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At El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we are focused on treating patients after debilitating 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 Dr. Alex Jimenez feels you need other treatment, then you will be referred to a clinic or Physician that is best suited for you. Dr. Jimenez has teamed with the top surgeons, clinical specialists, medical researchers, and premiere rehabilitation providers to bring El Paso the top clinical treatments to our community. Providing the top non-invasive protocols is our priority. Clinical insight is what our patients demand in order to give them the appropriate care required. For answers to any questions you may have please call Dr. Jimenez at 915-850-0900
Certain neurological disorders can cause acute episodes of peripheral neuropathy, and for individuals diagnosed with chronic peripheral neuropathy, can physical therapy help improve the ability to move around safely along with medications, procedures, and lifestyle adjustments to help control and manage symptoms?
Peripheral Neuropathy Treatments
Peripheral neuropathy treatment includes symptomatic therapies and medical management to help prevent worsening nerve damage.
For acute types of peripheral neuropathy, medical interventions and therapies can treat the underlying process, improving the condition.
For chronic types of peripheral neuropathy, medical interventions and lifestyle factors can help to prevent the condition’s progression.
Chronic peripheral neuropathy treatment focuses on controlling the pain symptoms and protecting areas of diminished sensation from damage or infection.
Self-Care and Lifestyle Adjustments
For individuals who have been diagnosed with peripheral neuropathy or are at risk of developing the condition, lifestyle factors play a significant role in managing symptoms and preventing nerve damage from worsening and can even prevent the condition from developing. (Jonathan Enders et al., 2023)
Pain Management
Individuals can try these self-care therapies and see if and which help reduce their discomfort and then develop a routine that they can work off of. Self-care for pain symptoms include:
Placing a warm heating pad on painful areas.
Placing a cooling pad (not ice) on painful areas.
Covering the area or leaving it uncovered, depending on comfort levels.
Wear loose-fitting clothes, socks, shoes, and/or gloves not made with material that can cause irritation.
Avoid using lotions or soaps that can cause irritation.
Use soothing creams or lotions.
Keeping the painful areas clean.
Injuries Prevention
Diminished sensation is one of the most common effects that can lead to problems like stumbling, difficulty getting around, and injuries. Preventing and regularly checking for injuries can help avoid complications like infected wounds. (Nadja Klafke et al., 2023) Lifestyle adjustments to manage and prevent injuries include:
Wear well-padded shoes and socks.
Inspect feet, toes, fingers, and hands regularly to look for cuts or bruises that may not have been felt.
Clean and cover cuts to avoid infections.
Use extra caution with sharp utensils like cooking and work or gardening tools.
Disease Management
Lifestyle factors can help prevent disease progression and are closely correlated with the risks and underlying causes. To help prevent peripheral neuropathy or its progression can be done by: (Jonathan Enders et al., 2023)
Maintain healthy glucose levels if you have diabetes.
Avoid alcohol for any peripheral neuropathy.
Maintain a well-balanced diet, which can include vitamin supplements, especially for vegetarians or vegans.
Over-the-Counter Therapies
A few over-the-counter therapies can help with painful symptoms and can be taken as needed. Over-the-counter pain therapies include: (Michael Überall et al., 2022)
Topical lidocaine spray, patch, or creams.
Capsaicin creams or patches.
Topical Icy Hot
Non-steroidal anti-inflammatory medications – Advil/ibuprofen or Aleve/naproxen
Tylenol/acetaminophen
These treatments can help relieve painful symptoms of peripheral neuropathy, but they do not help improve diminished sensation, weakness, or coordination problems. (Jonathan Enders et al., 2023)
Prescription Therapies
Prescription therapies for treating peripheral neuropathy include pain medications and anti-inflammatories. Chronic types of peripheral neuropathy include:
Alcoholic neuropathy
Diabetic neuropathy
Chemotherapy-induced neuropathy
The prescription treatments for chronic types differ from the treatments for acute types of peripheral neuropathy.
Pain Management
Prescription treatments can help manage the pain and discomfort. Medications include (Michael Überall et al., 2022)
Sometimes, a prescription strength supplement or vitamin B12 given through injection can help prevent progression when peripheral neuropathy is associated with a severe vitamin deficiency. Prescription treatment can help treat the underlying process in some types of acute peripheral neuropathy. Treatment for acute peripheral neuropathy, such as Miller-Fisher syndrome or Guillain-Barré syndrome, can include:
Corticosteroids
Immunoglobulins – immune system proteins
Plasmapheresis is a procedure that removes the liquid portion of blood, returning the blood cells, which modifies the overactivity of the immune system. (Sanja Horvat et al., 2022)
Researchers believe there is an association between these conditions and inflammatory nerve damage, and modifying the immune system is beneficial for treating symptoms and the underlying disease.
Surgery
In some cases, surgical procedures can benefit individuals who have certain types of peripheral neuropathy. When another condition is exacerbating the symptoms or process of peripheral neuropathy, surgery may help relieve symptoms and prevent disease progression. This has proved effective when nerve entrapment or vascular insufficiency are factors. (Wenqiang Yang et al., 2016)
Complementary and Alternative Medicine
Some complementary and alternative approaches can help individuals cope with the pain and discomfort. These treatments can serve as an ongoing option for those who have chronic peripheral neuropathy. Options can include: (Nadja Klafke et al., 2023)
Acupuncture involves the placement of needles in specific areas of the body to help reduce pain symptoms.
Acupressure involves applying pressure on specific areas of the body to help reduce pain symptoms.
Massage therapy can help relax muscle tension.
Meditation and relaxation therapies can help manage symptoms.
Physical therapy can also serve as an important component of living with chronic peripheral neuropathy and recovering from acute peripheral neuropathy.
Physical therapy can help strengthen weak muscles, improve coordination, and learn how to adapt to sensory and motor changes to get around safely.
Individuals considering complementary or alternative treatment are encouraged to speak with their primary healthcare provider to determine whether it is safe for their condition. Injury Medical Chiropractic and Functional Medicine Clinic will work with the individual’s healthcare provider and/or specialists to develop an optimal health and wellness treatment solution to provide pain relief and improve quality of life.
Peripheral Neuropathy: A Successful Recovery Story
References
Enders, J., Elliott, D., & Wright, D. E. (2023). Emerging Nonpharmacologic Interventions to Treat Diabetic Peripheral Neuropathy. Antioxidants & redox signaling, 38(13-15), 989–1000. doi.org/10.1089/ars.2022.0158
Klafke, N., Bossert, J., Kröger, B., Neuberger, P., Heyder, U., Layer, M., Winkler, M., Idler, C., Kaschdailewitsch, E., Heine, R., John, H., Zielke, T., Schmeling, B., Joy, S., Mertens, I., Babadag-Savas, B., Kohler, S., Mahler, C., Witt, C. M., Steinmann, D., … Stolz, R. (2023). Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy (CIPN) with Non-Pharmacological Interventions: Clinical Recommendations from a Systematic Scoping Review and an Expert Consensus Process. Medical sciences (Basel, Switzerland), 11(1), 15. doi.org/10.3390/medsci11010015
Überall, M., Bösl, I., Hollanders, E., Sabatschus, I., & Eerdekens, M. (2022). Painful diabetic peripheral neuropathy: real-world comparison between topical treatment with lidocaine 700 mg medicated plaster and oral treatments. BMJ open diabetes research & care, 10(6), e003062. doi.org/10.1136/bmjdrc-2022-003062
Horvat, S., Staffhorst, B., & Cobben, J. M. G. (2022). Intravenous Lidocaine for Treatment of Chronic Pain: A Retrospective Cohort Study. Journal of pain research, 15, 3459–3467. doi.org/10.2147/JPR.S379208
Yang, W., Guo, Z., Yu, Y., Xu, J., & Zhang, L. (2016). Pain Relief and Health-Related Quality-of-Life Improvement After Microsurgical Decompression of Entrapped Peripheral Nerves in Patients With Painful Diabetic Peripheral Neuropathy. The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons, 55(6), 1185–1189. doi.org/10.1053/j.jfas.2016.07.004
For individuals dealing with chronic fatigue syndrome, can incorporating acupuncture with other treatment protocols help regain functionality and improve quality of life?
Acupuncture For Chronic Fatigue Syndrome
Research is looking at how acupuncture can help manage symptoms of chronic fatigue. These studies focused on specific acupoints and techniques and how they affected certain symptoms or abnormalities linked to the condition. The researchers found that acupuncture may help manage and alleviate some symptoms (Qing Zhang et al., 2019). However, they were still unable to determine the mechanisms of how acupuncture exactly works.
Symptom Relief
Various studies showed that acupuncture could improve physical and mental fatigue symptoms, including:
One case study showed improvements in groups of athletes who were put through a series of exhaustive physical exercises and short-term rest. One group of athletes was treated with acupuncture on selected acupoints while the others were given an extended rest. Analysis was applied to the metabolic profiles of urine samples collected from the athletes at three points: before the exercises, before and after the acupuncture treatment, or taking extended rest. The results indicated that the recoveries of disturbed metabolites in the athletes treated with acupuncture were significantly faster than in those who only took extended rest. (Haifeng Ma et al., 2015)
Researchers said studies involving acupuncture alone or in combination with other treatments appear to show that it is effective at lessening fatigue. (Yu-Yi Wang et al., 2014) However, further studies are needed to confirm the benefits. This is a significant change from a review that found limited evidence for the effectiveness of alternative treatments for relieving chronic fatigue symptoms. (Terje Alraek et al., 2011)
Another review of alternative therapies found acupuncture and certain meditation techniques showed the most promise for future investigation. (Nicole S. Porter et al., 2010)
Another study compared prednisone, a steroid, with an acupuncture technique called coiling dragon and an additional treatment called cupping. It suggested that acupuncture and cupping treatments surpassed the steroid regarding fatigue. (Wei Xu et al., 2012)
Another study found that needling with heat application or moxibustion produced better results than standard acupuncture regarding physical and mental fatigue scores. (Chen Lu, Xiu-Juan Yang, Jie Hu 2014)
From Consultation to Transformation: Assessing Patients In A Chiropractic Setting
References
Zhang, Q., Gong, J., Dong, H., Xu, S., Wang, W., & Huang, G. (2019). Acupuncture for chronic fatigue syndrome: a systematic review and meta-analysis. Acupuncture in medicine : journal of the British Medical Acupuncture Society, 37(4), 211–222. doi.org/10.1136/acupmed-2017-011582
Frisk, J., Källström, A. C., Wall, N., Fredrikson, M., & Hammar, M. (2012). Acupuncture improves health-related quality-of-life (HRQoL) and sleep in women with breast cancer and hot flushes. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 20(4), 715–724. doi.org/10.1007/s00520-011-1134-8
Mandıroğlu, S., & Ozdilekcan, C. (2017). Impact of Acupuncture on Chronic Insomnia: A Report of Two Cases with Polysomnographic Evaluation. Journal of acupuncture and meridian studies, 10(2), 135–138. doi.org/10.1016/j.jams.2016.09.018
Zhu, L., Ma, Y., Ye, S., & Shu, Z. (2018). Acupuncture for Diarrhoea-Predominant Irritable Bowel Syndrome: A Network Meta-Analysis. Evidence-based complementary and alternative medicine : eCAM, 2018, 2890465. doi.org/10.1155/2018/2890465
Ma, H., Liu, X., Wu, Y., & Zhang, N. (2015). The Intervention Effects of Acupuncture on Fatigue Induced by Exhaustive Physical Exercises: A Metabolomics Investigation. Evidence-based complementary and alternative medicine : eCAM, 2015, 508302. doi.org/10.1155/2015/508302
Wang, Y. Y., Li, X. X., Liu, J. P., Luo, H., Ma, L. X., & Alraek, T. (2014). Traditional Chinese medicine for chronic fatigue syndrome: a systematic review of randomized clinical trials. Complementary therapies in medicine, 22(4), 826–833. doi.org/10.1016/j.ctim.2014.06.004
Alraek, T., Lee, M. S., Choi, T. Y., Cao, H., & Liu, J. (2011). Complementary and alternative medicine for patients with chronic fatigue syndrome: a systematic review. BMC complementary and alternative medicine, 11, 87. doi.org/10.1186/1472-6882-11-87
Porter, N. S., Jason, L. A., Boulton, A., Bothne, N., & Coleman, B. (2010). Alternative medical interventions used in the treatment and management of myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia. Journal of alternative and complementary medicine (New York, N.Y.), 16(3), 235–249. doi.org/10.1089/acm.2008.0376
Lu, C., Yang, X. J., & Hu, J. (2014). Zhen ci yan jiu = Acupuncture research, 39(4), 313–317.
For individuals experiencing eye problems, can acupuncture treatment help and benefit overall eye health?
Acupuncture For Eye Health
Acupuncture is an alternative medical practice that involves inserting thin needles at specific points on the body. The objective is to restore balance and health by restoring and balancing energy circulation through pathways throughout the body. These pathways, known as meridians, are separate from nerve and blood pathways.
Studies have shown that the insertion of needles manipulates accumulations of certain neurotransmitters by nearby nerves and may be what causes beneficial health effects. (Heming Zhu 2014)
Scientists are not sure exactly how acupuncture works, but it has been shown to provide pain relief and alleviation of cancer treatment nausea. (Weidong Lu, David S. Rosenthal 2013)
Studies have shown that acupuncture can help treat eye conditions like dry eye syndrome. (Tae-Hun Kim et al., 2012)
Eye Problems
For some individuals, a body imbalance can be caused by eye problems or disease. With acupuncture, imbalance-causing symptoms are addressed. Acupuncture promotes the circulation of energy and blood around the eyes.
Acupuncture has been used as an alternative treatment for chronic dry eye syndrome. (Tae-Hun Kim et al., 2012)
Studies have shown acupuncture helps reduce the eye surface’s temperature to reduce the evaporation of tears.
The procedure is also sometimes used to treat glaucoma.
Glaucoma is an optic nerve disease usually caused by above-normal eye pressure levels.
Another study showed successful reduced allergic and inflammatory eye disease symptoms. (Justine R. Smith et al., 2004)
Eye Acupoints
The following acupoints are for eye health.
Jingming
Jingming – UB-1 is located in the inner corner of the eye.
This point is thought to increase energy and blood and to help with problems such as blurry vision, cataracts, glaucoma, night blindness, and conjunctivitis. (Tilo Blechschmidt et al., 2017)
Zanzhu
The Zanzhu point – UB-2 is in the crease at the inner end of the eyebrow.
This acupoint is used when individuals complain of headaches, blurred vision, pain, tearing, redness, twitching, and glaucoma. (Gerhard Litscher 2012)
Yuyao
Yuyao is in the middle of the eyebrow, above the pupil.
This point is used for treating eye strain, eyelid twitching, ptosis, or when the upper eyelid droops over, cloudiness of the cornea, redness, and swelling. (Xiao-yan Tao et al., 2008)
Sizhukong
The Sizhukog – SJ 23 area is in the hollow area outside the eyebrow.
It is thought to be a point where acupuncture can help with eye and facial pain, including headaches, redness, pain, blurred vision, toothache, and facial paralysis. (Hongjie Ma et al., 2018)
Tongzilia
The Tongzilia – GB 1 is located on the outside corner of the eye.
The point helps brighten the eyes.
Acupuncture also helps treat headaches, redness, eye pain, light sensitivity, dry eyes, cataracts, and conjunctivitis. (GladGirl 2013)
Early studies with acupuncture have shown promise for improving eye health. Individuals considering acupuncture are recommended to consult their primary healthcare provider to see if it can be an option for those who have not found a resolution by traditional means.
Neck Injuries
References
Zhu H. (2014). Acupoints Initiate the Healing Process. Medical acupuncture, 26(5), 264–270. doi.org/10.1089/acu.2014.1057
Lu, W., & Rosenthal, D. S. (2013). Acupuncture for cancer pain and related symptoms. Current pain and headache reports, 17(3), 321. doi.org/10.1007/s11916-013-0321-3
Kim, T. H., Kang, J. W., Kim, K. H., Kang, K. W., Shin, M. S., Jung, S. Y., Kim, A. R., Jung, H. J., Choi, J. B., Hong, K. E., Lee, S. D., & Choi, S. M. (2012). Acupuncture for the treatment of dry eye: a multicenter randomised controlled trial with active comparison intervention (artificial teardrops). PloS one, 7(5), e36638. doi.org/10.1371/journal.pone.0036638
Law, S. K., & Li, T. (2013). Acupuncture for glaucoma. The Cochrane database of systematic reviews, 5(5), CD006030. doi.org/10.1002/14651858.CD006030.pub3
Smith, J. R., Spurrier, N. J., Martin, J. T., & Rosenbaum, J. T. (2004). Prevalent use of complementary and alternative medicine by patients with inflammatory eye disease. Ocular immunology and inflammation, 12(3), 203–214. doi.org/10.1080/092739490500200
Blechschmidt, T., Krumsiek, M., & Todorova, M. G. (2017). The Effect of Acupuncture on Visual Function in Patients with Congenital and Acquired Nystagmus. Medicines (Basel, Switzerland), 4(2), 33. doi.org/10.3390/medicines4020033
Litscher G. (2012). Integrative laser medicine and high-tech acupuncture at the medical university of graz, austria, europe. Evidence-based complementary and alternative medicine : eCAM, 2012, 103109. doi.org/10.1155/2012/103109
Tao, X. Y., Sun, C. X., Yang, J. L., Mao, M., Liao, C. C., Meng, J. G., Fan, W. B., Zhang, Y. F., Ren, X. R., & Yu, H. F. (2008). Zhongguo zhen jiu = Chinese acupuncture & moxibustion, 28(3), 191–193.
Can individuals with jaw pain find relief in acupuncture therapy to reduce pain and improve jaw mobility in the upper body portions?
Introduction
The head is part of the upper musculoskeletal body quadrant supported by the neck area, which consists of the skull, various muscles, and vital organs that provide stability, mobility, and functionality. Around the head, the different facial features include the mouth, nose, eyes, and jaw to allow the host to eat, speak, smell, and see. While the head provides sensory and motor function, the neck includes motor stability to ensure no injuries or trauma affect the head. Located below the eyes is the jaw, which allows motor function with various muscles and joints to hyperextend without pain or discomfort. However, multiple factors can affect the jaw muscles and joints to invoke pain and discomfort, which can cause radiating referred pain down to the neck muscles. Today’s article looks at how jaw pain can affect the upper body, how non-surgical treatments can help with jaw pain, and how treatments like acupuncture can help restore jaw mobility. We talk with certified medical providers who consolidate our patients’ information to provide treatments to reduce jaw pain affecting their jaw and neck area. We also inform and guide patients on how acupuncture and non-surgical treatments can benefit many individuals with pain correlating with the jaw. We encourage our patients to ask their associated medical providers intricate and important questions about how their pain affects their quality of life and reduces jaw pain. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
Jaw Pain Affecting The Upper Body
Do you feel muscle soreness in your jaw and neck muscles throughout the day? Have you constantly rubbed or massaged your jaw muscles to reduce tension? Or have you been dealing with headaches or neck pain continually that affects your daily routine? Many individuals experiencing these pain-like symptoms are dealing with jaw pain or TMJ (temporomandibular joint syndrome). The jaw consists of mastication muscles on each side that help provide various functions like chewing, swallowing, or talking. When multiple traumatic or ordinary factors start to affect the jaw, it can disrupt the sensory-motor function of the upper body. For individuals, jaw pain is common worldwide, and with TMJ, it can become an issue as the pain seems to affect the jaw’s motor control while being accompanied by restricted mouth opening and impaired max bite force. (Al Sayegh et al., 2019) Additionally, TMJ affects not only the mastication muscles but also the temporomandibular joint, the joint that connects the jaw to the skull, which becomes inflamed and causes more issues.
So, how would TMJ affect the upper body? Well, when TMJ affects the mastication muscles and the temporomandibular joint, many individuals will experience various symptoms like:
Difficulty moving mouth when chewing
Popping/cracking sensation when opening or closing the jaw
Headaches/Migraines
Ear pain
Tooth pain
Neck and shoulder pain
This causes myofascial and intraarticular disorders that affect the muscles and joints of the jaw, which are linked to the skull. (Maini & Dua, 2024) To that point, many individuals will be experiencing referred pain, thinking they are dealing with a toothache when it is due to trigger points in the mastication muscles. This is when TMJ is accompanied by muscle-joint pain in the neck or upper back or if teeth issues accompany TMJ, but it depends on the individual and situation they are under. However, numerous treatments can reduce jaw pain and its associated symptoms that affect the jaw and the neck.
The Non-Surgical Approach To Wellness- Video
Non-Surgical Treatments For Jaw Pain
When reducing jaw pain, many individuals seek treatment to minimize the pain-like effects and regain mobility back to their jaws. It can be challenging and complex when people are dealing with jaw pain. It is a multifactorial issue that can affect the neck and back areas. So, when people speak with their primary doctors about their jaw pain, they will get an evaluation of where their pain is located and if they have any complaints correlating with the jaw pain. Afterward, many doctors will refer to musculoskeletal specialists to relieve the jaws’ pain. Treatments and techniques used by chiropractors, massage therapists, and physiotherapists can help ease the inflamed and tense mastication muscles. Techniques like soft tissue mobilization can help relax the masticatory muscles by lengthening them to the extent of releasing the trigger points in the muscles. (Kuc et al., 2020) At the same time, physiotherapy can help the jaw muscle through various relaxing techniques to increase the range of motion while strengthening the jaw to reduce pain and stress. (Byra et al., 2020) Many of these treatments are non-surgical, which means they are non-invasive and effective for the person’s pain while affordable.
Acupuncture To Restore Jaw Mobility
When it comes to non-surgical treatments, one of the oldest forms is acupuncture, which can help reduce the pain-like effects of jaw pain and restore mobility. Acupuncture originates from China, and highly trained medical professionals use thin, solid needles to be placed in acupoints on the body to disrupt the pain signal and provide relief. For jaw pain, acupuncturists will put needles on the acupoints of the jaw or the surrounding muscles to reduce mechanical hypersensitivity of the nerve cells that are causing pain while improving the sensory-motor function with a positive response. (Teja & Nareswari, 2021) Additionally, when dealing with ear pain associated with TMJ affecting the neck muscles, acupuncture can help enhance the neck’s range of motion by placing the needles on the trigger points of the cervical muscles. (Sajadi et al., 2019) When acupuncture treatment helps many individuals with jaw pain affecting their necks and heads, they can provide beneficial, positive results through consecutive treatment and improve jaw mobility function.
References
Al Sayegh, S., Borgwardt, A., Svensson, K. G., Kumar, A., Grigoriadis, A., & Christidis, N. (2019). Effects of Chronic and Experimental Acute Masseter Pain on Precision Biting Behavior in Humans. Front Physiol, 10, 1369. doi.org/10.3389/fphys.2019.01369
Byra, J., Kulesa-Mrowiecka, M., & Pihut, M. (2020). Physiotherapy in hypomobility of temporomandibular joints. Folia Med Cracov, 60(2), 123-134. www.ncbi.nlm.nih.gov/pubmed/33252600
Kuc, J., Szarejko, K. D., & Golebiewska, M. (2020). Evaluation of Soft Tissue Mobilization in Patients with Temporomandibular Disorder-Myofascial Pain with Referral. Int J Environ Res Public Health, 17(24). doi.org/10.3390/ijerph17249576
Sajadi, S., Forogh, B., & ZoghAli, M. (2019). Cervical Trigger Point Acupuncture for Treatment of Somatic Tinnitus. J Acupunct Meridian Stud, 12(6), 197-200. doi.org/10.1016/j.jams.2019.07.004
Teja, Y., & Nareswari, I. (2021). Acupuncture Therapies for Addressing Post Odontectomy Neuropathy. Med Acupunct, 33(5), 358-363. doi.org/10.1089/acu.2020.1472
Individuals that engage in heavy exercise can develop heat cramps from overexertion. Can knowing the causes and symptoms help prevent future episodes from happening?
Heat Cramps
Heat cramps can develop during exercise from overexertion or prolonged exposure to high temperatures. The muscle cramps, spasms, and pain can range from mild to severe.
Electrolytes like sodium, calcium, and magnesium are important for properly functioning muscles, including the heart. The primary role of sweating is to regulate the body’s temperature. (MedlinePlus. 2015) Sweat is mostly water, electrolytes, and sodium. Excessive sweating from physical activity and exertion or a hot environment can cause electrolyte imbalances that lead to cramps, spasms, and other symptoms.
Causes and Activities
Heat cramps most commonly affect individuals who sweat excessively during strenuous activity or are exposed to hot temperatures for prolonged periods. The body and organs need to cool down, which causes sweat production. However, too much sweating can lead to dehydration and electrolyte depletion. (Centers for Disease Control and Prevention. 2022)
Age – Children and adults 65 years and older have the highest risk.
Excessive sweating.
Low sodium diet.
Preexisting Medical Conditions – heart disease, diabetes mellitus, and obesity are conditions that can increase the risk of muscle cramping.
Medications – blood pressure, diuretics, and antidepressants can affect electrolyte balance and hydration.
Alcohol consumption.
Self-Care
If heat cramps begin, immediately stop the activity and look for a cool environment. Rehydrate the body to replenish the fluid loss. Staying hydrated and drinking fluids regularly during intense activity or in a hot environment can help prevent the body from cramping. examples of beverages that increase electrolytes include:
Gently applying pressure and massaging affected muscles can help reduce pain and spasms. As symptoms resolve, it is recommended to not return to strenuous activity too soon because additional exertion can progressively lead to heatstroke or heat exhaustion. (Centers for Disease Control and Prevention. 2021) Heatstroke and heat exhaustion are two heat-related illnesses. (Centers for Disease Control and Prevention. 2022)
Heatstroke is when the body loses the ability to regulate temperature and can cause dangerously high temperatures.
Heat exhaustion is the body’s response to excessive fluid and electrolyte loss.
The majority of heat cramps develop during activities because of the exertion and sweating, causing more electrolytes to be lost and the body to become more dehydrated.
Symptoms can also develop minutes to hours after activity has ceased.
Duration
Most heat-related muscle cramps will resolve with rest and hydration within 30–60 minutes.
If muscle cramping or spasms do not subside within one hour, seek professional medical attention.
For individuals with heart conditions or on a low-sodium diet who develop heat cramps, regardless of duration, medical help is necessary to ensure there are no complications.
The discs between the spine’s vertebrae provide cushioning and shock absorption in the spine and the rest of the body. Degenerative changes to the discs are believed to be the start of spinal stenosis. When the discs lack sufficient hydration/water and disc height decreases over time, the cushioning and shock absorption becomes less and less effective. The vertebrae can then become compressed, causing friction. Degenerative spinal stenosis can also develop from excess scar tissue and bone spurs (growth that develops on the edge of a bone) that can form after injury or spinal surgery.
Assessment
A physician will make a diagnosis of spinal stenosis. The doctor will take an imaging scan of the spine to determine the exact location of the degeneration and to measure how narrow the openings have become. Pain, stiffness, limited mobility, and loss of range of motion are often present. If spinal stenosis has caused nerve compression, there may also be pain, numbness, tingling, or weakness in the buttocks (sciatica), thighs, and lower legs. A physical therapist will determine the degree by assessing the following:
Vertebrae mobility – how the spine bends and twists in different directions.
Ability to change positions.
The strength of the core, back, and hip muscles.
Balance
Posture
Gait pattern
Nerve compression to determine if there are any symptoms in the legs.
Milder cases usually do not involve nerve compression, as back stiffness is more common.
In more severe cases, there may be significant pain, limited mobility, and nerve compression, causing leg weakness.
The most common symptom of spinal stenosis is increased pain with backward bending or extension of the lumbar spine. This includes positions that extend the spine, such as standing, walking, and lying on the stomach. Symptoms usually improve when bending forward and when the spine is positioned more into a flexed or bent position, like when sitting and reclining. These body positions open up the spaces in the central spinal canal.
Surgery
Spinal stenosis is the most common reason for undergoing surgery in adults 65 and older. However, surgery is almost always performed as a last resort if pain, symptoms, and disability persist after trying conservative therapies, including chiropractic, non-surgical decompression, and physical therapy, for months or years. The severity of symptoms and current state of health will determine whether a doctor will recommend surgery. (Zhuomao Mo, et al., 2018). Conservative measures can be safer and just as effective. A systematic review or study based on all available primary research found that physical therapy and exercise resulted in similar outcomes to surgery for improving pain and disability. (Zhuomao Mo, et al., 2018). Except for severe cases, surgery is often not necessary.
Physical Therapy for Spinal Stenosis
The objective of physical therapy includes:
Decreasing pain and joint stiffness.
Relieving nerve compression.
Reducing tightness in the surrounding muscles.
Improving the range of motion.
Improving postural alignment.
Strengthening the core muscles.
Improving leg strength to help with balance and overall function.
Stretching of the back muscles, including those running vertically along the spine and those running diagonally from the pelvis to the lumbar spine, helps relieve muscle tightness and pain and can improve overall mobility and range of motion of the lumbar spine.
Stretching the hip muscles, including the hip flexors in the front, the piriformis in the back, and the hamstrings that run from the back of the hip down the leg to the knee, is also important as these muscles are attached to the pelvis, which directly connects to the spine.
Exercises for strengthening the abdominal core muscles, including the muscles in the trunk, pelvis, lower back, hips, and abdomen, help stabilize the spine and protect it from excessive movement and compressive forces.
With spinal stenosis, the core muscles often become weak and inactive and unable to do their job to support the spine. Core exercises often begin by activating the deep abdominal muscles while lying flat on the back with the knees bent.
Exercises will progress as the individual gains more strength and control as the spine stabilizes.
Spinal stenosis physical therapy will also involve balance training and glute exercises for strengthening the leg muscles.
Prevention
Working with a physical therapist can help prevent future problems by maintaining spinal mobility, keeping the individual active, and exercising to maintain strength and stability to provide a solid foundation to support the lower back and prevent symptoms from worsening.
Severe Spinal Stenosis Physical Therapy
Physical therapy usually involves performing stretches for the lower back, hips, and legs, mobility exercises, and core strengthening exercises to improve spinal support and decrease pain. Treatments like heat or electrical stimulation may also be used on a case-by-case basis if there is significant pain or tightness in the back muscles. However, there is not enough clinical evidence to support that there are additional benefits. (Luciana Gazzi Macedo, et al., 2013) The effectiveness of physical therapy is high because surgery alone cannot strengthen the muscles that stabilize the spine, increase the mobility or flexibility of the surrounding muscles, and improve postural alignment.
The Root Causes of Spinal Stenosis
References
Lurie, J., & Tomkins-Lane, C. (2016). Management of lumbar spinal stenosis. BMJ (Clinical research ed.), 352, h6234. doi.org/10.1136/bmj.h6234
Mo, Z., Zhang, R., Chang, M., & Tang, S. (2018). Exercise therapy versus surgery for lumbar spinal stenosis: A systematic review and meta-analysis. Pakistan journal of medical sciences, 34(4), 879–885. doi.org/10.12669/pjms.344.14349
Macedo, L. G., Hum, A., Kuleba, L., Mo, J., Truong, L., Yeung, M., & Battié, M. C. (2013). Physical therapy interventions for degenerative lumbar spinal stenosis: a systematic review. Physical therapy, 93(12), 1646–1660. doi.org/10.2522/ptj.20120379
For individuals affected by headaches that occur 15 or more days a month for more than three months, can knowing the signs and symptoms help healthcare providers help treat and prevent chronic tension headaches?
Chronic Tension Headaches
Most individuals have experienced a tension-type headache. The pain is usually described as a dull tightening or pressure on both sides of the head, like having a tightening band around the head. Some individuals experience these headaches frequently, a condition known as chronic tension headaches. Chronic tension headaches are uncommon but can be debilitating, as they can interfere with a healthy quality of life and daily living.
Tension headaches are typically caused by stress, anxiety, dehydration, fasting, or lack of sleep and usually resolve with over-the-counter medications. (Cleveland Clinic. 2023)
This is a primary headache disorder that affects around 3% of the population.
Chronic tension headaches can occur daily and negatively impact the quality of life and daily functioning. (Cleveland Clinic. 2023)
Symptoms
Tension headaches can be referred to as stress headaches or muscle contraction headaches.
They can present with dull, aching pain and include tightness or pressure across the forehead, sides, or back of the head. (Cleveland Clinic. 2023)
Additionally, some individuals experience tenderness on the scalp, neck, and shoulders.
Chronic tension headaches materialize 15 or more days a month on average for more than three months.
The headache can last for several hours or be continuous for several days.
Causes
Tension headaches are typically caused by tight muscles in the shoulders, neck, jaw, and scalp.
Teeth grinding/bruxism and jaw clenching can also contribute to the condition.
Headaches can be brought on by stress, depression, or anxiety and are more common in individuals who:
Individuals experiencing headaches that interfere with daily life or need to take medication more than twice a week are recommended to consult a healthcare provider. Before the appointment, it can be helpful to keep a headache diary:
Record the days
Times
Description of the pain, intensity, and other symptoms.
Some questions the healthcare provider may ask include:
Is the pain pulsating, sharp, or stabbing, or is it constant and dull?
Where is the pain most intense?
Is it all over the head, on one side, on the forehead, or behind the eyes?
Do the headaches interfere with sleep?
Is working or doing tasks difficult or impossible?
A healthcare provider will likely be able to diagnose the condition based on symptoms alone. However, if the headache pattern is unique or different, the provider may order imaging tests, like MRI or CT scans, to rule out other diagnoses. Chronic tension headaches can be confused with other chronic daily headache disorders like chronic migraine, hemicrania continua, temporomandibular joint dysfunction/TMJ, or cluster headaches. (Fayyaz Ahmed. 2012)
Treatment
Pharmacological therapy for chronic tension headaches usually involves preventive medication.
Amitriptyline is one medication that has been found to be beneficial in chronic tension headache prevention.
According to a meta-analysis of 22 published studies in the Journal of General Internal Medicine, these medications are superior to placebo in reducing headache frequency, with an average of 4.8 fewer headache days per month.
Additional preventive medications may include other antidepressants like:
Remeron – mirtazapine.
Anti-seizure medications – like Neurontin – gabapentin, or Topamax – topiramate.
A healthcare provider may also prescribe medication to treat headache episodes, which include:
Prescription non-steroidal anti-inflammatory drugs or NSAIDs, including acetaminophen, naproxen, indomethacin, or ketorolac.
Opiates
Muscle relaxants
Benzodiazepines – Valium
Non-Medication Treatment
Behavioral therapies are sometimes used on their own or in combination with medication to prevent and manage chronic tension headaches. Examples include:
Acupuncture
An alternative therapy that involves using needles to stimulate specific points on the body believed to connect with certain pathways/meridians that carry vital energy/chi throughout the body.
Biofeedback
In Electromyography – EMG biofeedback, electrodes are placed on the scalp, neck, and upper body to detect muscle contraction.
The process can be costly and time-consuming, and there is little evidence to support its effectiveness.
Physical Therapy
A physical therapist can work out stiff and tight muscles.
Train individuals on stretches and targeted exercises for loosening tight head and neck muscles.
Cognitive Behavioral Therapy/CBT
Involves learning how to identify headache triggers and cope in a less stressful and more adaptive way.
Headache specialists often recommend CBT in addition to medication when developing a treatment plan. (Katrin Probyn et al., 2017)
Teeth-grinding and jaw-clenching training/treatment can help when they are contributors.
Regular exercise, as well as practicing healthy sleep hygiene, can be beneficial in prevention.
Supplements
Some individuals with chronic tension headaches may find relief using supplements. The American Academy of Neurology and the American Headache Society report the following supplements can be effective: (National Center for Complementary and Integrative Health. 2021)
Butterbur
Feverfew
Magnesium
Riboflavin
If the headaches come on suddenly, cause waking up from sleep, or last for days, it’s important to consult a healthcare provider to rule out any underlying causes and develop a personalized treatment plan.
Ahmed F. (2012). Headache disorders: differentiating and managing the common subtypes. British journal of pain, 6(3), 124–132. doi.org/10.1177/2049463712459691
Jackson, J. L., Mancuso, J. M., Nickoloff, S., Bernstein, R., & Kay, C. (2017). Tricyclic and Tetracyclic Antidepressants for the Prevention of Frequent Episodic or Chronic Tension-Type Headache in Adults: A Systematic Review and Meta-Analysis. Journal of general internal medicine, 32(12), 1351–1358. doi.org/10.1007/s11606-017-4121-z
Probyn, K., Bowers, H., Mistry, D., Caldwell, F., Underwood, M., Patel, S., Sandhu, H. K., Matharu, M., Pincus, T., & CHESS team. (2017). Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components. BMJ open, 7(8), e016670. doi.org/10.1136/bmjopen-2017-016670
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