Complex injuries occur when people experience severe or catastrophic injuries, or whose cases are more complex due to multiple trauma, psychological effects and pre-existing medical histories. Complex injuries can be serial injuries of the upper extremity, severe soft tissue trauma and concomitant (naturally accompanying or associated), injuries to vessels or nerves. These injuries go beyond the common sprain and strain and require a deeper level of assessment that may not be easily apparent. El Paso, TX’s Injury specialist, chiropractor, Dr. Alexander Jimenez discusses treatment options, as well as rehabilitation, muscle/strength training, nutrition and getting back to normal body functions. Our programs are natural and use the body’s ability to achieve specific measured goals, rather than introducing harmful chemicals, controversial hormone replacement, un-wanted surgeries, or addictive drugs. We want you to live a functional life that is fulfilled with more energy, positive attitude, better sleep, and less pain. Our goal is to ultimately empower our patients to maintain the healthiest way of living.
Achilles injury, which turns out to be a ruptured Achilles tendon.
This is a devasting injury for anyone, especially world-class athletes. Take NBA player Kevin Durant and his injury that could keep him out for some time. To be fair Durant was dealing with a calf injury on the same leg, for some weeks before this injury.
But it was his first game back in action and it led to a crushing injury!
Calf & Achilles Tendon Relationship
The calf and Achilles tendon are so interrelated that when one has an issue so does the other.
The fascia of these muscles segue ways to form the Achilles tendon.
If the calf is tight, then the Achilles is going to be tight.
The relationship between calf injury and an Achilles injury.
Cycle of Injury
Going through any area of the cycles can lead to a devastating injury.
Symptoms
Pain and stiffness around the lower leg, right above the back of the heel
Begins as a mild ache and worsens throughout the day
Jumping, running, stair climbing, and sprinting can spark intense pain
Tenderness or stiffness especially in the morning, but improves with movement/activity
The key is to intervene to stop the cycle.
A few ways:
Rest
Massage
Physical Therapy
Chiropractic
Custom orthotics
Active Release Therapy (ART)
ART is extremely effective for breaking up scar tissue and improving issues with soft tissues. Treatment can do a lot to improve the health of your tendon and the surrounding tissues to avoid further complications. It will also do a lot to help relieve the pain you are experiencing.
Chiropractic Adjustments/Manual Manipulations
Many times, the issues with your Achilles tendon are the result of misalignment in other parts of your body. When your joints are misaligned it tends to put extra stress on your feet and Achilles tendons. To minimize the stress on your joints, your chiropractor will adjust your spine and other joints to ensure proper alignment.
Get Help for Your Achilles Injury & Call Us Today!
If you are experiencing heel pain, please get in touch with our chiropractic team. We can help to alleviate your pain and help you avoid experiencing further problems with your Achilles tendon.
Difference Foot Orthotics Make to *REDUCE FOOT PAIN* & Correct Posture | El Paso, TX (2019)
Custom made foot orthotics can help control foot motion and posture. Healthcare professionals prescribe custom foot orthotics to help patients focus on their foot posture and mobility control. Research studies have ascertained that using custom foot orthotics for posture and mobility control can help fix excessive foot pronation and supination to prevent a variety of foot health problems. The subsequent video describes how custom foot orthotics will help control foot posture and mobility to improve health and wellness.
What’s Afoot
If you have low back pain or have had it, you are not alone. Experts estimate that around 80% of people will experience some type of back problem at some point in their lives. The Global Burden of Disease 2010 lists low back pain as the number one cause of disability worldwide. The good news is the majority of back pain is mechanical in origin or is not organic. This means that infection, cancer, fracture, inflammatory arthritis, and other serious conditions are not the cause. In fact, you may benefit by looking to your feet, knees, and hips as the culprits.
The large, thick tendon that travels up from the base of the heel and into the calf muscle is the Achilles tendon. It connects the calf muscle and heel. It allows you to walk, run and jump. The Achilles tendon is strong and durable, but it is possible to overwork it and cause enough overuse injury.
Asking questions is the best way to learn, of course, and chiropractic patients often ask questions about some of the health issues they face. Some chiropractic patients are curious about back problems, for example, because chiropractors are well known for being extremely knowledgeable when it comes to spine health and the musculoskeletal system. A few chiropractic patients want to know about TMJ disorders.
Here are a few of the most common things chiropractic patients want to know about TMJ disorders.
The Most Frequently Asked Questions about TMJ Disorders
TMJ disorder?
A TMJ disorder affects the temporomandibular joint (TMJ), which is the joint where the jawbone connects to the head, just in front of the ear. The bones and muscles of the TMJ allow the jaw to move up and down, and side to side, enabling a person to talk, chew and yawn.
TMJ disorders (TMDs) can cause pain in the jaw joint and in the muscles that control the movement of the jaw.
How common is it?
About 12 percent of the population experiences symptoms of TMJ at any given time, according to the TMJ Association.
The Causes?
There are several known causes of TMJ disorders, including:
Dental procedures, especially those that require the mouth be open for a long time
Insertion of a breathing tube prior to surgery
Arthritis
Misalignments of the jaw
Grinding teeth, known as bruxism, may cause TMJ disorders but not everyone who grinds their teeth develops a TMD.
Medical professionals may not be able to determine the underlying cause of TMJ disorders in many cases but chiropractors can treat TMJ disorders even if the cause cannot be determined.
The Symptoms of TMJ disorder?
Many people with TMD describe their symptoms as a dull, aching pain that comes and goes in their jaw joint and in nearby areas. Some people with TMJ disorders do not experience pain but have trouble moving their jaws.
Other common symptoms of TMJ disorders include:
Pain or stiffness in the jaw muscles
Chronic headaches
Neck, shoulder pain
Clicking, popping or grating of the jaw joint when the individual opens or closes his or her mouth
Limited movement of the jaw
“Locking” of the jaw
Tinnitus, which includes ear pain, fullness, pressure, and ringing in the ears
Dizziness, vision problems
A bite that feels “off” when the person closes his or her mouth
Treatment for TMJ disorders?
The best way to treat TMJ disorders is to eat soft foods, ice the affected area with ice packs to ease pain and try to avoid extreme jaw movements, such as chewing gum or yawning.
Does Chiropractic treat TMJ disorders?
Yes, chiropractic safely and effective treats TMJ disorders. A chiropractor will perform a full evaluation of the patient’s temporomandibular joint and surrounding bones, muscles, tendons and ligaments to assess the full scope of the TMJ problem and determine its underlying causes. The chiropractor can then suggest a range of treatment that can include stretches and exercises that alleviate pain and melt stiffness in the jaw joint. The chiropractor can also detect and address any misalignments that may be contributing to TMJ pain.
For more information about the temporomandibular joint, TMJ disorders and chiropractic for TMJ problems, contact a chiropractor with experience in diagnosing and treating TMJ problems.
Reduce *IMBALANCE & PAIN* with Functional Orthotics | El Paso, Tx
Foot pronation is a natural movement during standing, walking, or running, however, excessive foot pronation can cause postural imbalances which can result in chronic pain, including low back pain and sciatica. Dr. Alex Jimenez, a chiropractor in El Paso, TX, can help diagnose and treat a variety of health issues associated with foot problems through the utilization of functional custom foot orthotics.
Functional custom foot orthotics are specially designed to accommodate every person’s unique foot anatomy. Excessive foot pronation can ultimately lead to poor posture, which can add unnecessary pressure to the spine and it’s surrounding structures. Dr. Alex Jimenez is the non-surgical choice for foot problems and other health issues through the use of functional custom foot orthotics.
Custom Orthotics & Store Bought Insoles
Store-bought orthotic insoles are cheap but the cost to you and your health can be very high. Understanding the differences between over the counter and custom made orthotics is important. Foot Levelers customized orthotics provide the highest-quality and most effective orthotic out there.
Foot Levelers custom orthotics are individually designed for your feet. This achieves a balanced foundation and a stabilized pelvis. These orthotics are handmade based on 3D scans or casts, and your doctor’s examination.
Over-the-counter insoles do cost less, but they only support one arch in the foot. When only one arch is supported, the structure can collapse, and that’s when problems can begin in other parts of the body. Over-support of one arch can cause pain and symptoms, instead of relieving them.
Orthotics Treat Way More Than Feet
Radiculopathy is associated with some of the most significant causes of chronic or acute low back pain. However, it is important to note that the condition itself does not cause pain. Instead, elements of radiculopathy, such as disc herniation, nerve root impingement, and facet arthropathy are actually what causes the pain.
Radiculopathy is a condition of the spine that occurs when a nerve is compressed, causing pain, weakness, tingling, or numbness along the nerve’s course. In the lower back, that course is in the leg. While it is most common in the lower back, radiculopathy can occur in the cervical or thoracic regions of the spine as well.
The temporomandibular joints, TMJ, are the lower jaw hinges that sit on either side of the head in front of each ear. They are responsible for the lower jaw opening, closing, sliding, and rotating. The TMJs are the most body’s most complex joints. The typical person uses them more than 5,000 times a day by talking, laughing, yawning, chewing, eating, smiling, and swallowing.
De Quervain’s Tenosynovitis, also called “washerwoman sprain,” is a condition of the hand that typically affects people who do continuous, fast, repetitive movements. The patient can experience a sudden onset of the condition or it can be gradual, beginning with tenderness in the thumb area and slowly progressing. It can restrict activity, but it doesn’t have to be a long-term disability. Chiropractic care can help relieve the symptoms of De Quervain’s Tenosynovitis and the hand can return to normal function.
What Is De Quervain’s Tenosynovitis?
De Quervain’s Tenosynovitis is a condition affecting the thumb side of the wrist. It is a very painful condition that makes many everyday activities difficult or impossible. Many activities like playing golf, lifting a child, garden work, and racket sports can worsen the condition.
What are the Symptoms ofDe Quervain’s Tenosynovitis?
There are several distinctive symptoms of De Quervain’s tenosynovitis which include:
Pain near or at the base of the thumb
Difficulty moving or controlling the thumb and wrist when doing activities that involve pinching or grasping
Swelling near or at the base of the thumb
A “catch” or “sticking” sensation when moving the thumb
If the condition is allowed to progress or goes untreated it can involve the forearm and entire thumb, causing pain and swelling in those areas. The pain and symptoms can be exacerbated by movements that involve the wrist and thumb. The symptoms can last for a long time, weeks or even months.
What causes De Quervain’s Tenosynovitis?
The exact cause of De Quervain’s Tenosynovitis is not known, but the condition is commonly associated with chronic overuse of the wrist. There are tendons that connect the wrist and lower thumb, enabling movement like grasping, gripping, pinching, and wringing. The tendons slide through a sheath as they facilitate the movement. Over time, the sheath can swell and thicken which inhibits the amount of the tendon’s movement. When the movements are repetitive, it can cause irritation of the sheath, resulting in inflammation.
Who is at Risk for De Quervain’s Tenosynovitis?
Research has identified several groups that are at risk for developing De Quervain’s Tenosynovitis:
30 to 50 years of age with a higher concentration statistically around 40
Female
African ethnicity or descent
Pregnant
Caring for a child or baby
Works at a job that involves repetitive wrist and hand motions
This condition has typically been considered to be one that affects people who are middle-aged. However, with the popularity of texting, many young people experience symptoms of De Quervain’s. In one study, more than half of students who texted extensively were labeled positive for De Quervain’s.
What are the Treatments for De Quervain’s Tenosynovitis?
Treatment for De Quervain’s Tenosynovitis include:
Resting the affected thumb and wrist
Bracing or immobilization
Ice to the affected area
Anti-inflammatory medications like ibuprofen and naproxen
If standard treatment is not effective it may be necessary to seek medical attention. If the condition is severe or chronic, the doctor may inject corticosteroid directly into the tendon sheath. Surgery for De Quervain’s is not common, but it may be deemed necessary in order to release the thumb. The speed of healing and the degree of normal use of the thumb depends on the treatment chosen and if the activity that exacerbates the condition is stopped.
Can Chiropractic Help De Quervain’s Tenosynovitis?
A chiropractor may recommend rest, ice, and bracing for a patient with De Quervain’s Tenosynovitis. Upon reviewing the patient’s lifestyle and habits, he or she may also advise ergonomic changes, modification of activity, and reduce exposure to positions that exacerbate the symptoms. Soft tissue therapies may be used to quickly bring relief to the soft tissue, minimizing the inflammation and pain. As the pain decreases, the chiropractor will recommend specific strengthening and stretching exercises that involve the wrist, thumb, and forearm.
With regular care and modification to activities, the condition can be healed and full mobility of the thumb and wrist can be restored.
A baker’s cyst can cause pain, swelling, and limit the mobility in the affected knee. In some cases, complications can develop, causing severe problems with the leg. The problem with this type of cyst is that even if it is drained if the underlying cause isn’t addressed, the cyst can return. Chiropractic can be used to treat baker’s cyst and help relieve the pain that it causes.
What is a Baker’s Cyst?
A Baker’s cyst, also known as a popliteal cyst, is a fluid-filled lump behind the knee. Synovial fluid builds up to form the benign cyst. It starts inside the knee but eventually extruded through the back part of the knee and forms a lump. Many times there is no discomfort or pain from the cyst, although there may be some pressure on the back side of the knee. The pain that is often associated with a Baker’s cyst is usually caused by the underlying problem that causes it. In some cases, a Baker’s cyst can become large enough to inhibit movement which can impact mobility.
What Causes a Baker’s Cyst?
A Baker’s cyst is caused by overproduction of synovial fluid in the knee that leads to the fluid building up and forming a lump. There are several reasons that this can happen, including knee joint inflammation and injury to the knee. A meniscal cartilage tear or another cartilage injury of the knee can cause a cyst to develop. Certain types of arthritis in the knee, such as osteoarthritis and rheumatoid arthritis can cause the excess fluid to accumulate. Knee arthritis, a common condition among older adults, can also cause the development of a Baker’s cyst.
What are the Potential Complications of Baker’s Cyst?
Sometimes the location or size of a Baker’s cyst can cause swelling in the back of the knee. The cyst itself can be as large as a golf ball. This can put pressure on the joint, making it difficult to bend the knee. This pressure can extend through the calf muscle. The patient may experience tenderness and pain after exercising.
In rare cases, a Baker’s cyst can burst, causing the synovial fluid to leak into the calf. This can cause swelling and knee pain that is sharp and can be intense. The patient may notice redness in the calf or experience the sensation of water running down the back of the calf area. Because symptoms of a burst Baker’s cyst can closely resemble a blood clot in the leg, the patient should seek immediate medical attention to rule out a more severe condition.
How is a Baker’s Cyst Treated?
Some no treatment for popliteal cysts and they go away on their own. If a form of arthritis is causing the cyst, treating that problem may resolve the cyst. The same goes for a cyst caused by an injury to the knee. Once the damage is fixed, the cyst typically resolves as well.
If the cyst does not go away or if it is problematic, causing intense pain or limits mobility, the patient may talk to their doctor about getting it drained. The doctor will use a needle, insert it directly into the cyst and drain the fluid. Steroid medications may also be prescribed to reduce inflammation and swelling. In sporadic cases, surgery may be required to remove the cyst.
Chiropractic for Baker’s Cyst
Many patients choose to seek chiropractic care to treat a Baker’s cyst because it is noninvasive and does not use medications that can have unpleasant or harmful side effects. The chiropractor will assess the cyst and conduct diagnostic tests to determine the cause. This will help them decide the best course of treatment. Sometimes an old injury can continue to put stress on the joint, causing a lingering tension pattern. A chiropractor can address this, bringing the body back into alignment, thus alleviating the problem. This will help reduce the pain, inflammation, and swelling. Chiropractic is also an effective treatment for arthritis so if that is the cause of the cyst; regular chiropractic care can help considerably. Often, once the underlying condition is corrected, the cyst goes away on its own.
When the weather warms, melting the snow and ice as it ushers in the newness of spring, people are drawn outdoors, and increased activity soon follows. Runners top the list, training for upcoming marathons and races, or to get faster and increase endurance.
While some runners won’t let anything stop them, be it rain, sleet, or snow, most will not venture outside or engage in more rigorous training until the environment is more pleasant. This increased activity, though, can increase a person’s risk of injury, especially if they have been mostly inactive during the winter months. The most prevalent injury is runner’s knee, an umbrella term used to describe a variety of knee injuries including patellofemoral tracking syndrome.
What is Patellar Tracking Disorder?
When the patella, or kneecap, does not remain in place as the leg straightens or bends, it is called patellofemoral tracking syndrome. Many people believe that the kneecap only moves up and down, but that is not accurate. The kneecap is very mobile, rotating and tilting so that there are a variety of contact points between the femur and patella. The most common way that this disorder presents is the kneecap extends too far to the outside of the leg. Less frequent is when the kneecap shifts to the inside. The result is pain (sometimes severe) and limited mobility.
Understanding the syndrome means understanding the mechanics of the knee joint. The thighbone (femur) and lower leg (tibia and fibula) are joined by the knee, a large, complex hinge. A groove runs along the front of the joint, where the thighbone ends. The patella sits in the groove and is held in place by a network on the sides by ligaments and at the top and bottom by tendons. The underside of the kneecap is a layer of cartilage that allows it to move easily, or glide, along with the groove. When there is a problem with any of the parts that make up the knee it can lead to patellofemoral tracking syndrome.
Causes of Patellofemoral Tracking Syndrome
While overuse of the knee is the blanket term that describes the cause of patellofemoral tracking syndrome, it is the result of a combination of several problems. These can include:
Leg ligaments, tendons, or muscles that are too loose or too tight
Structural problems with the knee bones
Weak thigh muscles
The continuous stress put on the knee, such as activities that use a twisting motion to the knee
Repetitive, high-stress activities like running
Repeated movements like squatting, knee bending, or jumping
Improper alignment of the knee bones
Trauma to the knee that forces the kneecap off track, usually to the outside area of the leg
People who are most likely to develop the syndrome are those who experience any of these problems in addition to playing sports or running. Obesity or being overweight, when combined with the above problems can also put a person at risk for the syndrome.
Chiropractic for Patellofemoral Tracking Syndrome
Many people have experienced relief from the pain of patellofemoral tracking syndrome by using chiropractic care. Chiropractic for patellofemoral tracking syndrome is a medication free, non-invasive treatment that quickly and effectively treats the pain and helps to restore mobility. This is usually done by bringing the body back into alignment and performing specific manipulations depending on the unique needs of the patient. Treatment may involve the foot, ankle, spine, and hip in addition to the knee.
The patient may also be advised to make specific dietary adjustments, take special, targeted supplements, and do specific exercises in addition to the chiropractic treatments. Stretching is often recommended, and Kinesio taping is also a standard therapy to aid healing. Chiropractic will not only return the body to its natural balance and alignment, but it will get it to a state where it can begin healing itself.
If you’ve ever had a rib slip out of place, you know well the extreme pain it can cause. Every breath can be excruciating. Movement and laughing can also be very painful. It can be located in the back, side, or front on of the ribcage. It is often confused with other conditions such as gastroesophageal reflux disease, a heart condition, pleurisy, or heartburn. The area is usually very tender, and sometimes the area will swell, and a lump will form over the joint. Chiropractic care has been proven to be a very effective treatment for this painful condition.
Structure of the Rib cage
Many people believe that the ribcage is a fixed skeletal structure that houses and protects the heart, lungs, and other internal organs. That is only partly true.
The ribcage is somewhat flexible. Note how the chest expands when inhaling. This is because each rib is attached to the spine by three joints in the back, and to the breastbone by one joint in the front. These joints are small but do allow some movement or flexing so that the ribs do not impair breathing. Instead, they rise and fall with each breath.
However, these joints can become inflamed, and that is where the problems start. Because breathing is an involuntary response – and necessary for life – it is impossible to avoid movement in these joints. When there is inflammation in one or several, it can be unbearable.
Causes of a Rib Subluxation
There is any number of reasons for a dislocated rib. Some experience it by doing simple, everyday things like putting dishes in the dishwasher or putting the milk in the refrigerator. Some of the more common causes include:
Extreme sneezing or coughing – Excessive or severe coughing such as is associated with bronchitis or pneumonia puts a great deal of strain on the ribcage. However, even coughing due to a common cold can add enough stress to cause the rib to dislocate. Sneezing very hard can also cause it. Often the illness associated with coughing and sneezing can make a person more susceptible to rib dislocation due to the weakened state of the muscles.
Excessive vomiting – Much like sneezing or coughing, vomiting can also cause this condition. While it does not necessarily involve the lungs, the convulsive action of vomiting can cause a rib to “pop.”
Exercise – Working out can cause the ribs to move out of position, particularly if the person has poor or improper form, or if they do a lot of work with their arms extended in front of them. This is especially true when weights are involved. The muscles involved in the movement may not be strong enough to handle the added weight and movement combination, causing the rib to move out of place.
Improper Posture – Poor posture puts stress on the body, including the spine which, in turn, puts pressure on the posterior portion of the ribcage. Over time, this can cause ribs to dislocate.
Pregnancy – As a woman’s body changes toward the end of her pregnancy, her weight shifts to the front. This can create a continual downward pull on her rib cage, increasing her risk of rib dislocation.
Pain or discomfort in the area of the chest or back.
Swelling and bruising in the affected area.
The formation of a lump over the injured rib.
Extreme pain and difficulty when breathing, trying to sit up, or while straining.
Painful sneezing and coughing.
Pain when moving or walking.
Difficulty breathing.
Numbness or paralysis in nearby or surrounding ribs.
Tenderness in the affected area.
Treatments for a Dislocated Rib
Chiropractic care is considered one of the best, most effective treatments for dislocated or subluxated ribs. Once the chiropractor has determined that the rib is out of place, he or she will often begin by using various techniques that will “loosen” the area, making the muscles more pliable.
They may do this by using stretching, massage, or a vibration tool. They will then apply gentle but firm pressure to “pop” the rib back into place. In some cases stabilization may be used after to keep the area protected, allowing it to heal. The treatment is usually far less painful than the condition, and some patients report not experiencing any pain at all.
Hip pain is a well-known health issue which can be caused by a wide array of problems, however, the site of the patient’s hip pain can provide valuable information regarding the underlying cause of this common health issue. Pain on the inside of the hip or groin can be due to problems within the hip joint itself while pain on the outside of the hip, upper thigh and outer buttocks may be due to problems with the ligaments, tendons and muscles, among other soft tissues, surrounding the hip joint. Furthermore, hip pain can be due to other injuries and conditions, including back pain.
Abstract
Hip pain is a common and disabling condition that affects patients of all ages. The differential diagnosis of hip pain is broad, presenting a diagnostic challenge. Patients often express that their hip pain is localized to one of three anatomic regions: the anterior hip and groin, the posterior hip and buttock, or the lateral hip. Anterior hip and groin pain is commonly associated with intra-articular pathology, such as osteoarthritis and hip labral tears. Posterior hip pain is associated with piriformis syndrome, sacroiliac joint dysfunction, lumbar radiculopathy, and less commonly ischiofemoral impingement and vascular claudication. Lateral hip pain occurs with greater trochanteric pain syndrome. Clinical examination tests, although helpful, are not highly sensitive or specific for most diagnoses; however, a rational approach to the hip examination can be used. Radiography should be performed if acute fracture, dislocations, or stress fractures are suspected. Initial plain radiography of the hip should include an anteroposterior view of the pelvis and frog-leg lateral view of the symptomatic hip. Magnetic resonance imaging should be performed if the history and plain radiograph results are not diagnostic. Magnetic resonance imaging is valuable for the detection of occult traumatic fractures, stress fractures, and osteonecrosis of the femoral head. Magnetic resonance arthrography is the diagnostic test of choice for labral tears.
Introduction
Hip pain is a common presentation in primary care and can affect patients of all ages. In one study, 14.3% of adults 60 years and older reported significant hip pain on most days over the previous six weeks.1 Hip pain often presents a diagnostic and therapeutic challenge. The differential diagnosis of hip pain (eTable A) is broad, including both intra-articular and extra-articular pathology, and varies by age. A history and physical examination are essential to accurately diagnose the cause of hip pain.
Anatomy
The hip joint is a ball-and-socket synovial joint designed to allow multiaxial motion while transferring loads between the upper and lower body. The acetabular rim is lined by fibrocartilage (labrum), which adds depth and stability to the femoroacetabular joint. The articular surfaces are covered by hyaline cartilage that dissipates shear and compressive forces during load bearing and hip motion. The hip’s major innervating nerves originate in the lumbosacral region, which can make it difficult to distinguish between primary hip pain and radicular lumbar pain.
The hip joint’s wide range of motion is second only to that of the glenohumeral joint and is enabled by the large number of muscle groups that surround the hip. The flexor muscles include the iliopsoas, rectus femoris, pectineus, and sartorius muscles. The gluteus maximus and hamstring muscle groups allow for hip extension. Smaller muscles, such as gluteus medius and minimus, piriformis, obturator externus and internus, and quadratus femoris muscles, insert around the greater trochanter, allowing for abduction, adduction, and internal and external rotation.
In persons who are skeletally immature, there are several growth centers of the pelvis and femur where injuries can occur. Potential sites of apophyseal injury in the hip region include the ischium, anterior superior iliac spine, anterior inferior iliac spine, iliac crest, lesser trochanter, and greater trochanter. The apophysis of the superior iliac spine matures last and is susceptible to injury up to 25 years of age.2
The hip joint is one of the larger joints found in the human body and it serves in locomotion as the thigh moves forward and backward. The hip joint also rotates when sitting and with changes of direction while walking. A variety of complex structures surround the hip joint. When an injury or condition affects these, it can ultimately lead to hip pain.
Dr. Alex Jimenez D.C., C.C.S.T.
Evaluation of Hip Pain
History
Age alone can narrow the differential diagnosis of hip pain. In prepubescent and adolescent patients, congenital malformations of the femoroacetabular joint, avulsion fractures, and apophyseal or epiphyseal injuries should be considered. In those who are skeletally mature, hip pain is often a result of musculotendinous strain, ligamentous sprain, contusion, or bursitis. In older adults, degenerative osteoarthritis and fractures should be considered first.
Patients with hip pain should be asked about antecedent trauma or inciting activity, factors that increase or decrease the pain, mechanism of injury, and time of onset. Questions related to hip function, such as the ease of getting in and out of a car, putting on shoes, running, walking, and going up and down stairs, can be helpful.3 Location of the pain is informative because hip pain often localizes to one of three basic anatomic regions: the anterior hip and groin, posterior hip and buttock, and lateral hip (eFigure A).
Physical Examination
The hip examination should evaluate the hip, back, abdomen, and vascular and neurologic systems. It should start with a gait analysis and stance assessment (Figure 1), followed by evaluation of the patient in seated, supine, lateral, and prone positions (Figures 2 through 6, and eFigure B). Physical examination tests for the evaluation of hip pain are summarized in Table 1.
Imaging
Radiography. Radiography of the hip should be performed if there is any suspicion of acute fracture, dislocation, or stress fracture. Initial plain radiography of the hip should include an anteroposterior view of the pelvis and a frog-leg lateral view of the symptomatic hip.4
Magnetic Resonance Imaging and Arthrography. Conventional magnetic resonance imaging (MRI) of the hip can detect many soft tissue abnormalities, and is the preferred imaging modality if plain radiography does not identify specific pathology in a patient with persistent pain.5 Conventional MRI has a sensitivity of 30% and an accuracy of 36% for diagnosing hip labral tears, whereas magnetic resonance arthrography provides added sensitivity of 90% and accuracy of 91% for the detection of labral tears.6,7
Ultrasonography. Ultrasonography is a useful technique for evaluating individual tendons, confirming suspected bursitis, and identifying joint effusions and functional causes of hip pain.8 Ultrasonography is especially useful for safely and accurately performing imaging-guided injections and aspirations around the hip.9 It is ideal for an experienced ultrasonographer to perform the diagnostic study; however, emerging evidence suggests that less experienced clinicians with appropriate training can make diagnoses with reliability similar to that of an experienced musculoskeletal ultrasonographer.10,11
These are numerous causes for hip pain. Although some hip pain may only be temporary, other forms of hip pain can become chronic if left untreated for an extended period of time. Several common causes of hip pain include, arthritis, fracture, sprain, avascular necrosis, Gaucher’s disease, sciatica, muscle strain, iliotibial band syndrome or IT band syndrome and hematoma, among others described below.
Dr. Alex Jimenez D.C., C.C.S.T.
Differential Diagnosis of Anterior Hip Pain
Anterior hip or groin pain suggests involvement of the hip joint itself. Patients often localize pain by cupping the anterolateral hip with the thumb and forefinger in the shape of a “C.” This is known as the C sign (Figure 1A).
Osteoarthritis
Osteoarthritis is the most likely diagnosis in older adults with limited motion and gradual onset of symptoms. Patients have a constant, deep, aching pain and stiffness that are worse with prolonged standing and weight bearing. Examination reveals decreased range of motion, and extremes of hip motion often cause pain. Plain radiographs demonstrate the presence of asymmetrical joint-space narrowing, osteophytosis, and subchondral sclerosis and cyst formation.12
Femoroacetabular Impingement
Patients with femoroacetabular impingement are often young and physically active. They describe insidious onset of pain that is worse with sitting, rising from a seat, getting in or out of a car, or leaning forward.13 The pain is located primarily in the groin with occasional radiation to the lateral hip and anterior thigh.14 The FABER test (flexion, abduction, external rotation; Figure 3) has a sensitivity of 96% to 99%. The FADIR test (flexion, adduction, internal rotation; Figure 4), log roll test (Figure 5), and straight leg raise against resistance test (Figure 6) are also effective, with sensitivities of 88%, 56%, and 30%, respectively.14,15 In addition to the anteroposterior and lateral radiograph views, a Dunn view should be obtained to help detect subtle lesions.16
Hip Labral Tear
Hip labral tears cause dull or sharp groin pain, and one-half of patients with a labral tear have pain that radiates to the lateral hip, anterior thigh, and buttock. The pain usually has an insidious onset, but occasionally begins acutely after a traumatic event. About one-half of patients with this injury also have mechanical symptoms, such as catching or painful clicking with activity.17 The FADIR and FABER tests are effective for detecting intra-articular pathology (the sensitivity is 96% to 75% for the FADIR test and is 88% for the FABER test), although neither test has high specificity.14,15,18 Magnetic resonance arthrography is considered the diagnostic test of choice for labral tears.6,19 However, if a labral tear is not suspected, other less invasive imaging modalities, such as plain radiography and conventional MRI, should be used first to rule out other causes of hip and groin pain.
Iliopsoas Bursitis (Internal Snapping Hip)
Patients with this condition have anterior hip pain when extending the hip from a flexed position, often associated with intermittent catching, snapping, or popping of the hip.20 Dynamic real-time ultrasonography is particularly useful in evaluating the various forms of snapping hip.8
Occult or Stress Fracture
Occult or stress fracture of the hip should be considered if trauma or repetitive weight-bearing exercise is involved, even if plain radiograph results are negative.21 Clinically, these injuries cause anterior hip or groin pain that is worse with activity.21 Pain may be present with extremes of motion, active straight leg raise, the log roll test, or hopping.22 MRI is useful for the detection of occult traumatic fractures and stress fractures not seen on plain radiographs.23
Transient Synovitis and Septic Arthritis
Acute onset of atraumatic anterior hip pain that results in impaired weight bearing should raise suspicion for transient synovitis and septic arthritis. Risk factors for septic arthritis in adults include age older than 80 years, diabetes mellitus, rheumatoid arthritis, recent joint surgery, and hip or knee prostheses.24 Fever, complete blood count, erythrocyte sedimentation rate, and C-reactive protein level should be used to evaluate the risk of septic arthritis.25,26 MRI is useful for differentiating septic arthritis from transient synovitis.27,28 However, hip aspiration using guided imaging such as fluoroscopy, computed tomography, or ultrasonography is recommended if a septic joint is suspected.29
Osteonecrosis
Legg-Calvé-Perthes disease is an idiopathic osteonecrosis of the femoral head in children two to 12 years of age, with a male-to-female ratio of 4:1.4 In adults, risk factors for osteonecrosis include systemic lupus erythematosus, sickle cell disease, human immunodeficiency virus infection, smoking, alcoholism, and corticosteroid use.30,31 Pain is the presenting symptom and is usually insidious. Range of motion is initially preserved but can become limited and painful as the disease progresses.32 MRI is valuable in the diagnosis and prognostication of osteonecrosis of the femoral head.30,33
Differential Diagnosis of Posterior Hip and Buttock Pain
Piriformis Syndrome and Ischiofemoral Impingement
Piriformis syndrome causes buttock pain that is aggravated by sitting or walking, with or without ipsilateral radiation down the posterior thigh from sciatic nerve compression.34,35 Pain with the log roll test is the most sensitive test, but tenderness with palpation of the sciatic notch can help with the diagnosis.35
Ischiofemoral impingement is a less well-understood condition that can lead to nonspecific buttock pain with radiation to the posterior thigh.36,37 This condition is thought to be a result of impingement of the quadratus femoris muscle between the lesser trochanter and the ischium.
Unlike sciatica from disc herniation, piriformis syndrome and ischiofemoral impingement are exacerbated by active external hip rotation. MRI is useful for diagnosing these conditions.38
Other
Other causes of posterior hip pain include sacroiliac joint dysfunction,39 lumbar radiculopathy,40 and vascular claudication.41 The presence of a limp, groin pain, and limited internal rotation of the hip is more predictive of hip disorders than disorders originating from the low back.42
Differential Diagnosis of Lateral Hip Pain
Greater Trochanteric Pain Syndrome
Lateral hip pain affects 10% to 25% of the general population.43 Greater trochanteric pain syndrome refers to pain over the greater trochanter. Several disorders of the lateral hip can lead to this type of pain, including iliotibial band thickening, bursitis, and tears of the gluteus medius and minimus muscle attachment.43–45 Patients may have mild morning stiffness and may be unable to sleep on the affected side. Gluteus minimus and medius injuries present with pain in the posterior lateral aspect of the hip as a result of partial or full-thickness tearing at the gluteal insertion. Most patients have an atraumatic, insidious onset of symptoms from repetitive use.43,45,46
In conclusion, hip pain is a common complaint which may occur due to a wide variety of health issues. Moreover, the precise location of the patient’s hip pain can provide valuable information to healthcare professionals regarding the underlying cause of the problem. The purpose of the article above was to demonstrate and discuss the evaluation of the patient with hip pain. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Data Sources: We searched articles on hip pathology in American Family Physician, along with their references. We also searched the Agency for Healthcare Research and Quality Evidence Reports, Clinical Evidence, Institute for Clinical Systems Improvement, the U.S. Preventive Services Task Force guidelines, the National Guideline Clearinghouse, and UpToDate. We performed a PubMed search using the keywords greater trochanteric pain syndrome, hip pain physical examination, imaging femoral hip stress fractures, imaging hip labral tear, imaging osteomyelitis, ischiofemoral impingement syndrome, meralgia paresthetica review, MRI arthrogram hip labrum, septic arthritis systematic review, and ultrasound hip pain. Search dates: March and April 2011, and August 15, 2013.
Back pain is one of the most prevalent causes of disability and missed days at work worldwide. Back pain attributes to the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
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3. Martin HD, Shears SA, Palmer IJ. Evaluation of the hip. Sports Med Arthrosc. 2010;18(2):63–75.
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6. Czerny C, Hofmann S, Neuhold A, et al. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging. Radiology. 1996;200(1):225–230.
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8. Deslandes M, Guillin R, Cardinal E, et al. The snapping iliopsoas tendon: new mechanisms using dynamic sonography. AJR Am J Roentgenol. 2008;190(3):576–581.
9. Blankenbaker DG, De Smet AA. Hip injuries in athletes. Radiol Clin North Am. 2010;48(6):1155–1178.
10. Balint PV, Sturrock RD. Intraobserver repeatability and interobserver reproducibility in musculoskeletal ultrasound imaging measurements. Clin Exp Rheumatol. 2001;19(1):89–92.
11. Ramwadhdoebe S, Sakkers RJ, Uiterwaal CS, et al. Evaluation of a training program for general ultrasound screening for developmental dysplasia of the hip in preventive child health care. Pediatr Radiol. 2010;40(10):1634–1639.
12. Altman R, Alarcón G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34(5):505–514.
14. Clohisy JC, Knaus ER, Hunt DM, et al. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res. 2009;467(3):638–644.
15. Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res. 2004;(429):262–271.
16. Beall DP, Sweet CF, Martin HD, et al. Imaging findings of femoroacetabular impingement syndrome. Skeletal Radiol. 2005;34(11):691–701.
17. Burnett RS, Della Rocca GJ, Prather H, et al. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am. 2006;88(7):1448–1457.
18. Leunig M, Werlen S, Ungersböck A, et al. Evaluation of the acetabular labrum by MR arthrography [published correction appears in J Bone Joint Surg Br. 1997;79(4):693]. J Bone Joint Surg Br. 1997;79(2):230–234.
19. Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009;2(2):105–117.
20. Blankenbaker DG, De Smet AA, Keene JS. Sonography of the iliopsoas tendon and injection of the iliopsoas bursa for diagnosis and management of the painful snapping hip. Skeletal Radiol. 2006;35(8):565–571.
21. Egol KA, Koval KJ, Kummer F, et al. Stress fractures of the femoral neck. Clin Orthop Relat Res. 1998;(348):72–78.
22. Fullerton LR Jr, Snowdy HA. Femoral neck stress fractures. Am J Sports Med. 1988;16(4):365–377.
24. Margaretten ME, Kohlwes J, Moore D, et al. Does this adult patient have septic arthritis? JAMA. 2007;297(13):1478–1488.
25. Eich GF, Superti-Furga A, Umbricht FS, et al. The painful hip: evaluation of criteria for clinical decision-making. Eur J Pediatr. 1999;158(11):923–928.
26. Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg Am. 1999;81(12):1662–1670.
27. Learch TJ, Farooki S. Magnetic resonance imaging of septic arthritis. Clin Imaging. 2000;24(4):236–242.
28. Lee SK, Suh KJ, Kim YW, et al. Septic arthritis versus transient synovitis at MR imaging. Radiology. 1999;211(2):459–465.
29. Leopold SS, Battista V, Oliverio JA. Safety and efficacy of intraarticular hip injection using anatomic landmarks. Clin Orthop Relat Res. 2001; (391):192–197.
30. Mitchell DG, Rao VM, Dalinka MK, et al. Femoral head avascular necrosis: correlation of MR imaging, radiographic staging, radionuclide imaging, and clinical findings. Radiology. 1987;162(3):709–715.
31. Mont MA, Zywiel MG, Marker DR, et al. The natural history of untreated asymptomatic osteonecrosis of the femoral head. J Bone Joint Surg Am. 2010;92(12):2165–2170.
32. Assouline-Dayan Y, Chang C, Greenspan A, et al. Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum. 2002;32(2):94–124.
33. Totty WG, Murphy WA, Ganz WI, et al. Magnetic resonance imaging of the normal and ischemic femoral head. AJR Am J Roentgenol. 1984;143(6):1273–1280.
35. Hopayian K, Song F, Riera R, et al. The clinical features of the piriformis syndrome. Eur Spine J. 2010;19(12):2095–2109.
36. Torriani M, Souto SC, Thomas BJ, et al. Ischiofemoral impingement syndrome. AJR Am J Roentgenol. 2009;193(1):186–190.
37. Ali AM, Whitwell D, Ostlere SJ. Case report: imaging and surgical treatment of a snapping hip due to ischiofemoral impingement. Skeletal Radiol. 2011;40(5):653–656.
38. Lee EY, Margherita AJ, Gierada DS, et al. MRI of piriformis syndrome. AJR Am J Roentgenol. 2004;183(1):63–64.
39. Slipman CW, Jackson HB, Lipetz JS, et al. Sacroiliac joint pain referral zones. Arch Phys Med Rehabil. 2000;81(3):334–338.
40. Moore KL, Dalley AF, Agur AM. Clinically Oriented Anatomy. 6th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2010.
41. Adlakha S, Burket M, Cooper C. Percutaneous intervention for chronic total occlusion of the internal iliac artery for unrelenting buttock claudication. Catheter Cardiovasc Interv. 2009;74(2):257–259.
42. Brown MD, Gomez-Marin O, Brookfield KF, et al. Differential diagnosis of hip disease versus spine disease. Clin Orthop Relat Res. 2004; (419):280–284.
43. Segal NA, Felson DT, Torner JC, et al.; Multicenter Osteoarthritis Study Group. Greater trochanteric pain syndrome. Arch Phys Med Rehabil. 2007;88(8):988–992.
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Posterior tibial tendon dysfunction is a very common ankle and foot problem that occurs when there is a tear or inflammation in the posterior tibial tendon – the tendon that is at the back of the ankle and is the key player in stabilizing the foot. The inflammation or tear affects the integrity of the tendon, weakening it so that is no longer provides the support or stability of the arch of the foot. This results in what is commonly known as flatfoot.
While this condition rarely requires surgery, there is pain, sometimes severe, swelling, and impaired mobility associated with it. Chiropractic for flatfoot has been found to be very effective for most patients, helping them heal faster and manage their pain.
What Causes Posterior Tibial Tendon Dysfunction?
The most common causes of flatfoot are overuse and injury. Falls are common culprits, causing injury to the tendon so that it tears or becomes inflamed.
Overtraining, particularly in high impact exercise or sports like basketball, dancing, soccer, and high impact aerobics can get tears due to the repetitive motion and constant pressure on the foot. Once the tendon is torn or inflamed, the arch begins to collapse until eventually the foot is flat.
This condition occurs more often in women than men. Also, people over 40 seem to be more prone to posterior tibial tendon dysfunction, although it can occur in younger people who overtrain or have any of the other risk factors including diabetes, obesity, and hypertension.
What Are The Symptoms Of Posterior Tibial Tendon Dysfunction?
Pain is the first and most common indicator of flatfoot. It typically is located where the tendon lies; along the inner portion of the ankle and foot. Sometimes swelling may be present.
The patient will also notice that the pain increases with activity. High impact or high intensity activities can be excruciating and quite difficult. It can get to the point where standing or walking for extended periods of time are very painful.
In advanced stages, the pain may shift to the outer portion of the ankle. As the arch collapses, the movement may cause the heel bone to shift outward. This, in turn, puts pressure on the outer ankle bone.
How Is Posterior Tibial Tendon Dysfunction Treated?
The treatment for flatfoot depends on the severity of the condition. Most patients can avoid surgery, but it is still a long healing process.
Typically, the patient will be advised to rest and ice the area, switch to low impact exercise, and take nonsteroidal anti-inflammatory medication for the pain. In moderate to severe cases, the patient may be put in a walking boot or short leg cast for 6 to 8 weeks in order to immobilize the foot and ankle, letting the tendon rest and heal. The downside of this is that the other muscles around the ankle will also “rest” and atrophy as a result.
Shoe inserts, or orthotics, as well as braces are also common treatments for flatfoot. However, any type of immobilization of the ankle and foot is usually accompanied by physical therapy either while the brace is worn or after a cast has been removed.
In more severe cases, the doctor may recommend a steroid injection directly into the tendon although there is an increased risk of the tendon rupturing. Surgery is usually a last resort and it is much more complex. Patients who undergo surgery for flatfoot rarely regain all of the mobility they had prior to the operation.
Chiropractic For Posterior Tibial Tendon Dysfunction
There has been a great deal of success in using chiropractic to treat flatfoot. The chiropractor will typically recommend rest and ice as well as chiropractic manipulations to help bring the ankle, foot, and leg back into alignment to counteract the weakened tendon. Often the ankle will lose mobility as the arch collapses and the bones in the foot and ankle shift. This, in turn, causes the arch to collapse even more.
By using chiropractic techniques to bring the ankle back into alignment, thus restoring the forward glide of the joint, they can alleviate the pain and help heal the condition. They may also recommend an air brace to stabilize the ankle when the patient will be doing a lot of walking as well as advise on lifestyle changes such as weight loss and a healthy diet. Often patients who have tried working with medical doctors to cure their flatfoot but were unsuccessful, were finally able to gain relief and improvement when they started working with their chiropractor.
Injury Medical Clinic: Ankle Sprain Chiropractic Treatment
Sitting at a desk for extended periods of time is not healthy and can lead to a host of health problems. As more and more studies show the detriments of prolonged sitting, some companies are taking action to protect their employees’ health by installing upright work stations. These desks take the person from a seated position and move them into one where they are leaning. As a result, most of the workers are enjoying several health benefits.
Health Benefits
It Facilitates Healthy Postural Transitions
Simply put, postural transitions are the body movements made when changing positions. There are large movements like going from sitting to standing, standing to leaning, and standing to sitting, but also small movements like adjusting arm placement or moving a foot.
Ergonomists suggest that a person should be making postural transitions several time an hour. They also recommend that people avoid any static position such as standing, sitting, or leaning for an extended period of time, instead advocating a transition or movement every 20 minutes when possible.
Static positioning has been linked to obesity, heart disease, and other health conditions. When the body is positioned in such a way that facilitates healthy movement, the body moves more often and in a more natural way. This is not likely to happen with static positioning, especially prolonged sitting.
It Improves Spine Health
Sitting or standing for long periods of time is not good for the spine. When a person stands or sits without any healthy postural transitions the spine can begin to compact and the discs become hard. This undermines the spines ability to adequately support the body, leading to loss of mobility, decreased flexibility, and pain.
The spine is made up of small bones, vertebrae, which are cushioned by spongy, fluid filled discs. In a healthy spine, the discs are filled with fluid providing a good cushion for the vertebrae as they move and support the body. However, the discs need movement to encourage blood flow so they can continue working as they should. Working upright facilitates those movements, thus decreasing the likelihood of spinal problems.
It Discourages Painful Posture
Standing and sitting for prolonged periods of time can cause pain and certain mobility problems. While they share some pain points, each brings its own problems. A strained neck and stiff, sore shoulders are often associated with sitting and standing, usually due to improper computer monitor placement. Poor leg circulation, tight hips, and lower back pain are also common problems of people who do a lot of standing or sitting on their jobs.
Using an upright workstation moves the body into a more natural, healthier posture that encourages natural, frequent movement. The spine is properly aligned over the hips, the hips are open, and the feet are adequately supported. It promotes posture that is completely contrary to being hunched over a desk – the typical posture for a sitting workstation.
It Keeps Core Muscles Engaged
When in a seated position, the core muscles are mostly lax and rarely engaged. Over time, these muscles can actually be trained to become weak, or lazy and not engage as they should. This means that they stop supporting the back and body which leads to poor posture, loss of balance, lack of mobility, decrease in flexibility, and pain.
Working upright encourages micro movements that engage the core. It’s not like crunches at the gym, but more like an ongoing mini-workout that keeps the core muscles toned and supportive. The results are a healthier spine, fewer gastrointestinal problems, better posture, and improved circulation.
Other health benefits of working upright include a decreased risk of certain cancers like colon cancer and breast cancer, improved circulation, better brain function, and a decreased risk of health conditions like diabetes, heart disease, and hypertension. Working upright is the most natural position for the body’s best function and health.
Health Benefits: Chiropractic Care Crossfit Rehabilitation
Gale Grijalva suffered from severe back pain as a result of an automobile accident injury. Where it was once very difficult to go about her regular daily tasks, Gale Grijalva is now able to participate in physical activities she wasn’t able to engage in before thanks to Dr. Alex Jimenez, chiropractor in El Paso, TX. Gale Grijalva describes how patient Dr. Jimenez is and she discusses how thoroughly he’s been able to help her, including answering any concerns she may have. Gale Grijalva also experienced results through rehabilitation.
Chiropractic Severe Back Pain Treatment
Severe chronic back pain is a serious, recurring condition which affects a person’s everyday life. Back pain lasting over three months is considered chronic. The spine is an essential component of the body. Severe chronic back pain might be the backbone’s manner of telling the body that there is an issue. The spine is composed of bony vertebrae, soft spinal discs, facet joints, tendons, ligaments and tendons. Within the bony vertebral artery lies the spinal cord, the delicate but effective nerve pathway of the central nervous system.
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One of my friends recommended me, over and over, and just extended how good he (Dr. Alex Jimenez, D.C.) was. So I gave it a shot. I had really bad sciatica and it was killing me, I couldn’t walk, but he has been helping me out, I can walk now… I couldn’t walk more than 25 yards, it (sciatica) was really affecting me. I had to get some help. I can’t say enough about Dr. Jimenez, he’s been helping me out, I can walk.
Edgar M. Reyes
According to the American Association of Neurological Surgeons, approximately 75 to 85 percent of individuals in the United States alone will experience some form of back pain throughout their lifetime, where 50 percent will suffer more than one episode within a year. Back pain is one of the most common complaints frequently reported among the general population and it is often a symptom which could indicate the presence of another underlying condition. Back pain can be caused by a variety of factors, some due to bad habits, such as improper posture, and others due to injuries from accidents. Other health issues, such as degenerative disc disease, or DDD, and arthritis can also result in back pain. While the causes can vary, they share the same symptoms.
Bak pain can include upper back pain, middle back pain and lower back pain, often connected to sciatica, or sciatic nerve pain, a condition characterized by the compression or impingement of the sciatic nerve found in the low back. Back pain and sciatica have been closely associated with several common health issues. Often times, sciatica, or sciatic nerve pain, is caused by an underlying health issue along the lumbar spine. The sciatic nerve is the longest nerve in the human body, which connects to nerve roots in the region of the lower back and runs through the buttocks, down along the hips and into the back of each leg. Further sections of this nerve then branch out from the calf to the foot and into the toes. Sciatica can be identified by the following symptoms.
Low back pain which radiates down one or both legs
Leg and/or foot pain along with tingling and burning sensations
Numbness in the leg, feet and/or toes
Persistent pain and discomfort on one or both sides of the buttocks
Intense painful symptoms in the lower extremities
Having difficulties when sitting and while getting up
It’s essential to understand that back pain and sciatica are not generally considered to be a specific health issue themselves but rather, they are usually only considered to be a collection of several symptoms associated with an underlying injury and/or condition. A proper diagnosis of the root cause of your symptoms is additionally important in order to safely and effectively treat back pain and sciatica. As mentioned above, numerous factors can cause back pain and sciatica symptoms. Below, we will discuss some of the most common spine health issues which can cause back pain and sciatica, including degenerative disc disease, lumbar spinal stenosis, lumbar herniated disc and spondylolisthesis. Approximately 90 percent of sciatica cases are due to disc herniations.
Degenerative Disc Disease
The degeneration of the intervertebral discs, found between each vertebrae of the spine, is a natural process which often occurs with age, while for some individuals, however, it can begin to develop earlier than usual. In a healthy spine, the intervertebral discs function as shock absorbers between the bones of the spine, which ultimately provide height and allow the back to remain flexible while resisting forces. As we begin to get older, these rubbery discs begin to shrink and lose integrity. Almost everyone will demonstrate signs of wear-and-tear along their spinal discs over time, but not everyone will experience degenerative disc disease, or DDD. Although not actually a disease, DDD refers to a condition in which pain with the degeneration of the intervertebral discs.
One or more degenerated discs along the length of the spine may irritate a nerve root and cause sciatica. This condition is commonly characterized when a reduced disc becomes exposed. Bone spurs can also develop with disc degeneration and can lead to sciatica. Symptoms of degenerative disc disease, or DDD, frequently occur along the lower back, however, they can also develop in the neck, depending on the location of the degenerated discs. Common symptoms of DDD include, pain and discomfort, particularly when sitting, bending, lifting or twisting, tingling sensations and/or numbness in the extremities, and lessened symptoms when walking and moving, as in with changing positions or lying down. Weakness in the leg muscles or foot drop may be a sign that there is damage to the nerve root.
Lumbar Spinal Stenosis
Another common cause of back pain and sciatica is lumbar spinal stenosis. The natural degeneration of the spine which occurs with age can cause a variety of changes to the spine. Lumbar spinal stenosis is brought on by a gradual narrowing of the spinal canal that is common in the aging process and it generally affects people over the age of 50. When the space around the spinal cord narrows, it can place unnecessary amounts of pressure on the spinal cord and nerve roots. Additionally, it can be the result of a bulging disk, enlarged aspect joints, or an overgrowth of tissue. Only a small number of individuals are born with spine health issues which can develop into lumbar spinal stenosis. This is known as congenital spinal stenosis and it is frequently diagnosed in men.
Arthritis, or the degeneration of any joint in the body, has been attributed to be the most common cause of spinal stenosis. As the intervertebral discs begin to wear-and-tear naturally begin, they can lose water content and eventually dry out, ultimately losing height and even collapsing. This can place pressure on the facet joints, the joints which provide flexibility and movement to the spine, resulting in arthritis. As a result, the ligaments around the structures of the spine can increase in size, lessening the space for the nerves. Also, the human body may respond by growing new bone, additionally narrowing the space for the nerves to pass through. Symptoms of lumbar spinal stenosis may include, pain, tingling or burning sensations, numbness and weakness, as well as less painful symptoms when leaning forward or sitting.
Lumbar Herniated Disc
A herniated disc is a condition which can occur anywhere along the length of the spine, however, it most commonly affects the lower back or lumbar spine. It may also be referred to as a bulging, protruding or ruptured disc. A lumbar herniated disc is considered to be one of the most common causes of back pain in the lower back, as well as sciatica. An intervertebral disc begins to herniate when the soft, jelly-like nucleus, known as the nucleus pulposus, pushes against its outer ring, known as the annulus fibrosus, due to wear-and-tear or a sudden injury. With persistent pressure, the jelly-like nucleus may push through the disc’s outer ring or it may cause the ring to bulge, putting additional pressure on the spinal chord and its surrounding nerve roots.
Moreover, the intervertebral disc material can release chemicals and/or substances which may ultimately irritate the surrounding structures of the spine, contributing to nerve inflammation. When a nerve root becomes irritated, it can potentially lead to symptoms of pain and discomfort, numbness and weakness in one or both legs, otherwise referred to as sciatica, or sciatic nerve pain. An individual may also develop a herniated disc without ever experiencing any symptoms. A lumbar herniated disc is generally caused by the natural degeneration of the spine and discs, however, trauma and/or injury may also result in lumbar disc herniations. Symptoms of a lumbar herniated disc includes sciatica, tingling sensations, numbness, weakness, and loss of bladder or bowel control in severe cases. This last symptoms will require immediate medical attention.
Spondylolisthesis
Spondylolisthesis is another common cause of back pain and sciatica, particularly in young athletes. Repeated stress on the lower back, or lumbar spine, can create a crack or stress fracture in one of the vertebrae. In these cases, however, the stress fracture can often weaken the bone so much, to the point where it is unable to maintain its proper position in the spine, ultimately causing the vertebra to begin to shift or slip out of place. This condition is what is commonly known as spondylolisthesis. In children and adolescents, spondylolisthesis can occur through periods of rapid growth, by way of instance, during an adolescent growth spurt. This condition frequently occurs as a result of overuse, overstretching, or hyperextension, and even due to genetics.
Many healthcare professionals characterize spondylolisthesis as either low grade or high grade, depending on how much the vertebrae have shifted or slipped out of place. A high grade slip is generally identified when more than 50 percent of the width of the fractured vertebra slips forwards onto the vertebra beneath it. Individuals with high grade cases of spondylolisthesis will commonly describe experiencing significant levels of pain and discomfort as well as nerve injury. In the majority of instances, however, individuals with spondylolisthesis will not experience any obvious symptoms, as a matter of fact, most are unaware of the condition till an x-ray is taken for an unrelated injury and/or condition. Individuals with spondylolisthesis may experience back pain and sciatica, including muscle spasms, back stiffness and tight hamstrings.
Dr. Alex Jimenez’s Insight
Back pain is one of the most common reasons why individuals often miss days from work or go to the doctor, as it has also become one of the leading causes of disability worldwide. As a matter of fact, it has been statistically determined that approximately 80 percent of people will or have experienced back pain at least once throughout their life. Fortunately, a variety of treatments are available which can help ease the symptoms of back pain. It’s essential to understand back pain and sciatica, a collection of symptoms commonly associated with spine health issues along the lower back, in order to seek proper diagnosis and continue with an appropriate treatment plan in order to relieve your symptoms of back pain and sciatica.
Treatment for Back Pain and Sciatica
Chiropractic care is a well-known, alternative treatment option commonly utilized to help diagnose, treat and prevent back pain and sciatica. Since there are many factors which can contribute to symptoms of back pain and sciatic nerve pain, a doctor of chiropractic’s, or chiropractor’s, initial step would be to determine the root cause of the patient’s symptoms. Determining a diagnosis involves a thoughtful review of the patient’s health history, and a physical and neurological examination. Diagnostic testing may involve an x-ray, MRI, CT scan and/or electrodiagnostic tests, such as a nerve conduction speed evaluation or an electromyography. These examinations and tests help determine possible contraindications to treatment.
The aim of chiropractic care is to help promote the human body’s potential to heal itself. It is based on the scientific principle that limited spinal motion results in pain and reduced function and performance. Chiropractic care is non-invasive, or non-surgical, and drug-free. The type of chiropractic treatment provided is dependent upon the cause of the individual’s back pain and sciatica. A treatment program may include many distinct treatments and therapies, like ice/cold therapies, ultrasound, TENS, and spinal adjustments or manual manipulations. If the doctor of chiropractic decides that the patient’s spinal health issue requires treatment by a different kind of physician, then the individual may be referred to another healthcare professional.
Physical therapeutics for these conditions is also effective and generally has two components: active and passive. Passive physical therapeutics consist of ultrasound, electric stimulation, heat and ice packs as well as iontophoresis. Active physical therapeutics modalities include stretching exercises, back exercises and low-impact aerobic conditioning. Manual physical therapeutics, such as spinal adjustments and/or manual manipulations, might be integrated in part by a chiropractor. Physical therapists normally recommend 20 minutes of dynamic lumbar stabilization exercises every day. Core muscle strengthening is also important in treating back pain. Low-impact aerobics are also important and include water therapy, biking, and walking.
Physical therapeutics are an important element of treating spinal health issues. If you meet with a physical therapist, there will be a full assessment. Tests will be performed and an individualized treatment plan will be developed based on the patient’s goals. If you’re experiencing back pain or sciatica, don’t wait any longer for relief. Contact a healthcare professional to establish a one-on-one consultation and complete evaluation. Many chiropractors and physical therapists are certified, experienced and dedicated to helping you feel better. They have helped many others recover from spinal health issues and can help you too. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Back Pain
Back pain is one of the most prevalent causes for disability and missed days at work worldwide. As a matter of fact, back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience some type of back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
Bobby Gomez describes how each visit with Dr. Alex Jimenez and to PUSH Fitness with Daniel Alvarado has resulted in great improvements in the stability of his shoulders as well as in the placement of his hips. Although Bobby Gomez’s recovery has been progressing gradually, he discusses the tremendous changes he has experienced mentally, emotionally and physically. Bobby Gomez highly recommends Dr. Alex Jimenez as the non-surgical choice for neck and back pain, as well as shoulder and hip pain.
Shoulder Pain Treatment
Cerebral palsy (commonly known as CP) affects ordinary motion in various areas of the human body and has many degrees of severity. CP causes problems with posture, gait, muscle tone and coordination of movement. Some children with CP have coexisting conditions, such as eyesight and hearing impairment. These disorders are brought on by brain damage and aren’t a direct result of cerebral palsy. Cerebral palsy does not affect life expectancy. Based on the way in which the condition is handled, motor abilities can improve or decrease over time. While severity and symptoms vary, most individuals with this condition go on to direct a rich, fulfilling life.
We are blessed to present to you El Paso’s Premier Wellness & Injury Care Clinic.
As El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
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Heel Spur: Blanca, born and raised in El Paso, TX, has been suffering from heel spurs for about two years. As a registered nurse, her symptoms significantly affected her ability to work and her overall quality of life. Determined to improve her health, Blanca considered chiropractic care. Once she started treatment with Dr. Alex Jimenez, however, Blanca experienced tremendous relief from her heel spurs, almost instantly. Blanca highly recommends chiropractic care with Dr. Alex Jimenez as the non-surgical choice for treatment of heel spurs.
Chiropractic Heel Spur Treatment
A heel spur is a calcium residue resulting in a bony protrusion on the bottom of the heel bone. Although heel spurs are often painless, they can lead to heel pain. They are often associated with plantar fasciitis, a painful inflammation of the fibrous band of connective tissue (plantar fascia) that runs across the bottom of the foot and also connects the heel bone to the ball of the foot. Heel spurs are usually caused by strains on foot muscles and ligaments, stretching of the plantar fascia, and repeated tearing of the membrane which covers the heel bone. Heel spurs are particularly common among athletes.
We are blessed to present to you El Paso’s Premier Wellness & Injury Care Clinic.
As El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and share us.
Functional short leg is a fairly common condition that typically occurs due to inflexibility or muscle weakness at the pelvis, ankle, and foot complex. Runners sometimes experience the condition when running over certain surfaces that are unstable or not level. It can also occur due to inappropriate footwear.
This condition can cause pain in the lower spine, hips, buttock, and leg. If left untreated, it can lead to balance issues, neck and shoulder problems, and incorrect weight distribution. Chiropractic care has been proven to effectively treat functional leg syndrome.
What Is Functional Short Leg?
Patients with a functional short leg have an apparent short leg although structurally both legs are the same length when measured. The most common method for measuring leg length is from the medial malleolus (inside ankle bone) to the ASIS (front of the pelvis). When the legs are measured in the case of a functional short leg, they are equal in length.
Mothers who always carry a child on one hip or individuals who always sleep on the same side can experience functional short leg syndrome. In fact, any movement, posture, or activity that causes increased stresses on the joints, nerves, and muscles involved can create an imbalance.
Functional Short Leg vs Anatomical Short Leg
Where with functional short leg syndrome one leg is apparently shorter than the other but not structurally so, an anatomical short leg is structurally shorter. This can happen due to growth problems, structural issues, and curvature of the spine.
The differences between the two conditions are significant, particularly when it comes to treatment. Both conditions can be treated by chiropractic for pain. Functional short leg syndrome can greatly benefit from chiropractic care as it helps to realign the body.
Symptoms Of Functional Short Leg
Functional short leg syndrome symptoms can remain confined to the leg, lower back, and hip region, or it can affect the entire body. When walking it can affect the way your feet hit the ground, causing pain in the foot and ankle.
However, it can even affect how you chew your food and how your teeth come together. When a person has short leg syndrome, they will often adjust their body in order to compensate, but that is when the real problems start. Symptoms of functional short leg syndrome include:
Pain in the lower back
Pain in the knee of both the long and short legs
Pain in the leg and lower back due to inflammation or sciatica
The human body is a marvelous, mysterious machine. When part of the machine is not working properly, the body will naturally attempt to fix it. If it cannot fix the problem, it finds a work around to compensate for the problem. This can lead to misalignment of the spine and imbalance in the body.
Chiropractic Treatment For Functional Short Leg
When you go to a chiropractor for functional short leg, he or she will do a thorough exam on you including diagnostic tests like MRI and x-ray. Once a diagnosis has been confirmed, the chiropractor will begin what is usually a multi-faceted approach that incorporates spinal alignment, a heel lift, lifestyle change recommendations, and exercises that you can do at home.
The chiropractic adjustments will return the spine to its natural position and bring the body back into balance. Patients will usually experience a dramatic decrease in pain or the pain will go away completely. They will also enjoy increased mobility and flexibility as well and an overall sense of wellness.
Injury Medical Clinic: Athletic Recovery & Rehabilitation
Ankle pain and injury are not issues reserved solely for athletes. In the United States, more than 25,000 people deal with ankle sprains or pain every day. Studies show that somewhere around 40 percent of ankle sprains are not treated correctly or are misdiagnosed, which leads to disability or chronic ankle pain.
When the ankle does not function properly, it can affect the entire body. The muscles on either side of the leg or even under the foot can become sore or painful. This can lead to loss of mobility, an uneven gait, and hip and back pain.
Anatomy Of The Ankle
Three bones connect to the joint that is the ankle. The lower ends of the tibia (shinbone) and the fibula (lower leg small bone) meet to form a socket that the talus (ankle bone) sits in.
The bottom of the talus rests on the calcaneus (heel bone). There is about an inch-thick lining of somewhat soft cartilage in the joint, which provides shock absorption for carrying body weight, but it is tough and durable so that, provided there is no injury, it will last for a lifetime.
The bones are held together by ligaments and the muscles are attached to the bones by tendons. When there is an injury, it can impact the bone, muscles, tendons and ligaments.
Treatment For Ankle Injury & Pain
The typical treatment for pain, such as with a sprain, is R.I.C.E., which is rest, ice, compression and elevation. A somewhat newer treatment approach replaces the R with an M, meaning that instead of rest, movement is required instead.
However, it is important that the movement is done safely and carefully. Certain types of ankle injuries can be exacerbated by movement so it should be approached with care.
Other types of traditional treatment include varying methods of pain control from ibuprofen to opioids. Severe injuries, such as a torn ligament, may require surgery. When a patient experiences pain, an x-ray is often used to see if there is an injury and to determine the extent of that injury. Sometimes, though an x-ray is not able to see the injury. In such cases, an MRI may be used.
Chiropractic For Ankle Pain
Chiropractic is very effective for treating foot and ankle pain. The chiropractor will begin by assessing the patient’s source of pain and determine what is causing it. They may use x-rays, MRI, CT scan, and other types of diagnostic tools to help them select the best course or treatment.
When an injury is new and the area is inflamed and tender, the course of treatment may include ultrasound, iontophoresis and whirlpool baths. This is in addition to rest, ice, compression and elevation. As it heals, the inflammation subsides and it becomes more stable, chiropractic adjustments to the foot may be introduced.
Chiropractic can help reduce pain without prescription medication and the associated side effects. This alone is often a great draw for many patients. However, there are other benefits that chiropractic can provide for ankle pain.
Regular chiropractic treatment can help strengthen the ankle and increase its stability while increasing mobility and flexibility. Often nerves and soft tissue can become damaged. Chiropractic treatments done on a consistent basis facilitates blood flow, which speeds healing and reduces the chance of injury. It also uses a whole body approach so that the patient can get recommendation on diet and lifestyle changes, such as losing weight or exercising.
Chiropractic care is a very effective therapy for treating ankle pain and injury. It is non-invasive and a natural approach to healing that allows the body to heal itself.
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