For example, instead of eating one or more bananas a day, try eating half of a banana to see if symptoms resolve.
  • Alternatively, if there is a belief that there is fructose malabsorption, try temporarily removing all high-fructose foods.
  • If the body begins to feel better, slowly add foods that contain fructose.
  • This can help you pinpoint the foods that are causing the problem. (UW School of Medicine and Public Health. 2019)
  • If you’re eating bananas that are too green or unripe, you may also experience stomach discomfort.
  • Unripened bananas contain high amounts of resistant starch. In large quantities, this can cause mild symptoms like gas and bloating. (Jennifer M Erickson, et al., 2018)
  • Resistant starch ferments slowly, so it usually does not cause as much gas as other fiber types. (The Johns Hopkins Guide to Diabetes. 2020)
  • Ripe or cooked bananas have less starch and more simple sugars, making them easier to digest. (University of Hawaii. 2006)
  • Drinking more water and gradually increasing fiber intake can also reduce GI side effects. (The Johns Hopkins Guide to Diabetes. 2020)

Gut Dysfunction


References

MedlinePlus. Bananas and nausea.

Jackson Siegelbaum Gastroenterology. Colon gas and flatus prevention.

U.S. Food and Drug Administration. Sorbitol.

Capili, B., Anastasi, J. K., & Chang, M. (2016). Addressing the Role of Food in Irritable Bowel Syndrome Symptom Management. The journal for nurse practitioners: JNP, 12(5), 324–329. https://doi.org/10.1016/j.nurpra.2015.12.007

Johns Hopkins Medicine. 5 foods to avoid if you have IBS.

Monash University. Bananas re-tested.

Dayıoğlu A, Akgiray S, Nacaroğlu HT, Bahçeci Erdem S. The clinical spectrum of reactions due to banana allergy. BMB. 2020;5(2):60-63. doi: 10.4274/BMB.galenos.2020.04.013

Family Medicine Austin. Banana allergy.

UW School of Medicine and Public Health. Fructose-restricted diet.

Erickson, J. M., Carlson, J. L., Stewart, M. L., & Slavin, J. L. (2018). The Fermentability of Novel Type-4 Resistant Starches in In Vitro System. Foods (Basel, Switzerland), 7(2), 18. https://doi.org/10.3390/foods7020018

The Johns Hopkins Guide to Diabetes. What is resistant starch?

The University of Hawaii. Cooking banana.

Upper Crossed Syndrome Muscle Health

Upper Crossed Syndrome Muscle Health

Can musculoskeletal therapies treat individuals with upper crossed syndrome to relieve pain, improve posture, and strengthen the muscles in the neck, shoulders and chest?

Upper Crossed Syndrome Muscle Health

Upper Crossed Syndrome

Upper crossed syndrome is a condition in which the muscles of the shoulders, neck, and chest become weak and tight, and is usually brought on from practicing unhealthy posture. Symptoms typically include:

  • Neck stiffness and pulling sensations.
  • Jaw tension and/or tightness
  • Upper back tension, lack of flexibility, stiffness, and aching soreness.
  • Neck, shoulder, and upper back pain.
  • Tension headaches
  • Rounded shoulders
  • Hunched spine

Upper Crossed Syndrome and Posture

  • The condition affects healthy posture by creating imbalanced muscles between the upper back and chest.
  • The tight short muscles in the upper chest get overly stretched and remain in a semi-contracted state pulling on the back muscles.
  • This causes the muscles in the upper back, shoulders, and neck to get pulled and weaken.
  • The result is a hunched back, forward shoulders, and protruded neck.
  • The specific muscles affected include the trapezius and the levator scapula/side of the neck muscles. (Hospital for Special Surgery. 2023)

Individuals having back pain lasting two weeks or longer are recommended to consult a spine specialist or healthcare provider to examine and determine the cause of the pain symptoms. (National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2023)

Lingering Pain

  • The imbalances in muscle activation and movement and unhealthy posture all contribute to the symptoms.
  • The syndrome is characterized by chronic stiffness, tension, pain, and increasing immobility of the chest and shoulder muscles.
  • Over time the tightness and pulling, combined with weakness can lead to shoulder joint damage. (Seidi F, et al., 2020)

Causes

There are certain activities and jobs that can contribute to the development and worsening of the syndrome. Factors that worsen symptoms include: (National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2023) – (Seidi F, et al., 2020)

  • Physical trauma/injury to any of the muscle regions.
  • Occupations with high amounts of physical exertion, heavy lifting, and injury risks.
  • Practicing incorrect postures and positioning.
  • Jobs requiring extended periods of sitting and/or standing.
  • Inactivity and/or sedentary lifestyle.
  • Over athletic activity.
  • Smoking.

However, the syndrome is preventable and manageable.

Therapies

Working with a chiropractor and physical massage therapy team can help determine and develop a personalized treatment plan that is the most effective and suitable. A chiropractic and physical therapist will provide several options, which can include: (Cedars-Sinai. 2022) – (National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2023) – (Bae WS, et al., 2016)

  • Bracing
  • Massage therapy to increase circulation, relax, and retrain the muscles.
  • Chiropractic adjustments for spinal realignment and posture retraining.
  • Non-surgical mechanical traction and decompression therapy.
  • Kinesiology taping – recovery and preventive.
  • Posture retraining.
  • Muscle movement training.
  • Exercises targeting soft tissues and joints.
  • Core strengthening.
  • Steroid injections to a specific area.
  • Prescription anti-inflammatory medication for pain symptoms – short-term.
  1. Individuals may be advised by the chiropractic therapy team to avoid too much bed rest and to limit or avoid activities that can cause pain or worsen symptoms. (Cedars-Sinai. 2022)
  2. Studies have shown chiropractic spinal manipulation effectively reduces neck, spine, and low back pain symptoms. (Gevers-Montoro C, et al., 2021)

Self Management

There are ways to self-manage upper-crossed syndrome and associated symptoms. Common techniques include: (National Institute of Neurological Disorders and Stroke. 2023) – (National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2023)

  • Practicing correct posture.
  • Increasing or decreasing physical activity as recommended by the therapy team.
  • Using ice or heat packs to relieve pain and increase circulation to promote muscle rehabilitation and healing.
  • Using topical pain creams or gels.
  • Over-the-counter nonsteroidal – NSAIDs, like Advil or Motrin and Aleve.
  • Muscle relaxants to relieve tension short-term.

Enhance Your Lifestyle


References

Hospital for Special Surgery. Move with the purpose to combat upper and lower crossed syndromes.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Back pain.

Seidi, F., Bayattork, M., Minoonejad, H., Andersen, L. L., & Page, P. (2020). Comprehensive corrective exercise program improves alignment, muscle activation, and movement pattern of men with upper crossed syndrome: a randomized controlled trial. Scientific reports, 10(1), 20688. https://doi.org/10.1038/s41598-020-77571-4

Bae, W. S., Lee, H. O., Shin, J. W., & Lee, K. C. (2016). The effect of middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises in upper crossed syndrome. Journal of physical therapy science, 28(5), 1636–1639. https://doi.org/10.1589/jpts.28.1636

National Institute of Neurological Disorders and Stroke. Back pain.

Cedars-Sinai. Back and neck pain.

Gevers-Montoro, C., Provencher, B., Descarreaux, M., Ortega de Mues, A., & Piché, M. (2021). Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain. Frontiers in pain research (Lausanne, Switzerland), 2, 765921. https://doi.org/10.3389/fpain.2021.765921

Terms For Nerve Pain: Radiculopathy, Radiculitis, Neuritis

Terms For Nerve Pain: Radiculopathy, Radiculitis, Neuritis

 Are treatments more successful when patients know key terms that describe their back pain and associated conditions?

Terms For Nerve Pain: Radiculopathy, Radiculitis, Neuritis

Nerve Pain Types

When individuals need to better understand their spine diagnosis, being able to distinguish between key terms can make a significant difference in understanding the development of a personalized treatment plan. Terms that describe back pain and various associated conditions can include:

  • Sciatica
  • Radiating and Referred pain
  • Radiculopathy
  • Radiculitis
  • Neuropathy
  • Neuritis

Causes of Back Pain

Back pain symptoms are most commonly caused by the continued practice of unhealthy/poor posture and overcompensated and weakened muscles. Even for individuals that exercise regularly, the movement choices that are made throughout the day can disrupt the way the muscles, tendons, ligaments, and fascia function to maintain proper body alignment.

  • Injuries to, and conditions of, the structures of the spinal column like the bones, discs, and nerves, are generally more serious than posture problems and soft tissue-related pain.
  • Depending on the diagnosis, structural problems can cause symptoms related to nerve compression, irritation, and/or inflammation. (Michigan Medicine, 2022)

Spine and Nervous System

  • The peripheral nerves extend out to the extremities with sensation and movement capabilities.
  • Nerve roots exit the spinal canal which is part of the peripheral nervous system.
  • The spinal nerve root then exits the spinal column through the foramen. (American Academy of Neurological Surgeons, 2023)
  • The branching of nerves from the spinal cord and exit out of the foramina occurs at every level of the spine.

Terms

There are different medical terms when getting a spine diagnosis or going through the treatment process.

Radiculopathy

  • Radiculopathy is an umbrella term, describing any disease process that affects a spinal nerve root and is something that’s happening to the body.
  • When a healthcare provider informs you that your pain is due to radiculopathy, a number of more specific diagnoses, clinical signs, and symptoms may be included as part of the description.
  • Common causes of radiculopathy include herniated disc/s and spinal stenosis.
  • Less common causes can include a synovial cyst or tumor that presses on the nerve root. (Johns Hopkins Medicine, 2023)
  • Radiculopathy can occur in the neck, low back, or in the thoracic area.
  • Often, radiculopathy is brought on by some form of compression of the nerve root.
  • For example, extruded material from a herniated disc can land on a nerve root, causing pressure to build.
  • This can cause symptoms associated with radiculopathy, including numbness, weakness, pain, or electrical sensations. (Johns Hopkins Medicine, 2023)

Even though there’s a spinal nerve root on either side of the spinal column, injury, trauma, or issues stemming from degeneration affect the nerves in an asymmetric fashion. Degenerative changes, known as normal wear and tear, typically occur in this fashion. Using the previous herniated disc example, the material that leaks from the disc structure tends to travel in one direction. When this is the case, the symptoms tend to be experienced on the side where the nerve root makes contact with the disc material, but not the other side. (American Association of Neurological Surgeons, 2023)

Radiculitis

  • Radiculitis is a form of radiculopathy but it is about inflammation and not compression. (Johns Hopkins Medicine, 2023)
  • Radicu– refers to the spinal nerve root.
  • The suffix  – itis refers to inflammation.
  • The word refers to a spinal nerve root that is inflamed and/or irritated rather than compressed.
  • In disc herniations, it is the gel substance that contains various chemicals that is inflammatory.
  • When the gel substance makes contact with nerve roots, an inflammatory response is triggered. (Rothman SM, Winkelstein BA 2007)

Radiating or Referred Pain

  • Radiating pain follows the path of one of the peripheral nerves that transmit sensory information like heat, cold, pins and needles, and pain.
  • The most common cause of radiating pain is impingement/compression of a spinal nerve root. (American Academy of Orthopaedic Surgeons. OrthoInfo)
  • Referred pain is experienced in a different area of the body that is away from the pain source which tends to be an organ. (Murray GM., 2009)
  • It can be brought on by myofascial trigger points or visceral activity.
  • An example of referred pain is symptoms in the jaw or arm when an individual is having a heart attack. (Murray GM., 2009)

Radicular

  • The terms radicular pain and radiculopathy tend to get confused.
  • Radicular pain is a symptom of radiculopathy.
  • Radicular pain radiates from the spinal nerve root to either part or all the way down the limb/extremity.
  • However, radicular pain does not represent the complete symptoms of radiculopathy.
  • Radiculopathy symptoms also include numbness, weakness, or electrical sensations like pins and needles, burning, or shock that travels down the extremity. (Johns Hopkins Medicine, 2023)

Neuropathy

  • Neuropathy is another umbrella term that refers to any dysfunction or disease that affects the nerves.
  • It’s usually classified according to the cause, like diabetic neuropathy, or the location.
  • Neuropathy can occur anywhere in the body – including the peripheral nerves, the autonomic nerves/organ nerves, or nerves that are located inside the skull and innervate the eyes, ears, nose, etc.
  • An example of peripheral neuropathy is carpal tunnel syndrome. (American Academy of Orthopaedic Surgeons. OrthoInfo. 2023)
  • One spinal condition that is known to cause peripheral neuropathy is spinal stenosis. (Bostelmann R, Zella S, Steiger HJ, et al., 2016)
  • In this condition, changes in the foramina have a narrowing effect on the space that begins to compress the nerves as they exit.
  • Neuropathy can affect just one nerve or many nerves simultaneously.
  • When multiple nerves are involved it is known as polyneuropathy.
  • When it’s just one, it’s known as mononeuropathy. (Cleveland Clinic. 2023)

Neuritis

Sciatica

  • Sciatica describes symptoms that include radiating pain and sensations that travel into the hip, buttock, leg, and foot.
  • One of the most common causes of sciatica is radiculopathy.
  • Another is spinal stenosis. (Cleveland Clinic. 2023)
  • Piriformis syndrome is where a tight buttock/piriformis muscle constricts the sciatic nerve, which runs underneath. (Cass SP. 2015)

Chiropractic

Chiropractic adjustments, non-surgical decompression, MET, and various massage therapies can relieve symptoms, release stuck or trapped nerves and restore function. Through the treatments, the chiropractor and therapists will explain what is happening and why they are using a specific technique. Knowing a little about how the neuromusculoskeletal system operates can help the healthcare provider and the patient in developing and adjusting effective treatment strategies.


Sciatica During Pregnancy


References

Michigan Medicine. Upper and Middle Back Pain.

American Academy of Neurological Surgeons. Anatomy of the Spine and Peripheral Nervous System.

Johns Hopkins Medicine. Health Conditions. Radiculopathy.

American Association of Neurological Surgeons. Herniated Disc.

American Academy of Orthopaedic Surgeons. OrthoInfo. Cervical Radiculopathy (Pinched Nerve).

Rothman, S. M., & Winkelstein, B. A. (2007). Chemical and mechanical nerve root insults induce differential behavioral sensitivity and glial activation that are enhanced in combination. Brain Research, 1181, 30–43. https://doi.org/10.1016/j.brainres.2007.08.064

Murray G. M. (2009). Guest Editorial: referred pain. Journal of applied oral science: Revista FOB, 17(6), i. https://doi.org/10.1590/s1678-77572009000600001

American Academy of Orthopaedic Surgeons. OrthoInfo. Carpal Tunnel Syndrome.

Bostelmann, R., Zella, S., Steiger, H. J., & Petridis, A. K. (2016). Could Spinal Canal Compression be a Cause of Polyneuropathy? Clinics and practice, 6(1), 816. https://doi.org/10.4081/cp.2016.816

Cleveland Clinic. Mononeuropathy.

American Association of Neurological Surgeons. Glossary of Neurosurgical Terminology.

National Institutes of Health. U.S. National Library of Medicine. Medline Plus. Peripheral Nerve Disorders.

Cleveland Clinic. Spinal Stenosis.

Cass S. P. (2015). Piriformis syndrome: a cause of non-discogenic sciatica. Current sports medicine reports 14(1), 41–44. https://doi.org/10.1249/JSR.0000000000000110

Head Pressure

Head Pressure

Can chiropractic treatment protocols diagnose what’s causing head pressure in individuals, and provide effective treatment?

Head Pressure

Head Pressure

Head pressure can have various causes and symptoms that affect different areas depending on whether the cause is a headache, allergies, injury, illness, or disease. The location of the pressure or pain can help a doctor of chiropractic determine the cause.

  • The underlying factor is usually not life-threatening, but the pressure that has built can be the result of serious conditions like a head injury or brain tumor.
  • Chiropractic ​care, which includes a combination of spinal manipulation, active and passive exercises, and massage, is often used for headache management and prevention. (Moore Craig, et al., 2018)
  • Chiropractic therapy is often sought out for tension and cervicogenic headaches, migraines, and each responds differently to the treatment.

The Head

  • The head is made up of a complex system of lobes, sinuses/channels, blood vessels, nerves, and ventricles. (Thau L, et al., 2022)
  • The pressure of these systems is regulated and any disruption to this balance can be noticeable.
  • Diagnosis can be difficult to figure out what is causing discomfort or head pressure.
  • Pain, pressure, irritability, and nausea are all symptoms that can occur with headaches. (Rizzoli P, Mullally W. 2017)

Location

  • Head pressure in more than one spot is possible with a migraine or a severe cold. (American Migraine Foundation 2023)
  • Pain can present in more than one area if there has been a head injury.
  • If the pressure is more specific in a certain region, it can help provide clues about the cause of the symptoms.
  • Medical issues can cause pressure in different areas. (Rizzoli P, Mullally W. 2017)
  • An example is a sinus infection which can cause pressure under the eyes and around the nose.
  • A migraine or tension headache can present as: (MedlinePlus. Migraine 2021)
  • A tight band around the head.
  • Pain or pressure behind the eyes.
  • Stiffness and pressure in the back of the head and/or neck.

Causes of Pressure

The root cause of the problem is not always clear. There can be a number of potential causes.

Tension Headache

Tension headaches are the most common that feels like pressure squeezing the head. They usually develop because of tightening scalp muscles caused by:

  • Stress
  • Depression
  • Anxiety
  • Head injuries
  • Unusual positioning of the head or illness can cause tension headaches.

Other than muscle tension, tension headaches can develop from: (MedlinePlus. Tension headache.)

  • Physical stress
  • Emotional stress
  • Eye strain
  • Fatigue
  • Overexertion
  • Overuse of caffeine
  • Caffeine withdrawal
  • Over alcohol use
  • Sinus infections
  • A cold or flu
  • Smoking
  • Tension headaches can also run in families. (MedlinePlus. Tension headache.)

Sinus Headache

  • A sinus headache – rhinosinusitis – is caused by a viral or bacterial infection in the sinus cavities. (American Migraine Foundation 2023)
  • There are sinus cavities on each side of the nose, between the eyes, in the cheeks, and on the forehead.
  • The location of where these headaches cause pressure varies, depending on which sinuses are infected. (Cedars Sinai. Sinus Conditions and Treatments)
  • Sinus infection headaches are obvious from the discolored nasal drainage.
  • Individuals can have facial pain and pressure, lose their sense of smell, or have a fever. (American Migraine Foundation 2023)

Ear Conditions

  • The ears help the body sense movement and balance.
  • A problem in the inner ear that helps control balance can cause a type of migraine known as a vestibular migraine. (American Speech-Language-Hearing Association)
  • This type of migraine doesn’t always present with pain symptoms.
  • Problems with balance and feelings of vertigo/sense of spinning are common with these types of migraines. (American Migraine Foundation)
  • An ear infection can also cause feelings of head pressure and/or pain.
  • Infections can cause pressure to build on the delicate structures of the middle and inner ear.
  • These infections are usually caused by viral illness or bacteria. (FamilyDoctor.org)

Neurological Causes

  • Neurological diseases and conditions can lead to increased pressure in the head.
  • The pain symptoms depend on the specific cause.
  • For example, a stroke can affect the whole head, while decreased brain fluid levels may affect just the base of the skull.
  • The latter condition is known as intracranial hypertension which means increased pressure in the brain. (Schizodimos, T et al., 2020)
  • For some individuals, there is no clear cause, this is known as idiopathic intracranial hypertension. (Wall, Michael. 2017) (National Health Service 2023)

Other causes of increased intracranial pressure include:

Other

  • Head pressure can also occur only at times when standing up, bending down to pick up an object, or otherwise changing posture in some way that blood pressure is affected.

Chiropractic Treatment

The Injury Medical team will develop a personalized treatment plan to help relieve pressure symptoms through a multidisciplinary approach that can include. (Moore Craig, et al., 2018)

  • Spinal manipulation
  • Low-load craniocervical mobilization
  • Joint mobilization
  • Decompression
  • Deep neck flexion exercises
  • Neuromuscular massage
  • Physical therapy exercises
  • Relaxation techniques
  • Stress management
  • Nutritional recommendations

Multidisciplinary Evaluation and Treatment


References

Moore, C., Leaver, A., Sibbritt, D., & Adams, J. (2018). The management of common recurrent headaches by chiropractors: a descriptive analysis of a nationally representative survey. BMC neurology, 18(1), 171. https://doi.org/10.1186/s12883-018-1173-6

Thau, L., Reddy, V., & Singh, P. (2022). Anatomy, Central Nervous System. In StatPearls. StatPearls Publishing.

Rizzoli, P., & Mullally, W. J. (2018). Headache. The American journal of medicine, 131(1), 17–24. https://doi.org/10.1016/j.amjmed.2017.09.005

American Migraine Foundation. Is it a migraine or a sinus headache?

MedlinePlus. Migraine.

MedlinePlus. Tension headache.

Cedars Sinai. Sinus conditions and treatments.

American Speech-Language-Hearing Association. Dizziness and balance.

American Migraine Foundation. What to know about vestibular migraine.

FamilyDoctor.org. Ear infection.

Schizodimos, T., Soulountsi, V., Iasonidou, C., & Kapravelos, N. (2020). An overview of the management of intracranial hypertension in the intensive care unit. Journal of Anesthesia, 34(5), 741–757. https://doi.org/10.1007/s00540-020-02795-7

Wall M. (2017). Update on Idiopathic Intracranial Hypertension. Neurologic Clinics, 35(1), 45–57. https://doi.org/10.1016/j.ncl.2016.08.004

National Health Service. Intracranial hypertension.

National Institute of Neurological Disorders and Stroke. Hydrocephalus. https://www.ninds.nih.gov/health-information/disorders/hydrocephalus

Black Pepper Health Benefits

Black Pepper Health Benefits

Should individuals increase their intake of black pepper to help with various health issues like fighting inflammation, strengthening the immune system, and improving digestion?

Black Pepper Health Benefits

Black Pepper

One of the most popular spices, black pepper offers anti-inflammatory and pain-reducing effects. Piperine is the compound that gives black pepper its flavor, helps prevent inflammation, (Gorgani Leila, et al., 2016), and helps to increase the absorption of selenium, vitamin B12, and turmeric. (Dudhatra GB, et al., 2012) Piperine has been found to be almost as effective as prednisolone – a common medication for arthritis – in reducing symptoms.

  • Black pepper has been used in ancient Ayurvedic medicine for thousands of years because of its concentration of beneficial plant compounds. (Johns Hopkins Medicine, 2023)
  • Pepper is made by grinding peppercorns, which are dried berries from the vine Piper nigrum.
  • The plant is a tall woody plant with small flowers that bloom a yellowish-red color.
  • It has a sharp and mildly spicy flavor that goes with all kinds of dishes.

Nutrition

The following nutrition is for 1 tablespoon of black pepper. (USDA, FoodData Central)

  • Calories – 17
  • Fat – 0.2g
  • Carbohydrates – 4.4g
  • Sodium – 1.38mg
  • Fiber – 1.8g
  • Sugars – 0g
  • Protein – 0.7g
  • Magnesium – 11.8mg
  • Vitamin K – 11.3mg
  • Calcium – 30.6mg
  • Iron – 0.7mg
  • Potassium – 91.7mg
  • Black pepper provides vitamin K, necessary for blood clotting, bone metabolism, and regulating blood calcium levels.
  • Additional vitamins include C, E, A, and B vitamins, calcium, and potassium. (Platel K, Srinivasan K., et al., 2016)

Benefits

Decrease Inflammation

Inflammation is the immune system’s response to injury, illness, or any mental or physical stressor, that triggers the body’s healing and repair process. However, long-term inflammation can lead to various health problems and, in individuals that begin to develop arthritis, joint degeneration. Damage to the body’s pain processors can exacerbate pain and other uncomfortable symptoms.

  • The main active component piperine, has been shown to decrease inflammation. (Kunnumakkara AB, et al., 2018)
  • Chronic inflammation can be a cause of diabetes, arthritis, asthma, and heart disease.
  • While the anti-inflammatory effects have not been extensively studied in humans, there are several mouse studies that show promising results.
  • In one study, treatment for arthritis with piperine resulted in less joint swelling and decreased inflammation markers. (Bang JS, Oh DH, Choi HM, et al., 2009)

Antioxidants

  • The active compound, piperine is rich in antioxidants, which prevent or delay the free radical damaging effects from exposure to pollution, smoke, and the sun.
  • Free radicals are associated with diseases like heart disease and cancer. (Lobo V., et al., 2010)
  • In one study, rats with a diet of concentrated black pepper had less free radical damage than a group that did not ingest concentrated black pepper. (Vijayakumar RS, Surya D, Nalini N. 2004)

Brain Function Improvement

  • Piperine has been shown to decrease symptoms associated with Parkinson’s and Alzheimer’s and improve brain function. (Ramaswamy Kannappan, et al., 2011)
    Studies show piperine increased memory as well as the ability to decrease the production of amyloid plaques, which are damaging proteins associated with Alzheimer’s disease.

Blood Sugar Control Improvement

  • Studies suggest that piperine can improve blood sugar and improve insulin sensitivity.
  • In one study, individuals with insulin resistance took a piperine supplement for 8 weeks.
  • After 8 weeks, improvements were seen in the response to the insulin hormone to remove glucose from the blood (Rondanelli M, et al., 2013)

Improved Nutrient Absorption

  • Black pepper is considered to have the ability to bind and activate with other foods for improved positive health effects.
  • It increases the absorption of certain nutrients such as calcium, turmeric, selenium, and green tea.
  • It is often recommended to consume calcium or selenium with a source of black pepper and to ensure any turmeric supplement you take contains black pepper. (Shoba G, et al., 1998)

Storage

  • Whole peppercorns sealed in a container and stored in a cool, dry place can last up to a year.
  • Over time ground black pepper loses its flavor, therefore it is recommended to use within 4 to 6 months.

Allergic Reactions

  • If you believe you are allergic to black pepper, see a healthcare professional who can perform testing to determine the root cause of symptoms.
  • Allergies can present as tingling or itching in the mouth, hives, abdominal pain, and possible nausea and vomiting.
  • Symptoms can also include wheezing, congestion, and/or swelling of the lips, tongue, mouth, and throat.
  • Black pepper can be substituted with spices like chili powder, cayenne pepper, and allspice.

The Healing Diet


References

Gorgani, L., Mohammadi, M., Najafpour, G. D., & Nikzad, M. (2017). Piperine-The Bioactive Compound of Black Pepper: From Isolation to Medicinal Formulations. Comprehensive reviews in food science and food safety, 16(1), 124–140. https://doi.org/10.1111/1541-4337.12246

Dudhatra, G. B., Mody, S. K., Awale, M. M., Patel, H. B., Modi, C. M., Kumar, A., Kamani, D. R., & Chauhan, B. N. (2012). A comprehensive review on pharmacotherapeutics of herbal bio-enhancers. TheScientificWorldJournal, 2012, 637953. https://doi.org/10.1100/2012/637953

Johns Hopkins Medicine. Ayurveda, 2023. https://www.hopkinsmedicine.org/health/wellness-and-prevention/ayurveda

USDA, FoodData Central. Spices, pepper, black.

Platel, K., & Srinivasan, K. (2016). Bioavailability of Micronutrients from Plant Foods: An Update. Critical reviews in food science and nutrition, 56(10), 1608–1619. https://doi.org/10.1080/10408398.2013.781011

Kunnumakkara, A. B., Sailo, B. L., Banik, K., Harsha, C., Prasad, S., Gupta, S. C., Bharti, A. C., & Aggarwal, B. B. (2018). Chronic diseases, inflammation, and spices: how are they linked? Journal of translational medicine, 16(1), 14. https://doi.org/10.1186/s12967-018-1381-2

Bang, J. S., Oh, D. H., Choi, H. M., Sur, B. J., Lim, S. J., Kim, J. Y., Yang, H. I., Yoo, M. C., Hahm, D. H., & Kim, K. S. (2009). Anti-inflammatory and antiarthritic effects of piperine in human interleukin 1beta-stimulated fibroblast-like synoviocytes and in rat arthritis models. Arthritis research & therapy, 11(2), R49. https://doi.org/10.1186/ar2662

Lobo, V., Patil, A., Phatak, A., & Chandra, N. (2010). Free radicals, antioxidants, and functional foods: Impact on human health. Pharmacognosy reviews, 4(8), 118–126. https://doi.org/10.4103/0973-7847.70902

Vijayakumar, R. S., Surya, D., & Nalini, N. (2004). Antioxidant efficacy of black pepper (Piper nigrum L.) and piperine in rats with high-fat diet-induced oxidative stress. Redox report: communications in free radical research, 9(2), 105–110. https://doi.org/10.1179/135100004225004742

Kannappan, R., Gupta, S. C., Kim, J. H., Reuter, S., & Aggarwal, B. B. (2011). Neuroprotection by spice-derived nutraceuticals: you are what you eat! Molecular neurobiology, 44(2), 142–159. https://doi.org/10.1007/s12035-011-8168-2

Rondanelli, M., Opizzi, A., Perna, S., Faliva, M., Solerte, S. B., Fioravanti, M., Klersy, C., Cava, E., Paolini, M., Scavone, L., Ceccarelli, P., Castellaneta, E., Savina, C., & Donini, L. M. (2013). Improvement in insulin resistance and favorable changes in plasma inflammatory adipokines after weight loss associated with two months’ consumption of a combination of bioactive food ingredients in overweight subjects. Endocrine, 44(2), 391–401. https://doi.org/10.1007/s12020-012-9863-0

Shoba, G., Joy, D., Joseph, T., Majeed, M., Rajendran, R., & Srinivas, P. S. (1998). Influence of piperine on the pharmacokinetics of curcumin in animals and human volunteers. Planta medica, 64(4), 353–356. https://doi.org/10.1055/s-2006-957450

Mastodon